Psychosocial well-being of prospective orthognathic-surgical patients

OBJECTIVE: To compare the psychosocial well-being of prospective orthognathic-surgical patients and controls.

MATERIALS AND METHODS: Sixty patients referred for assessment of orthognathic-surgical treatment need and 29 controls participated. All participants filled in the modified version of Secord and Jourard's Body Image Questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem scale, the Acceptance and Action Questionnaire II and a structured diary developed by the authors. Patients also filled in the Symptom Checklist 90. Patients assessed their dental appearance on a visual analogue scale modified from the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Professional assessment was made from study models with the AC.

RESULTS: Patients rating their dental appearance as AC grades 5-10 suffered from lower orthognathic quality-of-life and poorer body image than the controls, while those with AC grades of 1-4 only had poorer oral function. Self-perceived dental appearance was more important to orthognathic quality-of-life and body image than an orthodontist's assessment. Patients and controls had equal psychological flexibility and self-esteem. In all, 23-57% of patients had significant psychiatric symptoms, which explained the adverse emotions patients felt during the day. Fifteen per cent of the patients had been bullied.

CONCLUSIONS: Many orthognathic-surgical patients cope well with their dentofacial deformities, despite functional masticatory problems. It seems that a subjective view of dental appearance may be a key factor in finding patients with psychosocial problems. It should be a major issue when considering psychosocial support and other treatment options.