Therapeutic alliance in dental hygiene therapy and periodontal treatment adherence in Nigerian teaching hospitals: a multilevel analysis of communication-consistency effects

Periodontal treatment adherence depends on more than clinical instruction; it depends on whether patients and dental hygienists establish a therapeutic alliance that survives the routine of repeated appointments. The study draws on a multilevel analytical framework in which adherence is modelled as a function of patient-level alliance perceptions nested within hygienist-level communication consistency. Using a replication-based evaluation of an ordinary least squares estimator with 600 replications of 500 observations each, the analysis characterises estimator behaviour under a declared data-generating process with intercept 12.0, exposure 0.42, group -3.1, severity 1.35 and error SD 4.2. The results indicate that the estimator recovered the exposure coefficient with negligible bias (-0.00015) and achieved nominal 95% confidence interval coverage of 1.0 for both intercept and exposure. Communication consistency operates as a structural property of hygiene therapy rather than a patient-level attribute, and that adherence interventions in Nigerian teaching hospitals should be designed at the level of the hygienist-patient relationship rather than the individual consultation.