Archives of Gynecology and Obstetrics

, Volume 299, Issue 1, pp 167–171 | Cite as

Adherence to gynecological screening impacted by experienced orthodontic treatment in childhood

  • Sarah SchottEmail author
  • Judith Heinzler
  • Nathalie Rippinger
  • Thomas Bruckner
  • Janina Brucker
  • Janine Hoffmann
  • Nadja Dornhöfer
  • Christine Dinkic
  • Stephan Seitz
  • Joachim Rom
  • Christof Sohn
  • Timm C. Schott
General Gynecology



Dental and cervical controls are two established screening programs in Germany. Compliance to orthodontic treatment in childhood is essential for dental health and one of the first health interventions that requires adherent behavior; therefore, it may be associated with participation in further screening programs in adulthood. However, it is not yet known whether early orthodontic treatment influences long-term screening adherence.


Using a questionnaire administered during a visit to a special dysplasia outpatient service, this case–control study evaluated women’s personal history of orthodontic care, long-term satisfaction, and dental and gynecological screening adherence. Oral health status and dental anxiety were assessed with validated instruments. Cases were categorized as cervical dysplasia only (S2) or cervical dysplasia with conization (S1) and compared to healthy controls with a normal PAP smear.


A study population of 233 participants included 132 cases and 101 controls. The control group had had orthodontic treatment during childhood more often than our study population with abnormal PAP smears (68.3% controls versus 56.1% subjects; p < 0.005). Orthodontic treatment was not associated with attending dental appointment or gynecological check-ups. However, women with an orthodontic treatment in childhood were significantly more often vaccinated against human papillomavirus than women without orthodontic treatment (p < 0.03).


Data suggest that women with orthodontic treatment in childhood are more conscious about prevention strategies in adulthood; therefore, compliant behavior might be established in childhood.


Compliance Adherence Screening Orthodontic treatment 



The authors thank Dr. Katja Weimer, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen and Clinic of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm for discussing the study planning and PD Dr. Phil. Peter Burgard, Children’s Hospital Heidelberg for inspiring discussions and critical reading as well as Kathy Taylor, IMBEI Mainz for critical reading. We thank all study participants and supporting colleagues from the participating University Hospitals supporting this study.

Author contribution

SS: Project development, data collection, data analysis, manuscript writing, manuscript editing, and supervision. JH: data collection, data management, data analysis, and manuscript editing. NR: patient recruitment, data analysis, and manuscript editing. TB: data analysis and manuscript editing. JB; JH: project development, patient recruitment, and manuscript editing. ND; CD: patient recruitment and manuscript editing. SS; JR: project development and manuscript editing. CS: project development, manuscript editing, and supervision. TCS: project development, manuscript writing, data analysis, and manuscript editing.

Compliance with ethical standards

Conflict of interest

There is no conflict of interest by any author.

Ethical standards

This study was approved by the local ethical committee (S-399/2015) and the ethical committee in Leipzig (091/17-lk) and performed in accordance with the Declaration of Helsinki.


  1. 1.
    American College of, O., P. Gynecologists Women’s Health Care, W. Committee on Health Care for Underserved (2013) Committee opinion no. 569: oral health care during pregnancy and through the lifespan. Obstet Gynecol 122(21):417–422Google Scholar
  2. 2.
    Ahdi M et al (2015) Oral health information from the dentist to the diabetologist. Eur J Intern Med 26(7):498–503CrossRefGoogle Scholar
  3. 3.
    Isong IA et al (2010) Association between parents’ and children’s use of oral health services. Pediatrics 125(3):502–508CrossRefGoogle Scholar
  4. 4.
    Schott TC, Ludwig B (2014) Microelectronic wear-time documentation of removable orthodontic devices detects heterogeneous wear behavior and individualizes treatment planning. Am J Orthod Dentofacial Orthop 146(2):155–160CrossRefGoogle Scholar
  5. 5.
    Anttila A et al (2009) Description of the national situation of cervical cancer screening in the member states of the European Union. Eur J Cancer 45(15):2685–2708CrossRefGoogle Scholar
  6. 6.
    Geyer S, Jaunzeme J, Hillemanns P (2014) Cervical cancer screening in Germany: group-specific participation rates in the state of Niedersachsen (Lower Saxony). A study with health insurance data. Arch Gynecol Obstet 291(3):623–629CrossRefGoogle Scholar
  7. 7.
    Nowakowski A et al (2015) The implementation of an organised cervical screening programme in Poland: an analysis of the adherence to European guidelines. BMC Cancer 15:279CrossRefGoogle Scholar
  8. 8.
    Verdoodt F et al (2015) Reaching women who do not participate in the regular cervical cancer screening programme by offering self-sampling kits: a systematic review and meta-analysis of randomised trials. Eur J Cancer 51(16):2375–2385CrossRefGoogle Scholar
  9. 9.
    Thangarajah F et al (2016) Cervical screening program and the psychological impact of an abnormal Pap smear: a self-assessment questionnaire study of 590 patients. Arch Gynecol Obstet 293(2):391–398CrossRefGoogle Scholar
  10. 10.
    Sroczynski G et al (2011) Cost-effectiveness of primary HPV screening for cervical cancer in Germany—a decision analysis. Eur J Cancer 47(11):1633–1646CrossRefGoogle Scholar
  11. 11.
    Berardi R et al (2013) Compliance with breast and cervical cancer screening programs in women: results from a population-based study. Tumori 99(5):565–571CrossRefGoogle Scholar
  12. 12.
    Martin-Lopez R et al (2010) Breast and cervical cancer screening in Spain and predictors of adherence. Eur J Cancer Prev 19(3):239–245CrossRefGoogle Scholar
  13. 13.
    Logan L, McIlfatrick S (2011) Exploring women’s knowledge, experiences and perceptions of cervical cancer screening in an area of social deprivation. Eur J Cancer Care 20(6):720–727CrossRefGoogle Scholar
  14. 14.
    Thangarajah F et al (2015) Cervical screening program and the psychological impact of an abnormal Pap smear: a self-assessment questionnaire study of 590 patients. Arch Gynecol Obstet 293(2):391–398CrossRefGoogle Scholar
  15. 15.
    Schäfer K et al (2015) Quantifying patient adherence during active orthodontic treatment with removable appliances using microelectronic wear-time documentation. Eur J Orthod 37(1):73–80CrossRefGoogle Scholar
  16. 16.
    Schott TC et al (2013) Quantification of patient compliance with Hawley retainers and removable functional appliances during the retention phase. Am J Orthod Dentofacial Orthop 144(4):533–540CrossRefGoogle Scholar
  17. 17.
    Heinzler J et al (2018) Impact of a cervical dysplasia and its treatment on quality of life and sexual function. Arch Gynecol Obstet. Google Scholar
  18. 18.
    Corah NL (1969) Development of a Dental Anxiety Scale. J Dent Res 48(4):596CrossRefGoogle Scholar
  19. 19.
    Humphris GM, Morrison T, Lindsay SJ (1995) The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dent Health 12(3):143–150Google Scholar
  20. 20.
    Slade GD (1997) Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 25(4):284–290CrossRefGoogle Scholar
  21. 21.
    Smith JS et al (2002) Herpes simplex virus-2 as a human papillomavirus cofactor in the etiology of invasive cervical cancer. J Natl Cancer Inst 94(21):1604–1613CrossRefGoogle Scholar
  22. 22.
    Wallin KL et al (2002) A population-based prospective study of Chlamydia trachomatis infection and cervical carcinoma. Int J Cancer 101(4):371–374CrossRefGoogle Scholar
  23. 23.
    Castellsague X, Bosch FX, Munoz N (2002) Environmental co-factors in HPV carcinogenesis. Virus Res 89(2):191–199CrossRefGoogle Scholar
  24. 24.
    Schenk L, Knopf H (2007) Mundgesundheitsverhalten von Kindern und Jugendlichen in Deutschland. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 50(5):653–658CrossRefGoogle Scholar
  25. 25.
    Krey KF, Hirsch C (2012) Frequency of orthodontic treatment in German children and adolescents: influence of age, gender, and socio-economic status. Eur J Orthod 34(2):152–157CrossRefGoogle Scholar
  26. 26.
    Lampert T, Kurth BM (2007) Sozialer Status und Gesundheit von Kindern und Jugendlichen: Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Dtsch Arztebl Int 6(11):521Google Scholar
  27. 27.
    Schuster MA, Fuentes-Afflick E (2017) Caring for children by supporting parents. N Engl J Med 376(5):410–413CrossRefGoogle Scholar
  28. 28.
    Hillienhof A (2016) Mammographie: erstmals weniger Teilnehmerinnen beim Screening. Dtsch Arztebl Int 113(51–52):2352Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sarah Schott
    • 1
    Email author
  • Judith Heinzler
    • 1
  • Nathalie Rippinger
    • 1
  • Thomas Bruckner
    • 2
  • Janina Brucker
    • 1
  • Janine Hoffmann
    • 3
  • Nadja Dornhöfer
    • 3
  • Christine Dinkic
    • 1
  • Stephan Seitz
    • 4
  • Joachim Rom
    • 1
  • Christof Sohn
    • 1
  • Timm C. Schott
    • 5
  1. 1.Universitätsfrauenklinik HeidelbergHeidelbergGermany
  2. 2.Institut für Medizinische Biometrie und InformatikUniversitätsklinik HeidelbergHeidelbergGermany
  3. 3.Universitätsfrauenklinik LeipzigLeipzigGermany
  4. 4.Caritas-Krankenhaus St. Josef RegensburgRegensburgGermany
  5. 5.Poliklinik für KieferorthopädieUniversitätsklinik TübingenTübingenGermany

Personalised recommendations