Elective orthognathic treatment decision making: a survey of patient reasons and experiences

Few studies have explored decisions about orthognathic treatment (OGT) from the patient's perspective. This study describes the factors associated with the patient's decision to have or not have orthognathic treatment, and assesses whether the process can be considered to be informed decision making.

A cross-sectional survey employing both interview and questionnaire methods, conducted in four OGT services in Yorkshire.

Participants were patients aged over 16 years, either making an OGT decision over a 6-month period or had made their treatment choice 18-42 months prior to the study start date in 2003.

Questionnaires assessed patient demographics, dental history and psychopathology (anxiety, satisfaction with self, body satisfaction, facial appearance); interviews explored patients' reasons for, and experiences of, orthognathic treatment.

Of 138 patients approached, 61 participated (mean age 25 years, 66% female). Psychopathology scores were within the normal range. The thematic content analysis of interview transcripts found: reasons given for having OGT were to improve the 'bite', as well as gaining a more normal facial appearance; most patients reported the service information was satisfactory, but about half made negative comments, with some reporting staff communications made them feel worse; knowledge of OGT risks and benefits was poor; patients had strong emotions about their facial appearance and the orthognathic treatment they received, which did not seem to be addressed by current practice.

Some OGT patients do not appear to be making informed decisions about their treatment. They seem to have unmet needs in relation to support for their decision making, and managing the emotional effects of undergoing and adjusting to treatment. The implications for information provision, assessment and support during treatment are discussed.