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Review

Influence of Personality Traits on Pain Perception, Attitude, Satisfaction, Compliance, and Quality of Life in Orthodontics: A Systematic Review

by
Fabiana Nicita
1,
Arianna Nicita
2,* and
Francesco Nicita
3
1
Department of Biomedical, Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy
2
Department of Health Sciences, University of “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
3
Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, 00133 Rome, Italy
*
Author to whom correspondence should be addressed.
Appl. Sci. 2025, 15(9), 5075; https://doi.org/10.3390/app15095075
Submission received: 16 March 2025 / Revised: 26 April 2025 / Accepted: 30 April 2025 / Published: 2 May 2025
(This article belongs to the Special Issue Clustering Methods and Statistical Analysis of Clinical Data in Dentistry)
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Abstract

:
Orthodontic treatment demand has surged due to heightened aesthetic concerns and the increased recognition of oral health’s role in overall well-being. This systematic review was conducted by searching across multiple databases (PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar) for observational studies published between January 2000 and April 2024 that assessed personality traits using validated instruments, with inclusion criteria focused on outcomes such as pain perception, treatment attitude, compliance, satisfaction, and quality of life. The results consistently indicate that negative personality traits, particularly high neuroticism, are associated with increased pain perception, lower satisfaction, and reduced compliance. In contrast, positive traits, including extraversion, agreeableness, and conscientiousness, were correlated with improved orthodontic outcomes and more favorable treatment attitudes. Additionally, extraversion and openness were observed to moderate the negative impact of malocclusion severity on oral health-related quality of life. When examining gender, overall differences were minimal; however, some studies indicated that females reported slightly higher pain scores. These findings underscore the multifaceted role of personality by suggesting that psychological profiling should be incorporated into clinical practice. By recognizing individual personality profiles, clinicians can tailor treatment approaches to foster patient-centered care, optimizing orthodontic outcomes and enhancing overall patient satisfaction.

1. Introduction

The demand for orthodontic treatment has recently increased among people of all ages [1,2,3,4]. This trend is driven by aesthetic concerns and the recognized importance of proper dental alignment for enhancing quality of life [5,6,7,8,9,10]. It is known that malocclusions, which represent deviations from ideal dental alignment, can adversely impact oral health-related quality of life (OHRQoL) by causing functional limitations as well as psychological and social discomfort [11,12,13], ultimately affecting overall patient well-being [14,15,16,17].
Although considerable attention has been paid to the clinical correction of malocclusions, emerging evidence suggests that successful orthodontic outcomes extend beyond physical alignment to include psychological factors. A wealth of research in general health has underscored the influence of personality on treatment outcomes. Personality traits, defined as enduring patterns of thoughts, feelings, and behaviors, guide how individuals perceive and respond to various situations, including healthcare interventions [18,19]. The well-established Big Five personality model, comprising extraversion, agreeableness, openness, conscientiousness, and neuroticism [20,21,22], has emerged as a valuable framework for understanding these dynamics [23]. Individuals with high extraversion—characterized by sociability, assertiveness, and a tendency to experience positive emotions—tend to engage in proactive healthy behaviors [24,25,26]. Similarly, those with high agreeableness, marked by altruism, empathy, and cooperation, are more likely to follow medical recommendations [27,28,29,30]. People with high openness, intellectual curiosity, creativity, and a willingness to explore new experiences [31,32,33], are more likely to consider different treatment options, facilitating better health management [34,35]. Conscientious individuals, recognized for their organization, dependability, and strong sense of duty [36,37], tend to engage in behaviors that promote well-being, such as regular exercise, a balanced diet, and adherence to medical guidelines. Conversely, they are less likely to engage in harmful behaviors like smoking or substance abuse [38,39,40]. In contrast, individuals with high levels of neuroticism—characterized by emotional instability, anxiety, and a tendency to experience negative emotions such as fear, sadness, and irritability [41]—are more prone to maladaptive behaviors and adverse health outcomes, including poor health literacy and impaired decision-making [42,43,44]. Furthermore, heightened neuroticism can hinder the development of effective coping strategies, leading to increased stress and unhealthy behaviors [45]. Integrating the Big Five model into the orthodontic context provides a more nuanced framework for understanding patient experiences beyond the purely clinical aspects of treatment. In orthodontics, psychological factors may influence a patient’s orthodontic treatment experience by affecting compliance, satisfaction, pain perception, and overall treatment attitudes.
Despite the growing research on the psychological aspects of orthodontic care, there remains a lack of comprehensive synthesis regarding the role of personality traits in influencing orthodontic treatment experiences. Previous studies have explored aspects of the psychological determinants of orthodontic outcomes, but they did not systematically integrate personality traits within the orthodontic context or address the interplay between personality and clinical outcomes comprehensively. The present study is designed to address this gap by systematically reviewing the literature on how personality traits relate to key orthodontic outcomes such as compliance, pain perception, satisfaction, and treatment attitudes. For this review, the null hypothesis is that no significant relationship exists between personality traits and orthodontic treatment outcomes. In doing so, it aims to bridge the fields of psychology and orthodontics, providing a deeper understanding of how individual personality differences may shape treatment responses and overall satisfaction.

2. Materials and Methods

2.1. Registration and Protocol

This systematic review was developed following the 2020 guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [46]. Before drafting this paper, a detailed protocol outlining the methodology was developed. The review was registered on the CRD York website (PROSPERO protocol number CRD42024591408).

2.2. Eligibility Criteria

The research question was defined based on the PICO (Population, Intervention, Comparison, Outcomes) study design: (P) adolescents and adults undergoing or who have undergone orthodontic treatment without limitations on the type or severity of malocclusion, the orthodontic technique used, or the types of orthodontic appliances utilized; (I) assessment of personality traits using validated instruments; (C) a comparison group was considered not applicable for this review; and (O) the impact of personality traits on pain perception, attitude toward orthodontic treatment, patient compliance, satisfaction, and quality of life. Consequently, the following research question was posed: how do varying personality traits of patients influence their pain perception, attitude toward orthodontic treatment, compliance, satisfaction, quality of life, and willingness to undergo different orthodontic procedures?
The eligibility criteria for inclusion in this systematic review are outlined in Table 1.

2.3. Search Strategy

A comprehensive literature search was conducted using the following electronic databases: PubMed/MEDLINE, Scopus, Web of Science, and ScienceDirect. Additionally, Google Scholar was utilized to identify the relevant grey literature. The search strategy combines orthodontic terms, personality-related terms, and outcome measures, tailored for each database to optimize the retrieval of pertinent articles (Table 2).

2.4. Screening and Selection Process

All articles identified through a search across various databases were imported into reference management software (Mendeley Desktop, version 1.19.8), where duplicates were eliminated. Following this, the titles and abstracts of the remaining studies were independently reviewed by two reviewers (FN and AN) to determine their relevance to the research question. Case reports, case series, reviews, and meta-analyses were excluded. Studies containing relevant search terms in the title and/or abstract were selected for full-text review. The two reviewers (FN and AN) independently evaluated the full-text articles of potentially relevant studies based on predefined eligibility criteria. Studies that satisfied all criteria were included for data extraction, while those that did not were excluded, with reasons for exclusion documented. Any disagreements between the two reviewers at this stage were discussed and resolved by consensus. If disagreements persisted, a third independent reviewer (FN) was consulted.

2.5. Data Extraction

The two reviewers (FN and AN) independently extracted the following data from the selected articles: authors, year of publication, population characteristics (number, age, and sex), instruments used, and main findings. In cases where discrepancies emerged between data extractions, the third reviewer (FN) was consulted to resolve any disagreements. The consensus approach was used to finalize the extracted data. Finally, the data were compiled into a standardized database to capture relevant information wholly and consistently.

2.6. Data Synthesis

Given the heterogeneity in study designs, population characteristics, assessment tools, and outcome measures, a meta-analysis was not feasible. Therefore, a narrative synthesis was conducted for each study.

2.7. Quality Assessment

Two authors (FN and AN) independently assessed the quality of the included studies using the Joanna Briggs Institute (JBI) Checklist for observational studies [47]. This tool consists of 8 questions assessing key aspects such as the appropriateness of study design, participant selection, measurement of exposures and outcomes, control of confounding variables, and the clarity of reporting. Each included study was assigned a rating of “yes,” “no,” “unclear,” or “not applicable” for each criterion. The quality assessment agreement between the two reviewers was measured with Cohen’s kappa coefficient [48]. In cases of persistent disagreement, a third author (FN) provided input to reach a consensus.

2.8. Certainty of Evidence Assessment

The certainty of evidence for each outcome (pain perception, treatment attitude, compliance, satisfaction, and OHRQoL) was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach [49]. Four primary domains were considered: risk of bias, inconsistency, indirectness, and imprecision. Each domain was rated as “not serious”, “serious”, or “very serious” according to pre-specified criteria: risk of bias was assessed using the JBI Critical Appraisal Checklist; inconsistency was evaluated by examining variability in study results and considering differences in study methods and populations; indirectness was evaluated by examining how closely the included studies aligned with the PICO elements defined in the eligibility criteria; imprecision was appraised based on the number of studies, sample size, and the presence or absence of pooled effect estimates and confidence intervals. Other considerations included possible residual confounding, effect size directionality, and study limitations. In addition, effect directions were summarized to indicate whether higher levels of specific personality traits were associated with positive, negative, or no significant effects on the outcomes. The overall certainty of evidence for each outcome was categorized as high, moderate, low, or very low [50].

3. Results

3.1. Articles Selection

The preliminary database search identified a total of 4667 records. After the elimination of duplicates, 3610 unique articles remained. Subsequently, these records underwent screening based on their titles and abstracts, excluding 3550 articles deemed irrelevant to the research topic or that did not satisfy the established inclusion criteria. As a result of this initial screening process, 60 articles were retained for full-text review. During the comprehensive assessment of the full texts, 45 articles were excluded. Ultimately, 15 studies were identified as meeting all eligibility criteria and were included for extraction.
The process of selecting studies is illustrated in Figure 1.

3.2. Study Characteristics and Participant Details

This systematic review included fifteen observational studies investigating the relationship between personality traits, pain perception, attitude, satisfaction, compliance, and quality of life in orthodontics. These studies varied in methodology, including cross-sectional [51,52,53,54,55,56,57,58] and longitudinal [59,60,61,62,63,64,65] designs. Sample sizes ranged from small groups of 22 participants to larger cohorts of up to 1037 participants. The age range varied across studies, with some focusing on adolescents [51,52,53,55,58,59,61,65] and others including young adults [51,56,57,58,63,65] and adults [54,58,60,62,64,65]. The gender distribution was relatively balanced in most studies, with a slight predominance of female participants in some cases [53,54,55,56,58,60,61,62,64,65]. The studies utilized various validated tools to assess personality traits, including the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI) [51,52,54,56,57,59,62,63,64,65], Modified Big Five Inventory (BFI)-10 [53,58], Brief Symptom Inventory (BSI) and Narcissistic Vulnerability Scale (NVS) [60], Basic Personality Traits Inventory (BPTI) [55], 16 Personality Factors-Adolescent Personal Questionnaire (16PF-APQ) [61], and Temperament Questionnaire (EAS-C) [59].
Outcomes measured included oral health-related quality of life (OHRQoL) [54,55,60,62], pain perception [51,52,57,60,63], patient satisfaction [56], compliance with orthodontic treatment [58,61,65], attitude toward orthodontic treatment [51,52,57,63,64], and willingness to undergo treatment [53]. Across the selected studies, various validated instruments were employed to assess key orthodontic outcomes. Patient satisfaction was measured using the Dental Impact on Daily Living (DIDL) questionnaire [56] or an online questionnaire for the aesthetic perception of orthodontic appliances [64]. Cooperation during treatment was measured with scales such as the Orthodontic Patient Cooperation Scale (OPCS) [61] or by a questionnaire designed for this purpose [58]. Compliance was also objectively monitored using electronic sensors to track appliance wear time [59]. The patients’ willingness to accept various treatment options was evaluated with a questionnaire designed for this purpose [53]. Pain perception and treatment attitudes were commonly quantified using visual analog scales (VASs) marked at 10 mm intervals [51,52,57,63]. Oral health-related quality of life (OHRQoL) was assessed using instruments like the Oral Health Impact Profile-14 (OHIP-14) [54,62] and the Health-Related Quality of Life (HRQOL) questionnaire [60], while treatment need was determined using indices such as the Index of Orthodontic Treatment Need (IOTN) [65] or a combination of the Index of Complexity, Outcome, and Need (ICON), and the Child Perceptions Questionnaire (CPQ) [55].

3.3. Summary Findings

The included studies reveal a complex relationship between personality traits and orthodontic outcomes. Several studies reported that higher levels of neuroticism were linked to negative treatment experiences, such as lower patient satisfaction [56], increased pain perception [51,52,57], and poorer compliance [65]. In contrast, higher extraversion and conscientiousness were generally associated with more favorable outcomes, including better appearance satisfaction [56], reduced pain and improved treatment attitudes [51,52], and enhanced compliance [59]. While no significant associations were found between personality traits and patient cooperation [61], one study observed that agreeableness was positively correlated with a greater willingness to accept various treatment options [53]. Additionally, studies examining OHRQoL revealed modest associations between treatment need, self-esteem, and personality dimensions such as neuroticism and extraversion [54], with further evidence indicating that extraversion and openness can moderate the impact of malocclusion severity on quality of life [55]. Moreover, findings suggest that orthodontic treatment may positively influence personality profiles over time, as demonstrated by decreased neuroticism and increased openness, agreeableness, and conscientiousness post-treatment [63]. Aesthetic perceptions of orthodontic appliances and overall satisfaction were also found to vary with personality, with those rating smiles as “very beautiful” exhibiting higher extraversion, openness, and agreeableness, while the preference for brackets was linked to higher neuroticism [64].
Finally, gender-specific analyses indicated that certain associations, such as the predictive value of openness, extraversion, and conscientiousness on post-treatment OHRQoL, were more pronounced in males [58,62]. Additionally, differences in pain perception between treated and untreated subjects, as well as between genders, were highlighted in one study [57], and differential recovery outcomes associated with psychological factors were reported in another [60].

3.4. Studies Included

Al-Omiri et al. [56] conducted research with 50 patients, investigating factors influencing patient satisfaction with their dentition following orthodontic treatment. Results showed that higher levels of neuroticism were significantly associated with lower satisfaction after treatment. Additionally, extroversion was positively correlated with appearance satisfaction, and conscientiousness was associated with better oral comfort. Other factors, such as age, sex, and pretreatment orthodontic needs, did not impact satisfaction levels. Additionally, patients treated without extractions were more likely to express dissatisfaction with their dentition.
Amado et al. [61] conducted a cross-sectional study with 70 adolescents to explore the relationship between personality traits and cooperation during orthodontic treatment. Cross-tabulation analyses of cooperation and various personality dimensions, including extroversion, anxiety, harshness, self-control, and independence, showed no statistically significant differences. Furthermore, neither gender nor age significantly affected cooperation levels.
Abu Alhaija et al. [57] investigated the relationship between personality traits, attitude toward orthodontic treatment, and pain perception in 400 subjects (200 treated, 200 untreated). Results indicated that personality traits did not affect attitude toward treatment or pain perception. Treated and untreated subjects had similar attitudes toward orthodontic treatment, and no significant gender differences were detected in attitude scores among both treated and untreated subjects. However, significant gender differences emerged in pain perception, with females reporting higher pain levels. Additionally, a more positive attitude was observed in patients experiencing less pain, and those with prior knowledge of orthodontic treatment reported lower pain levels.
Hansen et al. [53] surveyed 96 adolescents to assess personality traits and their relationship with willingness to undergo different orthodontic treatments. The study found that agreeableness was positively correlated with a greater willingness to accept various treatment options, including stopping eating hard/sticky foods, wearing a retainer, using clear aligners, wearing rubber bands, and undergoing Herbst appliance treatment. In contrast, a significant negative association between neuroticism and willingness to eat hard and sticky foods was found. Conscientiousness was negatively associated with the willingness to wear a Herbst appliance. In addition, openness and extraversion did not significantly predict the willingness for any orthodontic procedures evaluated. Patient age, gender, and ethnicity were not associated with willingness to undergo orthodontic treatments.
Cooper-Kazaz et al. [60] conducted a study with 68 adult patients divided into three groups based on orthodontic appliance type (buccal, lingual, and clear aligners). Results indicated that the narcissistic vulnerability was similar across all patient groups and did not drive appliance selection. Patients choosing lingual or clear aligner appliances reported higher somatization levels than those selecting buccal appliances. Although lingual patients also showed elevated obsessive-compulsive symptoms, this did not reach statistical significance. Regarding pain severity, over the initial three days of treatment, a significant relationship was found between reduced self-esteem regulation and increased pain on day three. For lingual patients, higher pain levels were significantly associated with increased narcissistic features related to exploitation, whereas no association was observed with grandiosity. Additionally, in the buccal group, recovery outcomes were influenced by somatization, obsessive-compulsive traits, grandiosity, hostility, and paranoid ideation, while in lingual and clear aligner groups, recovery times were differentially affected by psychological factors such as exploitation and depression.
Abu Alhaija et al. [63] conducted a study with 100 participants to examine changes in personality traits, attitudes toward orthodontic treatment, and pain perception before and after treatment (T1 and T2). At T1, gender differences were evident in neuroticism and agreeableness, but these differences were no longer significant at T2. Post-treatment, neuroticism scores significantly decreased, while openness, agreeableness, and conscientiousness scores increased significantly. Although positive attitudes toward orthodontic treatment were initially reported, improvements were noted post-treatment, particularly among male subjects. Average pain scores remained statistically similar between genders at both timepoints.
Kadu et al. [52] conducted a cross-sectional study involving 200 adolescents, with equal groups of treated and untreated individuals. The findings revealed a strong positive correlation between pain perception and attitude. Additionally, higher levels of neuroticism were significantly associated with increased pain perception, whereas higher conscientiousness was linked to reduced pain and more favorable attitudes. There was no significant difference in pain perception or attitudes between the treated and untreated groups, but patients with more positive attitudes tended to experience less pain. Gender comparisons revealed no significant differences in pain perception or attitude within either the treated or untreated groups.
Clijmans et al. [54] investigated the association between orthodontic treatment needs, OHRQoL, self-esteem (SE), and personality traits in 189 adults. Total OHIP-14 scores did not differ significantly by gender or across most age groups, although individuals over 50 reported worse OHRQoL. Approximately 79% of subjects were classified as needing orthodontic treatment based on the Dental Health Component (DHC) of the IOTN, compared to 38% based on the Aesthetic Component (AC). Univariate analyses demonstrated modest to weak associations between treatment need and OHRQoL, with higher treatment need correlating with poorer quality of life, particularly in domains such as functional limitations, physical discomfort, psychological discomfort, and psychological disability. Significant links were found between self-esteem and OHRQoL, as well as between personality traits like neuroticism and extraversion and OHRQoL. However, no evidence was found that self-esteem or personality traits moderate the association between OHRQoL and treatment need.
Sigh et al. [51] examined the effects of personality traits on pain perception and attitudes toward orthodontic treatment in 300 young adults (150 treated and 150 untreated). The study found no significant differences in pain perception or attitudes between treated and untreated groups. A significant correlation was observed between attitude and pain perception, with a more positive attitude linked to less reported pain. Moreover, the analysis of personality traits revealed that higher neuroticism was significantly associated with increased pain perception, while variations in conscientiousness (from very low to very high levels) also significantly influenced pain and were strongly correlated with attitude.
Sarul et al. [59] conducted a longitudinal study involving 38 children to examine how personality traits influence compliance, measured as the average daily wearing time of removable appliances. The average wearing time was 6.09 h per day (range: 1.38–15.00 h), generally below the prescribed duration. Secondary analyses examined correlations between psychological test outcomes (from both patients and caregivers) and appliance-wearing time. These findings revealed strong positive correlations between wear time and traits such as self-efficacy, conscientiousness, and parental involvement. Although some measurements were rejected based on power analysis, those tests confirmed a significant relationship between psychological factors and patient compliance.
Aydoğan [55] conducted a study with 230 adolescents to examine the influence of personality traits on the relationship between orthodontic treatment need and OHRQoL. While the treatment need did not differ by gender, girls reported significantly poorer emotional well-being. Regarding personality, girls were more agreeable, whereas boys scored higher in openness to experience and negative valence. Correlation analyses revealed weak associations between treatment need and overall OHRQoL, as well as with its emotional and social well-being subscales. Notably, extraversion, openness, and dispositional optimism were negatively correlated with many quality-of-life scores, while neuroticism was positively correlated with most OHRQoL dimensions. Through regression analyses incorporating ICON scores, extraversion significantly moderates the relationship between malocclusion severity and overall OHRQoL and emotional and social well-being. Similarly, openness to experience moderates the effect of malocclusion severity on the emotional well-being domain, indicating that higher levels of these traits may buffer the negative impact of malocclusion on quality of life.
Al Nazeh et al. [62] examined the relationship between personality traits and OHRQoL before and after Invisalign treatment in 50 patients. Results indicated that females experienced fewer negative oral health impacts after treatment than at baseline. Furthermore, regression analyses conducted separately by gender indicated that openness, extraversion, and conscientiousness significantly predicted post-treatment OHIP scores among males. In contrast, neither personality traits nor demographic variables significantly predicted treatment outcomes in the female group.
Pascoal et al. [64] explored how personality traits influence the aesthetic perception of different orthodontic appliances. Using an online questionnaire with 461 participants, the researchers examined the role of personality traits in evaluating orthodontic treatment options. Among laypeople, those who considered the smile “very beautiful” had significantly higher scores in extraversion, openness, and agreeableness than participants with less favorable evaluations. In addition, significant differences in personality traits were found based on the preferred type of treatment. Participants favoring aligners showed higher openness and agreeableness, while those preferring brackets had significantly higher neuroticism scores.
The study of Ghoneim and Afif [58] involved 67 patients aged 12–60 undergoing clear aligner treatment. Participants completed an online questionnaire assessing compliance and personality traits. The study found that 50.75% of patients demonstrated high adherence to aligner wear time and follow-up visits. Notably, younger participants (ages 12–34) and those in treatment for one year or less showed higher compliance. Males were significantly more compliant compared to females. No statistically significant correlations were found between personality traits and compliance behavior, suggesting that other factors, such as age, gender, and treatment duration, may substantially impact patient cooperation.
Beļajevs and Jākobsone [65] investigated the relationship between personality traits (via the NEO-FFI) and compliance with Invisalign treatment among 22 adult patients. Of these, 55% were classified as cooperative, whereas 45% were noncompliant. The IOTN indices were similar between compliant and noncompliant groups. The findings showed that noncompliant patients had significantly higher neuroticism scores. Elevated neuroticism was further associated with an increased number of missed appointments, a discrepancy between the planned and actual number of aligners used at 6 months, reduced ability to control financial aspects related to treatment, and a negative correlation with the achieved movement of the upper premolars. Conversely, higher extraversion scores were linked with more frequent complaints about the treatment process and poorer oral hygiene outcomes at the 12-month assessment. Elevated conscientiousness was associated with better financial control and increased parental involvement in the treatment process at 6 and 12 months. Additionally, higher openness correlated positively with the desire to inform family members about the initiation of treatment.
An overview of the selected studies is presented in Table 3.

3.5. Quality Evaluation

The quality assessment of the studies is shown in Table 4. Twelve studies had a low risk of bias [45,46,48,49,50,51,52,53,54,55,56,57,58,59], while the remaining three had a moderate risk [59,61,65]. The inter-rater reliability between the two authors (FN and AN) indicated excellent agreement (0.85).

3.6. Certainty of Evidence

For all outcomes (pain perception, attitude toward orthodontic treatment, compliance, satisfaction, and OHRQoL), the certainty was rated as very low, mainly due to serious imprecision, inconsistency, and potential residual confounding. The main limitations included heterogeneity across studies, small sample sizes, and the absence of pooled quantitative estimates. A detailed rating is reported in Table 5.

4. Discussion

This systematic review reveals how subjective outcomes of orthodontic treatments are linked to distinct personality traits. The findings suggest that personality can influence patient experiences, but the relationship is complex and significantly variable across the selected studies. These differences can be attributed to variations in study designs, measurement tools, and sample characteristics.

4.1. Personality and Attitudes Toward Orthodontic Treatment

Personality traits are crucial in shaping patients’ attitudes toward orthodontic treatment. Two studies have demonstrated how certain traits, such as agreeableness, openness, extraversion, conscientiousness, and neuroticism, influence the willingness to undergo treatment [52,53]. Agreeableness is positively correlated with a greater acceptance of various treatment options [53], suggesting that cooperative and trusting individuals are more receptive to orthodontic care. Similarly, elevated extraversion has been linked to more positive attitudes toward treatment, with these patients often being more motivated and engaged, leading to better adherence to treatment protocols and improved overall experiences [52,55,66]. In addition, patients with high openness are more likely to perceive orthodontic treatment favorably [52,63], promoting better compliance and outcomes [64,66]. Patients open to new experiences may exhibit greater adaptability to the discomfort and lifestyle changes associated with orthodontic treatment, such as dietary restrictions and oral hygiene modifications [67]. In contrast, high neuroticism is associated with negative treatment attitudes [53], likely due to increased anxiety and reduced stress-coping abilities [52,57,68]. The influence of conscientiousness presents an interesting dynamic. Although this trait generally promotes adherence through organization and responsibility, it may also raise patient expectations, potentially contributing to treatment apprehension [53].

4.2. Personality and Satisfaction

Patient satisfaction is heavily influenced by personality. Al-Omiri et al. [56] reported that elevated neuroticism correlates with lower satisfaction, suggesting that individuals prone to emotional instability may perceive their dental outcomes more negatively. This relationship appears to be driven by an increased sensitivity and emotional reactivity, which can amplify dissatisfaction even when clinical results are objectively favorable [69,70]. Furthermore, such patients often develop unrealistic expectations, increasing the risk of dissatisfaction [71,72]. Conversely, positive traits such as agreeableness, extraversion, and conscientiousness positively influence aesthetic perceptions and treatment decisions [64]. Patients with high agreeableness tend to facilitate smoother interactions, while those with high openness and conscientiousness report higher satisfaction due to their proactive engagement in the treatment process [64]. Interestingly, some studies have not found a significant effect of personality on treatment attitudes [57] or between satisfaction and certain personality traits (such as extraversion, openness, agreeableness, and conscientiousness) [56]. These inconsistencies in findings suggest that further research is warranted. Finally, Abu Alhaija et al. [63] reported that orthodontic treatment may improve personality traits by increasing openness, agreeableness, and conscientiousness and reducing neuroticism, suggesting a bidirectional relationship between personality and treatment outcomes.

4.3. Personality and Compliance

Patient compliance with orthodontic protocols is crucial for optimal outcomes. It involves following treatment regimens, attending appointments, and adhering to hygiene instructions. Poor cooperation can compromise results, prolong treatment, and increase risks of dental issues [73,74]. Multiple factors, including personality traits, influence compliance. Although some studies found no significant association between personality and compliance [58,61], several investigations have confirmed this relationship. Individuals with high neuroticism tend to exhibit less cooperation and poorer compliance [65], likely due to increased anxiety and maladaptive coping [75]. Conversely, those with high extraversion could have better compliance due to optimism and social involvement [52,57,63]. Additionally, high agreeableness and conscientiousness are associated with better adherence to orthodontic recommendations [65]. Specifically, conscientiousness emerges as a key predictor. Organized and responsible patients tend to comply better with treatment protocols, achieving superior health outcomes [76,77,78]. Moreover, high openness facilitates adaptation to orthodontic appliances [64], further supporting compliance. However, the predictive power of personality traits alone is limited. Other factors—such as general self-efficacy, malocclusion severity, treatment type, prior experience, and familial influences—also play substantial roles in determining compliance [58,59,79,80]. Patients with previous orthodontic experience and those under active parental supervision showed higher compliance [80]. In this perspective, Sarul et al. [59] highlighted that self-efficacy, conscientiousness, and parental involvement enhance treatment compliance.

4.4. Personality and Pain Perception

The role of personality traits in pain perception during orthodontic treatment remains a contentious issue. Several studies have linked neuroticism to increased pain sensitivity [51,52,57,60,63] and lower tolerance [81,82], indicating that neurotic individuals could need additional psychological support. Emotional responses such as catastrophizing can worsen pain perception, leading to reduced treatment adherence due to anxiety and fear [52,53,63]. This may create a cycle where pain anticipation increases anxiety, amplifying pain during treatment [83,84]. Conversely, positive traits like agreeableness and openness correlate with lower pain perception [51,57,63], suggesting that cooperative and resilient patients engage better in treatment, minimizing pain associated with orthodontic adjustments [52,62,66]. Extroverted individuals, who typically employ effective coping strategies and rely on robust social support networks, tend to exhibit enhanced pain tolerance and a lower propensity for pain catastrophizing [84,85,86,87]. Moreover, highly conscientious patients report lower pain experiences, likely due to their proactive and disciplined approach to following treatment protocols [51,52].

4.5. Personality and OHRQoL

Studies also found associations between certain personality traits, such as neuroticism and extraversion, and OHRQoL [54,62]. Higher levels of neuroticism often correlate with lower satisfaction and poorer OHRQoL following orthodontic treatment [56], indicating that patients with this trait might perceive their oral health more negatively. Conversely, extraversion and openness to experience buffer the impact of treatment needs on quality of life [55], suggesting that these traits may contribute to a more positive perception of one’s oral health status even when orthodontic needs are present.

4.6. Gender Effects

The interplay between gender and personality traits has been identified as a significant determinant in shaping patient experiences and treatment responses. It is important to consider that gender was not a primary variable in this review, so insights emerged incidentally from individual studies rather than through systematic analysis. Several studies reported baseline differences in personality profiles between male and female patients. For instance, females often show higher agreeableness, while males may exhibit more openness or greater negative valence [55,63]. Abu Alhaija et al. [57] found that, although personality traits did not significantly impact attitudes toward orthodontic treatment, females reported higher pain levels, possibly due to differences in neuroticism.
Gender differences also appeared to influence treatment compliance. Ghoneim and Afif [58] reported that males were significantly more compliant with treatment protocols than females, suggesting that traits such as conscientiousness might be more pronounced or function differently across genders. In addition, Al Nazeh et al. [62] demonstrated that, when regression analyses were conducted separately by gender, traits like openness, extraversion, and conscientiousness significantly predicted post-treatment oral health-related quality of life in males but not in females. However, not all studies support a significant gender moderation effect. Some investigations found that, aside from specific differences in pain perception or compliance, the influence of personality traits on treatment attitudes or satisfaction did not differ considerably by gender [53,56]. These gender-specific insights came from secondary analyses without standardized assessments across studies, so conclusions about gender–personality interactions should be interpreted cautiously.

4.7. Clinical Implications

These findings have significant clinical implications for orthodontic practice. Patients with high neuroticism are predisposed to increased pain perception, lower satisfaction, reduced compliance, and poorer OHRQoL. To counteract these effects, clinicians should consider implementing targeted strategies such as thorough pretreatment counseling, customized pain management protocols, and the setting of realistic expectations. On the other hand, individuals exhibiting more adaptive personality traits, such as high extraversion, agreeableness, conscientiousness, and openness, are generally more cooperative and show more positive attitudes toward treatment, contributing to improved outcomes. Tailoring communication and treatment approaches to reinforce these traits could enhance patient engagement and satisfaction. Additionally, incorporating brief psychological interventions could further improve adherence and satisfaction across varied personality profiles. Overall, integrating psychological profiling into orthodontic practice offers a promising strategy for developing patient-centered interventions that address all key outcomes—pain perception, treatment attitude, compliance, satisfaction, and OHRQoL—thereby enhancing the effectiveness and quality of orthodontic care.

5. Limitations and Future Directions

The selected studies exhibited considerable methodological heterogeneity. This variability limits the comparability of the findings and restricts the generalizability of the results across different populations and clinical settings. Variations in study design, including cross-sectional versus longitudinal approaches, differences in sample sizes, and the timing of outcome assessments, may contribute to inconsistent results. For instance, differences in the use or calibration of measurement tools (such as variations in the VAS scale for pain perception and in the scales used to assess treatment attitudes) likely contributed to inconsistent results. Additionally, cultural and socioeconomic differences across study samples may have influenced how personality traits were expressed and how patients responded to orthodontic treatment, increasing heterogeneity.
This can explain why certain studies did not find significant associations between personality dimensions and outcomes such as patient cooperation (e.g., Amado et al. [61]) or treatment attitudes (e.g., Abu Alhaija et al. [57]), whereas other investigations reported clear links between these variables. Moreover, the lack of standardized assessments across studies further complicates direct comparisons. Some investigations that reported null findings may have been limited by low statistical power or may have measured outcomes in less sensitive ways to the subtle influences of personality. These discrepancies underscore the need for future research that employs more consistent methodologies, larger and more culturally diverse samples, and standardized instruments. Moreover, it is important to note that the variability in sample characteristics, including age ranges, could partially account for the heterogeneity observed in the associations between personality traits and treatment-related outcomes such as compliance, pain perception, and satisfaction. This suggests that age might be a potential moderating factor worth exploring in future research.
Not all studies systematically measured or controlled for potential confounding variables, such as gender. Although some studies reported gender differences, these were not the review’s primary focus and were not consistently assessed using a standardized framework. This gap suggests that future research should explicitly integrate these factors into study designs to understand better their moderating effects on the relationship between personality traits and orthodontic outcomes. Another important limitation is the reliance on self-reported measures for treatment outcomes that may also introduce reporting bias. Future research should prioritize longitudinal studies with standardized methodologies that allow for more robust causality analyses.
The current literature indicates that patient cooperation is closely related to the type of orthodontic appliance used. Traditional fixed appliances and removable devices, such as clear aligners, each influence treatment compliance and quality of life in distinct ways. In recent years, especially among adults, clear aligners have gained popularity due to their aesthetic and comfort advantages, which have led to improved patient engagement and adherence. However, the studies included have primarily focused on fixed appliances and conventional removable devices, offering limited insight into how different orthodontic techniques specifically affect quality-of-life outcomes. A more detailed examination of various orthodontic methods, particularly the rising use of aligners, could elucidate the benefits and challenges of each modality, enabling clinicians to tailor treatment plans to enhance patient satisfaction and compliance.
Finally, the GRADE evaluation highlighted a very low certainty of evidence for all outcomes analyzed (pain perception, attitude toward treatment, compliance, satisfaction, and OHRQoL). Downgrades were mainly due to serious issues with imprecision, inconsistency, and potential residual confounding across studies. These results emphasize the urgent need for high-quality, large-scale, and methodologically standardized research to clarify the influence of personality traits on orthodontic treatment outcomes and better guide patient-centered clinical strategies.

6. Conclusions

This systematic review explored how personality traits such as patient satisfaction, cooperation, OHRQoL, pain perception, and treatment attitudes affect orthodontic outcomes. Evidence shows that traits like neuroticism, extraversion, conscientiousness, openness, and agreeableness significantly impact these results. While some studies report null findings, the overall data highlight personality’s role in orthodontic care. These insights emphasize the importance of incorporating psychological assessments into orthodontic routines. By customizing treatment plans to fit individual personality profiles, clinicians can apply targeted strategies like enhanced counseling, personalized pain management, and effective communication to boost patient adherence and satisfaction. A patient-centered approach addressing clinical and psychological needs is essential for managing expectations and ultimately enhancing treatment outcomes.

Author Contributions

Conceptualization, F.N. (Fabiana Nicita) and A.N.; methodology, F.N. (Fabiana Nicita); formal analysis, F.N. (Francesco Nicita); investigation, F.N. (Fabiana Nicita); data curation, A.N.; writing—original draft preparation, F.N. (Fabiana Nicita); writing—review and editing, F.N. (Francesco Nicita); visualization, F.N. (Francesco Nicita); supervision, A.N. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

All data are contained within the article.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. Articles selection process summarized by PRISMA Flowchart.
Figure 1. Articles selection process summarized by PRISMA Flowchart.
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Table 1. Inclusion and exclusion criteria.
Table 1. Inclusion and exclusion criteria.
Inclusion CriteriaExclusion Criteria
Studies involving adolescents and adults undergoing or having undergone orthodontic treatmentStudies involving patients with syndromes, cognitive impairments, or those undergoing treatments other than orthodontic appliances
Studies regarding the relationship between personality traits and patient-related outcomes (pain perception, OHRQoL, attitude toward orthodontic treatment, satisfaction, and compliance)Studies that do not report the relationship between personality traits and patient-related outcomes
Studies using validated and standardized instruments to measure personality traitsStudies do not use validated tools for personality traits
Observational studies (cross-sectional, longitudinal, and cohort) Case reports, case series, editorials, reviews, meta-analyses, and unpublished data
Table 2. Database-specific search strategies.
Table 2. Database-specific search strategies.
DatabaseSearch Strategy
PubMed/MEDLINE((orthodontic [Title/Abstract] OR orthodontics [Title/Abstract]) AND (personality [Title/Abstract] OR “personality traits” [Title/Abstract]) AND (attitude [Title/Abstract] OR satisfaction [Title/Abstract] OR pain [Title/Abstract] OR compliance [Title/Abstract] OR cooperation [Title/Abstract] OR “quality of life” [Title/Abstract] OR “treatment outcome” [Title/Abstract]))
Scopus(TITLE-ABS-KEY (orthodontic OR orthodontics) AND TITLE-ABS-KEY (personality OR “personality traits”) AND TITLE-ABS-KEY (attitude OR satisfaction OR pain OR compliance OR cooperation OR “quality of life” OR “treatment outcome”)
Web of ScienceTS = (orthodontic OR orthodontics) AND TS = (personality OR “personality traits”) AND TS = (attitude OR satisfaction OR pain OR compliance OR cooperation OR “quality of life” OR “treatment outcome”)
ScienceDirect(orthodontic OR orthodontics) AND (“personality traits” OR personality) AND (attitude OR pain OR satisfaction OR compliance OR “quality of life”)
Google Scholar(orthodontic OR orthodontics) AND (personality OR “personality traits”) AND TS = (attitude OR satisfaction OR pain OR compliance OR cooperation OR “quality of life” OR “treatment outcome”)
Table 3. Key characteristics of the included studies.
Table 3. Key characteristics of the included studies.
Study (Authors, Year)Population CharacteristicsInstrument UsedMain Findings
Al-Omiri et al. (2006) [56]50 young adults aged 13–28 years.Personality traits assessment by the NEO-FFI.
Patient satisfaction measurement after orthodontic treatment with DIDL questionnaire.		Higher neuroticism scores were associated with lower satisfaction with dentition after orthodontic treatment.
Extroversion and consciousness were positively correlated with
satisfaction with appearance and with oral comfort.
Gender distribution: 20 males and 30 females. Age, sex, and pretreatment orthodontic treatment need did not affect patient satisfaction.
Amado et al. (2008) [61] 70 adolescents aged 12–15 years.Personality assessment by 16PF-APQ. No statistically significant relationships were found between cooperation and personality traits, gender, or age in adolescent orthodontic patients.
Gender distribution: 24 males and 46 females.Cooperation assessment by OPCS.Personality traits alone do not predict cooperation during orthodontic treatment in adolescents.
Abu Alhaijaa et al. (2010) [57]400 participants divided into two groups: 200 untreated (mean age of 21.50 years) and 200 treated subjects (mean age of 20.92 years), equally divided by gender.Personality traits evaluation with NEO-FFI.Personality traits did not affect attitude toward orthodontic treatment or pain perception.
Equal number of males and females (100 each for the group).Pain perception and attitude toward orthodontic treatment measurement using a VAS scale and VAS marked at 10 mm intervals, respectively. Gender was the only variable affecting pain perception, with females reporting more pain than males.
A more positive attitude was found in patients who experienced less pain during orthodontic treatment.
Hansen et al. (2013) [53]96 adolescents aged 12–16 years.Personality traits evaluation with modified BFI-10.Personality traits, particularly agreeableness, significantly predict willingness to undergo orthodontic treatments.
Gender distribution: 39 males and 57 females.Willingness to undergo treatment measurement by weighted Kappa Statistics for Test-Retest Reliability Questionnaire Assessment.Agreeableness was positively associated with five treatment modalities, while conscientiousness and neuroticism showed negative associations with specific treatments.
Age and gender were not significant predictors of treatment willingness.
Cooper-Kazaz et al. (2013) [60]68 adult patients aged 19–60 years divided into three groups (buccal appliance, lingual appliance, and clear aligner).Psychological traits evaluation using the BSI Inventory and the NVS Scale before treatment. Somatization influenced the choice of lingual and clear aligner appliances, with anxious individuals preferring these options.
Gender distribution: 23 males and 45 females.Patients’ perceptions of pain and dysfunction evaluation using an HRQOL questionnaire and VAS scale.Reduced self-esteem regulation was associated with increased pain across all orthodontic appliances.
Buccal appliances allow a more significant impact of personality traits on adjustability than lingual and clear aligner appliances.
Abu Alhaijaa et al. (2015) [63]100 adolescents and young adults aged approximately 17.5 to 19.15 years.Personality traits assessment using the NEO-FFI.Personality traits such as neuroticism, openness, agreeableness, and conscientiousness improved after orthodontic treatment.
Equal number of males and females (50 each).Pain perception and attitudes toward orthodontic treatment measurement using VAS scale.Attitude toward orthodontic treatment improved after orthodontic treatment.
The pain experienced during orthodontic treatment was like expected pain before treatment.
Kadu et al. (2015) [52] 200 adolescents aged 14–18 years divided into two groups (treated and untreated), each consisting of 100.Personality traits evaluation with NEO-FFI.Pain perception was similar for treated and untreated groups, indicating no effect of orthodontic treatment on pain perception.
Equal number of males and females (100 each).Pain perception and attitude measurement using the VAS scale.Personality traits, particularly neuroticism and conscientiousness, significantly influenced pain perception and attitude toward orthodontic treatment.
Gender and treatment status did not affect pain perception or attitude towards orthodontic treatment.
Clijmans et al. (2015) [54] 189 adults aged 17–64 years (mean age 31.3 years).Personality traits evaluation with the Dutch adaptation of NEO-FFI.There is a significant association between orthodontic treatment need and oral health-related quality of life (OHRQoL), with higher treatment need correlating with worse OHRQoL.
Gender distribution: 55 males and 134 females.Self-esteem assessment with the Rosenberg self-esteem scale (RSES).Self-esteem is significantly associated with OHRQoL, where higher self-esteem correlates with better OHRQoL.
OHRQoL measurement by OHIP-14.Certain personality traits are associated with OHRQoL, but neither self-esteem nor personality traits moderate the relationship between treatment need and OHRQoL.
Orthodontic treatment need assessment by IOTN.
Sigh et al. (2017) [51] 300 adolescents and young adults aged 15–20 years divided into untreated and treated groups (150 each).Personality traits evaluation with NEO-FFI.Attitude, personality traits, and pain perception significantly influence patient cooperation and the success of orthodontic treatment.
Equal number of males and females (75 males and 75 females in each group).Pain perception and attitude assessment using a VAS scale. No significant difference in pain perception was found between treated and untreated groups or between genders.
Higher levels of neuroticism are associated with increased pain perception, while conscientiousness is directly proportional to pain perception.
Sarul et al. (2017) [59] 38 adolescents aged 9–12 years.Patient temperament and personality traits assessment by the EAS-C Temperament Questionnaire, Generalized Self-Efficacy Scale (GSES), NEO-FFI, and Parental Attitude Scale.Psychological traits such as high self-efficacy, conscientiousness, and strict parental requirements positively correlate with better compliance in wearing removable orthodontic appliances.
Equal number of males and females (19 each). Psychological assessments can predict patient compliance, suggesting their potential use in planning orthodontic treatments.
Aydoğan (2018) [55]230 adolescents aged 11–14 years (mean age 12.48 years).Personality traits assessment by BPTI.Personality traits such as extraversion and openness to experience moderate the relationship between orthodontic treatment need and oral health-related quality of life in adolescents.
Gender distribution: 105 males and 125 females. Dispositional optimism evaluation with the Revised Life Orientation Test.Adolescents with higher levels of extraversion and openness to experience are less negatively affected by their orthodontic treatment needs.
Orthodontic treatment need measurement by ICON.
Al Nazeh et al. (2020) [62]50 adults aged 18–48 years (mean age 27.62 years).Personality assessment by NEO-FFI. Females experienced a significant reduction in negative oral health impacts after Invisalign treatment.
Gender distribution: 24 males and 26 females. OHRQoL measurement by OHIP.Among males, personality traits such as openness, extraversion, and conscientiousness predicted oral health impacts after treatment.
Personality traits did not predict oral health impacts for females.
Pascoal et al. (2024) [64] 461 adults aged 18–70 years.
Gender distribution: 93 males and 368 females.		Personality traits assessment using the NEO-FFI inventory.
Questionnaire with sociodemographic variables and aesthetic perception of orthodontic appliances.		Personality traits such as agreeableness and openness are associated with a preference for aligners, while neuroticism is linked to a preference for fixed appliances.
Personality traits significantly influence aesthetic perception and decisions regarding orthodontic treatment, impacting patient satisfaction.
Ghoneim and Afif (2024) [58]67 participants aged 12–60 years.
Gender distribution: 18 males and 49 females.		BFI-10 tool for personality traits evaluation.
Questionnaire on compliance behavior (measured by adherence to follow-up visits and aligner wear time).		No significant correlation was found between personality traits and compliance with clear aligner therapy.
Compliance was higher among younger patients (aged 12–34) and males.
Patients undergoing treatment for one year or less showed better adherence.
Belajevs and Jākobsone (2024) [65]22 participants aged ≥18 years
Gender distribution: 3 males and 19 females.		Personality traits assessment with Latvian version NEO-FFI.
Cooperation measurement by orthodontists and premolar expansion measurements.		Higher neuroticism scores are associated with noncompliance treatment, including missed appointments and discrepancies in aligner use.
Extraversion correlates with complaints about the treatment process and poor hygiene, while conscientiousness is linked to better financial control and parental involvement.
Table 4. Quality assessment of included studies according to the JBI Critical Appraisal Checklist.
Table 4. Quality assessment of included studies according to the JBI Critical Appraisal Checklist.
CriteriaAl-Omiri et al. (2006) [56]Amado et al. (2008) [61] Abu Alhaijaa et al. (2010) [57]Hansen et al. (2013) [53]Cooper-Kazaz et al. (2013) [60]Abu Alhaijaa et al. (2015) [63]Kadu et al. (2015) [52] Clijmans et al. (2015) [54] Sigh et al. (2017) [51]Sarul et al. (2017) [59] Aydoğan (2018) [55]Al Nazeh et al. (2020) [62]Pascoal et al. (2024) [64]Ghoneim and Afif (2024) [58]Beļajevs and Jākobsone (2024)
[65]
Q1YesYesYesYesYesYesYesYesYesYesYesYesYesYesYes
Q2YesYesYesYesYesYesYesYesYesYesYesYesYesYesYes
Q3YesYesYesYesYesYesYesYesYesYesYesYesYesYesYes
Q4YesYesYesYesYesYesYesYesYesYesYesYesYesYesYes
Q5YesNoYesYesYesYesYesYesYesNoYesYesYesYesUnclear
Q6YesNoYesYesYesYesYesYesYesNoYesYesYesYesUnclear
Q7YesYesYesYesYesYesYesYesYesYesYesYesYesYesYes
Q8YesYes YesYesYesYesYesYesYesYesYesYesYesYesYes
RISK OF BIASLowModerateLowLowLowLowLowLowLowModerateLowLowLowLowModerate
Table 5. Assessment of the certainty of evidence using the GRADE tool.
Table 5. Assessment of the certainty of evidence using the GRADE tool.
Outcomes
Pain PerceptionAttitudeComplianceSatisfactionOHRQoL
Number of studies (participants)5 studies [51,52,57,60,63]
(1068 patients) 		5 studies [51,52,53,57,63]
(1096 patients) 		4 studies [58,59,61,65]
(197 patients) 		2 studies [56,64]
(511 patients) 		4 studies [54,55,56,62]
(519 patients)
Study designObservational studies (mainly cross-sectional and one study including a short-term prospective observation)Observational studies (cross-sectional)Observational studies (mostly cross-sectional and one longitudinal observational study)Observational studies (cross-sectional)Observational studies (cross-sectional)
Risk of BiasNot seriousNot seriousSerious aNot seriousNot serious
InconsistencyNot seriousNot seriousSerious bSerious bSerious b
IndirectnessNot seriousNot seriousNot seriousSerious cNot serious
ImprecisionSerious dSerious dSerious dSerious dSerious d
Other
considerations		None eNone eNone eNone eNone e
Effect of directionHigher neuroticism and maladaptive traits are associated with increased pain perception.Extraversion, openness, and conscientiousness are associated with more positive treatment attitudes.Higher conscientiousness and self-efficacy are associated with better compliance, but some studies show mixed results.Higher neuroticism is associated with lower satisfaction; extraversion and openness are linked to better aesthetic perceptions.Higher neuroticism is associated with poorer OHRQoL, while extraversion and openness buffer negative impacts.
Overall GRADE
certainty		⨁◯◯◯
Very low		⨁◯◯◯
Very low		⨁◯◯◯
Very low		⨁◯◯◯
Very low		⨁◯◯◯
Very low
a Methodological limitations in some included studies. b Variations in study design, measurement instruments, outcome definitions, sample characteristics, and gender-based differences explain different study results. c One study focused on aesthetic perception rather than post-treatment satisfaction, introducing indirectness in population and outcome measurement. d Lack of pooled effect sizes, absence of confidence intervals, variability in measurement tools, and in some cases, small or limited sample sizes. e No additional factors (e.g., large effect size or plausible residual confounding) were identified that could upgrade or downgrade the certainty of evidence.
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Nicita, F.; Nicita, A.; Nicita, F. Influence of Personality Traits on Pain Perception, Attitude, Satisfaction, Compliance, and Quality of Life in Orthodontics: A Systematic Review. Appl. Sci. 2025, 15, 5075. https://doi.org/10.3390/app15095075

AMA Style

Nicita F, Nicita A, Nicita F. Influence of Personality Traits on Pain Perception, Attitude, Satisfaction, Compliance, and Quality of Life in Orthodontics: A Systematic Review. Applied Sciences. 2025; 15(9):5075. https://doi.org/10.3390/app15095075

Chicago/Turabian Style

Nicita, Fabiana, Arianna Nicita, and Francesco Nicita. 2025. "Influence of Personality Traits on Pain Perception, Attitude, Satisfaction, Compliance, and Quality of Life in Orthodontics: A Systematic Review" Applied Sciences 15, no. 9: 5075. https://doi.org/10.3390/app15095075

APA Style

Nicita, F., Nicita, A., & Nicita, F. (2025). Influence of Personality Traits on Pain Perception, Attitude, Satisfaction, Compliance, and Quality of Life in Orthodontics: A Systematic Review. Applied Sciences, 15(9), 5075. https://doi.org/10.3390/app15095075

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