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Crooked teeth, but still happy

January 29, 2007|Melissa Healy | Times Staff Writer

Getting a mouthful of hardware designed to straighten the teeth is a rite of passage for almost 3 in 10 American children. But a new study suggests these kids do not come out happier for it once they grow into adulthood.

Parents and patients often hear orthodontists tout the improved confidence and self-esteem that will come from correcting misalignments of the teeth and jaw. But a 20-year study conducted by British psychologists and dentists has found that by the time they reach 31, children who were identified as needing some orthodontia -- and who didn't get it -- were no more likely to have psychological difficulties than those who needed -- and got -- their smiles straightened.

The study, which tracked the psychological well-being of more than 1,000 children, focused on a smaller subset of kids whose orthodontic needs were not extreme, but considered to be "borderline," and who did not have them treated.

"Orthodontic treatment, in the form of braces placed on children's teeth in childhood, had little positive impact on their psychological health and quality of life in adulthood," said Dr. William Shaw, an orthodontist from the University of Manchester and one of the authors of the study, published in the Jan. 22 issue of the British Journal of Health Psychology. "This runs contrary to the widespread belief among dentists that orthodontic treatment improves psychological well-being, for which there is very little evidence."

That belief is due to be dealt a further blow by a study set for presentation to the International Assn. for Dental Research at its March 21 to 24 conference. A comprehensive review of all studies addressing the impact of orthodontia on self-esteem has come up empty.

Dr. David Locker, chairman of the University of Toronto's Community Dentistry department, and coauthor Shoroog Agou, a dentist in the program, found a "lack of self-esteem gain following early orthodontic treatment."

Dr. Clarice Law, an orthodontist and pediatric dentist at UCLA's School of Dentistry, says studies like this are helping fill in a key part of the puzzle that orthodontists and patients -- and their paying parents -- need to consider when a child's teeth are just a little uneven.

In conferring with parents, "one of the things [orthodontists] have always listed is that maybe the psychosocial aspect is important. It's interesting to me to hear that for most kids, it doesn't seem to have that great an impact," says Law.

The British findings may come as little surprise to the likes of retired Supreme Court Justice Sandra Day O'Connor or singer Madonna, both of whom have -- and have never fixed -- a pronounced gap between their front teeth that orthodontists call a diastema. Actress Kirsten Dunst has managed to find happiness with teeth that don't all point in the exact same direction, and celebrity chef Jamie Oliver has cooked up a successful career with a mouthful of misaligned choppers.

For Rita Melin, a 31-year-old occupational therapist from Pasadena, having bottom teeth that fan out to the sides has not made her smile less. But it has made her smile differently, she says.

"I'm a pretty happy person," said Melin, whose parents, with seven children, could not afford the orthodontia she was told she needed. "I've never felt depressed over it, but I don't like to show the bottom part of my teeth."

Melin underscores one of the findings of the British study: that self-esteem generally increases as kids grow into adulthood, and that peculiarities of physical appearance matter less to grown-ups than to adolescents.

In her teens, said Melin, it bothered her to have teeth that shot out prominently. Now, Melin added, she's considering orthodontic treatment -- but to prevent tooth loss, not for aesthetic or psychological reasons. "When you're older, you become an adult, you start seeing the person for who they are."

For many, but not all, patients with teeth that are misaligned, orthodontic therapy prevents tooth decay and loss and gum disease later in life. In borderline cases, orthodontists often argue that a patient must weigh the importance of a more confident smile.

But James E. Richeson Jr., past president of the Academy of General Dentistry, says doing a 20-year study on the psychological impact of orthodontia misses the point. Getting teeth straightened and aligned is about preserving the teeth and making the teeth, gums and jaw work better as a unit, he says; any increase in self-confidence is a happy byproduct of that treatment, not the reason to get it, he says.

"I would say that preserving oral health is by far the most common motivator for patients," said Richeson, who has written on the benefits of orthodontic care for the Academy of General Dentistry. "But form does follow function, so there will almost invariably be an improved aesthetic side effect."

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