Issues in decision making: Should i have orthognathic surgery?

Hillary L. Broder, Ceib Phillips, Sharon Kaminetzky

Research output: Contribution to journalArticlepeer-review


This article reviews theoretical issues related to self-perception and decision making in patients with dentofacial disharmony. The decision-making process among patients seeking treatment for severe malocclusion is not well understood. Using phone interviews and chart audits, attitudes, behaviors, and demographics of 118 patients for whom orthognathic surgery was recommended within the past 2 years at 2 university-based dentofacial centers were examined. The mean age was similar (24.6 and 24.2 years) at both sites. Gender and ethnic distributions differed slightly. The northeast site (UMDNJ) had 50% females and 36% white, while the southeast site (UNC) had 77% females and 79% white. Treatment decisions were comparable across sites: approximately 60% of the patients chose orthognathic surgery, 30% chose orthodontics only, and 10% were undecided, waiting, or under observation. No perceptual differences across sites were observed. More than 50% of patients reported awareness of their condition since early adolescence: 11% indicated that someone else (eg, dentist) made them aware of their problem. Twenty percent said the timing for seeking care was related to financial security or schedule flexibility. Fifty percent reported aesthetics and function were their primary motives. Focus groups/interviews were held (orthognathic v orthodontics only; 2 groups per site). Emerging themes included the importance of patientdoctor communication and interpersonal skills (patient education, patience, and willingness to use "my words," take time to explain), the importance of the patients' readiness to change, and availability of resources such as social support and finances/insurance. Knowing someone who had completed treatment at their facility was a significant facilitator expressed across sites. No insurance and fear were relevant barriers in the orthodontic group only. The decision-making process is murtifaceted. Interpersonal communication skills (rapport, understanding), enabling resources (financial, social support), and psychosocial factors (stress, motivation) were primary factors in patients' decision making. Implications for clinicians are presented as well. (Semin Orthod 2000;6:249-258.)

Original languageEnglish (US)
Pages (from-to)249-258
Number of pages10
JournalSeminars in Orthodontics
Issue number4
StatePublished - 2000

ASJC Scopus subject areas

  • Orthodontics


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