Psychological status of patients seeking orthodontic

treatment.

► Psychological outcomes of orthodontics on the

patients self image is positive.

► Psychology to the clinical practice of orthodontics can

be divided into:-
-Social psychology
-Motivational psychology
► Social Psychology of Orthodontics:-
Why patients seek orthodontic treatment?
-Dentofacial anomalies such as crooked teeth & skeletal
disharmonies have been reported as the cause of teasing &
harassment among children.
-Bennet & Philip.
► Adults seek for treatment to improve their facial & dental
appearance which in turn will lessen social embarrassment &
improve the self confidence.
-Hunt & Johnston.
Psychologic outcomes of orthodontic
treatment:-
treatment:-
Dentofacial esthetics play an important role in a
individual’s self image.
Children with malocclusion did not have poor self image
& orthodontic treatment did not improve it-Dann
it-Dann..
Dentofacial disharmonies have significant social &
psychological effect on the patient-Albino
patient-Albino..
► Kiyak et al reported psychological influences
on the timing of orthodontic treatment.
-Developing children well being may be an
indication for early orthodontic treatment.
-Racial differences may be present in the psychological
influences of orthodontics.
► Motivational psychology:-
The success of orthodontic therapy depends on patient
compliance.

 Egolf described a compliant patient as one who practices

good oral hygiene, wears appliance, follows an appropriate
diet and keeps appointment.

 Southard et al pointed out that improved co-operation by the

patient helps to achieve the treatment objectives within a
minimum time.
► Improved oral hygiene can decrease damage to the
periodontal tissues and limit the effects of enamel
decalcification and caries
-Nanda & Sinha
 Patient Management.

► Motivation.

► Communication.

► Pre appointment behaviour modification.

► TSD technique (Addelston).

(Addelston).

► Efficiency & organization.

 Psychology of malocclusion.
► An acquired habit is nothing but a new pathway of discharge
formed in the brain, by which certain incoming currents ever
after tend to escape – William James

► Habits can be classified as

useful habits
harmful habits
► Developmental psychologists have produced a
number of theories to explain thumb sucking
-Digital sucking has been related to inadequate suckling
activity - Freud.
-Prolonged suckling can lead to thumb sucking – Sears &
Wise.
► Thumb sucking is a simple learned habit and
contradicts the psychoanalytic theory which uses the
habit as a symptom of a deeper emotional
disturbance – Haryett et al
According to Dr.Barton
► Lack of love and affection
► Habit is evidence of a feeling of personal inadequacy,
frustration & insecurity.
► Improper nursing .
 •Malocclusion can have a profound psychological impact and
most of these children are shy, self-conscious and withdrawn.

•The youngster who sucks his finger beyond the time that is
normal, faces a psychological problem as he knows that this
habit is not liked by parents or the society and also realizes
that he is causing a facial abnormality.

►Unfavorable psychological effects tend to accompany

speech defects that are attributable to dental malocclusions.

 Psychosocial implications of facial deformities
H. Asuman Kiyak
Rebecca Bell

► Meanings of the Face

► Psychosocial characteristics of patients with facial deformities

 Meanings of the Face
► “The face is the area of one’s body that produces the greatest
concern regarding physical attractiveness; it is the individual’s
focal point and the source of vocal and emotional
communications with others”

► Berscheid et al in a survey of over 1000 adults found that

people who were satisfied with their facial features expressed
greater self-confidence.
 Meanings of the Face
► Berscheid et al – the area of greatest dissatisfaction for
subjects in their large sample was the appearance of
their teeth

► Attractive adults & children are evaluated as more

successful and more intelligent than are unattractive
persons and are viewed as more socially skilled – GR
Adams
 Psychosocial characteristics of patients with facial
deformities

► Children with craniofacial anomalies are more introverted,

neurotic and demonstrate poor self-concept – Perschuk et al

► Children with Down’s syndrome were rated as being less

intelligent, less attractive, and less socially acceptable.
Postoperative ratings of these same children were significantly
more positive in all three domains – Strauss et al
 Psychosocial characteristics of patients with facial
deformities

► A seriously handicapping orthodontic condition is the one that

“severely compromises a person’s physical or emotional
health” – AL Morris et al

► Physical compromise – serious problems with breathing,

speaking, or eating, especially if accompanied by tissue
destruction

► Emotional health – includes other’s reactions to the individual

in a way that influences self-esteem
 Summary
► Research in the areas of self-esteem and attractiveness indicates that the
face is a major source of one’s psychologic identity

► Orthognathic surgery differs from surgery for congenital anomalies (in that
the changes in appearance are less dramatic and improvements in
occlusion, mastication, speech, and TM joint function are likely to be major
reasons for treatment) – but patients undergoing this surgeries also expect
esthetic changes. They must adapt not only to changes in their oral
function, but also to changes in their perceived appearance and
interactions with others
 Psychosocial studies of patients with dentofacial
deformities - Kiyak et al

► The First Study

To study patient’s motives for seeking orthognathic surgery, the effect of this
procedure on people with diverse needs, and patient’s satisfaction with
treatment outcomes
6 questionnaires were asked over a 26 month period

► The Second Study

Attempted to examine in greater detail the variables that emerged as
significant predictors of long-term outcomes
The effect of orthognathic surgery was measured by comparing patients who
underwent surgery and orthodontics with those who were recommended
to have both but elected orthodontics alone
6 questionnaires were asked before and up to 24 months after surgery
 Patients before surgery
► Motives for treatment
► A scale to assess patient’s motives
► Self-perceptions of facial profile
► Sex differences
► Orthognathic-surgery patients
 Motives for surgery
Parameter Male Female
Professional advice
Orthodontist 24(83%) 34(76%)
Family dentist 12(41%) 17(38%)
Other 5(17%) 1(2%)
Desire esthetic changes 12(41%) 13(53%)
Functional problems
Mastication 12(41%) 13(29%)
Speech 4(14%) 1(2%)
TM joint 1(3%) 7(16%)
Social: family, friends 12(41%) 24(53%)
 A scale to assess patient’s motives
► Subjective Expected Utility (SEU) Model
Items are based on interviews with orthognathic surgery patients,
orthodontists, and oral-maxillofacial surgeons
Using a 10 point scale, patients are asked to indicate the importance of each
item in the list above and whether they consider it positive , negative or
neutral.
In this study, SEU suggest that the decision to seek surgical correction is
influenced by functional reasons. Conversely, the decision to reject surgery
and undergo conventional orthodontics seems to be based more on a
desire for improved esthetics
A scale to assess patient’s motives
Questions Score

Less difficulty with chewing 3

Stop jaw from clicking 0
Eat foods unable to eat now 0
Better fit of upper/lower teeth 1.5
General health improvement 1.5
Possible pain after surgery 0
Better smile 0
Improved profile, jaw and chin 0
Straight teeth 0
Cost of surgery 0
Lost time from work/school 0.8
Chance of unsuccessful surgery 1.9
Be able to speak clearer 0
Less self-conscious 0
Perform better in job/school 0
Advice of family/friends 0
Advice of dentist/orthodontist 0.9
Know of someone else’s surgery 0
 Self-perceptions of facial profile
► For all dimensions of facial deformity, patients who accept
surgical treatment view themselves as less normal than do
those who opt for no treatment or orthodontics

► At the 24-month follow-up assessment, nearly all the surgery

patients rated themselves as normal. Orthodontics-only
patients also rated themselves improved on all scales, but the
improvement was not as great.
 Sex differences
► Broverman and colleagues have found experimental evidence
that women place relatively greater importance on physical
attractiveness

► Kurtz et al found that women can more easily distinguish what

they like and dislike about their bodies than can men of the
same age, who give only global self-descriptions.
 Orthognathic surgery patients
► In present study both men and women scored within the
normal range, notably better than the cosmetic-surgery
population.

► Sex differences were not significant in post surgical satisfaction

or in self-reports of pain.
 Response to treatment
► Overall satisfaction with the outcomes is generally high at all post surgical
assessments
► Overall body image was found to be in the moderate range throughout the
course of treatment
► Surgery patients initially expressed a lower body image than did non
surgical and no-treatment patients
► Surgical patients had high levels of tension and anxiety just before surgery,
with a steady decline later
► Orthodontics-only patients had negative mood states at 6 months which
later improved
► In surgical-orthodontic patients, expectations matched the actual
experience for most patients.
 Application of research findings to patient
management
► Summary of research findings
The patients undergoing orthognathic surgery are always within
the psychologically normal range
They are more stable than people who seek plastic surgery
Their greatest concern before treatment appears to be self-
consciousness regarding their facial body image, but functional
problems also are important
 Application of research findings to patient
management
► Summary of research findings
Orthodontics-only patients report negative emotions during the
later stages of their treatment
Contrary to literature on cosmetic surgery, most patients
undergoing orthognathic surgery readily accept changes in
appearance and are satisfied with the esthetic effects
85% to 90% of the patients undergoing surgical-orthodontic
treatment eventually indicate that they are satisfied with the
treatment
Recommendations for interaction with
patients
► There is a need for systematic selection of patients,
preparation for surgical treatment, and careful psychologic
management throughout the course of surgical and
orthodontic treatment
► Provide greater psychosocial support and encouragement for
the patient with a neurotic personality style, especially in the
early stages of treatment
► Patient education materials provide information in a standard
way so that no important points are omitted, and the patient
can review it repeatedly to gain a better understanding of the
process.
Pre- and post surgical psycho-emotional aspects of the
orthognathic surgery patient - Bertolini et al

► Levels of pre surgical anxiety, post surgical depression, body

concept, and all the important changes in physiologic functions
were measured by 4 questionnaires.
► The results of this study suggest that surgery does in fact,
produce improvements in self-esteem and body image and in
mastication and speech, and therefore in their lifestyles
► All patients experienced a medium to high level of pre surgical
anxiety, but no major problems after surgery.
 Psychological status of cleft lip & palate patients.

► A study comparing the self-concept of children with cleft lip

and palate to children without these conditions found a
significantly lower self-concept in the former group – JE Jones
► Serious social and psychological difficulties were encountered
in everyday life . The social rejection for these facially disabled
patients extended to their attempts to obtain jobs, make
friends, set apart as different from others, frequently
developed psychological disturbances – --Mac--Mac Gregor
► Public perception of cleft lip & palate patients - least
liked by children & adults.
-Landsdown & polak
-Glass et al
► Also, lip impairment & hypernasality of voice were
considered most favorable in these children.