Psychological support for orthognathic patients: Who is doing what?

Abstract

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.

Does one size fit all? A qualitative study about the need for individualized information transfer for orthognathic patients

“…Interestingly, some stated, that they „test their patients“, whether they want a lot of information or only the least necessary prior to treatment start, but it remained unclear how they did so. Over time, professionals might develop strategies during everyday orthognathic routine to find out what kind of patient they are dealing with – scared or tough; with high, maybe unrealistic expectations or potentially easy to please – but it is crucial to question those strategies once in a while, alter them, if needed, and ask for psychological assistance when trying to properly assess patient’s psychological traits [ 21 , 24 , 25 ]. As we are usually specialized dentists , we might lack detailed communicative knowledge, which is especially important when dealing with orthognathic patients.…”

The Role of the Orthodontist

“…Accordingly, the orthodontist needs to be well equipped with psychological skills that can evaluate and support the OS patient during pre-treatment assessment, pre-surgical preparation, peri-surgical phase, and postoperatively during the healing and finishing phase. A study done in the United Kingdom investigated the orthodontists' training experience in the psychological assessment of OS patients and concluded that although many orthodontists had some sort of training, further training was demanded [4].…”

“…Do not try to handle them on your own. Adverse incidents such as suicide or suicide attempts after OS have been reported in the literature [4].…”