The need for preoperative psychological risk assessment.

Adverse psychological outcomes are more prevalent among patients undergoing elective, appearance-altering surgery than are physical complications. Patients may experience depression, posttraumatic stress disorder, or an exacerbation of preexisting symptoms related to body dysmorphic disorder. Some have directed anger against themselves or against the operating surgeon with suicide, litigation, harassment, and homicide, all well documented. Although there are well-established protocols to conduct medical and anesthetic risk stratification, such protocols do not exist for psychological risk assessment (PRA). The literature related to this is reviewed, the need for PRA is discussed, and an approach to PRA for dentists and surgeons is proposed.