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Psychological support for orthognathic patients – what do orthodontists want?

The John Radcliffe Hospital, Oxford and UCL Eastman Dental Institute, London, UK

C. Feinmann and J. Shute

UCL Eastman Dental Institute, London and Department of Mental Health Science, The Royal Free and University College London School of Medicine, London, UK

S. J. Cunningham

UCL Eastman Dental Institute, London, UK

Address for correspondence: K. J. Juggins, Department of Orthodontics, The John Radcliffe Hospital, Oxford, OX3 9DU, UK. Email: kjjuggins{at}hotmail.com

Aims: (1) To evaluate consultant orthodontist opinion on referral of orthognathic patients to a liaison psychiatrist or psychologist and (2) To investigate the value of training orthodontic specialists in recognition of patients with psychological profiles that might affect orthognathic outcome.

Design: Questionnaire-based study

Subjects and Methods: A structured questionnaire was distributed to all consultant orthodontists in the UK.

Results: Approximately 40% of consultants thought that up to 10% of their orthognathic patients would benefit from psychological assessment by appropriately trained personnel. Twenty per cent of consultants were not certain what proportion of their patients would benefit from referral and over half the respondents said they do not refer any orthognathic patients for assessment. The most common reasons for referral were past/current psychiatric history (36%), unrealistic expectations (32%), ‘gut instinct’ (14%), no significant clinical problem (13%). Reasons not to refer were: nobody to refer to (30.5%), fear of patient reacting badly (15.8%), not sure who to refer to (14.7%), response from mental health team not useful (12.4%), waiting list too long (9.6%). The majority of clinicians felt they would benefit from training in this field (84.7%), as over 80% reported no teaching or training in psychological assessment/management.

Conclusions: Although we have no evidence to prove that interdisciplinary care is better for patients, clinical experience and reports from clinicians working in large centres, tells us there are probable advantages. The development of a training programme for both orthodontists and mental health teams would seem to be beneficial for both clinicians and patients.

Key words: Liaison psychiatry, maxillofacial surgery, orthodontics, orthognathic treatment, psychology

^* Liaison psychiatrist: someone who is concerned with the overlap between psychiatry and the rest of medicine and surgery. http://www.studentbmj.com/issues/03/04/careers/106.php

Clinical psychology: the branch of psychology devoted to the study, diagnosis and treatment of mental and behavioural disorders. http://cirrie.buffalo.edu/thesc.html

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				D. O. Morris Improving standards in orthognathic care: the bigger picture (a national and international perspective). J. Orthod., September 1, 2006; 33(3): 149 - 151. [Full Text] [PDF]