Anxiety and post-traumatic stress symptoms in orthognathic surgery patients

Objective: To assess the impact of orthognathic surgery in terms of anxiety and stress levels in pre-treatment and post-treatment groups compared with controls and the role of previous trauma exposure on anxiety and stress levels following treatment. Materials and methods: A case-control study was performed involving three age-gender matched groups: 38 'pre-surgery', 39 'post-surgery' and 39 'control' subjects. All subjects had assessment of dental anxiety, post-traumatic stress responses and frequency of previous distressing events. Seventeen subjects were followed up prospectively for 1 year after surgery. Results: 'Post-surgery' group reported lower dental trait anxiety (S-DAI) scores than other groups (P = 0.001). S-DAI was significantly associated with frequency of previous traumatic events in 'pre-surgery' and 'post-surgery' groups (P < 0.01), and was significantly associated with post-traumatic stress disorder (PTSD) symptoms in 'pre-surgery' subjects (P < 0.01) who had the highest PTSD symptoms among the three groups (P = 0.005). Symptom severity (IES-R) levels were significantly associated with frequency of previous distressing dental events in 'pre-surgery' (P < 0.05) and 'post-surgery' groups (P < 0.01). Post-operative S-DAI and IES were significantly associated with pre-operative PTSD symptoms (P < 0.01). Conclusions: The two orthognathic groups were associated with low levels of anxiety and PTSD symptoms in comparison with the control group of the study. Trauma exposure prior to orthognathic treatment can be considered as a risk factor for the development of dental anxiety and PTSD symptoms. The need to improve communication between patients and team is emphasized, especially during the assessment of patients' emotional state pre-operatively, in addition to discussing psychological issues and psychosocial treatment implications.