Why simple aesthetic dental treatment in general practice does not make all patients happy

Effect of personality traits on the association between clinically assessed malocclusion and the psychosocial impact of dental aesthetics

OBJECTIVE

We aimed to assess whether personality traits affect the relationship between malocclusion and the psychosocial impact of dental aesthetics and whether they act as its mediators or moderators.

SETTINGS AND SAMPLE POPULATION

The cross-sectional study included 252 participants with permanent dentition (62% female) aged 12-39 years.

MATERIALS AND METHODS

The Big Five Inventory, the Psychosocial Impact of Dental Aesthetics Questionnaire and the Index of Complexity, Outcome and Need were used. Moderation and mediation were tested by hierarchical stepwise multiple linear regression.

RESULTS

Malocclusion was the most significant predictor of dental self-confidence (DSC), aesthetic concern (AC), social impact (SI) and psychological impact (PI), accounting for 12%-28% of respective variability (P < .05). Adult age, male sex and higher neuroticism and agreeableness were additional predictors of higher DSC (P < .05). Adolescent age was a predictor of higher AC, SI and PI, and female sex of higher AC and PI (P < .05). Mediation by personality traits was not proven, however, openness, agreeableness and neuroticism were moderators. A tendency of decrease in AC was associated with an increase in malocclusion complexity in adolescents lower in openness and decrease in SI in adolescents with lower agreeableness. There was also a tendency of higher increase of AC associated with an increase of malocclusion degree in adults higher in neuroticism.

CONCLUSION

In adolescents, openness and agreeableness moderate the relationship between malocclusion and AC and SI, respectively. Neuroticism is a moderator of the association between malocclusion and AC in adults.

Effects of Visual Stimuli from Media on the Perception of Dentofacial Esthetics

Objectives

The study explored whether television commercials change the perception of one's own dentofacial attractiveness and to identify if it is influenced by personality traits.

Materials and methods

The sample included 83 participants, aged 19-27 years. The experimental group (N=42) watched commercials portraying famous young individuals with high smile esthetics, bright teeth and no visible malocclusions, while the control group (N=41) watched neutral commercials (without people or visible teeth). The perception of subjects` own orofacial esthetics and its psychosocial effects were assessed a month before the exposure and immediately after it. The subjects` malocclusion severity and personality characteristics (extraversion, conscientiousness, agreeableness, neuroticism, intellect, self-esteem and perfectionism) were assessed.

Results

In their second report, respondents were inclined to report less psychosocial impacts with small differences (ranging from 0-3 scalar points on average) and less significant in the active group compared to neutral group (2 out of 7 vs. 5 out of 7 aspects). Types of visual stimuli were a significant predictor only of changes pertaining to psychological impact of dental esthetics (p=0.045; r=0.221). The intellect moderated perception of smile esthetics, after having been exposed to commercials, accentuated beautiful smiles as a suppressor (ΔR²=0.076; p=0.005; total model R²=0.347; p=0.033). In subjects with higher cognitive abilities, an increase in the self-perceived malocclusion level induced a smaller decrease in psychological impact of dental esthetics as compared to those with lower intellect.

Conclusion

Psychosocial influences of malocclusion are not stable and tend to decrease during time. However, the exposure to a high smile esthetic of other individuals can inhibit that process in persons with more severe malocclusion and higher cognitive abilities.

The use of a psychological testing instrument as an indicator of dissatisfaction with aesthetic dental treatment - a preliminary study

Background

The use of psychological testing to indicate the potential for dissatisfaction with dental treatment has many potential patient and clinician benefits but has been rarely investigated. The study aimed to explore the use of the Symptom Checklist-90-Revised (SCL-90-R) psychological testing instrument in describing the relationship between pre-treatment psychological traits and aesthetic restorative treatment satisfaction.

Methods

Thirty patients requiring aesthetic restorative dental treatment completed three questionnaires, namely 1) a pre-treatment expectation assessment, 2) an SCL-90-R analysis pre-treatment and 3) an outcome assessment post-treatment to assess patient’s expectations and satisfaction of the proposed dental treatment relating to function, aesthetics, comfort and tissue preservation. Logistic regression models were used to assess the impact of psychological variables on patient satisfaction after adjusting for baseline expectations (P < 0.05).

Results

The satisfaction for the aesthetic component of treatment was significantly associated with psychoticism and positive symptom distress index. The satisfaction for the comfort component of treatment was significantly associated with obsessive compulsive symptoms, depression and anxiety. Following adjustment for baseline expectation, tissue preservation satisfaction was associated with somatization, obsessive compulsive, interpersonal sensitivity, depression and global severity index. No baseline psychological measures were significantly associated with chewing satisfaction.

Conclusions

The SCL-90-R shows initial promise in assisting clinicians to identify and understanding patients who have a high risk of dissatisfaction with aesthetic dental treatment. The ability to indicate aesthetic restorative treatment dissatisfaction is of great benefit to clinicians in maximising success and mitigating risk.

Body dysmorphia in dentistry and prosthodontics: A practice based study

The prevalence of Body Dysmorphic Disorder (BDD) and dysmorphic concern in dentistry and prosthodontics have not been properly assessed, yet the mouth and the teeth are amongst the top preoccupation for these individuals.

OBJECTIVES

To evaluate the prevalence of dysmorphic symptoms and BDD using validated tools in patients presenting to general and specialist prosthodontic practice.

METHODS

Patients were recruited by two prosthodontics practices and three general dentist practices. Patients were given a Dysmorphic Concern Questionnaire (DCQ) integrated into a medical history form. Treating clinicians also completed a Baseline Rating Form assessing the patients´ reason for presentation. Two DCQ score cut-offs were used (9 and 12).

RESULTS

Two hundred and thirteen patients were recruited, the majority of patients showed DCQ scores below 9 (84%). The prevalence of BDD was 7% (cut-off ≥ 9) or 4% (cut-off ≥12). Women were more likely to present with high DCQ scores as well as people with a history of mental health problems. The cosmetic practice, the implant clinic, and the prosthodontic practice received a higher proportion of patients with high DCQ scores when compared with the general family practice. The type of procedure was not related to DCQ scores. The defect severity assessment and whether this was amenable to correction was moderately correlated with DCQ scores.

CONCLUSIONS

The DCQ seems to be a suitable tool to be used by dentists as part of history taking and patient examination due to its brevity, simplicity and the good sensitivity/specificity reported in the literature.

CLINICAL SIGNIFICANCE

Identifying patients with dysmorphia is important before irreversible treatment is carried out due to high levels of dissatisfaction, poor patient centred outcomes and the question of whether these individuals have the capacity to consent.

Management of Tooth Wear: A Holistic, Dental, Medical, and Mental Healthcare Approach

Tooth wear is a condition that affects a substantial cohort of dental patients. It has a measurable impact on patients' satisfaction, and overall quality of life. Recently, with growing evidence, our understanding of the aetiology, progression, and management of tooth wear has evolved. The paper argues that pathological tooth wear should not be solely considered as a dental condition, but rather a dental manifestation of other mental and medical disorders. As such, successful management of tooth wear, and its underlying aetiology, requires a holistic, multidisciplinary management approach, involving dental, medical, and mental healthcare providers.

Mediation and moderation effect of the big five personality traits on the relationship between self-perceived malocclusion and psychosocial impact of dental esthetics

OBJECTIVE

To explore the mediation and moderation effects of personality traits on the relationship between self-perceived malocclusion and the psychosocial impact of dental esthetics.

MATERIALS AND METHODS

The sample included 252 subjects (62% female) aged 12-39 years. Self-perceived malocclusion was estimated using the 10-point scale Aesthetic Component of the Index of Orthodontic Treatment Need. The Psychosocial Impact of Dental Aesthetics Questionnaire was used to assess the psychological impact and the Big Five Inventory for personality traits. Moderation and mediation effects were evaluated with Pearson correlations and stepwise regression analysis, respectively.

RESULTS

Self-perceived malocclusion ranged from 1 to 8 and was the most significant predictor of psychosocial impact of dental esthetics, whose unique contribution accounted for 11%-36.4% of variability, while age and sex accounted for 1.2%-2.5%. Personality traits had no mediating effect on this relationship. The moderating effect of agreeableness was present in the relationship between self-perceived degree of malocclusion and Social Impact (SI), Psychological Impact (PI), and Aesthetic Concern (AC) (ΔR2  =  0.035, 0.020, and 0.013, respectively; P < .001), while conscientiousness affected the relationship between perception of malocclusion and SI and PI (ΔR2  =  0.018 and 0.016, respectively; P < .05). In people with lower agreeableness and conscientiousness, increasing the severity of self-perceived malocclusion leads to less increase in SI and PI. In people with lower agreeableness, the increase influences AC in a similar manner. Extraversion, neuroticism, and openness do not have a moderating effect.

CONCLUSIONS

The relationship between self-perceived malocclusion and the psychosocial impact of dental esthetics appears to be moderated and not mediated by personality traits. Adolescents and young adults with lower agreeableness and conscientiousness seem to be less affected by the increased severity of self-perceived malocclusion, as demonstrated in reporting some psychosocial impacts.