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Factors Associated with Patient Satisfaction After Orthodontic Treatment: A Retrospective Cross-Sectional Study

This retrospective cross-sectional study of 210 patients at a university-based orthodontic clinic found that overall treatment satisfaction was high and significantly associated with the orthodontist–patient relationship, clinic atmosphere, patient personality traits, and acceptance of treatment-related adverse conditions, rather than pre-treatment expectations.

Original authors: Kantakawee Ruankaeo, Supanee Suntornlohanakul, Nattaporn Youravong

Published 2026-08-07

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Kantakawee Ruankaeo, Supanee Suntornlohanakul, Nattaporn Youravong

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine you just bought a new video game. You spent hours reading the reviews, watching trailers, and imagining how epic the graphics would be. But when you finally play it, the game crashes, the controls feel weird, and the story is confusing. You're going to be pretty unhappy, right? Now, imagine the opposite: the game runs perfectly, the characters are fun to talk to, and even when a glitch happens, you laugh it off because you know the developers are cool. That feeling of "yes, this was worth it" is what scientists call satisfaction.

In the world of dentistry, specifically orthodontics (the branch that straightens teeth), getting a perfect smile is the goal. But it's not just about the teeth looking straight; it's about how the patient feels about the whole journey. Did the dentist listen? Was the clinic a friendly place? Did the patient handle the pain or the weird side effects well? Researchers have long wondered: what makes a patient say, "I love my new smile," versus "I wish I never started"? Is it the doctor's skill? The patient's personality? Or maybe just how high their expectations were before they even put on the braces? This study dives into that exact question, looking at the hidden ingredients that make a dental treatment feel like a success story.

The Big Smile Survey

A team of researchers from Prince of Songkla University in Thailand decided to play detective. They wanted to know what makes patients happy after they finish their orthodontic treatment. They looked back at 210 people who had just taken off their braces between 2018 and 2020. Instead of just asking, "Did you like it?", they sent these patients a fun, detailed online questionnaire. They wanted to know about the patients' personalities, what they expected before starting, how the clinic felt, and how they handled the bumps in the road (like pain or cavities) during the process.

The Results: A Very Happy Crowd
The news is great: almost everyone was thrilled. A massive 99.1% of the people who answered said they were either "satisfied" or "very satisfied" with their results. In fact, not a single person said they were dissatisfied!

When they broke it down, the patients were happiest with how their teeth were aligned (96.6%). They were also very happy with how their teeth functioned and how they felt emotionally. However, the score was a bit lower for "social acceptance" (73.3%). The authors suggest this might be because the survey happened during the COVID-19 pandemic. Since everyone was stuck at home and wearing masks, maybe people felt less confident about how their smile looked in social situations, even though their teeth were perfect.

The Secret Ingredients of Happiness
The researchers dug deeper to find out why these patients were so happy. They found that it wasn't just about the teeth; it was about the whole experience. Here are the magic ingredients that made the biggest difference:

The "Vibe" of the Relationship: If the patient felt a friendly, positive connection with their orthodontist, they were much more likely to be happy overall. It's like having a coach who believes in you; it makes the hard work feel easier.
The Clinic Atmosphere: A clinic that felt welcoming and encouraging helped patients stick with their treatment and feel good about it.
The "Acceptance" Superpower: This was a surprising one. The study found that patients who could accept that things might go wrong—like getting a cavity or having bad breath during treatment—were happier in the end. It's not that they wanted a cavity, but if they understood it could happen and didn't let it ruin their mood, they ended up more satisfied. It's like accepting that a road trip might have a flat tire; if you just fix it and keep driving, the trip is still fun.
Personality Matters: The study used a "Big Five" personality test. They found that people who were extraverted (outgoing and energetic) tended to be happier with their results, especially regarding how they felt socially. People who were open to new experiences were happier with how their teeth looked and their facial aesthetics.

What Didn't Matter (As Much)
Here is the twist: You might think that if you have super high expectations before you start, you'll be super happy if the results are good. But this study suggests that's not necessarily true. The researchers found that expectations before treatment did not predict overall satisfaction.

It's like buying a ticket to a concert. Whether you expected the show to be "okay" or "the best night of your life," if the band plays well and the sound is great, you'll have a great time. The patients in this study had high expectations, and they got great results, so they were happy. But having high hopes didn't cause the happiness; the actual experience and the relationship with the doctor did.

The Takeaway
So, what does this all mean? If you are a patient, you don't need to be a specific personality type to love your new smile. But, having a friendly doctor, a welcoming clinic, and a mindset that can handle the little hiccups of treatment (like a sore tooth or a cavity) makes a huge difference.

The study concludes that while straight teeth are the goal, the journey there is what really counts. When the orthodontist-patient relationship is strong and the clinic feels like a safe, happy place, patients walk away with a smile that is 99% satisfied. And that's a result worth celebrating.

Technical Summary: Factors Associated with Patient Satisfaction After Orthodontic Treatment

Problem Statement
Patient satisfaction is a critical outcome metric in orthodontic treatment, yet existing literature presents a wide variance in reported satisfaction levels (ranging from 34% to 95%) due to differing measurement criteria and study populations. While previous research has identified potential influencers such as gender, age, personality traits, and the patient-orthodontist relationship, there is a scarcity of data regarding patient satisfaction specifically within dental education institutions. Furthermore, the relationship between pre-treatment expectations and post-treatment satisfaction remains inconclusive, with some theories suggesting a direct correlation while others find inconsistencies. Additionally, the impact of adverse conditions occurring during treatment (e.g., pain, dental caries, halitosis) and the patient's psychological acceptance of these conditions on overall satisfaction has not been definitively established. This study addresses these gaps by evaluating satisfaction levels and identifying associated factors among patients treated at a university-based orthodontic clinic.

Methodology
The researchers conducted a retrospective cross-sectional study involving patients who completed orthodontic treatment at the Orthodontic Clinic, Faculty of Dentistry, Prince of Songkla University, between July 2018 and July 2020.

Participants: From an initial pool of 675 patients, 495 met the inclusion criteria (completed treatment with residents, records available, age >18 at survey time). Exclusion criteria included combined orthognathic surgery, cleft lip/palate, or prior orthodontic treatment.
Sampling: A simple randomization was performed to select 387 patients for contact. Ultimately, 210 patients completed the online questionnaire, yielding a response rate of 54.3% among contacted patients.
Instrument: A self-administered questionnaire was developed based on literature review and pilot testing (Cronbach's alpha coefficients ranged from 0.729 to 0.840). It comprised five sections:
1. Demographics.
2. Personality traits (measured via a 10-item Big-Five inventory).
3. Pre-treatment expectations (overall and specific domains: alignment, aesthetics, function, emotion, social acceptance).
4. Service/situational factors during treatment (information sufficiency, orthodontist-patient relationship, clinic atmosphere, treatment duration, and occurrence/acceptance of abnormalities like pain, caries, halitosis, and plaque).
5. Post-treatment satisfaction (overall and specific domains).
Statistical Analysis: Data were analyzed using descriptive statistics. For bivariate analysis, Likert-scale variables were dichotomized based on median scores. Variables with $p \le 0.20$ in bivariate analysis were entered into a multivariable logistic regression model using a forward stepwise approach to identify independent predictors of satisfaction.

Key Results

Demographics: The cohort consisted of 78.1% females, with 57.6% under 20 years of age at the start of treatment. The primary motivation for treatment was aesthetic concerns (76.2%).
Satisfaction Levels: Overall satisfaction was exceptionally high, with 99.1% of respondents reporting they were "satisfied" or "very satisfied." No respondents reported being dissatisfied or very dissatisfied.
- Highest Satisfaction: Tooth alignment (96.6%).
- Lowest Satisfaction: Social acceptance (73.3%).
Treatment Experience: 97.2% felt they received sufficient information, 99.5% perceived a friendly orthodontist-patient relationship, and 98.1% felt the clinic atmosphere was encouraging. However, 46.7% reported the treatment duration was longer than expected.
Adverse Conditions: Significant proportions of patients experienced severe pain (46.6%), increased plaque (60.5%), halitosis (37.1%), and dental caries (28.6%). Notably, acceptance rates for these conditions were high (e.g., 73.3% accepted dental caries).
Predictors of Satisfaction (Multivariable Analysis):
- Overall Satisfaction: Significantly associated with a positive orthodontist-patient relationship, a favorable clinic atmosphere, acceptance of dental caries occurring during treatment, and higher levels of extraversion.
- Specific Domains: Acceptance of dental caries was associated with satisfaction in all specific components. Extraversion correlated with social acceptance satisfaction, while openness to new experiences correlated with tooth alignment and facial aesthetics satisfaction.
- Expectations: Pre-treatment expectations were not independently associated with overall satisfaction. They only influenced satisfaction within their specific corresponding domains (e.g., facial aesthetics expectations affected facial aesthetics satisfaction).

Significance and Claims
The authors conclude that patients treated in a dental education institution report a very high level of satisfaction (99.0%), which exceeds or aligns with the upper bounds of previous studies. The study highlights that satisfaction is a multifaceted outcome driven by both patient-related factors (personality traits, acceptance of adverse conditions) and treatment-related experiences (interpersonal dynamics, clinic environment).

Crucially, the paper challenges the direct application of marketing theories to healthcare satisfaction, noting that high pre-treatment expectations did not negatively impact overall satisfaction, suggesting that treatment outcomes in this setting met or exceeded expectations. The findings suggest that for orthodontic training institutions, optimizing the patient experience requires focusing on the orthodontist-patient relationship, maintaining a positive clinic atmosphere, and educating patients to foster acceptance of inevitable treatment-related adverse conditions (such as caries or pain). Understanding these specific factors may help institutions improve care delivery and patient experience.

Limitations
The authors acknowledge several limitations, including potential recall bias inherent in the retrospective design, a moderate response rate which may introduce non-response bias, and the use of self-reported data susceptible to social desirability bias. Additionally, the single-institution setting limits the generalizability of findings to private practices or public hospitals, and the highly imbalanced outcome variable (99% satisfaction) may contribute to sparse-data bias.

The Big Smile Survey

Technical Summary: Factors Associated with Patient Satisfaction After Orthodontic Treatment

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