Communication originates from the Latin term Communicate and signifies Sharing: Making something common or transmitting something, Transmission: The act of expressing one’s thoughts or feelings through speech, writing, gesture, and facial expression, with the aim of being understood, Relationship: The act of establishing a relationship with another person.

The concept of communication is broader and more complex than that of information. Information can be defined as that which suppresses or reduces uncertainty without provoking an immediate feedback response. Communication is an exchange and a relationship between two or more people. It is a dynamic process in movement, which evolves the situation [1].

In orthodontic practice, effective and coherent communication between practitioners, patients, and support staff is essential for achieving successful treatment outcomes. Clear, goal-oriented communication helps establish trust and enables patients and their families to understand treatment objectives, follow instructions, and feel confident throughout their care journey. However, misunderstandings, unmet expectations, and inconsistent advice can create obstacles that hinder progress and lead to patient dissatisfaction. A structured communication strategy, beginning from the first consultation and reinforced throughout treatment, has become increasingly crucial for maintaining alignment between the patient and orthodontist [2].

Tele-orthodontics and social media have emerged as innovative solutions to bridge communication gaps, offering increased accessibility and regular contact points between patients and practitioners. Tele-orthodontic platforms, including video calls and secure messaging applications, allow orthodontists to provide consultations, share treatment progress, and address concerns in real-time or asynchronously. This approach is particularly valuable for patients facing logistical challenges in attending frequent in-office appointments or requiring regular follow-up to maintain compliance. The increased use of telecommunications since the COVID-19 pandemic has demonstrated that virtual interactions can effectively mitigate many difficulties associated with traditional consultations and reduce appointment frequency.

In addition to tele-orthodontics, social media platforms represent a unique medium for continuous engagement and patient education. Social networks enable orthodontists to disseminate educational content, maintain regular contact with patients outside formal appointments, and foster a sense of connection by sharing information asynchronously. This approach not only enhances compliance but also reinforces transparency, potentially reducing misunderstandings regarding treatment objectives and therapeutic progress.

Despite advances in tele-orthodontics and social media utilization within orthodontic practice contexts, empirical research remains limited. Previous investigations have explored factors influencing patient compliance, such as pain tolerance, appointment adherence, and communication with healthcare providers. However, few studies have specifically examined the impact of virtual communication methods on patient adherence to appliance-wear directives, hygiene practices, and treatment instructions.

Therefore, the objective of this study is to characterize, from the perspective of private practitioners in Casablanca, the modalities of orthodontist-patient communication and their perceptions regarding the influence of communication strategies on therapeutic success.

This was a descriptive cross-sectional observational study conducted among orthodontists working in private practice in Casablanca, Morocco. The aim was to assess the communication methods used between orthodontists and patients, as well as practitioners’ perceptions of the impact of communication on treatment adherence and therapeutic success.

The target population consisted of dental practitioners specialized in orthodontics and working in private practices in Casablanca. Orthodontists were included if they were practicing in the private sector in Casablanca, registered with the professional council, and agreed to participate in the survey. Practitioners working outside Casablanca, those working exclusively in the public sector, and incomplete or unusable questionnaires were excluded from the analysis.

The list of orthodontists practicing in Casablanca was obtained from the registry of the National Council of the Order of Dentists of Morocco and comprised 304 practitioners who met the eligibility criteria. All 304 identified orthodontists were invited to take part in the survey. A total of 102 practitioners returned complete and analyzable questionnaires, corresponding to a response rate of 33.6%.

Data collection was carried out over a six-week period, from January 17 to February 28, 2026.

Data were collected using a structured, self-administered questionnaire developed based on the objectives of the study and available data from the literature. The questionnaire included several sections covering practitioners’ professional characteristics, the communication methods used with patients, the use of digital tools, tele-orthodontics and social media, as well as practitioners’ perceptions of the impact of communication on treatment adherence, oral hygiene, appliance wear, and treatment success. The questionnaire comprised 31 items organized into six sections: (A) general information on the practitioner (years of experience, type of practice, and consultation frequency); (B) communication practices (channels used for appointments and reminders, time devoted to consultations and treatment visits, content addressed, use of visual aids, tele-orthodontics, perceived patient comprehension, and post-treatment follow-up); (C) communication of clinical information (risks, emergencies, and social-media content); (D) communication challenges; (E) perceived patient satisfaction and treatment adherence; and (F) suggestions for improvement. Items comprised single- and multiple-choice questions, five-point Likert scales (1 = very low to 5 = very high), and frequency scales (from “very often” to “never”), together with a few open-ended questions. No composite score was computed; all responses were summarized as frequencies and percentages. The full questionnaire is provided as Supplementary Material.

Before distribution, the questionnaire was pretested among a small group of orthodontists to assess the clarity, comprehensibility, and relevance of the questions. Feedback obtained during this pretest was used to make the necessary adjustments before final administration.

The orthodontists were contacted by telephone, email, or directly at their private practices. After the study objectives had been explained, the questionnaire was provided in paper and/or electronic format.

Participation was voluntary and anonymous. Practitioners were free to decline participation or withdraw from the study at any time. Returned questionnaires were checked before data entry in order to exclude incomplete or unusable responses.

The collected data were entered and analyzed using SPSS software. A descriptive analysis was performed. Qualitative variables were expressed as frequencies and percentages. Quantitative variables were described using the mean and standard deviation when normally distributed, or the median and interquartile range otherwise.

The study was conducted in accordance with the principles of anonymity, confidentiality, and voluntary participation. No identifying information was collected from the participants. Participation in the survey was based on the respondents’ free and informed consent.

The study sample consisted of 102 practitioners, of whom 89 (87.3%) had a multidisciplinary practice. In terms of professional experience, 37.3% of practitioners surveyed had less than 5 years of practice, while 21.6% had more than 20 years of experience. Regarding the average frequency of consultations per patient, 77.5% of practitioners opted for one session per month.

Regarding how appointment dates were communicated to patients, 88.2% of practitioners communicated them directly face-to-face, while 64.7% did so by phone. For appointment reminders, 80.4% of practitioners used the phone. During the first consultation, regarding time spent communicating with the patient, 59.8% of practitioners spent between 10 and 20 minutes explaining the treatment.

During the first consultation, 90.2% of practitioners discussed the importance of oral hygiene and the methods to adopt with their patients, and 85.3% addressed the duration of treatment. For 45.1% of practitioners, the average time spent on treatment/care appointments was between 10 and 20 minutes. To explain treatment procedures, 43.1% of practitioners reported always using visual aids (photos, X-rays, 3D models).

Among the 102 practitioners surveyed, 29.4% reported using teleorthodontics in their practice. Among the 30 orthodontists who used teleorthodontics, 66.67% used it for initial consultations and 53.3% for monitoring aligner treatments. According to the responses of 102 orthodontists, 52.9% rated patients’ understanding of their explanations as satisfactory.

Concerning the frequency of patient questions and the impact of effective communication on their experience, the results are presented in Table 1.

According to 38.2% of practitioners, discussing current events with patients could sometimes influence their cooperation. For 44.1% of practitioners, patient expectations very often influenced their treatment plan.

Regarding communication obstacles, patients’ non-compliance with care instructions, and the main areas of misunderstanding, the results are summarized in Table 2.

Practitioners’ perceptions of patient satisfaction, treatment adherence, and the adequacy of information provided were also assessed and are presented in Table 3.

Post-treatment follow-up was maintained by 72.5% of practitioners, most commonly every six months (52.6%) or annually (26.3%), and was carried out mainly through face-to-face visits (70.3%) rather than digital channels. When follow-up was not maintained, practitioners most often cited patient disengagement once visible results had been achieved, a problem-driven model of care, and the absence of automated reminder systems.

During follow-up, risk communication focused mainly on caries (89%), relapse (69%), and root resorption (44%), whereas periodontal damage and general treatment-related information were mentioned less frequently.

Communication regarding emergencies concentrated on bracket or wire debonding (92%), aligner fracture (53%), and appliance loss (50%), with less systematic attention to pain or discomfort.

Regarding social media, 52.9% of practitioners reported using it mainly to share before-and-after cases, 36.3% for practical advice, and 14.7% for promotional content, while 30.7% did not use social media at all.

When asked how communication could be improved, practitioners expressed a preference for enhanced visual aids (71.6%), digital tools such as applications or follow-up emails (52%), clearer brochures (33.3%), and communication training (18.6%); a small minority (2%) considered that nothing could replace direct human interaction.

Table 1.Frequency of patient questions and the impact of effective communication on their experience.

Table 2. Obstacles in communication, non-compliance with care instructions, and areas of misunderstanding.

Table 3. Practitioners’ perceived assessment of patient satisfaction, treatment adherence, and information adequacy.

Most practitioners in our sample (77.5%) scheduled one session per patient per month, communicated appointment dates mainly face-to-face (88.2%) or by phone (64.7%), and relied on the telephone for reminders (80.4%). In a randomized controlled trial conducted in Jordan, Al-Abdallah et al. (2021) found no statistically significant difference between traditional and digital channels for conveying appointment and treatment information, suggesting that the consistency of the message matters more than the medium itself [3].

The first consultation emerged as a pivotal moment for communication. Most practitioners (59.8%) devoted 10 - 20 minutes to the first consultation, during which 90.2% addressed oral hygiene and 85.3% discussed treatment duration. Mehra et al. (1998) showed that educating patients on the consequences of poor cooperation, expected outcomes, and the value of a strong interpersonal bond improves long-term adherence, while parental involvement is particularly important for younger patients [4]. Hiemstra et al. (2009) similarly emphasized that communication should be adapted to the patient’s age rather than directed at parents alone, while still clarifying expectations and providing detailed guidance on anticipated discomfort [5]. Visual aids—used systematically by 43.1% of our respondents—play a comparable role: Chiang et al. described a 3D simulation system that improves comprehension and aligns expectations with realistic outcomes [6]. Thomson et al. (2001) recommended reinforcing verbal explanations with written or visual material, particularly regarding hygiene, daily-life impact, and retention [7], while Ackerman and Proffit (1995) stressed the importance of shared decision-making, clarity, and reassurance in informed consent [8]. More recent work by Perry et al. (2021), based on a Delphi survey of UK orthodontists, identified ten risks that should systematically be disclosed, including demineralization, relapse, and root resorption [9]; Karkazi et al. (2024) added that risk prioritization varies culturally, with Greek and Slovak orthodontists emphasizing different concerns [10].

Comprehension followed a similar pattern: 52.9% of practitioners rated patient understanding as satisfactory, and patients asked questions far more often at the start of treatment (62.7% “very often”) than during it (35.3% “often”), reinforcing the importance of the initial visit while underscoring the need for sustained communication thereafter. Maestre et al. (2016) linked comprehension directly to treatment acceptance and realistic expectations [2], and Sinha et al. (1996) showed that active listening and detailed explanation strongly predict patient participation [11]. Yet time pressure remains a concern: while 45.1% spent 10 - 20 minutes per treatment visit, 38.2% reported time sufficient only for the technical procedure itself, despite 83.3% of practitioners believing communication strengthens trust and comfort and 51% believing it reduces fear—revealing a gap between stated conviction and actual practice time. This gap is not trivial, as Klages et al. (1992) showed that the orthodontist’s verbal behavior during routine orthodontic visits is directly associated with patients’ communicative cooperation [12].

Teleorthodontics, which expanded considerably during the COVID-19 pandemic, was used by only 29.4% of practitioners, mainly for initial consultations (66.7%) and aligner follow-up (53.3%). These figures align closely with international data: Kayalar and Küçükkurt (2023) and Park et al. (2021) both described pandemic-driven growth concentrated on remote monitoring and initial assessment, tempered by technical and legal constraints [13][14], while Abu Arqub et al. (2024) found that many AAO members recognize its value yet remain hesitant to adopt it routinely [15]. Saccomanno et al. (2020) and Homsi et al. (2023) noted growing post-pandemic interest limited by traditional clinical preferences and insufficient training [16][17], whereas Lo Giudice et al. (2022) viewed teleorthodontics more favorably, as a complementary tool that enables early complication detection, reduces unnecessary visits, and strengthens patient engagement and organizational efficiency [18].

Non-clinical exchange also shaped cooperation: 38.2% of practitioners felt conversation about everyday topics sometimes improved it, consistent with Maestre’s (2016) emphasis on the human relationship as foundational to care [2]. Patient expectations very often influenced treatment plans for 44.1% of respondents, echoing McKeta et al. (2021), who called for balancing clinical rigor with growing attention to patient-centered goals [19].

Post-treatment, 72.5% of practitioners maintained regular contact, most commonly every six months (52.6%) or annually (26.3%), largely through face-to-face visits (70.3%) rather than digital channels—reflecting both the clinical need for visual assessment of retention and limited adoption of orthodontic-specific apps, as documented by Prithiviraj (2023) and Nelson (2015), and a generally promotional rather than therapeutic use of platforms like Instagram (Yavan, 2024) [20]-[22]. Where follow-up was absent, practitioners most often cited patient disengagement once visible results were achieved, a largely reactive model of care limited to problem-driven visits, and a lack of automated reminder systems. During follow-up, risk communication centered on caries (89%), relapse (69%), and root resorption (44%), while broader risk categories—periodontal damage, general treatment information—were rarely mentioned, despite Perry’s (2021) call for systematic, standardized disclosure of at least five core risks [9] and Karkazi’s (2024) emphasis on culturally adapted communication [10]. Emergency-related communication followed a similar pattern, concentrated on bracket or wire debonding (92%), aligner fracture (53%), and appliance loss (50%), with less systematic attention to pain or discomfort—despite Baidas (2020) showing that unanticipated discomfort can undermine engagement and even lead to treatment abandonment [23].

Digital communication strategies varied widely: 52.9% of practitioners used social media mainly to share before/after cases, 36.3% for practical advice, and 14.7% for promotional content, while 30.7% did not use social media at all—patterns broadly consistent with Yavan (2024) and Prithiviraj (2023), who described social platforms as serving both image-building and patient education functions, albeit inconsistently applied [20][22]. The main barriers to effective communication identified by practitioners were the complexity of medical terminology (41.2%), lack of patient interest (37.3%), time pressure and patient anxiety (31.4%), and language barriers (11.8%)—only 6% reported no communication difficulties at all. These findings mirror Chiang et al. (2023), who advocated visual and interactive tools to simplify technical language [6], and Mehra (1998), who linked patient motivation directly to comprehension [4].

Non-compliance with care instructions, particularly around hygiene, was frequently reported (43.1% “often”), with hygiene methods identified as the leading source of patient misunderstanding (68.6%). Le Fouler et al. (2021) showed that active, kinesthetic instruction improves adolescent compliance more than passive methods [24], while Al-Abdallah et al. (2021), in a randomized controlled trial, found that adding weekly digital messages to traditional communication produced only a slight, statistically non-significant improvement in compliance, indicating that message consistency matters more than the channel used [3]. Sinha (1996) further linked relationship quality—listening, clarity, availability—to both satisfaction and compliance [11]. Consistent with this, practitioner-perceived patient satisfaction and treatment adherence were both rated “satisfactory” by roughly half of respondents (51% and 50%, respectively), though only a minority reported very high satisfaction (15.7%) or very good adherence (7.8%), in line with Wong (2018) and Sinha (1996), who linked communication quality directly to satisfaction and engagement [11][25].

Despite this generally positive self-assessment—64.7% of practitioners believed their patients were well informed about treatment progress—McKeta (2012) cautioned that practitioners often overestimate patient comprehension relative to what patients actually report, since the volume of information delivered matters less than how well it is retained and understood [19]. This gap underscores the value of practitioners critically reassessing their own communication practices.

Finally, when asked how communication could be improved, practitioners expressed a clear preference for enhanced visual aids (71.6%), digital tools such as apps or follow-up emails (52%), clearer brochures (33.3%), and communication training (18.6%), with a small minority (2%) insisting that nothing replaces direct human interaction. These priorities align with Chiang (2023), Al-Abdallah (2021), and Maestre (2016), all of whom emphasized that visual, digital, and team-consistent communication strategies improve comprehension, adherence, and overall patient experience [2][3][6].

This study highlights the central role of communication in the success of orthodontic treatment among private practitioners in Casablanca. Beyond technical skill, treatment outcomes depend on a structured, personalized, and continuous patient-practitioner relationship that shapes adherence, satisfaction, and clinical results. While most orthodontists recognize the value of effective communication, disparities persist in the methods used, time allocated, and consistency of information delivered—particularly during the first consultation, appointment reminders, risk disclosure, and post-treatment follow-up. Teleorthodontics and digital tools, despite their recognized potential, remain underused, and social media, while valuable for patient education and professional image, requires ethical and targeted use.

These findings call for a shift toward a more humanized, pedagogical, and technologically adapted orthodontic practice—one that integrates visual aids, strengthens follow-up protocols, tailors communication to individual patient profiles, and trains teams in clinical and intercultural communication. Ultimately, successful orthodontic treatment relies not only on clinical competence but, just as importantly, on the quality of the therapeutic alliance built through clear, empathetic, and sustained communication. The orthodontist of tomorrow must be as much an educator and communicator as a clinician.