Does orthognathic treatment improve patients' psychosocial well-being?

OBJECTIVE: To analyse changes in patients' psychosocial well-being from before treatment until post-surgical orthodontic treatment (including retention) is completed. MATERIALS AND METHODS: Data was collected six times: before treatment (T0), 6-8 weeks after the placement of orthodontic appliances (T2), 3-4 weeks before surgery (T3), six weeks after surgery (T4), one year after surgery (T5) and after completing orthodontic treatment (T6; 20-57 months after surgery). At T0, 60 patients participated while at T6, data was available for 15 patients. All patients completed the Orthognathic Quality of Life Questionnaire (OQLQ), Rosenberg Self-Esteem Questionnaire (RSES), Acceptance and Action Questionnaire II (AAQ-II) and the Symptom Checklist 90 (SCL-90). All pairwise comparisons between variables were conducted with the Wilcoxon signed-rank test. RESULTS: OQLQ function, RSES, AAQ-II and SCL GSI worsened from T0 to T2. At T5, improvements compared to T0 were found in all aspects of OQLQ and SCL GSI. When comparing results at T6 to T0, improvements where only found in OQLQ sum, OQLQ facial aesthetics and OQLQ function. CONCLUSIONS: Although well-being of orthognathic patients seems to improve during treatment, many improvements cannot be verified anymore at the completion of the retention period. Most stable changes are found in the oral function component and in the facial aesthetics component of the OQLQ.

Association between quality of life and severity of profile deviation in prospective orthognathic patients.

AIM: to evaluate whether severity of skeletal facial profile deviation assessed by professionals associates with quality of life and psychosocial factors in patients with dentofacial deformities and prospective orthognathic treatment. MATERIALS AND METHOD: The study consisted of 55 patients admitted to orthognathic treatment. Skeletal profile was assessed from lateral head films using cephalometric analysis. The following angles were used to assess the sagittal position of upper and lower jaw and profile: Sella-Nasion-A-point-angle, Sella-Nasion-B-point-angle, and A-point-Nasion-B-point-angle (ANB). For vertical assessment, gonial angle and the angle between Sella-Nasion and mandibular plane were used. Merrifield's Z-angle was used to assess soft-tissue profile. Severity of skeletal facial profile deviation was assessed with deviation in ANB angle. Orthognathic quality of life (OQoL) and psychosocial factors were defined with four questionnaires: Orthognathic Quality of Life Questionnaire, Symptom Checklist-90, Rosenberg Self-Esteem Scale, and a body image questionnaire. RESULTS: Increase in ANB deviation was associated with increased awareness of dentofacial deformity [Orthognathic Quality of Life Questionnaire subscale awareness of dentofacial deformity (OQLQ-AoDD), r = 0.319, P = 0.017). OQOL-AoDD was not found to be equal when ANB angle was divided into three different categories (χ 2 = 6.78, P = 0.034): G1. ANB = 0-4 degrees; G2. ANB <0 degrees; and G3. ANB >4 degrees. Furthermore, categories G1 and G2 differed significantly (U = 50.5, P = 0.017). Increase in ANB angle was also associated with a more positive body image (r = 0.342, P = .023). There were no significant correlations between other cephalometric variables, quality of life, and psychosocial factors. CONCLUSION: Skeletal facial profile seems to associate with some aspects of orthognathic quality of life. Professional cephalometric analysis of the severity of facial profile deviation correlates with patients' awareness of their own facial and dental appearance. Patients with more deviating skeletal profile are more aware of their dentofacial deformities compared to patients with normal values.

Introduction and assessment of orthognathic information clinic.

BACKGROUND/OBJECTIVES: Orthognathic treatment is routine practice to rehabilitate severe malocclusions and dentofacial deformities. Because orthognathic treatment is elective, patient's involvement in deciding whether to proceed with treatment is vital. Interaction and communication between patient and treating team plays a key role in achieving post-treatment satisfaction. To achieve satisfaction, an orthognathic 'information clinic' for prospective orthognathic patients was established at Oral and Maxillofacial Unit, Tampere University Hospital, Finland. 'Information clinic' includes short talks with power-point presentation given by orthodontist, oral hygienist, oral and maxillofacial surgeon, psychologist, and previous patient. Aim of the study was to set up an 'information clinic' and, more specifically, 1. to assess patients' opinions on the 'clinic' during pilot phase (2013-14) and 2. to analyse general statistics during the first 3 years (2013-16). METHODS: During the pilot phase, patient opinions, based on voluntary questionnaire, were obtained from 85 people. General data were collected for the clinics run in 2013-16. RESULTS: Seventy-two per cent of respondents reported the information provided to help in their decision-making to proceed/not proceed with treatment. Majority considered the information about the surgical aspects and meeting patient who had undergone orthognathic treatment to be the most important part of the clinic. Between March 2013 and 2016, 290 prospective orthognathic patients were invited to 29 'information clinics'. One hundred and ninety-four patients attended, of whom 137 were female and 57 male (age range 15-67 years). CONCLUSIONS: The questionnaire and verbal feedback from the patients was positive; hence, the 'information clinic' is now offered as a routine process to all prospective orthognathic patients in our clinic.

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.

Patients' perceptions of orthognathic treatment, well-being, and psychological or psychiatric status: a systematic review.

OBJECTIVE: To conduct a systematic review of studies concerning the psychosocial well-being of surgical-orthodontic patients. MATERIAL AND METHODS: Articles published between 2001 and 2009 were searched using PubMed, Web of Science, and PsycInfo. Only articles written in English were included. Articles on methodological issues or on patients with clefts or syndromes or studies in which treatment had included surgically assisted maxillary expansion or intermaxillary fixation were excluded. The exclusion of articles was carried out in collaboration with two reviewers. To find new relevant articles, references from all the obtained review articles were hand-searched. Thirty-five articles fulfilled the selection criteria and were included in this review. RESULTS: The main motives for seeking treatment were improvements in self-confidence, appearance, and oral function. Patients were not found to suffer from psychiatric problems. Treatment resulted in self-reported improvements in well-being, even though these improvements were not found with current assessment methods. Changes in well-being were most often registered using measures designed for evaluation of the impact of oral health on quality of life (e.g. the Orthognathic Quality of Life Questionnaire and the Oral Health Impact Profile). CONCLUSIONS: Surgical-orthodontic patients do not experience psychiatric problems related to their dentofacial disharmony in general. However, subgroups of patients may still experience problems, such as anxiety or depression, as many studies only report patients' mean problem scores and compare them to controls' scores or population norms. New assessment methods focusing on day-to-day changes in mood and well-being, as well as prospective studies with controls, are needed.