# Factors Influencing Appliance Wearing Time during Orthodontic Treatments: A Literature Review
## 4 Results and Discussion
### \"Patient-Related\" Factors  
Psychological studies have shown how individuals cope with any general discomfort, including pain caused during orthodontic treatments, as influenced by personal values, personality, and the attitude towards the therapy's phases [5; 35]. Therefore, it is essential, helpful, and interesting to discuss the psychological dimension behind the patients and the related factors that may influence the adherence to the treatment and how much they wear the devices. Orthodontic treatments usually last several years and are often undertaken in the middle of skeletal growth; thus, orthodontic patients are generally people who are in the pubertal phase. This implies that cooperation is influenced by developmental factors [3], including the patient's age and personality. In the past, it was believed that gender could influence cooperation [17; 52], but more recent studies have not recognized it as a significant influential factor [13; 40]. Patients with different ages can face the treatment in different ways: it seems that there is a compliance reduction with the increase in age--from middle childhood to early adulthood [40]. It has been observed that patients in middle childhood (6-8 years) are more compliant than adolescents (12-15 years) and early adults [12]. Compliance is influenced by different factors in each of these life periods: during middle childhood, the \"parent-child\" bond is central and has a strong impact on treatment motivation [1]. Since a child is not aware enough of his/her appearance, parents and caregivers pay attention to the patients' needs, including orthodontic treatment [1]; during adolescence and adulthood, self-perception, self-esteem, and social feedback deeply influence motivation and adherence to the treatment [53]. It has been observed how the psychological dynamics underlying the level of collaboration and adherence to the rules in any situation of everyday life are regulated by the \"effect\" that they have on the quality of people's life: if positive, the level of compliance would be high [45]; on the contrary, if negative, it would be low. People are strongly motivated to take medications that relieve pain and promote healing because they have a positive effect on their quality of life. In orthodontics, the treatment represents a transitory phase in which it is possible to experience pain or discomfort, negatively affecting patients' compliance [37; 45]; however, in the long term, the treatment would lead to an improvement in aesthetics and quality of life. Psychological \"patient-related\" factors include the self-perception of facial appearance, attitude towards the treatment, pain, and discomfort threshold. Facial appearance determines how a person feels about himself/herself and how society feels about people's appearances [44]. If someone is particularly concerned about their physical appearance and has a high self-esteem, when malocclusions or irregularities of the teeth are noticed, the person is strongly motivated to resolve them to gain or maintain acceptance and compliments from other people [23]. Subjects with a good self-esteem who are emotionally stable and have a tendency to observe the rules and understand the importance of constantly wearing the orthodontic device will be highly collaborative. On the contrary, subjects with a confused lifestyle or an attitude of distrust towards their own therapy management skills tend to be unpredictable in terms of collaboration, as their personality makes them nervous and whiny about pain and discomfort when experiencing the treatment [38]. The perception of malocclusions is another important factor that influence the wearing time of orthodontic devices. [PERSON] et al. showed that dental irregularities are perceived in a different way based on two opposite patient personalities: subjects with slight defects are excessively alarmed, while subjects with severe malocclusions are fine with their appearance.