A 20-year cohort study of health gain from orthodontic treatment: psychological outcome.

INTRODUCTION Despite the widespread expectation that orthodontic treatment improves psychological well-being and self-esteem, there is little objective evidence to support this. The aim of this study was to compare the dental and psychosocial status of people who received, or did not receive, orthodontic treatment as teenagers. METHODS A prospective longitudinal cohort design was adopted. A multidisciplinary research team evaluated 1018 participants, aged 11 to 12 years, in 1981. Extensive assessments of dental health and psychosocial well-being were conducted; facial and dental photographs and plaster casts of dentition were obtained and rated for attractiveness and pretreatment need. No recommendations about orthodontic treatment were made, and an observational approach was adopted. At the third follow-up, 337 subjects (30-31 years old) were reexamined in 2001. One-way ANOVA was used to explore differences between the 4 groups (need/no need; treatment/no treatment). RESULTS The percentage changes in index of complexity, outcome and need scores for the 4 groups were need/no treatment (12.7%), no need/no treatment (-17.1%), need/treatment (31%), and no need/treatment (-11.4%). Participants with a prior need for orthodontic treatment as children who obtained treatment had better tooth alignment and satisfaction. However, when self-esteem at baseline was controlled for, orthodontic treatment had little positive impact on psychological health and quality of life in adulthood. CONCLUSIONS Lack of orthodontic treatment when there was need did not lead to psychological difficulties in later life.