Body Dysmorphic Disorder in Orthodontic Patients: A Review of Prevalence, Diagnosis, and Management Approaches

Background: Body Dysmorphic Disorder (BDD) is a psychiatric condition marked by excessive concern about perceived flaws in physical appearance, often resulting in emotional distress and functional impairment. Given that orthodontic treatment primarily addresses facial esthetics, orthodontic patients may have a higher prevalence of BDD than the general population. Objective: To review the literature on BDD in orthodontic patients, focusing on prevalence, diagnostic challenges, clinical implications, and management strategies. Methods: A narrative review of PubMed, Scopus, and Web of Science databases was performed using the keywords “Body Dysmorphic Disorder,” “Orthodontics,” “Malocclusion perception,” and “Psychiatric rehabilitation.” Articles from 2000 to 2025 were analyzed. Results: BDD prevalence is 1.7%–2.4% in the general population but 7%–12% in orthodontic patients. Risk factors include perfectionism, history of bullying, and comorbid psychiatric disorders. Diagnostic challenges arise because appearance-related dissatisfaction is common in orthodontics. Undiagnosed BDD can result in unrealistic expectations, dissatisfaction, treatment dropout, and litigation risk. Early screening and interdisciplinary management involving mental health professionals are recommended. Conclusion: BDD screening should be part of orthodontic evaluation, and interdisciplinary management is crucial for preventing treatment failure and psychological harm.