Functional and social discomfort during orthodontic treatment--effects on compliance and prediction of patients' adaptation by personality variables

During the course of treatment orthodontic patients frequently endure a number of functional complaints and are anxious about their appearance. The aims of this longitudinal study were to follow the progress of patients' adaptation to discomfort, to elucidate the putative relationship between the type of appliance worn and functional and social discomfort experienced, to study potential predictability by their attitude to treatment and to evaluate the effects of discomfort as predictors of patients' compliance. Eighty-four patients undergoing either removable, functional, or fixed appliance treatment monitored their complaints during the first 7 days of treatment and rated them retrospectively 14 days, and 3 and 6 months after appliance insertion. The most frequent complaints were impaired speech, impaired swallowing, feeling of oral constraint and lack of confidence in public. A significant reduction in the number of complaints was observed between 2 and 7 days after insertion of the appliance. No further differences were revealed after longer periods of appliance wear. The type of appliance had an effect on impaired speech and swallowing. Patients' expectations of favourable treatment performance and appreciation of dental aesthetics were predictive of reported feeling of oral constraint and lack of confidence in public. There was a relationship between the complaints and acceptance of the appliance, as well as between lack of confidence in public and compliance with treatment. The results of this study highlight the importance of patients' attitudes to treatment and of functional and social discomfort associated with appliance wear for the theory and practice of the management of orthodontic patients, and the necessity for early intervention by clinicians.     

Zunge und pharyngealer Raum bei operativer Rückverlagerung des Unterkiefers

Zusammenfassung Anhand von Fernröntgenseitenbildern werden die Auswirkungen der operativen Rückverlagerung des Unterkiefers bei Progenie auf die Zungenlage und den pharyngealen Luftweg untersucht. Es zeigt sich, daß der pharyngeale Raum durch die Operation und die dadurch bedingte Rückverlagerung der Zunge eingeengt wird. Über längere Zeit werden durch Anpassungsvorgänge die ursprünglichen räumlichen Beziehungen annähernd wieder hergestellt.

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Summary The effect on tongue position and pharyngeal air-space was studied by cephalometric radiography in cases where the mandible had been surgically repositioned. The results indicate that the pharyngeal space decreased through a repositioning of the tongue. Over a longer period the original spatial relations were restablished by adaptive changes.

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Résumé Les conséquences postopératoires après réduction de la prognathie inférieure ont été étudiées à l'aide de téléradiographies de profil: le repositionnement plus postérieur de la langue entraine une diminution de l'espace pharyngien. Toutefois avec le temps, celui-ci reprend sa dimension primitive.

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