Psychological support for orthognathic patients: Who is doing what?

OBJECTIVE: To investigate: (1) orthodontists' training experience in the psychological assessment of orthognathic patients and their wish for training/further training; (2) the availability of psychological support, referral patterns and outcomes after referral; (3) and adverse incidents prompting orthodontists to refer patients for psychological assessment. DESIGN: Prospective cross-sectional study. METHODS: A 25-item questionnaire was designed to investigate the above mentioned aims. After a pilot study, the questionnaire was distributed to all members of the Consultant Orthodontist Group, British Orthodontic Society. RESULTS: Based on a 29.1% response rate (n = 102), 76.5% of respondents had undertaken training in identifying orthognathic patients who may benefit from psychological assessment. However, 90.2% favoured further training. All respondents believed that some orthognathic patients would benefit from referral; however, 31.3% of units referred no patients at all, mostly due to limited/no access (66.7%). Most referrals (68.9%) were to psychiatrists/psychologists with dentofacial deformity expertise, with 28.9% of units having such services onsite (14 different units). Psychological referrals had potentially useful outcomes, with 36.4% of respondents sometimes changing treatment plans following referral. Clinical incidents were experienced by 35.1% of respondents, prompting referral of patients for psychological assessment; such incidents included patient suicides (n = 4). CONCLUSION: Most respondents had trained in psychological assessment of orthognathic patients; however there was a large demand for further training. Clinicians value the psychological services available; however, limited availability may affect referrals for some respondents. Adverse incidents are of real concern and highlight the need to ensure that training and resources are provided to support orthognathic patients and teams.

An incidental dense bone island: A review of potential medical and orthodontic implications of dense bone islands and case report.

Dense bone islands (DBIs) are usually asymptomatic and do not require any treatment. This case report presents a DBI of an unusual presentation, which was an incidental finding on a radiograph of a 15-year-old orthodontic patient. The DBI lesion was 24 mm in size, occupying at least 50% of the alveolar process between the upper right canine and lateral incisor, extending up the lateral aspect of the anterior margin of the right nasal fossa. Generally, DBIs are 2-3 mm in size and more commonly found in the mandible in the molar and premolar region. This article further discusses the impact of DBIs on orthodontic treatment such as difficulty with achieving space closure and adequate root tip or torque. We also examine the potential medical implications of DBIs. This is clinically important, especially if multiple DBIs, or osteomas which have a similar radiographic appearance to DBIs, are found in a patient as they may be associated with adenomatous intestinal polyps, which, if not treated, have a 100% chance of becoming malignant transformation.