The Cardiff dental study: A 20-year critical evaluation of the psychological health gain from orthodontic treatment
The Cardiff dental study: A 20-year critical evaluation of the psychological health gain from orthodontic treatment
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DOI：
10.1348/135910706x96896
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发表时间：
2007-02-01
影响因子：
7.9
通讯作者：
Shaw, William C.
中科院分区：
文献类型：
--
作者：
Kenealy, Pamela M.;Kingdon, Anne;Shaw, William C.
目标。尽管人们普遍认为正畸可以改善心理健康和自尊，但很少有客观证据支持这一观点（Kenealy et al., 1989a; Shaw， O'Brien, Richmond, & Brook, 1991）。一项为期20年的随访研究比较了青少年时期接受或未接受正畸治疗的个体的牙齿和心理社会状况。一项前瞻性纵向队列设计，包括四项正畸治疗效果的研究。结果数据的二次分析纳入了基线时的正畸需求和在2 × 2因子设计中接受的治疗。方法。1981年，一个多学科研究项目对11811 -12岁的参与者进行了研究。对牙齿健康和社会心理健康进行了广泛评估；获得牙列的面部和牙齿照片和石膏模型，并对吸引力和预处理需求进行评级。未对正畸治疗提出建议，采用观察方法。在第三次随访中，337名（30-31岁）于2001年再次接受了检查。先前需要正畸治疗的儿童接受治疗的参与者表现出更好的牙齿排列和满意度。然而，当控制基线自尊时，正畸对成年期心理健康和生活质量的积极影响很小。先前有正畸治疗需要的患者，不接受正畸治疗，并不会导致以后生活中的心理困难。牙齿状况本身是一个微弱的自尊预测因子，解释了8%的差异。成年期的自尊更能被以下心理变量预测（65%的方差）：生活质量感知、生活满意度、自我效能、抑郁、社交焦虑、情绪健康和自我吸引力感知。纵向分析显示，观察到的正畸治疗对结果自尊的影响是由基线自尊来解释的。儿童时期的治疗需求评估对成年后20年的自尊预测有很小的贡献。成年后的牙齿状况虽然在统计上很重要，但在包含其他心理变量的模型中似乎不太重要。当考虑到先前的治疗需要时，很少有客观证据支持正畸可以改善长期心理健康的假设。
Objectives. Despite the widespread belief that orthodontics improves psychological well-being and self-esteem, there is little objective evidence to support this (Kenealy et al., 1989a; Shaw, O'Brien, Richmond, & Brook, 1991). A 20 year follow-up study compared the dental and psychosocial status of individuals who received, or did not receive, orthodontics as teenagers.Design. A prospective longitudinal cohort design with four studies of the effect of orthodontic treatment. Secondary analysis of outcome data incorporated orthodontic need at baseline and treatment received in a 2 X 2 factorial design. Methods. A multidisciplinary research programme studied a cohort of 1,0 18, 11-12 year old participants in 1981. Extensive assessment of dental health and psychosocial well-being was conducted; facial and dental photographs and plaster casts of dentition were obtained and rated for attractiveness and pre-treatment need. No recommendations about orthodontic treatment were made, and an observational approach was adopted. At the third follow-up 337 (30-31 year olds) were re-examined in 2001.Results. Participants with a prior need for orthodontic treatment as children who obtained treatment demonstrated better tooth alignment and satisfaction. However when self-esteem at baseline was controlled for, orthodontics had little positive impact on psychological health and quality of life in adulthood. Lack of orthodontic treatment where there was a prior need did not lead to psychological difficulties in later life. Dental status alone was a weak predictor of self-esteem at outcome explaining 8% of the variance. Self-esteem in adulthood was more strongly predicted (65% of the variance) by psychological variables at outcome: perception of quality of life, life satisfaction, self-efficacy, depression, social anxiety, emotional health, and by selfperception of attractiveness.Conclusions. Longitudinal analysis revealed that the observed effect of orthodontic treatment on self esteem at outcome was accounted for by self esteem at baseline. Prior need for treatment assessed in childhood made a small contribution to the prediction of self-esteem 20 years later in adulthood. Dental status in adulthood, whilst statistically significant, appeared to be of minor importance in a model that included other psychological variables. When prior need for treatment was taken into account there was little objective evidence to support the assumption that orthodontics improves long-term psychological health.