The first line of defense against the development of incipient caries lesions has traditionally been patient education, with a special emphasis on optimal oral hygiene. The advocacy organization for orthodontists in the United States known as the American Association of Orthodontists (AAO) has developed patient manuals and a website to provide recommendations for patients undergoing orthodontic treatment (AAO, 2009). Specifically, the website suggests extra time for toothbrushing, specialized tips to get in between the braces, floss threaders, oral irrigators, and over-the-counter mouthrinses. Additionally, the AAO sponsored informed consent form emphasizes the need for excellent oral hygiene and routine visits to the general dentist (AAO, 2005). It also warns that inadequate oral hygiene could result in caries, discolored teeth, and periodontal disease. Finally, the form explains that the aforementioned problems may be aggravated if the patient has not had the benefit of fluoridated water. In many cases, patient education will also include an emphasis on proper diet with reduced intake of sugars. Despite these efforts by the orthodontist and staff members, many patients will still be non-compliant with oral hygiene instructions. Unfortunately, most orthodontists have a limited background in the behavioral basis of compliance (Mehra et al., 1998). Thus, patient non-compliance presents a unique challenge to orthodontic practices.
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