Orthodontists' perceptions of need for jaw surgery

Treatment recommendations in borderline orthognathic surgery cases were examined for influence of orthodontists' traits and orthodontist's perceptions of patients', surgeons', and psychologists' traits. A mail questionnaire consisted of 23 case vignettes describing borderline surgical candidates with certain physical, psychological, attitudinal, and support system traits, as well as demographic and attitudinal items. The response rate from 512 licensed Canadian orthodontists was 65%. Seventy-four percent of orthodontists preferred camouflage for themselves. Recommendation of camouflage predominated in 12 of 23 vignettes and surgery in only four, although the cost of surgery was considered justified. Psychological referral was recommended highly for certain patients: those hoping to improve negative life events through positive facial change, those having low self-esteem, and those wanting to opl out of surgery in the middle of orthodontic treatment. Certain patient traits appeared to influence orthodontists' treatment recommendations. The availability, expertise, and receptiveness to case discussion of oral surgeons and psychologists did not influence orthodontists' treatment recommendations.