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Psychological outcomes
READERS’ FORUM
Letters to the editor* Psychological outcomes Regarding the study by William Shaw and his colleagues of psychological outcomes after orthodontic treatment (Shaw WC, Richmond S, Kenealy PM, Kingdon A, Worthington H. A 20-year cohort study of health gain from orthodontic treatment: psychological outcome. Am J Orthod Dentofacial Orthop 2007;132:146-57), I applaud Dr Shaw and all who participated in the Cardiff study for taking on an important long-term longitudinal study of orthodontic outcomes. I believe, however, that to understand the meaning of the results the study, you must first put it in the context of research on psychological well-being in general. The study of well-being has become an area of important research in psychology, with researchers such as Nobel Prize winner Daniel Kahneman leading the way. Researchers such as Kahneman, Ed Diener, and others have been learning that well-being in individuals is difficult to change over time. Psychologists call this phenomenon the “hedonic treadmill.”1 Circumstances can change a person’s happiness or well-being temporarily, but the person will over time adapt to the new situation and return to his or her personal set point. Research has demonstrated that well-being is changed very little by significant factors, such as change in income, marriage, or the birth of a child. Only events such as the loss of a spouse or chronic unemployment have effects on well-being after 5 years. Diener and Seligman even showed that life satisfaction is the same for the Forbes 500 richest Americans, the Pennsylvania Amish, the Inuit of Greenland, and the African Masai.2 Placed in the context of the broader picture of research on well-being, it is clear that anything other than a null result for the impact of orthodontic treatment on well-being after 20 years would be a most remarkable outcome. It seems to me that Shaw and his colleagues have established what anyone familiar with well-being research would expect as the outcome. The result that orthodontic treatment does not affect well-being after 20 years does not reflect poorly on orthodontics or show that it has no psychological impact. Rather, it proves that orthodontic treatment has no more influence on psychological well-being than a person’s income, job, or family status. I am grateful for Shaw’s work, but it is important to see these results for what they are—the only possible outcome of this research. Leslie Pitner Columbia, SC Am J Orthod Dentofacial Orthop 2007;132:716 0889-5406/$32.00 Copyright © 2007 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2007.10.004
*The viewpoints expressed are solely those of the author(s) and do not reflect those of the editor(s), publisher(s), or Association.
716
REFERENCES 1. Diener E, Lucas RE, Scollon CN. Beyond the hedonic treadmill: revising the adaptation theory of well-being. Am Psychol 2006; 61:305-14. 2. Diener E, Seligman MEP. Beyond money: toward an economy of well-being. Psychol Sci Public Interest 2004;5:1-31.
Angle’s classification revisited Although it was quite flattering for a dim bulb like me to be characterized in the September 2007 AJO-DO article as among the “orthodontic luminaries,” it is the thrust of the article that I wish to applaud (Snyder R, Jerrold L. Black, white, or gray: finding commonality on how orthodontists describe the areas between Angle’s molar classifications. Am J Orthod Dentofacial Orthop 2007;132 302-6). Authors Randall Snyder and Laurance Jerrold are to be commended for bringing again to the attention of the orthodontic community the irony that dentistry’s oldest specialty still uses as its main descriptor of ideal occlusion the midpoint in a 7-mm range. “Tradition” might be wonderful music in Broadway’s Fiddler on the Roof, but it hardly sings to us in the 21st century. How can orthodontics profess to be a serious specialty when it adheres to a classification scheme that might have been cutting edge in 19001 but is hopelessly outmoded today? Unfortunately, the cult of personality still dominates much orthodontic thought and practice. Many orthodontists agree that Angle’s classification does not work but want to keep tradition and so make up their own personal variant.2 The problem with that solution is that no 2 orthodontists speak the same language. Others believe classification is an unimportant feature of their diagnosis. I disagree. Think how many times a day one writes Angle’s flawed classification in patient charts or repeats it to assistants and doctors when describing patients’ malocclusions. A properly classified malocclusion helps guide treatment to a satisfactory conclusion, whereas a confusing classification can send the practitioner down wrong paths. To standardize treatments and raise the bar for consistent quality of care, we must treat toward a more sharply defined goal than Angle described, and we should quantify with accuracy,3-5 preferably by numerical measures,6 each malocclusion’s deviation from that ideal. Morton I. Katz Baltimore, Md Am J Orthod Dentofacial Orthop 2007;132:716-7 0889-5406/$32.00 Copyright © 2007 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2007.10.007
REFERENCES 1. Katz MI, Sinkford JC, Sanders CF Jr. The 100-year dilemma: what is a normal occlusion, and how is malocclusion classified? Quintessence Int 1990;21:407-14.
Letters to the editor* Psychological outcomes Regarding the study by William Shaw and his colleagues of psychological outcomes after orthodontic treatment (Shaw WC, Richmond S, Kenealy PM, Kingdon A, Worthington H. A 20-year cohort study of health gain from orthodontic treatment: psychological outcome. Am J Orthod Dentofacial Orthop 2007;132:146-57), I applaud Dr Shaw and all who participated in the Cardiff study for taking on an important long-term longitudinal study of orthodontic outcomes. I believe, however, that to understand the meaning of the results the study, you must first put it in the context of research on psychological well-being in general. The study of well-being has become an area of important research in psychology, with researchers such as Nobel Prize winner Daniel Kahneman leading the way. Researchers such as Kahneman, Ed Diener, and others have been learning that well-being in individuals is difficult to change over time. Psychologists call this phenomenon the “hedonic treadmill.”1 Circumstances can change a person’s happiness or well-being temporarily, but the person will over time adapt to the new situation and return to his or her personal set point. Research has demonstrated that well-being is changed very little by significant factors, such as change in income, marriage, or the birth of a child. Only events such as the loss of a spouse or chronic unemployment have effects on well-being after 5 years. Diener and Seligman even showed that life satisfaction is the same for the Forbes 500 richest Americans, the Pennsylvania Amish, the Inuit of Greenland, and the African Masai.2 Placed in the context of the broader picture of research on well-being, it is clear that anything other than a null result for the impact of orthodontic treatment on well-being after 20 years would be a most remarkable outcome. It seems to me that Shaw and his colleagues have established what anyone familiar with well-being research would expect as the outcome. The result that orthodontic treatment does not affect well-being after 20 years does not reflect poorly on orthodontics or show that it has no psychological impact. Rather, it proves that orthodontic treatment has no more influence on psychological well-being than a person’s income, job, or family status. I am grateful for Shaw’s work, but it is important to see these results for what they are—the only possible outcome of this research. Leslie Pitner Columbia, SC Am J Orthod Dentofacial Orthop 2007;132:716 0889-5406/$32.00 Copyright © 2007 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2007.10.004
*The viewpoints expressed are solely those of the author(s) and do not reflect those of the editor(s), publisher(s), or Association.
716
REFERENCES 1. Diener E, Lucas RE, Scollon CN. Beyond the hedonic treadmill: revising the adaptation theory of well-being. Am Psychol 2006; 61:305-14. 2. Diener E, Seligman MEP. Beyond money: toward an economy of well-being. Psychol Sci Public Interest 2004;5:1-31.
Angle’s classification revisited Although it was quite flattering for a dim bulb like me to be characterized in the September 2007 AJO-DO article as among the “orthodontic luminaries,” it is the thrust of the article that I wish to applaud (Snyder R, Jerrold L. Black, white, or gray: finding commonality on how orthodontists describe the areas between Angle’s molar classifications. Am J Orthod Dentofacial Orthop 2007;132 302-6). Authors Randall Snyder and Laurance Jerrold are to be commended for bringing again to the attention of the orthodontic community the irony that dentistry’s oldest specialty still uses as its main descriptor of ideal occlusion the midpoint in a 7-mm range. “Tradition” might be wonderful music in Broadway’s Fiddler on the Roof, but it hardly sings to us in the 21st century. How can orthodontics profess to be a serious specialty when it adheres to a classification scheme that might have been cutting edge in 19001 but is hopelessly outmoded today? Unfortunately, the cult of personality still dominates much orthodontic thought and practice. Many orthodontists agree that Angle’s classification does not work but want to keep tradition and so make up their own personal variant.2 The problem with that solution is that no 2 orthodontists speak the same language. Others believe classification is an unimportant feature of their diagnosis. I disagree. Think how many times a day one writes Angle’s flawed classification in patient charts or repeats it to assistants and doctors when describing patients’ malocclusions. A properly classified malocclusion helps guide treatment to a satisfactory conclusion, whereas a confusing classification can send the practitioner down wrong paths. To standardize treatments and raise the bar for consistent quality of care, we must treat toward a more sharply defined goal than Angle described, and we should quantify with accuracy,3-5 preferably by numerical measures,6 each malocclusion’s deviation from that ideal. Morton I. Katz Baltimore, Md Am J Orthod Dentofacial Orthop 2007;132:716-7 0889-5406/$32.00 Copyright © 2007 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2007.10.007
REFERENCES 1. Katz MI, Sinkford JC, Sanders CF Jr. The 100-year dilemma: what is a normal occlusion, and how is malocclusion classified? Quintessence Int 1990;21:407-14.