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A psychological study of people who seek orthodontic treatment: Comparison with untreated controls
This article was originally published by Wolters Kluwer and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Objective
Improvement in appearance is an important motivation for orthodontic treatment; nevertheless, not all patients with malocclusion seek treatment; therefore, the aim of this study was to compare the psychological state of patients with moderate to severe malocclusion who seek orthodontic treatment with patients who suffer from similar malocclusion but do not seek treatment.
Materials and Methods
Minnesota multiphasic personality inventory-2 questionnaire which assesses psychological states of people were given to 100 subject with moderate to severe malocclusion who were undergoing orthodontic treatment and 100 subjects with similar malocclusion who did not request orthodontic treatment. All subjects had similar demographic variables. Clinical scales measured by the test included: Hypochondriasis, depression, hysteria, psychopathic deviate, paranoia, psychasthenia, schizophrenia, and hypomania. The questionnaire consisted of 71 questions, and the subjects had to mark “True” or “False” in response. The scores were transformed into T-scores by a trained psychologist. The results were evaluated by independent t-test.
Results and Conclusion
The results of the test showed that both treated and untreated subjects were in similar psychological state and were psychologically normal; therefore, it is likely that other factors affect patients’ willingness for seeking orthodontic treatment rather than their psychological state.
Keywords
Malocclusion
minnesota multiphasic personality inventory
orthodontic treatment
psychological test
INTRODUCTION
In recent years, there has been a noticeable increase in demand for seeking orthodontic treatment; nevertheless, not all patients with malocclusion, even those with extreme deviations from normal, seek orthodontic treatment.[1,2] Both social and cultural factors influence the perceived need for treatment.
One of the most significant effects of a malocclusion is its psycho-social impact on the individual patient.[3] A person’s dental appearance can have a significant effect on how they feel about themselves. There is little doubt that a poor dental appearance can have a profound psycho-social effect on children and adolescents. Shaw et al. found that children were teased more about their teeth than anything else, e.g., clothes, weight, ears.[4] This results in malocclusion patients being unsure of themselves in social interaction and having lower self-esteem. Adults may be less influenced by peer perceptions and are, generally, more stable in their concerns about appearance compared to adolescents.
In a study of need and demand for orthodontic treatment, Gravely found that girls were more aware of malocclusions than boys and were more prepared to accept treatment.[5] Gray and Anderson[6] also found that females had a greater desire to accept, undergo, and to be satisfied with orthodontic treatment than males. Bos et al. evaluated treated and untreated subjects’ attitudes toward orthodontic treatment.[7] They found that previously treated subjects had more positive attitude toward orthodontics than untreated subjects. They also reported that age, but not gender, was a significant predictor factor for the subject’s general attitude toward orthodontics.
A search in the literature shows that no previous study has compared psychological state of people who seek orthodontic treatment and the ones who do not. Therefore, the aim of this study was to compare the psychological state of patients who requested orthodontic intervention with a control group.
MATERIALS AND METHODS
The protocol of the study was approved by the Research Ethics Committee of Arak University of Medical Sciences (AUMS) and the study was performed in accordance with the declarations of Helsinki.
From an initial sample of 420 patients referred to the dental clinic of AUMS, 100 patients from 30 to 20 years old with moderate to severe malocclusion who were undergoing orthodontic treatment were chosen as experimental group and 100 subjects with the same age range and malocclusion but not seeking orthodontic treatment were selected as control group.
As the aim of study was to compare the psychological state of subjects seeking orthodontic treatment with subjects who suffer from similar malocclusion but do not request the treatment, the subjects had to be similar in different aspects such as age, gender, education, and other demographic aspects.
INSTRUMENT
The Minnesota multiphasic personality inventory (MMPI) was introduced by Hathaway and McKinley in 1940. The test earned acclaim for the accuracy of its diagnosis of psychological problems in test subjects and became the most popular clinical personality assessment procedure in use. The original MMPI test included 567 items. The MMPI used in this study was the validated Persian translation of a shorter version of the improved MMPI-2 (71 items).[8]
There is a total of 71 items on the MMPI-2, which the test-taker responds either “true” or “false.” The MMPI-2 used in this study has eight clinical scales that are used to indicate different psychological conditions and three validity scales to measure test-taking attitude and to assess whether the subject took a normal, honest approach to the test. In order to interpret the results, raw scores on the scales are transformed into a standardized metric known as T-scores (mean of 50 and standard deviation of 10). Table 1 shows the definition of each score.
| Scales | T > 50 |
|---|---|
| Clinical | |
| Hypochondriasis (Hs) | Concern with bodily symptoms |
| Depression (D) | Depressive symptoms |
| Hysteria (Hy) | Displaying hysteria in stressful situations |
| Psychopathic deviate (Pd) | A measure of disobedience. High scorers tend to be more rebellious and fight authority |
| Paranoia (Pa) | Paranoid symptoms such as suspiciousness, feelings of persecution, grandiose self-concepts, excessive sensitivity, and rigid attitudes |
| Psychasthenia (Pt) | Excessive doubts, compulsions, obsessions, and unreasonable fears |
| Schizophrenia (Sc) | Used to identify schizophrenic patients |
| Hypomania (Ma) | Elevated mood, accelerated speech, and motor activity, irritability, flight of ideas, and brief periods of depression |
| Validity | |
| Lie (L) | The testee is lying and trying to present himself/herself in a more positive way |
| Infrequency (F) | Subjects who score high on this test are trying to appear better or worse than they really are |
| Correction (K) | The testee is defensive and attempting to hide something |
MMPI – Minnesota multiphasic personality inventory
During the diagnostic appointment, the subjects were told that the intent of the questionnaire was to provide information about how they felt about themselves, and were given instructions on how to complete the questionnaire. All statistical analyses were performed using the statistical package for the social sciences (SPSS Inc, version 20, Chicago, IL, USA). Independent t-test was used to evaluate the data.
RESULTS
T-scores of >70 are indicative of marked elevation, T-scores of between 50 and 70 are indicative of moderate elevation and T-scores of below 50 are considered as normal values. As can be seen in Table 2, all the T-scores of the treated and untreated subjects are well below 70 and the differences between them are not significant. Mean T-score of Hypochondriasis was 33.1 (14.1) in treated group and 33.0 (14.3) in the untreated group. (P < 0.9) T-scores of 35.8 (14.4) and 35.2 (13.7) in treated and untreated subjects, respectively, showed that none of the subjects suffered from clear signs of depression. As with the validity scales, none of the subjects were trying to present themselves differently or had any defensive approach toward the test.
| Clinical and validity scales | Treated subjects Mean (SD) | Untreated subjects Mean (SD) | P |
|---|---|---|---|
| Hypochondriasis | 33.1 (14.1) | 33.0 (14.3) | 0.9 |
| Depression | 35.8 (14.4) | 35.2 (13.7) | 0.7 |
| Hysteria | 40.1 (11.3) | 40.9 (10.8) | 0.6 |
| Psychopathic deviate | 34.4 (13.0) | 37.5 (14.1) | 0.1 |
| Paranoia | 31.3 (14.9) | 31.2 (15.7) | 0.9 |
| Psychasthenia | 40.1 (21.0) | 37.6 (18.8) | 0.3 |
| Schizophrenia | 33.9 (14.8) | 34.5 (16.7) | 0.7 |
| Hypomania | 47.0 (17.0) | 44.0 (21.0) | 0.2 |
| Lie | 34.8 (25.0) | 34.2 (25.8) | 0.8 |
| Infrequency | 18.3 (14.5) | 18.8 (15.1) | 0.9 |
| Correction | 46.5 (15.8) | 48.2 (16.0) | 0.4 |
P value set at 0.05; SD – Standard deviation
DISCUSSION
This study found no difference in personality traits and psychological characteristics between patients who seek orthodontic treatment[9] and subjects with similar malocclusion who do not request treatment. Since current study is the only MMPI study of orthodontic patients direct comparison with other studies is not possible. In a similar study but done on orthognathic patients, Williams et al. assessed personality traits of 30 women who required orthognathic operations and a control group of 30 other women and found that orthognathic patients were psychologically normal except that they had more dissatisfaction with their facial appearance;[10] thus, they postulated that the desire for operation was caused by a genuine physical abnormality rather than a perceived exaggerated esthetic problem.
Numerous studies have assessed the psychological effects of orthognathic and orthodontic treatment in the same patient.[11] In a 2-year follow-up study of 61 orthognathic surgery patients, Flanary et al. observed a significantly positive effect in the subscales of self-esteem, self-satisfaction, self-identity, physical self, family self, social self, and total self-conflict.[12] They also mentioned that the improved changes in the psychological profile 2 years after orthognathic surgery were encouraging. In a review of 29 prospective and retrospective studies, Hunt et al. found that orthognathic patients experience psychosocial benefits as a result of orthognathic surgery, including improved self-confidence, body and facial image, and social adjustment.[13] Bos et al. also found that subjects who had undergone orthodontic treatment had more positive attitude toward orthodontics than untreated subjects.[7]
The results found by this study negate our null hypothesis, which was the difference between psychological state of patients who seek orthodontic treatment and the ones who do not; therefore, further tests with different questionnaires are recommended.
CONCLUSIONS
Patients with moderate to severe malocclusion who seek orthodontic treatment are psychologically similar to patients with similar malocclusion who do not request treatment.
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