Kenealy Pamela M, Kingdon Anne, Richmond Stephen, Shaw William C
Centre for Clinical and Health Psychology, School of Human and Life Sciences, Roehampton University, London, UK.
Br J Health Psychol. 2007 Feb;12(Pt 1):17-49. doi: 10.1348/135910706X96896.
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.
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.
A multidisciplinary research programme studied a cohort of 1,018, 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.
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 self-perception of attractiveness.
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.
尽管人们普遍认为正畸治疗能改善心理健康和自尊，但几乎没有客观证据支持这一点（凯内利等人，1989年a；肖、奥布赖恩、里士满和布鲁克，1991年）。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，包含四项关于正畸治疗效果的研究。对结果数据的二次分析纳入了基线时的正畸需求以及在2×2析因设计中接受的治疗。
一个多学科研究项目在1981年对1018名11 - 12岁的参与者进行了研究。对牙齿健康和心理社会福祉进行了广泛评估；获取了面部和牙齿照片以及牙列石膏模型，并对其吸引力和治疗前需求进行了评分。未给出关于正畸治疗的建议，采用了观察性方法。在第三次随访时，2001年对337名（30 - 31岁）参与者进行了重新检查。
儿童时期有正畸治疗需求且接受了治疗的参与者牙齿排列更好且满意度更高。然而，在控制了基线自尊水平后，正畸治疗对成年后的心理健康和生活质量几乎没有积极影响。以前有正畸治疗需求但未接受治疗在成年后并未导致心理问题。仅牙齿状况对结果时的自尊是一个较弱的预测因素，仅解释了8%的方差。成年后的自尊更多地由结果时的心理变量预测（方差的65%）：生活质量感知、生活满意度、自我效能感、抑郁、社交焦虑、情绪健康以及对自身吸引力的自我认知。
纵向分析表明，观察到的正畸治疗对结果时自尊的影响是由基线时的自尊所导致的。儿童时期评估的先前治疗需求对成年后20年自尊的预测有较小贡献。成年后的牙齿状况虽然在统计学上有显著意义，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求时，几乎没有客观证据支持正畸治疗能改善长期心理健康这一假设。
