Orthognathic patients “just want to look normal”
A protocol to meet the needs of patients who are referred to hospital with facial skeletal abnormalities should be considered in order to improve their care. This is one of the options recommended by the authors of an important study into the perspective of patients referred to hospital for orthognathic treatment.
The aim of the research was to find out whether patients make informed decisions about their treatment. It involved 61 patients from four different clinics in Yorkshire and many expressed strong emotions about living with their abnormality and with deciding whether to proceed with treatment.
Orthognathic treatment involves a combination of surgery and orthodontic treatment to realign the jaws and the teeth and to improve the bite. Studies to date have focused on the consequences of treatment itself rather than on the decision-making and experiences of patients.
This study was undertaken by the Institute of Health Sciences at Leeds University and led by a postgraduate student undertaking professional training in clinical psychology under the supervision of her course supervisors. The clinical expert supervisors were three Consultant Orthodontists, David Morris, Jay Kindelan and James Spencer.
The findings, published in the most recent Journal of Orthodontics, revealed that patients looked at orthognathic treatment as a way of:
• Improving the function and bite of their teeth
• Looking “more normal” – this was a strong motivating factor.
• “Blending into the background” – some patients were teased about their appearance.
Among the patients in the study, 71% were originally referred due to bite problems as well as the position of their teeth. Following surgical-orthodontic treatment, 58% of patients said their self-esteem had increased.
However, better information should be provided by the respective orthognathic teams to help certain patients more with their decision-making, according to the report’s recommendations. The findings also suggested that a proportion of patients would benefit from emotional support such as one-to-one counselling. Furthermore, a standardised, UK-wide information protocol, i.e. a formal care pathway, could enhance orthognathic treatment.
David Morris commented: “The functional and psychological benefit from orthognathic treatment is clear. However, we need to have better psychological tools and manpower provision to be able to measure this improvement. More funding is also needed to enable a clinical psychologist to provide a sessional service to orthognathic patients.”
Iain Hathorn, chairman of the British Orthodontic Society, said this research provided an important “snapshot” of the experiences of orthognathic patients. “I very much hope that this evidence is used to support the development of a care pathway. An informative DVD for patients is currently under development by BOS. It explains a patient’s orthognathic treatment “journey” as well as the inherent risks and benefits to prospective patients. Once completed, this DVD should assist potential patients with their decision-making issues.”
