Loss Aversion and Esthetic Orthodontic Treatment

The last few blogs have addressed some of the esthetic benefits that we can achieve with orthodontic treatment.  So now I would like to turn our attention to the possibilities of achieving the outcome in an esthetic way.   But of course, we need to back-up and elucidate the psychology behind the importance of keeping orthodontic treatment esthetic. 

There are lots of great examples of how despite our belief that we are making strictly rational choices, we are in fact subtly guided by tendencies of which we have no conscious awareness.   One of the best examples of this irrational behavior is called “loss aversion”.  Loss aversion, simply put, is the almost universal tendency to avoid losses over pursuing similarly sized gains.  We avoid pain more than pursue pleasure.  Think of a five dollar gamble on a coin flip.  For most of us, losing the flip and the five bucks is FEELS much worse than the winning FEELS good.  Psychologist have actually quantified this tendency and have found that it is nearly 2:1 depending on the study.

One of my favorite examples of Loss Aversion in a study comes from Dan Ariely (Predictably Irrational, 2009).  I like this example because it shows how even kids are guided by Loss Aversion.  In the study, he offers kids a choice:

Two Hershey's Kisses
A Snickers bar

Now (of course) the overwhelming majority of kids want the Snickers because it is just MORE chocolate.  But Dr. Ariely then gives a different group of kids the same choice but offers it a bit differently, and here is where it gets interesting.  

In the second group he gives the kids one Hershey’s Kiss to hold in their hand.  This first Kiss becomes “theirs” and its value is greatly elevated.  Dr. Ariely then tells the kids that they can have one of two choices again. 

He offers one more Hershey's Kiss "for free
He offers them the option to trade in the one Hershey's Kiss for a Snickers bar

Notice that the end points of the choices are the same as the first scenario; either the kid will end up with two Hershey’s Kisses, or the kid will end up with one Snickers bar.  So the choice seems exactly the same as the first scenario, only now the outcome is just the opposite. The overwhelming majority of the kids will keep their Hershey’s Kiss and take another “for free” rather than give up the one that they have for the Snickers.

What does this have to do with orthodontics?  Well, it turns out to have very much to do with “esthetic orthodontic treatment”.  One of the main reasons that patients seek orthodontic care is to help them (and their smile) look better.  So when they come to the orthodontist, they are seeking some improvement in smile esthetics, but are faced with the potential loss of smile esthetics associated with the application of braces on the outside of their teeth.  Because these patients are ‘loss averse’ they cannot get over the psychological hurdle of ‘the look of braces’.  This ‘aversion’ is particularly poignant because it is a loss of the same quality for which the patient is seeking care for in the first place.  That short-term loss of dental esthetics looms much larger (in their minds) than the long-term gain after treatment is complete. 

All of orthodontics is a short-term liability for a long-term gain in better dental esthetics.  Just imagine if I could tell you that if you exercised for 18 months that you could have the body of your dreams for the rest of your life.  Who wouldn’t do that?  I have to say that one or even two years of braces does not seem like a big deal to me when the reward is a lifetime of a beautiful smile and proper bite, but that may just be the orthodontist in me talking.  I have come to appreciate that for many patients, an esthetic means of treatment is the only way that they will consider care. 

For these esthetically minded (and loss-averse) patients, we have a whole myriad of choices that we offer.  We offer clear (ceramic) brackets, Invisalign and lingual braces (that are placed on the backs of the teeth).  Each has some definite advantages and disadvantages, and I will spend the next few blog posts high-lighting each in turn.  So if you have thought about improving your smile but have thought that the process would be too much to consider, stay tuned. . . .