The psychological impact of orthognathic surgery: a 9-month follow-up

In an attempt to determine the impact of surgical orthodontics on patients' personality and perceptions of oral function, fifty-five patients were examined longitudinally. Patients completed five questionnaires during the course of treatment, from 1 month before to 9 months after surgery. Orthodontic appliances were still being worn by 56.1 percent at the 9-month assessment. Satisfaction with surgery, self-esteem, and body image were high throughout the postsurgical stage but showed significant changes. Satisfaction peaked at 4 months but declined at 9 months postsurgery, as did self-esteem and facial body image. Most of this decline was attributable to patients being still under orthodontic treatment, but those with continuing problems of pain, paresthesia, and oral dysfunction were not more likely to report psychological dissatisfaction. Results are examined from the perspectives of integration of body image and patient expectations from orthognathic surgery.

Variables discriminating individuals who seek orthodontic treatment

Overall, these results support the view that dental-facial esthetics and self-perceptions of occlusal appearance, as well as attitudes toward malocclusion and orthodontic treatment, are important factors in the individual's decision to obtain orthodontic treatment. The data indicate that psychosocial variables not directly related to occlusal problems and treatment, do not add significantly to the description of differences between those who seek treatment and those who do not. While these analyses did not include a number of variables--such as socioeconomic factors or attitudes of significant others--which may also be important in predicting individual response to malocclusion, they do suggest strongly that psychosocial factors directly related to need for treatment are probably most productively assessed in terms of self-perceptions of occlusal appearance and attitudes regarding dental malrelations and their treatment.

A survey of adults' attitudes toward orthodontic therapy

This study was designed to discover the nature of concerns that adult patients have toward their orthodontic therapy. I had observed, after many years of treating this age group, that concerns brought to my office by prospective and active patients were similar. All patients, however, felt that their attitudes and feelings were unique. Initially, the investigation was carried out in the presence of a psychologist during evening meetings. This was then followed by giving questionnaires to thirty-five patients. The first questionnaire was distributed to patients who had decided to undergo therapy but had not yet started. The second was given to that same group of patients upon completion, or imminent completion, of their treatment. Thirty-three patients returned both questionnaires. The principal conclusion was that negative concerns and fears that the patients had about their course of treatment were soon dissipated. Perseverance toward the treatment goal was an overriding characteristic of every patient, and satisfaction with the end result was uniformly favorable. These patients would encourage all others to undergo treatment if it was required.

Reliability and stability of the orthodontic Patient Cooperation Scale

Patient cooperation is recognized as an important factor in the outcome of orthodontic treatment. In order to predict patient cooperation, there have been numerous studies which have examined its correlates in orthodontic treatment. However, few, if any, of these studies have considered the reliability or stability of their patient cooperation measures. Hence, the correlates found or not found are suspect. The present article reports on the internal consistency and stability of the Orthodontic Patient Cooperation Scale (OPCS). Using the responses of practicing orthodontists, a list was generated of ten patient behaviors frequently considered in evaluating a patient's cooperation. Subjects were eighth- and ninth-grade students undergoing orthodontic treatment, who were rated by their own orthodontists after 2 months and 6 months of treatment. The internal consistency for the scale was estimated to be 0.71 (N = 44) at 2 months and 0.80 (N = 45) at 6 months. The correlation between scores at 2 months and at 6 months was 0.58 (N = 44), which may be considered to be a conservative estimate of the long-term stability of the scale. In summary, the OPCS has adequate internal consistency and reasonably stable scores over a 4-month period. As such, it should prove useful in studies looking for predictors of patient cooperation and in studies examining the relationship of patient cooperation and outcome of treatment.

The adult orthodontic patient

Adults now make up an increasing portion of the orthodontist's patient load. Though most seek esthetic correction, requests for multidiscipline treatment are expanding. The etiology of adult malocclusion, unlike that of malocclusion in the young, presents us with psychological and physiologic factors that specifically affect treatment and dictate special diagnostic, planning, and mechanical procedures. The adult patient offers the orthodontist a new challenge and the stimulus to develop successful treatment approaches peculiar to the nongrowing patient. Careful diagnosis and treatment planning on a multidiscipline basis will result in satisfactory resolution of most adult malocclusions, and there is no requirement for esoteric appliances or mechanics. An evaluation of treated cases indicates that all corrective dental movements are possible and that the health, function, and esthetics of the dental apparatus can be markedly improved. The cases presented demonstrate that adults are amenable to treatment over the full orthodontic spectrum. Treating the adult patient can be very satisfying. The patient is invariably pleased with his effort (and your help), once the "braces" are off. Since the original need was great in the patient's mind, success in its satisfaction is especially rewarding and it overflows on everyone involved.

Self-concept, Class II malocclusion, and early treatment

Increased overjet has been associated with teasing, negative stereotyping, and low self-concept. Early treatment for children with Class II malocclusion is often recommended under the assumption that an improved dental appearance may benefit a child by increasing his or her social acceptance and hence self-concept. The self-concept of 208 patients, age 7 to 15 years and with increased overjet, was measured before treatment using the Piers-Harris self-concept scale; a subset of 87 of these children were measured again after 15 months of early growth modification. The mean self-concept score for these children was above the population norm, and there was no association between the child's score and the magnitude of his or her overjet or age. Although some significant associations were found between Class II malocclusion features and self-concept scores, the explained variation in self-concept scores was low (R2 from 5% to 8%). There was no change in the mean self-concept score of these children during early treatment, nor was there any association between reduction of Class II malocclusion features and improved self-concept. These findings suggest that children with Class II malocclusion do not generally present for treatment with low self-concept and, on average, self-concept does not improve during the brief period of early orthodontic treatment.