Doubt cast on the psychological health gains from orthodontic treatment

A major 20-year study by psychologists and dentists has cast doubt on the assumption that orthodontic treatment improves psychological well-being.

The multidisciplinary team studied the long-term effects of both orthodontic treatment and lack of treatment when a need had been identified in childhood, in a paper published in The British Journal of Health Psychology (January 22 2007).

Over a thousand 11-12 year olds were recruited to the project in Cardiff in 1981, and their dental health and psycho-social well-being assessed. They were re-assessed in 1984 and 1989 and finally in 2001, then aged 31-32.

Professor William Shaw of The University of Manchester, himself an orthodontist, said: "We revisited 337 of our original sample as adults, and those who had been assessed as needing orthodontic treatment in 1981 and received it had straighter teeth and were more likely to be satisfied with them.

"However orthodontic treatment, in the form of braces placed on children's teeth in childhood, had little positive impact on their psychological health and quality of life in adulthood.

"Further, a lack of orthodontic treatment in childhood did not lead to psychological difficulties in later life for those children where a need was identified but no treatment received.

"It can be concluded that, although in general participants' self-esteem increased over the 20-year period, it was not as a result of receiving braces and didn't relate to whether an orthodontic treatment need existed in 1981. This runs contrary to the widespread belief among dentists that orthodontic treatment improves psychological well-being, for which there is very little evidence."

The team, which included academics from the University of Roehampton (London) and Cardiff University's Dental School, also concluded that the health or attractiveness of a person's teeth is a minor factor in determining their psychological well-being in adulthood.

Fellow researcher and psychologist Dr Pamela Kenealy of Roehampton said: "Teeth are important to an individual's self-perception during adolescence, but by adulthood other factors have greater significance. So while it may make a minor contribution to an individual's perception of self-worth, orthodontics cannot be justified on psychological grounds alone."