The changes of self-esteem, sensitivity to criticism, and social appearance anxiety in orthognathic surgery patients: A controlled study.

OBJECTIVES: To evaluate the changes of psychologic parameters, such as self-esteem, sensitivity to criticism, and social appearance anxiety, in skeletal Class III patients undergoing orthognathic surgery and to compare the psychologic status of skeletal Class III patients with control subjects. METHODS: The first group consisted of 60 patients with a mean age of 22.07 ± 1.30 years who did not need orthognathic surgery. The second group comprised 45 patients with skeletal Class III malocclusion (mean age 21.40 ± 2.02 years) who were evaluated in terms of psychologic changes from before to after surgery. A third group consisted of 50 Class III patients (mean age 20.09 ± 2.59 years) who were evaluated before surgery and a different 50 Class III patients (mean age 22.15 ± 2.03 years) who were investigated after surgery. The Rosenberg Self-Esteem Scale and the Social Appearance Anxiety Scale were used to evaluate psychologic parameters both before and after surgery. Analysis was carried out with the use of independent- and dependent-sample t tests, 1-way analysis of variance, and post hoc Tukey test. RESULTS: Self-esteem of the patients with skeletal Class III malocclusion increased, and sensitivity to criticism and social appearance anxiety decreased significantly after the surgery (P <0.001). In the patients with Class III malocclusion, self-esteem was significantly lower and social appearance anxiety significantly higher before orthognathic surgery than in the control group, and at the postoperative evaluation Class III patients had significantly higher self-esteem than the control group (P <0.001). CONCLUSIONS: Through the improvement in facial appearance after surgery, patients' self-esteem increases and their sensitivity to criticism and social appearance anxiety decrease.

Improvement of Esthetic, Functional, and Social Well-Being After Orthognathic Surgical Intervention: A Sampling of Postsurgical Patients Over a 10-Year Period From 2007 to 2017.

PURPOSE: The objectives of this study were to evaluate the effect of orthognathic surgery on the long-term quality of life of patients who received this treatment and to delineate the common reasons for dissatisfaction. MATERIALS AND METHODS: In this retrospective cohort study, patients who underwent orthognathic surgery were studied. One hundred thirty-two patients who had undergone orthognathic surgery from 2007 to 2017 in the oral and maxillofacial surgery department participated in this study. They were divided based on their dentofacial deformity into those with Class II malocclusion and those with Class III malocclusion. Each participant completed a modified questionnaire used to assess the patient's esthetic, social, and functional abilities after orthognathic surgery. RESULTS: The rate of esthetic improvement in orthognathic surgery patients was 91.7%. No significant difference between male and female patients was found regarding the changes in social, esthetic, and functional aspects before and after orthognathic surgery. Both genders recommended orthognathic surgery for patients with similar problems. One in four patients was dissatisfied with the nasal appearance after the surgical procedure (25.8%). CONCLUSIONS: In this study the patients' satisfaction from the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and then functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance.

Oral Impacts on Quality of Life in Adult Patients with Class I, II and III Malocclusion.

PURPOSE: To compare the social impact of malocclusion on quality of life between adult patients with Angle Class I, II and III malocclusion. MATERIALS AND METHODS: A total of 222 adult patients (139, 42 and 41 with Angle Class I, II and III malocclusion, respectively) were recruited voluntarily from those attending the Orthodontic Clinic of Khyber College of Dentistry in Pesh awar, Pakistan. Participants were asked to complete the Urdu version of the short form of the Oral Health Impact Profile (OHIP-14), which was previously validated for this study. Multivariate analysis of variance (MANOVA) was used to compare the seven OHIP-14 domains scores and the total score between patients with malocclusion Class I, II and III. RESULTS: Adults with Class III malocclusion had a significantly higher OHIP-14 total score than those with Class I malocclusion (a mean difference of 5 units between groups), but there were no differences between other Angle malocclusion groups. In addition, adults with Class III malocclusion reported greater impacts on the three OHIP-14 disability domains (physical, psychological and social) than those with Class I malocclusion. No significant interactions with sex and age were found. CONCLUSION: These findings suggest that adult patients with Class III malocclusion had a poorer quality of life than those with Class I malocclusion. Differences were mainly found in the physical, psychological and social disability domains of the OHIP-14 instrument.

Impact of orthosurgical treatment phases on oral health-related quality of life.

INTRODUCTION: In this cross-sectional study, we investigated the impact of the orthosurgical treatment phases on the oral health-related and condition-specific quality of life (QoL) of patients with dentofacial deformities. METHODS: Two hundred fifty-four orthognathic patients were allocated into 4 groups according to treatment phase: initial (not yet treated), presurgical orthodontics, postsurgical orthodontics, and retention. Data were collected using the Oral Health Impact Profile to evaluate the oral health-related QoL, the Orthognathic QoL Questionnaire to analyze the condition-specific QoL, and the Index of Orthodontic Treatment Need to assess malocclusion severity and esthetic impairment. Specific malocclusion characteristics were also documented. RESULTS: A negative binomial regression analysis showed that the initial group had a more negative oral health-related QoL than did the postsurgical, presurgical, and retention groups (relative risks, 1, 0.79, 0.74 and 0.25, respectively). The initial group had a more negative condition-specific QoL than did the presurgical, postsurgical, and retention groups (relative risks, 1, 0.77, 0.38 and 0.15, respectively) regardless of age, income, or education; women reported greater negative impacts than men. Certain occlusal traits were related to higher Orthognathic QoL Questionnaire scores (P <0.01). CONCLUSIONS: Patients who completed their orthosurgical treatment had a significantly better oral health-related QoL and a more positive esthetic self-perception than did those undergoing treatment and those who were untreated. Crowding, crossbite, open bite, concave profile, edge-to-edge overjet, or Class III malocclusion negatively affected oral health-related QoL.

Effect of malocclusion severity on oral health-related quality of life and food intake ability in a Korean population.

INTRODUCTION: The aim of this study was to evaluate the effect of malocclusion severity on oral health-related quality of life and food intake ability in adult patients, controlling for sex, age, and the type of dental clinic visited. METHODS: The sample consisted of 472 Korean patients (156 male, 316 female) with a mean age of 21.1 (SD, 8.6) years in a dental hospital and a private clinic. The correlations between the Korean version of the Oral Health Impact Profile-14 (OHIP-14K), subjective food intake ability (FIA) for 5 key foods, and Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC) were investigated. RESULTS: The mean IOTN-DHC and OHIP-14K scores were significantly higher for the dental hospital patients than for the private clinic patients (IOTN-DHC, P <0.001; OHIP-14K, P <0.05). Malocclusion severity was significantly higher in male than in female subjects (P <0.001). Older patients perceived their oral health-related quality of life more negatively than did the teens (P <0.001). As the severity of the malocclusion increased, oral health-related quality of life and masticatory function worsened (OHIP-14K, P <0.001; FIA, P <0.05). CONCLUSIONS: As the severity of the malocclusion and the age of the patients increased, oral health-related quality of life and masticatory function relatively deteriorated. This finding provides evidence that severe malocclusions are associated with lower quality of life and less masticatory efficiency in older patients.

Early orthognathic surgery in response to bullying due to malocclusion.

Urifavourable dental and facial features can have a psychological impact on patients. Orthodontic treatment can have a positive impact on the psychosocial well-being of patients who are bullied about dentofacial features. The use of orthognathic surgery in growing patients to correct dentofacial deformity is a controversial topic. This case report describes the treatment performed for a 13-year-old girl who presented complaining of a "different bite and prominent chin", which was attracting insults at school. Insults regarding her teeth and jaw caused symptoms such as anxiety and stomach pains prior to school in the morning. As a result of the negative psychological effects of the serious bullying, it was decided to proceed with early orthognathic surgery for psychological reasons. As orthognathic surgery is usually timed in the late teens, or early twenties when growth is near completion, the risks of further growth and relapse were discussed at length with the patient and her parents, especially when informed consent was being obtained. Treatment included orthodontic alignment of the arches, early orthognathic bimaxillary surgery and post-surgical orthodontics to detail the occlusion. There was a dramatic improvement in the patient's self-esteem, with return to school and extra school activities only weeks after the surgery. This case demonstrates that early intervention may be appropriate for some orthognathic patients in exceptional circumstances. The patient and her parents were very happy with the outcome but post-treatment growth was unfavourable as expected.

The impact of dental appearance and anxiety on self-esteem in adult orthodontic patients.

OBJECTIVES: To analyse the relationship between different dimensions of dental appearance impact and self-esteem in adult patients undergoing orthodontic treatment, with special attention to the possible mediating role of anxiety. SETTING AND SAMPLE POPULATION: A quasi-experimental design was used with a matched control group (without orthodontic treatment). In each group (experimental and control), there were 85 patients. MATERIAL AND METHODS: The impact of dental appearance was measured using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). State anxiety was assessed with the State Anxiety Inventory (STAI-S) and self-esteem with Rosenberg's self-esteem scale. RESULTS: In both groups (experimental and control), self-esteem correlates negatively, ranging between 0.26 and 0.43, with all dimensions of dental appearance impact (except for the positive dental self-confidence dimension, where all correlations were positive). Anxiety correlates positively, ranges between 0.35 and 0.44, with social impact, psychological impact and aesthetic concern, although it maintains no significant correlations with dental self-confidence. Nevertheless, in patients undergoing orthodontic treatment, anxiety plays a mediating role between dental impact dimensions and self-esteem, whilst for the control group anxiety only plays a mediator role between psychological impact and self-esteem. CONCLUSION: Anxiety plays a fundamental role in the effect of perceived dental impact on self-esteem in adult patients undergoing orthodontic treatment. These results have important practical implications for the design of bio-psycho-social intervention programs that contemplate cognitive-affective variables as an essential part of orthodontic treatment in adults.

An Assessment of the Quality of Life of Patients With Class III Deformities Treated With Orthognathic Surgery.

PURPOSE: To evaluate quality of life (QoL) from a broad perspective by a comparison of Turkish patients undergoing orthognathic surgery to correct Angle Class III skeletal deformity with a control group composed of participants without dentofacial deformity using general health, generic oral health, and condition-specific QoL approaches. MATERIALS AND METHODS: Thirty patients who underwent orthognathic surgery to correct Class III relations (monomaxillary and bimaxillary groups) and 30 participants with Class I skeletal structure and good dentofacial harmony (control group) were evaluated. Condition-specific QoL through a 22-item Orthognathic Quality of Life Questionnaire (OQLQ), generic oral health-related QoL through a 14-item Short-Form Oral Health Impact Profile (OHIP-14), and generic health-related QoL through a 36-item Short-Form Health Survey (SF-36) were assessed. RESULTS: When the groups were compared, OQLQ scores showed a significant difference in the oral function domain only in the bimaxillary group (P < .05), and OHIP-14 scores showed significant differences in half the OHIP-14 subscale scores in the monomaxillary and bimaxillary groups (P < .05). The SF-36 scores showed significant differences only for the vitality domain in the monomaxillary group and the vitality and mental health domains in the bimaxillary group (P < .05). CONCLUSIONS: For condition-specific and health-related QoL, the QoL of orthognathic surgical patients appeared to be similar to that of participants without dentofacial deformities. Oral health-related QoL of orthognathic surgical patients seemed moderately similar to that of participants without dentofacial deformities. The combined use of these methods is helpful for evaluating QoL from a larger perspective.

Patient's Satisfaction in Skeletal Class III Cases Treated With Two-Jaw Surgery Using Orthognathic Quality of Life Questionnaire: Conventional Three-Stage Method Versus Surgery-First Approach.

OBJECTIVE: To compare the quality of life (QoL) of Class III patients between conventional three-stage method (CTM) and surgery-first approach (SFA) using Orthognathic QoL Questionnaire (OQLQ). MATERIALS AND METHODS: The subjects consisted of 26 Class III patients treated with nonextraction and two-jaw surgery. They were divided into CTM group (N = 15) and SFA group (N = 11). They retrospectively rated the OQLQ scores of 4 domains (social relationship, facial esthetics, function, and awareness of dentofacial deformity) using 0 to 4 scale at initial (T0), just before surgery (T1), 3 month after surgery (T2), and at debonding (T3). Mann-Whitney test and Wilcoxon signed-rank test were performed for statistical analysis. RESULTS: After total OQLQ score of CTM group was deteriorated at T1 stage compared with T0 stage, it was improved at T2 and T3 stages (T0 = 53.9, T1 = 58.1, T2 = 23.5, and T3 = 11.6). Total OQLQ score of SFA group, however, was improved at T2 and T3 stages compared with T0 stage (T0 = 51.6, T2 =  3.1, and T3 = 11.4; T1 was omitted.). Orthognathic QoL Questionnaire scores and their amounts of change did not show any significant difference in each domain and at each stage between 2 groups (T0, T2, T3, ΔT2 - T0, ΔT3 - T2, ΔT3 - T0; all P > 0.05). Both groups showed large change in effect size (ES) of all domains with descending order during T3 - T0: facial esthetics, oral function, social relationship, and awareness of dentofacial deformity (CTM group: -3.97, -3.40, -2.23, -1.25; SFA group: -2.83, -2.33, -1.76, -1.73) CONCLUSIONS: SFA might have an advantage over CTM group in terms of no deterioration stage of OQLQ score.

Assessing changes in quality of life using the Oral Health Impact Profile (OHIP) in patients with different classifications of malocclusion during comprehensive orthodontic treatment.

BACKGROUND: The objectives of this study were to investigated changes in OHRQoL among patients with different classifications of malocclusion during comprehensive orthodontic treatment. METHODS: Clinical data were collected from 81 patients (aged 15 to 24) who had undergone comprehensive orthodontic treatment. Participants were classified 3 groups: Class I (n = 35), II (n = 32) and III (n = 14) by Angle classification. OHRQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T0), after alignment and leveling (T1), after correction of molar relationship and space closure (T2), after finishing (T3). Friedman 2-way analysis of variance (ANOVA) and Wilcoxon signed rank tests were used to compare the relative changes of OHRQoL among the different time points. A Bonferroni correction with P < 0.005 was used to declare significance. RESULTS: Significant reductions were observed in all seven OHIP-14 domains of three groups except for social disability (P > 0.005) in class I and class II, Handicap in class II and class III (P > 0.005). Class I patients showed significant changes for psychological disability and psychological discomfort domain at T1, functional limitation, physical pain at T2. Class III patients showed a significant benefit in all domains except physical pain and functional limitation. Class II patients showed significant changes in the physical pain, functional disability, and physical disability domains at T1. CONCLUSIONS: The impact of comprehensive orthodontic treatment on patients' OHRQoL do not follow the same pattern among patients with different malocclusion. Class II patients benefits the most from the stage of space closure, while class I patients benefits the first stage (alignment and leveling) of treatment in psychological disability and psychological discomfort domains.

How Do Patients and Parents Decide for Orthodontic Treatment-Effects of Malocclusion, Personal Expectations, Education and Media.

OBJECTIVES: To examine patients' and parents' perceptions and expectations from orthodontic treatment. STUDY DESIGN: 491 patients (274 female, 217 male) aged 14-22 years, and 399 parents (245 female, 154 male) completed a questionnaire about preferences, needs and expectations about orthodontic treatment, and scored the present problem. Continuous variables were compared by Mann-Whitney U and Kruskal-Wallis tests, whereas Chi-square test was used for categorical variables. RESULTS: Patients'(77.1%) and parents'(84.6%), decision about orthodontic treatments were influenced by suggestion of dentists. Patients who decided to attend to clinic by themselves were higher than parents (p=0.006). Dental aesthetics was the determinant factor for treatment demand for patients(61.0%) and parents(57.3%). Improvement in oral functions was more important for Class III patients than Class I patients (p=0.040). Adult patients/parents with higher education gave more importance to oral functions as well as dental aesthetics (p=0.031). There was no difference among Angle classifications regarding orthodontic problem scores. Parents found media sources valuable (p=0.018) but majority expected dentists for information about orthodontic treatments. Education degree of adult patients/parents effected this decision(p=0.002). CONCLUSIONS: Desire to have better dental aesthetics was the primary motivating factor for all participants. Clinicians should consider concerns of Class III patients about oral functions during treatment planning.

Does the British Orthodontic Society orthognathic DVD aid a prospective patient's decision making? A qualitative study.

OBJECTIVES: To explore the views of potential orthognathic patients regarding the influence of the BOS Orthognathic DVD in their decision making process. DESIGN: Qualitative, cross-sectional study. SETTING: A UK dental teaching hospital. PARTICIPANTS: Patients considering orthognathic treatment. METHODS: New patients were recruited from orthognathic clinics following an initial consultation. After an appropriate time to view the DVD, in-depth interviews were conducted with 10 patients (aged 16-48 years) in their homes. Interviews explored the attitudes and perceptions that influenced decisions about surgery, with a focus on the role of the DVD in this process. The interviews were transcribed and a framework analysis was undertaken. RESULTS: The main themes identified were participant perceptions on the patient stories, use of images, the nature of the DVD itself and its usefulness in the decision making process. Participants reported they were heavily influenced by the patient stories. Virtual animations of surgery were seen as useful; whereas the before and after images of surgery were found to be disorientating. The design of the menu resulted in confusion or information being missed. The DVD was seen as a trusted resource, whereas the Internet was seen as biased, general and sensationalistic. CONCLUSIONS: The DVD gives trusted information that patients cannot obtain or process from professional sources or the Internet. If used properly it can have a role in the decision making process, but should be seen within the context of other influences on the patient. This research has highlighted some aspects of the DVD that could be improved upon.

Psychological status of patients with skeletal Class III malocclusion undergoing bimaxillary surgery: A comparative study.

Skeletal Class III malocclusion can significantly impact psychological well-being. Although bimaxillary surgery is a well-established corrective intervention, its psychological effects are not fully understood. This study aims to investigate changes in self-esteem, sensitivity to criticism, and social appearance anxiety following surgery to inform targeted nursing interventions for psychological adaptation. This comparative study included 205 participants: 150 patients with skeletal Class III malocclusion who underwent bimaxillary surgery, and a control group of 55 individuals without malocclusion. The malocclusion group had a mean age of 21.99 ±â€…2.28 years (96 males, 109 females). The control group consisted of department interns with Class I occlusion, normal overjet and overbite, and typical facial appearance, with a mean age of 21.61 ±â€…2.40 years (26 males, 29 females). Psychological assessments, validated for reliability, measured self-esteem, sensitivity to criticism, and social appearance anxiety before and after surgery. Statistical analyses, including independent sample t tests and one-way ANOVA, were performed to compare outcomes between the groups, with a significance level set at P < .05. Preoperative assessments revealed that patients with skeletal Class III malocclusion had significantly lower self-esteem and higher sensitivity to criticism and social appearance anxiety compared to the control group (P < .05). Postoperatively, there were modest improvements in self-esteem and significant reductions in sensitivity to criticism and social appearance anxiety, though levels of social appearance anxiety remained higher than those in the control group (P < .05). No significant differences in self-esteem and sensitivity to criticism were observed between the surgical and control groups postoperatively (P > .05). Within-group comparisons showed significant improvements in all measures after surgery (P < .05). Bimaxillary surgery positively affects the psychological well-being of patients with skeletal Class III malocclusion, enhancing self-esteem and reducing sensitivity to criticism and social appearance anxiety. However, some psychological concerns persist, indicating a need for targeted nursing interventions to further support these patients' psychological well-being.

Dentofacial deformities are associated with lower degrees of self-esteem and higher impact on oral health-related quality of life: results from an observational study involving adults.

PURPOSE: Patients with dentofacial deformities tend to show poorer oral health-related quality of life, but few studies thus far have focused on this topic. Therefore, the objectives of this study were to evaluate oral health-related quality of life, self-esteem, and depression in patients with Class II and Class III dentofacial deformities before orthodontic treatment and to compare these patients with controls with harmonic faces. MATERIALS AND METHODS: This observational, cross-sectional study compared 2 groups (experimental vs control) of patients recruited at an outpatient orthodontic clinic. Oral health-related quality of life was assessed using a short form of the Oral Health Impact Profile, self-esteem was evaluated with the Rosenberg Self-Esteem Scale, and depression symptoms were assessed using the General Hospital Depression Scale (outcome variables). The presence of dentofacial deformities (ie, group allocation) was the primary predictor variable. The χ(2) test and Spearman correlation coefficient were used to analyze data. RESULTS: The total sample was composed of 68 individuals (34 in each group). In the experimental group, 55.9% of patients were women, and 88.2% presented a Class III occlusal relation. The mean age in the experimental group was 27.56 years. Significant differences were observed between the 2 groups in oral health-related quality of life (P < .001) and self-esteem (P < .019), but no differences were found for depression (P = .161). CONCLUSIONS: Patients with dentofacial deformities had a more negative oral health-related quality of life and a lower self-esteem compared with controls. No association was observed between dentofacial deformities and depression.

Presurgical motivations, self-esteem, and oral health of orthognathic surgery patients.

PURPOSE: The aim of this study was to evaluate motivations, self-esteem, and oral health for undergoing orthognathic patients by gender in China before orthognathic surgery. PATIENTS AND METHODS: Using a prospective and control study design, 429 subjects in China were collected from December 2010 to May 2011. The patient group consisted of 210 consecutive healthy patients, and 219 young individuals comprised the control group. All the subjects filled out a questionnaire and were assessed by Self-esteem Scale and Oral Health Impact Profile validated for Chinese patients before surgery. To measure the discrepancy, the Student t test was computed. P <0.05 was considered significant. RESULTS: In China, major motivations for orthognathic surgery are to improve facial appearance (83.33%), occlusion (50%), and self-confidence (48.1%). Females expect to improve facial appearance (83.87%), self-confidence (43.55%), and occlusion (41.94%). Males are for the improvement of facial appearance (82.56%), occlusion (63.95%), and self-confidence (54.65%). Self-esteem in the patient group is obviously lower (P < 0.01). There is a significant difference of self-esteem in female groups (P < 0.01), but none in male groups. Statistically significant differences were observed on oral health between both sexes. CONCLUSIONS: (1) Special attention should be paid on patients' ethnic, economic, cultural, and social aspects. In Chinese orthognathic patients, improving facial appearance is the primary motivation. Self-confidence has been more frequently mentioned, while headache far less than other countries. (2) Female patients have less self-esteem than females in the control group. (3) Patients' oral health are worse than those in the control group.

Two-phase orthodontic treatment of a complex malocclusion: giving up efficiency in favor of effectiveness, quality of life, and functional rehabilitation?

The interceptive orthodontic treatment of patients with complex dentofacial abnormalities is frequently inefficient and produces less than ideal outcomes. Therefore, postponing therapy to a single-phase surgical-orthodontic approach might be considered a reasonable option. However, other relevant aspects of the patient's quality of life, such as possible psychosocial problems and functional impairments, should also be considered before deciding whether to intercept a severe dentofacial malocclusion while the patient is still growing, or wait and treat later. This case report describes the nonsurgical treatment of a young patient with a severe Class III open-bite malocclusion associated with a cervical cystic lymphangioma. Despite the poor interceptive therapy prognosis, a 2-phase approach was effective. A reflection about giving up efficiency in favor of effectiveness, functional rehabilitation, and the patient's quality of life is included.

What are orthognathic patients' expectations of treatment outcome--a qualitative study.

PURPOSE: Patient's expectations of treatment outcome are one of the key determinants of satisfaction. The aim of this study was to evaluate orthognathic patients' expectations of the outcome of orthognathic treatment. METHODS: This study was a cross-sectional qualitative study involving in-depth interviews with patients with dentofacial deformities. Patients who were about to commence orthognathic treatment were recruited from new-patient clinics. Inclusion criterion were patients of any ethnicity 16 years or older who were about to commence orthognathic treatment to correct a dentofacial deformity. Exclusion criteria were patients who had previously received orthognathic treatment, who were younger than 16 years, and those with congenital craniofacial anomalies or acquired defects. The data were analyzed using a framework approach to management and critical qualitative theory, which involved identifying the main themes and subthemes. RESULTS: Eighteen adult patients 18 to 40 years old were interviewed; 9 were women and 9 were men. Most were Caucasian and 6 were from the black and minority ethnic group. Participants' expectations could be divided broadly into 2 main categories: expectations of actual physical changes and expectations of the effects that these physical changes would indirectly have on them (nonphysical changes). In addition, a typology of patients, based on expectations, was identified, whereby patients could be classified as metamorphosizers, pragmatists, shedders, or evolvers, together with implications and suggestions for practice. CONCLUSIONS: These findings represent a new insight into the complex issues of managing patient expectations and satisfaction. The clinical relevance of identifying expectations is not just to ration treatment or identify those who will make good or bad candidates for treatment, but to be able to offer them additional support to enhance satisfaction with the outcome. This highlights the need for a qualitative methodology to complete the full circle of evidence-based practice.

Self-perception of dentofacial attractiveness among patients requiring orthognathic surgery.

OBJECTIVE: To test the hypothesis that the self-perception of dental and facial attractiveness among patients requiring orthognathic surgery is no different from that of control patients. MATERIALS AND METHODS: Happiness with dental and facial appearance was assessed using questionnaires completed by 162 patients who required orthognathic treatment and 157 control subjects. Visual analog scale, binary, and open response data were collected. Analysis was carried out using a general linear model, logistic regression, and chi-square tests. RESULTS: Orthognathic patients were less happy with their dental appearance than were controls. Class II patients and women had lower happiness scores for their dental appearance. Among orthognathic patients, the "shape" and "prominence" of their teeth were the most frequent causes of concern. Older subjects, women, and orthognathic patients were less happy with their facial appearance. Class III orthognathic patients, older subjects, and women were more likely to have looked at their own face in profile. A greater proportion of Class II subjects than Class III subjects wished to change their appearance. CONCLUSIONS: The hypothesis is rejected. The findings indicate that women and patients requiring orthognathic surgery had lower levels of happiness with their dentofacial appearance. Although Class II patients exhibited the lowest levels of happiness with their dental appearance, there was some evidence that concerns and awareness about their facial profile were more pronounced among the Class III patients.

Psychological status of patients referred for orthognathic correction of skeletal II and III discrepancies.

OBJECTIVE: To establish the extent of psychological problems among patients who require orthognathic treatment. MATERIALS AND METHODS: Five aspects of psychological functioning were assessed for 162 patients who required orthognathic treatment and compared with 157 control subjects. RESULTS: Analysis of variance did not detect any significant difference in the five psychological scores recorded for the skeletal II, skeletal III, and control groups. The proportion of subjects with one or more psychological measure beyond the normal range was 27% for skeletal II subjects, 25% for skeletal III subjects, and 26% for control subjects. One skeletal II subject (1.5%), three skeletal III subjects (3%), and five control subjects (3%) required referral for psychological counseling. CONCLUSIONS: The orthognathic patients did not differ significantly from the control subjects in their psychological status.

Effect of orthognathic surgery for class III correction on quality of life as measured by SF-36.

The purpose of this work was to evaluate the quality of life of patients with Angle's class III malocclusion submitted to orthognathic surgery. Twenty-nine patients of both sexes, ranging in age from 17 to 46 years, with Angle's class III malocclusion and indication for surgical treatment, were evaluated about 30 days before surgery and 6 months postoperatively. Surgery consisted of maxillary advancement or mandibular retrusion, or both. The generic SF-36 questionnaire was used to evaluate the following eight domains: functional capacity, physical aspects, pain, general health status, mental health, emotional aspects, social aspects and vitality. Descriptive and inferential statistical analyses were used to determine possible interactions between timing of evaluation, gender and type of surgery. With respect to physical and social aspects, a significant difference in outcomes was observed, with mean scores being higher after surgery regardless of gender or type of surgery. Regarding emotional aspects, an interaction effect was observed for timing and gender, with higher mean scores only being obtained for females after surgery. Orthognathic surgery had a positive impact on the quality of life of both male and female patients, improving physical and social aspects, and on that of female patients, improving emotional aspects.