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Non-Compliant Patients
Non-Compliant Patients
Michael Yoon avatar
Written by Michael Yoon
Updated over a week ago

Non-compliant Patients & Tips for Keeping Your Patient on Track

When it comes to OrthoSnap clear aligner treatment, one of the most important issues is patient compliance. Since patients can remove the aligners, they can get off track quickly if they leave them out too long or take them out too often.

The need to wear aligners for at least 22 hours a day, each and every day, should be stressed to patients during the initial consultation. If they cannot commit to this, you should have a frank discussion about their desire for orthodontic treatment. They may be better off going with non-removable traditional metal braces.

Non-compliant patients can end up with poor results. 

Tooth movement involves osteoclastic activity, which is the breakdown of bone that allows teeth to move. It occurs with consistent force applied to the teeth. When a patient moves to a new set of aligners, the teeth begin to move in place within 48-72 hours. 

However, when the force is removed (such as when taking the aligners out), this activity stops in just a few hours. Once it stops, it takes another 48-72 hours to start back up. Therefore, each time a patient goes without aligners for just a few hours, treatment time is slowed by two to three days. 

With noncompliant patients, their treatment will not progress as expected. This will leave the patient unsatisfied and unhappy. 

The Verification Key™ Aligner

At OrthoSnap, we understand about patient noncompliance. To help our providers, we developed the Verification Key™ aligner so you can easily check for compliance. This key is included after the eighth step, allowing you the opportunity to see your patients regularly. Its thicker, shorter design allows you to verify the treatment is tracking. 

The verification key is only for your use—in other words, it doesn’t go home with the patient—but it can be a useful tool for educating them. If the key does not fit correctly, you can have a discussion with your patient about the potential impact of failing verification and the importance of wearing their aligners as prescribed. 

Signs of a Non-compliant Patient

Aside from the Verification Key, there are other signs you may notice that could indicate noncompliance. 

Things you may notice include: 

  • The old aligner looks new

When patients wear their aligners properly for two to three weeks, they get dirty, discolored, and show signs of wear. 

  • The patient arrives at your office without their aligners

Chances are high that if your patient doesn’t wear the aligners to see you, they aren’t wearing them enough. 

  • The aligners are still tight

When patients wear their aligners properly, they get loose and should be easy to remove and insert. If your patient’s aligners remain tight after two weeks of wear, that could indicate they aren’t wearing them enough. 

  • Frequently rescheduled or missed appointments

When patients don’t put a priority on their appointments, it can make you wonder how much of a priority wearing their aligners is. 

Why are patients non-compliant?

When you understand why patients don’t wear their aligners as they should, you can better help them stay on track. Rather than scold them, offer them support. Ask them about their wear schedule. Let them know you want to help them figure out a better plan. 

Their answer may tell you a lot. And you may be able to help them find a solution. 

For instance, maybe they take them out to eat, and then they don’t want to put them back in until they can get home and brush their teeth. You can re-educate them about the importance of replacing them as soon as possible. Encourage them to keep a toothbrush and toothpaste on them at all times. 

Some of the most common reasons patients are noncompliant include:

  • Lack of understanding or education

  • The aligners interfere with an activity, life condition, or work

  • The aligners are uncomfortable

  • The patient is just plain forgetful

Some Solutions for Non-compliant Patients

The most effective solution is education. Explain about osteoblastic and osteoclastic activity. Make sure they fully understand the reasons behind wearing them 22 hours a day. Set goals and discuss the impact of not wearing their aligners enough. 

Let your patients know you care. They may be going through something serious at home or with their health, and aligners are not a current priority. Express empathy and let them know you will do whatever you can to help them achieve a beautiful smile. 

When you understand the specific issues, you and your patient can get creative and work together to find workable solutions. 

If they are forgetful, maybe there is something they can do to help them remember. Have them make a chart of some kind where they keep track of how much they wear their aligners. They earn a gold star or checkmark for wearing them so many hours each morning, afternoon, evening, and night. When they accrue so many checks or stars, they can reward themselves with something.    

If the aligners are uncomfortable, investigate it. There might be something you can do to help. Although, most often, aligners are uncomfortable because patients don’t wear them enough. Let them know that wearing them more often will help. 

Let’s say your patient is a football player, and he takes the aligners out so he can wear a protective mouthguard. A great idea, but if he spends a lot of time at practice and games, the best solution may be a customized mouthguard that allows him to keep his aligners in. 

Document Noncompliance

Make sure to document everything you can to help you if the patient later complains about poor results. 

Key documentation includes:

  • Missed appointments

  • Patients showing up without their aligners

  • Failing Verification

  • Tight or pristine aligners after two to three weeks of wear

If Needed, Adjust Treatment

In some cases, you may need to extend the wear time or try backtracking. If so, let the patient know this extends the overall treatment time. 

Use Remote Patient Monitoring

Ask us about Remote patient monitoring which greatly increases both patient compliance, patient satisfaction and also provides much more frequent, timely and documented progression evaluations, all while reducing costs of chair time! Find out more about Remote Patient Monitoring.

Related Topics and Information:

Click to learn more about Case Revisions, the Verification Key and Remote Patient Monitoring.

If you have questions or need to speak with someone at Orthosnap, please reach out to us at or chat with us now

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