Aesthetic demand: psychological aspect - ROS - 2012 - Tome 41 - N°2


Pages 109 to 120

Drapeau de la France
Even in the orthodontic consultation of an adolescent there also exists an aesthetic demand, the growing demand for adult
orthodontic treatments related mostly to the rise of aesthetic treatments, modifies our day-to-day orthodontic practice. Indeed,
this demand for treatment, said as aesthetic, constitute the essential motivation for consultation in adults.
We must then receive this demand and develop our practice based on its technical aspects, for which we are very well trained,
but also and of course in its psychological aspects, in order to permanently question the relevance of a treatment whatever the
orthodontic defect observed by the practitioner.
The topic is to try to give pointers to read the psychological aspects of these demands in order to bettermanage the consultations
and treatments with these new patients.
After having discussed several principles on aesthetics and the predominance of observation, we will discuss the evaluation of
the quality of the demand of the patient. The example of a body dysmorphic disorder (BDD) and elements that can guide us
during the first or initial consultations will make the objective of the first point.
Secondly, the mirror relationship, specular image and the Mirror Stage (J. Lacan) will be discussed in relation with the three
orthodontic ages thus allowing us to seize the possibility or impossibility of certain patients to articulate the treatment demands.
We will end by the actions to be taken before "dissatisfaction" ven the "distress" of certain patients before the therapeutic
results and how and why refer these patients to mental health professionals. Through 3 precise clinical examples, we will
illustrate these developments resulting from the teamwork created with orthodontist colleagues specializing in lingual
orthodontics, on the specificities (therapeutic relation, aesthetic demand) of these adult patients. In these examples we see how
these patients overcome these difficulties.
In conclusion, in the grand majority of the situations the demand of the adult patient is formulated reasonably and we can
start the orthodontic treatment with success. However, in certain cases, to be deprived of the possibility of psychological
assistance for these patients who we identified as "at risk" (including late in the course of treatment) engages our responsibility
as practitioners and we must surmount our resistance in order to refer our patient to a specialist for psychotherapy or specific