title: Adult orthodontic patients' views regarding dentofacial normality: a qualitative study.
abstract: BACKGROUND
  The concept of normality in orthodontic diagnosis and treatment is defined from the clinicians' point of view or derived from concepts developed from observation of "ideal" persons. In-depth appreciation of what a patient views as normal is paramount for effective shared decision making. In this study, we aimed to examine the concept of dentofacial normality in orthodontics from the patient's perspective.
  
  
  METHODS
  This was a qualitative study of adults attending for orthodontic consultations at a teaching hospital. Semistructured interviews were conducted until data saturation occurred (n = 15). The data were managed using a framework approach, and recurrent themes were identified.
  
  
  RESULTS
  Three main themes were identified in the interviews: the components of dentofacial normality, the impact of dentofacial abnormality, and factors influencing patients' conceptualization of dentofacial normality. The components of normal appearance are apparent in the views of potential adult orthodontic patients. These ideas are formed from personal observations in conjunction with the external influences of family, friends, and the commercial media. There was a biopsychosocial impact of dentofacial abnormality with both enacted and felt stigma playing substantial roles.
  
  
  CONCLUSIONS
  A normal dentofacial appearance cannot be solely constructed from measureable biologic variables. Patients view normality in terms of features that are acceptable biologically, psychologically, and socially, and there is significant overlap in these domains. Clinicians should be aware that traditionally held concepts of what they believe to be normal or abnormal might not fully represent patients' beliefs.
authors.affiliation: Senior registrar in orthodontics, Liverpool Dental Hospital, Liverpool, United Kingdom. Electronic address: nickystanford@googlemail.com.
authors.forename: Nicky D
authors.initials: ND
authors.lastname: Stanford
authors.affiliation: Consultant orthodontist, Newcastle Dental Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: Tze Bill
authors.initials: TB
authors.lastname: Ip
authors.affiliation: Senior lecturer in oral surgery and orofacial pain, NIHR clinical scientist, School of Dental Science, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Justin
authors.initials: J
authors.lastname: Durham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003146:Communications Media; D003766:Dental Occlusion; D004955:Esthetics, Dental; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008297:Male; D008310:Malocclusion / Q000473:pathology / Q000503:physiopathology / Q000523:psychology*; D008409:Mastication / Q000502:physiology; D008875:Middle Aged; D036301:Qualitative Research; D012649:Self Concept; D057545:Social Stigma; D055815:Young Adult