title: Patients offered orthognathic surgery: why do many refrain from treatment?
abstract: OBJECTIVE
  To examine factors associated with patients' decision to decline surgery.
  
  
  METHODS
  Of 470 consecutive patients referred to the University of Oslo from 2007 to 2009, a sample of 160 subjects who had not undergone surgery was identified and contacted. 236 operated patients from the same period served as a comparison group. Morphology was assessed from cephalograms and photographs, and the individuals' opinions were recorded using questionnaires.
  
  
  RESULTS
  Dentofacial morphology represented normative treatment need and was generally similar except for a higher rate of severe negative overjet in the operated group (p < 0.001). The most prevalent reasons for declining surgery were risks of side effects, the burden of care, and a general reluctance to undergo surgery. Many un-operated subjects were dissatisfied with their masticatory function and dentofacial appearance.
  
  
  CONCLUSIONS
  Informed consent to orthognathic surgery represents a challenge both to the patient and the professional. The findings imply that patients' motives and fears should be explored during consultation and that the information provided should be adapted to the potential risks and benefits related to the actual treatment.
authors.affiliation: Department of Orthodontics (Head: Prof. L. Espeland), University of Oslo, Faculty of Dentistry, P.O. Box 1109, Blindern, N0317 Oslo, Norway; Department of Maxillofacial Surgery (Head: Prof. P. Skjelbred), Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway. Electronic address: n.f.hagensli@odont.uio.no.
authors.forename: Niels
authors.initials: N
authors.lastname: Hågensli
authors.affiliation: Department of Orthodontics (Head: Prof. L. Espeland), University of Oslo, Faculty of Dentistry, P.O. Box 1109, Blindern, N0317 Oslo, Norway.
authors.forename: Arild
authors.initials: A
authors.lastname: Stenvik
authors.affiliation: Department of Orthodontics (Head: Prof. L. Espeland), University of Oslo, Faculty of Dentistry, P.O. Box 1109, Blindern, N0317 Oslo, Norway.
authors.forename: Lisen
authors.initials: L
authors.lastname: Espeland
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D002508:Cephalometry / Q000379:methods; D003657:Decision Making; D004954:Esthetics; D005146:Facial Asymmetry / Q000523:psychology / Q000601:surgery; D005239:Fear / Q000523:psychology; D005260:Female; D063172:Genioplasty / Q000523:psychology; D006801:Humans; D007258:Informed Consent; D008297:Male; D008310:Malocclusion / Q000523:psychology / Q000601:surgery*; D063168:Mandibular Osteotomy / Q000523:psychology; D008409:Mastication / Q000502:physiology; D009042:Motivation; D056948:Orthognathic Surgical Procedures / Q000523:psychology*; D019340:Osteotomy, Le Fort / Q000523:psychology; D059229:Osteotomy, Sagittal Split Ramus / Q000523:psychology; D017060:Patient Satisfaction; D010781:Photography / Q000379:methods; D016312:Treatment Refusal; D055815:Young Adult
keywords: Attitudes; Craniofacial morphology; Informed consent; Malocclusion; Orthognathic surgery; Treatment decisions