Analytical study of the psychosocial impact of malocclusion and maxillofacial deformity in patients undergoing orthodontic treatment.

Patients whose with facial appearance involves dental anomalies and malocclusion face an increased prevalence of various psychosocial problems such as a high level of social anxiety, social avoidance, and low quality of life. This study investigates the patients with craniofacial anomalies and their psychological adjustment concerning the facial and dental appearance. It also evaluates the expectations of this patient group from the orthodontic treatment. Two steps were done in this study. In the first step, translation and validation of the Derriford Appearance Scale (DAS59), The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and Patient Expectation from the Orthodontic Treatment (PEOTQ) questionnaires into Maithili were done, and then the main study was conducted using these valid questionnaires. This was a cross-sectional study conducted on the patients with congenital craniofacial anomalies visiting the orthodontics department of Patna Dental College and Hospital, Patna (Bihar). All the patients received the Maithili DAS, Maithili PIDAQ and Patients' Expectation from the orthodontic treatment questionnaires. The Maithili version of DAS59, PIDAQ and PEOTQ were developed with outstanding reliability and validity. A significant difference between PIDAQ (p<0.001) and DAS59 scores (p<0.001) was found. In females, the total PIDAQ score was significantly higher as compared to males, but there was no association of DAS scores with gender. Place of residence showed no association with PIDAQ and DAS59 scores in patients. Patients and controls had significant differences between various items, and a comparison was made in terms of expectation from the orthodontic treatment. Altered facial and dental appearance in patients with craniofacial anomalies showed a significant psychological impact.

Psychology input to an orthognathic clinic: Patients' perception of service quality.

AIMS: The aim of this study was to assess patient satisfaction with a clinical psychology service, integrated within an inter-disciplinary orthognathic planning clinic. METHOD: A self-report, custom-designed questionnaire was sent to patients who had completed orthognathic treatment within the last three years. Of the 60 patients approached, 49 responded. RESULTS: The great majority of patients agreed that there was a need for a psychological assessment and that its purpose was adequately explained. Most patients were happy with the information given during their appointment and found the experience helpful. A number of patients felt that additional appointments would have been helpful shortly before, and after, surgery. CONCLUSIONS: The group of orthognathic patients studied found the pre-treatment psychology assessment, provided for them through the combined clinic, to be very acceptable and beneficial. Some suggested that further appointments, throughout the treatment journey, as well as supportive literature, might also have been helpful.

Qualidade de vida, capacidade para o trabalho e deformidades faciais / Quality of life, work ability, and facial deformities

Introdução: A face exerce papel central nas relações interpessoais. Pessoas com deformidades faciais adquiridas ou congênitas tendem a apresentar dificuldades nas relações interpessoais. O tratamento desses pacientes deve visar à melhoria de sua qualidade de vida e da capacidade para o trabalho. Objetivo: Avaliar a qualidade de vida relacionada à saúde e a capacidade para o trabalho de pessoas com deformidades faciais. Método: Estudo misto de abordagem qualitativa e quantitativa. Entrevistas semiestruturadas sobre qualidade de vida em saúde e implicações no trabalho foram realizadas com 16 pessoas com deformidades faciais, oito congênitas e oito adquiridas, procedentes de serviços de atenção especializada de Salvador, Bahia. Aplicaram-se os questionários Índice de Capacidade para o Trabalho (ICT) e 36-Item Short-Form Health Survey. Resultados: A análise temática permitiu identificar duas categorias associadas às deformidades faciais: relações interpessoais e capacidade para o trabalho; e qualidade de vida e acesso a tratamento. Indivíduos com deformidades faciais adquiridas apresentaram menor escolaridade, renda e índices mais baixos nos indicadores de qualidade de vida e ICT, quando comparados aos do grupo com deformidades congênitas. Todos com deformidades congênitas receberam algum tipo de reabilitação e apresentaram menor comprometimento das relações sociais. Conclusões: Pessoas com deformidades faciais adquiridas apresentam maior comprometimento da sua capacidade para o trabalho e qualidade de vida do que aquelas com deformidades faciais congênitas. A reabilitação precoce das anormalidades congênitas parece exercer papel importante na melhora dos índices de ICT e de qualidade de vida em saúde

Background: The face plays a central role in interpersonal relationships. Individuals with congenital or acquired facial deformities might experience difficulties with interpersonal relationships. Treatment should seek to improve their quality of life and work ability. Objective: To analyze the health-related quality of life and work ability of individuals with facial deformities. Method: Study with mixed, quantitative and qualitative methods. We conducted semi-structured interviews on health-related quality of life and its implications for work with 16 individuals with facial deformities, eight cases of congenital and eight of acquired deformities, cared at specialized services in Salvador, Bahia, Brazil. The Work Ability Index (WAI) and 36-Item Short-Form Health Survey were administered. Results: Thematic analysis led us to detect two categories of themes associated with facial deformities: interpersonal relationships and work ability; and quality of life and access to treatment. The participants with acquired facial deformities exhibited lower educational level and income, and lower quality of life and WAI scores compared to the ones with congenital deformities. All the participants with congenital deformities had received some form of rehabilitation and their social relationships were less impaired. Conclusions: Individuals with acquired facial deformities exhibited poorer work ability and quality of life compared to the ones with congenital deformities. Early rehabilitation of congenital deformities seems to considerably improve work ability and health-related quality of life

Social anxiety in orthognathic patients.

There is evidence that patients seeking orthognathic treatment may be motivated by social anxiety disorder (SAD). The aim of this study was to investigate SAD in orthognathic patients using the Brief Fear of Negative Evaluation Scale (BFNES) and to compare these findings with those of the general population. This was a cross-sectional, questionnaire study conducted in two parts. Firstly, a national survey was conducted to yield data for the BFNES from a large, random sample of the UK general population. Secondly, orthognathic patients completed the BFNES. The BFNES scores are reported in two formats: the original 12-item scale (O-BFNES) and a shorter eight-item version (S-BFNES). With regards to the national survey, 1196 individuals participated. The mean O-BFNES score was 29.72 (standard deviation (SD) 9.39) and S-BFNES score was 15.59 (SD 7.67). With regards to the orthognathic sample, 61 patients participated. The mean O-BFNES score was 39.56 (SD 10.35) and the mean S-BFNES score was 24.21 (SD 8.41). Orthognathic patients had significantly higher scores than the general UK population (P<0.001), and multiple linear regression revealed that age, gender, and patient status were all independent predictors of BFNES scores. From the results of this study, orthognathic patients experience significantly higher levels of social anxiety than the general population.

Orthognathic surgery improves quality of life and depression, but not anxiety, and patients with higher preoperative depression scores improve less.

This study assessed quality of life (QoL), depression, and anxiety before and after orthognathic surgery and identified risk factors for poorer postoperative outcome. This multicentre prospective study included 140 patients from five French medical centres. We assessed patients before surgery (T1), 3 months after surgery (T2), and 12 months after surgery (T3). We assessed the severity of the orofacial deformity, physical, psychological, social, and environmental QoL (WHOQOL-BREF), and depression and anxiety (GHQ-28). Risk factors for poorer outcome were identified using linear mixed models. Between baseline and 12 months, there was significant improvement in psychological and social QoL and in depression (although below the norms reported in the general population), but not in anxiety. Physical QoL was poorer in patients who were younger, who had a mild orofacial deformity, and who were depressed. Psychological QoL was poorer in younger patients and in depressed patients. Social QoL was poorer in patients who were single, who had a mild orofacial deformity, and who were depressed. Although orthognathic surgery provides a moderate improvement in psychological and social QoL, the systematic screening and treatment of depression could further improve QoL after surgery because it is a major predictor of poor QoL in this population.

Psychologic health status of patients undergoing orthognathic surgery.

BACKGROUND: The appearance and dysfunction of deformities may cause psychologic disorders in patients. The aim of this study was to assess the psychologic health status of patients undergoing orthognathic surgery and its relationship with demographic characteristics, social activityof the individuals, and severity of maxillofacial deformity. METHODS: As a tool for assessing the psychologic health status, the Symptom Checklist-90 (SCL-90) questionnaire was used on 318 patients undergoing orthognathic surgery at the Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, China from January 2006 to November 2012. t-Test was used to compare the psychologic health status between the 318 patients and 200 healthy volunteers. Variance analysis (analysis of variance) was applied for assessing the relationship between the psychologic health status and the variables of the study. RESULTS: The SCL-90 total score of the patients undergoing orthognathic surgery was higher than that of the healthy volunteers (P < 0.05). Results of the t-test revealed statistically significant difference (P < 0.05) in the symptom dimensions of obsessive-compulsive, interpersonal sensitivity, depression, and paranoid ideation. An association between sex and the SCL-90 total score was observed (F = 11.293; P = 0.001 and P <0.05). The patients who had regular work presented better psychological health status than did the patients who had no regular work (F = 8.008; P = 0.005 and P < 0.05). The patients who received comfort from family and relatives presented better psychological health status than did the patients who did not receive such help (F = 10.064; P = 0.002 and P < 0.05). The patients who received economic help from family and relatives presented better psychological health status than did the patients who did not receive such help (F = 9.789; P = 0.002 and P < 0.05). An association was found between severity of deformity and psychologic health (F = 6.394; P = 0.002 and P < 0.05). CONCLUSIONS: Patients with jaw deformity have significant psychologic problems and their psychologic health is affected by demographic characteristics, social activity of individuals, and severity of maxillofacial deformity.

Oral health-related quality of life in orthognathic surgery patients.

INTRODUCTION: In the last decade, an increasing number of studies focusing on the impact of oral deformities and illnesses on quality of life have been published. Our goal was to evaluate the impact of oral problems on quality of life in 3 groups of adult patients in need of orthognathic-surgical treatment. METHODS: A total of 117 patients were recruited from the Clinic of Oral and Maxillofacial Surgery of the State University of Rio de Janeiro in Brazil: 20 in the initial phase, 70 in the presurgical phase (presurgical orthodontic preparation), and 27 in the postsurgical phase. The impact of treatment phase on oral health-related quality of life was evaluated with the oral health impact profile (OHIP-14). OHIP-14 scores were calculated by an additive method, and the participants were divided on the basis of level of impact into 2 groups: high impact (scores, >11) and low impact (scores, < or =11). RESULTS: Compared with patients in the postsurgical phase, those who needed orthognathic surgical treatment but had not yet begun it and those who were in the presurgical phase of treatment were 6.48 and 3.14 times more likely, respectively, to experience a negative impact of their oral condition. CONCLUSIONS: Among those undergoing or anticipating orthognathic-surgical treatment, orthognathic surgery positively affects the patients' quality of life.

Motivating factors for patients undergoing orthognathic surgery evaluation.

PURPOSE: Orthognathic surgery is generally performed to correct facial abnormalities related to the maxilla and/or mandible, and there are a variety of reasons for which patients choose to be evaluated for this procedure. We surveyed 637 cases to determine the patients' motivating factors for seeking surgical consultation. PATIENTS AND METHODS: We reviewed 637 cases from 1990 to 2006 in this study, and data were extracted from 501 appropriately completed surveys to determine why patients seek corrective maxillofacial surgery. Patients aged under 12 years and those with an identified syndrome were not included in the final data set. RESULTS: The results indicate that patients with dentofacial deformities have multiple complaints related to their poor maxillomandibular relationships. However, their primary motivation for undergoing surgical evaluation is not appearance; it is their bite/function. Of the 501 patients reviewed in this study, 216 (43%) were male and 285 (57%) were female. Age ranged from 12 to 45 years. Of the patients, 76% stated that their appearance was affected by their condition, but only 15% stated it was their primary motivation for undergoing surgical evaluation. Thirty-six percent stated that their bite was their primary motivation for seeking treatment. CONCLUSION: The most common reason for surgical evaluation was correction of bite or functional disability, not improvement of appearance. Most previously published studies on this subject included smaller sample sizes and showed appearance to be the primary motivating factor.

Quality of life in patients with severe malocclusion before treatment.

The aim of this study was to determine the occurrence of oral health impacts among patients with severe malocclusions and dentofacial deformities before treatment. A further aim was to evaluate the effect of gender or the type of malocclusion on the oral impacts. The study comprised 151 adult patients who were referred for orthodontic or surgical-orthodontic treatment to the Oral and Maxillofacial Department, Oulu University Hospital, Finland during the years 2001-2004. The study group consisted of 92 females and 59 males with a mean age of 35.5 years [standard deviation (SD) 11.5 years, range 16-64 years]. A self-completed Oral Health Impact Profile (OHIP)-14 questionnaire was used to measure oral impacts during a 1 month reference period. The prevalence, extent, and severity scores were calculated from the OHIP-14. Malocclusions were registered at clinical examination. The prevalence and mean extent and severity scores were compared among malocclusion groups and between genders. Statistical significance was evaluated with Mann-Whitney, Kruskall-Wallis, Chi-squared, and Fisher's exact tests. The prevalence of oral impacts perceived fairly or very often was 70.2 per cent. The mean severity and extent scores were 17.2 (SD 10.5, range 0-45) and 2.5 (SD 2.6, range 0-10), respectively. Physical pain as well as psychological discomfort and disability were the most commonly perceived oral impacts. Being self-conscious, feeling tense, having difficulties in relaxing, and being somewhat irritable with other people were more common in females than in males. No differences were observed in oral impacts among the malocclusion groups. Compared with a 'normal' population, patients with severe malocclusions report high levels of oral impacts. Females reported oral impacts more often than males.

Evaluation on the psychosocial status of orthognathic surgery patients.

OBJECTIVE: This study was performed to evaluate the psychosocial status of orthognathic surgery patients through the Minnesota Multiphasic Personality Inventory (MMPI) and the Symptom Checklist 90-Revision (SCL-90-R). STUDY DESIGN: A total of 34 patients were enrolled in the study. They were assessed with the MMPI and the SCL-90-R before surgery and followed-up for 6 months after the operation with the MMPI. Comparisons between the personality characteristics of preoperative and postoperative patients and a total of 30 dental students with class I occlusion were made with the t test. RESULTS: The majority of patients showed no abnormal findings in the MMPI psychologic status. Significant differences in personality characteristics were noticed after orthognathic surgery. CONCLUSIONS: The results of this study suggest that surgical treatment of dentofacial deformities may induce psychologic changes, such as depression, and that the improvement in facial deformities and enhanced sense of esthetic satisfaction may have a positive influence on psychosocial aspects.

Body dysmorphic disorder screening in maxillofacial outpatients presenting for orthognathic surgery.

Body dysmorphic disorder (BDD) is a severe psychiatric disease with delusions about defects in appearance for which patients seek surgical help. This is the first European study to determine the half-year prevalence of BDD in a maxillofacial outpatient clinic. A total of 160 patients with maxillofacial problems completed a validated self-report questionnaire, while a staff member scored maxillofacial defects on a severity scale. Twenty-eight (17%) patients had excessive concerns about their appearance, which negatively influenced their psychosocial functioning; 16 patients (10%; 95%CI 5-15%) screened positive for BDD. The high prevalence of problems related to psychosocial functioning and the occurrence of BDD in maxillofacial patients means that maxillofacial surgeons should take psychological concerns about physical defects into account.

Perceptions of preoperative expectations and postoperative outcomes from orthognathic surgery: part I: Turkish female patients.

This study was conducted in Turkish female patients to investigate their preoperative concerns, motivation, expectations, preoperative preparation for surgery and perception of outcomes concerning orthognathic surgery. Thirty women, with an age range of 18 to 31 years (mean age 21.8+/-3.8 years), participated in the study. The expectations and the results of orthognathic treatment were assessed based on the patients' subjective appraisal. Patients completed questionnaires before and after the operations, designed to investigate the preoperative and postoperative psychological impact of the surgery, the perception of problems with physical and psychological functioning, self-image, body image and satisfaction with surgical outcome. The questionnaires were evaluated statistically with SPSS 11.5 for Windows. The patients' perception of their psychological improvement, faith in the surgical team, physical functioning, self-esteem, social confidence, body image and satisfaction after dentofacial correction were higher than the preoperative levels. The conclusions of the study support the theory that enhancement of facial appearance by orthognathic surgery improves the psychological status of females with growth disturbances of the jaw.

Complex orthognathic surgery: assessment of patient satisfaction.

PURPOSE: The purpose of our survey study was to determine if bimaxillary orthognathic surgery with simultaneous intranasal surgery and other procedures carried out primarily for the correction of a developmental dentofacial deformity can be completed with a high level of patient satisfaction and minimal complications. PATIENTS AND METHODS: A consecutive series of 42 patients entered in the study from senior surgeon's (J.P.) patients at a single institution who underwent the minimum designated simultaneous procedures (Le Fort I, sagittal osteotomies of the mandible, septoplasty, inferior turbinate reduction) during a 1-year period. Patient satisfaction was assessed through analysis of data gathered from a postsurgical patient satisfaction questionnaire. The questionnaire is used to assess overall postsurgical/orthodontic patient satisfaction and patient assessment of head and neck function. The questionnaire was independently completed by each subject at least 6 months after surgery and only after removal of all orthodontic appliances and planned dental rehabilitation. RESULTS: The results of our study clarify that bimaxillary orthognathic surgery including simultaneous intranasal (septoplasty and turbinate reduction) and other procedures (genioplasty, liposuction, and removal of third molars) can be carried out with a high level of patient satisfaction (89% of our study patients). Nevertheless, 2 of 42 patients (5%) in our study group were dissatisfied despite the absence of surgical or orthodontic complications and the clinicians' feelings that the results achieved were an improvement. CONCLUSIONS: The results of our study clarify that complex bimaxillary orthognathic surgery including simultaneous intranasal and other procedures can be carried out with a high level of patient satisfaction.

[Deformities and therapeutic attitudes]. / Dysmorphies et attitude thérapeutique.

Because dental dysmorphias make up a large part of the problems we deal with in our daily practices, it is important that we classify them according to their severity. Accordingly, we should define the relevant concepts of norm, anomaly, dysmorphia, and malformation. Over the years these notions have been viewed in a great variety of ways depending on the epoch and the particular society. It seems that nowadays our concepts, enflamed by a relentless media, are orienting themselves toward a more and more narrow concept of what constitutes normality. Our professional attitude is not immune to this societal problem, and many practitioners are tempted to propose treatment when the need for it is uncertain.

Quality of life in patients with dentofacial deformity: a comparison of measurement approaches.

The aim of this study was to examine the effect of dentofacial deformity on quality of life (QOL) as assessed by generic health, generic oral health and condition-specific approaches. A case-control study was performed involving 154 subjects: 76 with dentofacial deformity (non-cleft) and 76 without dentofacial deformity. Generic health-related QOL was assessed employing the 36-item Short Form Health Survey (SF-36), generic oral health-related QOL was assessed by the 14-item short form Oral Health Impact Profile (OHIP-14) and condition-specific QOL was assessed by the 22-item Orthognathic Quality of Life Questionnaire (OQLQ). No significant difference in SF-36 scores between case and control groups was observed (P>0.05). There were significant differences in overall OHIP-14 scores (P<0.001) and overall OQLQ scores (P<0.001) between case and control groups. The results suggest that dentofacial deformity affects individuals in many aspects of their lives, and that generic oral health and condition-specific approaches to assessing QOL are able to discriminate patients with dentofacial deformities from those without, and thus have value in determining the impact of dentofacial deformities on QOL.

The enigma of facial beauty: esthetics, proportions, deformity, and controversy.

The study of the face and the ability to alter its form have fascinated mankind for thousands of years. The clinical ability to alter dentofacial form, whether through orthodontics, facial growth modification, or surgery, requires an understanding of facial beauty, including the evaluation of facial esthetics, proportions, and symmetry. The purposes of this article were to give a brief contemporary overview of our concepts of facial beauty and esthetics and to consider a long-standing and controversial debate on the treatment of patients with dentofacial deformities.