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Dental Esthetics and Self-Esteem


J Esthet Dent. 1998;10(5):235-42.

Issues in esthetic dentistry for older adults.

Goldstein RE, Niessen LC.

School of Dentistry, Medical College of Georgia, Augusta, USA.

Esthetic dentistry offers a myriad of opportunities for older adults wishing to improve their smile, oral function, and self-esteem. The challenge for dental professionals is to maintain oral health throughout the patient's lifetime, even through periods of dependence that may include residence in a nursing home. Dental professionals will have increasing opportunities to share their knowledge and expertise about the relation between oral health and overall health, with a variety of health professionals who care for the aging population.


J Dent. 1998 Sep;26(7):547-54.

Psychological effects of aesthetic dental treatment.

Davis LG, Ashworth PD, Spriggs LS.

Department of Restorative Dentistry, University of Sheffield School of Clinical Dentistry, UK. l.davis@shef.ac.uk

OBJECTIVE: To demonstrate that aesthetic restorative dental treatment, using the porcelain laminate veneer, has a positive effect on the self-esteem of a patient. METHODS: A study group of 17 patients, unhappy with their dental appearance, were assessed psychologically at the pre-operative, immediate post-operative and 6 month review stages. Porcelain laminate veneer restorations were used to improve the dental aesthetics for the patients in the study group. A comparison group of 27 subjects, without a dental appearance problem, were also psychologically assessed at comparable intervals. The assessments included Cattell's 16PF Personality Inventory, a Body-Esteem index, a computer administered version of the Repertory Grid technique and semi-structured interviews. RESULTS: The results showed that there were no significant differences between the study and comparison groups on any first or second-order factor of the 16PF. However, highly significant changes in a positive direction (p < 0.005) were observed in the study group in responses to a Body-Esteem questionnaire at each stage in the procedure. Comparison group changes were not significant. Repertory Grid analyses showed a significant overall convergence in the study group compared with the comparison group. There were also significant positive shifts amongst the study group in the normalized ratings of "self' on several of the constructs. Interviews confirmed the Repertory Grid findings. CONCLUSIONS: The study shows that aesthetic restorative treatment has a positive effect on patients' self-esteem.


J Esthet Dent. 1997;9(1):44-6.

Improving self-esteem by improving physical attractiveness.

Patzer GL.

School of Business Administration, California State University, Stanislaus, Turlock 95380, USA.

Many characteristics comprise a person's personality: achievement orientation, interest to be sociable, aggressiveness, need for order, disposition, and so on. One of the most important personality characteristics in every person's life is self-esteem, which can be defined in terms of cognitive generalizations derived from past experiences. Since people are not isolated from their environment, a person's experiences impact his or her self-esteem. Since a person's physical attractiveness is known to be a major factor in his or her experiences, it is logical (as well as empirically documented) to be a substantial influence on self-esteem. The research shows that improving a physical trait improves attitude, personality, and self-esteem. Likewise, improving physical attractiveness improves interpersonal interactions. These more positive interactions are internalized intrapersonally (within a person), with direct, corresponding impact on the person's self-esteem.


J Am Dent Assoc. 1989 May;118(5):565-70.

Dental esthetic satisfaction in adults.

Neumann LM, Christensen C, Cavanaugh C.

University of Illinois, Chicago Department of Operative Dentistry 60612.

This study determined the influence of teeth, mouth, and face on self-image and personal esthetic satisfaction in adults. A random sample of 125 patients completed a five-item questionnaire about personal esthetic satisfaction and oral self-image. As a group, general dental variables were stronger predictors of esthetic satisfaction than orthodontic variables (P less than .01). Discrepancies between clinical findings and patterns of self-perception and satisfaction suggest the dentist and patient should plan together for esthetic dental treatment.


J Prosthodont. 1996 Sep;5(3):166-71.

Esthetics: patients' perceptions of dental attractiveness.

Dunn WJ, Murchison DF, Broome JC.

US Air Force, Dental Corps. Howard Air Force Base, Panama, USA.

PURPOSE: The importance of dentofacial attractiveness to the psychosocial well-being of an individual has been well established. Very little information is available regarding dental patient perceptions of a pleasing esthetic image. The purpose of this study was to identify factors distinctive to attractive smiles versus unattractive smiles, as perceived by patients. MATERIALS AND METHODS: Standardized format photographs (5 x 7 in, matte finish, at f-32 and 1:2 magnification) of eight male and eight female smiles, framing only lips and teeth, were viewed by 297 subjects. The smiles exhibited differences in symmetry, tooth shade, number of teeth displayed, and height of maxillary lip line, and included both restored and unrestored teeth. Respondents ranked the photographs in order from most to least appealing appearance. Respondents viewed each series of photographs in a similar lighting and time period. A questionnaire identified the respondent's age, sex, race, education, income, and home town. Twenty-five demographic groups were established from the information in the questionnaire. Data were analyzed using stepwise discriminant analysis to determine the combination of smile characteristics that best predicted the ranking. RESULTS: The same female smile was chosen as the most attractive by 24 of the 25 demographic groups. This smile is characterized by natural teeth having light shade, high lip line, a large display of teeth, and radiating symmetry. Two female smiles typified by darker shade and asymmetry were rated by all groups as being least attractive. Two male smiles were judged equal as the most pleasing esthetically. Respondents favored those smiles characterized by light shade, a moderate display of teeth, moderate lip line, and a symmetrical arrangement of teeth. One male smile characterized by darker shade was rated as least attractive. CONCLUSIONS: In all cases, tooth shade was the most important factor, followed in sequence by unrestored natural teeth and number of teeth displayed. No correlation was found to exist between specific demographic groups and smile variables.


Int J Prosthodont. 1999 Jan-Feb;12(1):9-19.

The esthetics of the smile: a review of some recent studies.

Dong JK, Jin TH, Cho HW, Oh SC.

Department of Prosthodontics, Wonkwang University School of Dentistry, Iksan, South Korea. dong@wonnms.wonkwang.ac.kr

PURPOSE: This article reviews recent research on the esthetics of the smile, covering the attractiveness of the smile, the effect of aging on the smile, oral condition and the smile, personality and smile, and smile exercises. MATERIAL AND METHODS: The subjects were Koreans with normal occlusion. Photographs of a full smile were taken and the esthetic quality of the subjects' smiles was estimated. Smile scores were correlated with oral condition, personality, the practice of smile exercises, and elements of the smile, such as the position of the lip in a smile. The personality of the subjects was assessed by means of a Sixteen Personality Factor Questionnaire. Gibson's smile exercises were used to investigate the effect of smile exercise. RESULTS: In an attractive smile, the full shape of the maxillary anterior teeth was shown between the upper and lower lip, the upper lip curved upward or was straight, the maxillary anterior incisal curve was parallel to the lower lip, and teeth were displayed to the first molar. The amount of maxillary incisal exposure gradually decreased with age, accompanied by a gradual increase in mandibular incisal exposure. Personality traits such as warmth, calmness, extroversion, and low anxiety were closely related to an attractive smile. Smile exercises were an effective means of improving the esthetic level of the smile if patients exercised continuously. CONCLUSION: An attractive smile is important for esthetic treatment. The lip position, oral condition, personality traits, and smile exercise affect the esthetics of the smile.


Am J Orthod. 1985 Jan;87(1):21-6.

The influence of dentofacial appearance on the social attractiveness of young adults.

Shaw WC, Rees G, Dawe M, Charles CR.

The purpose of the study was to determine whether the social attractiveness of a young adult would be influenced by his or her dentofacial appearance. Black and white photographs of an attractive male, an unattractive male, an attractive female, and an unattractive female were obtained and modified so that, for each face, five different photographic versions were available. In each version, the face was standardized except that a different dentofacial arrangement was demonstrated. These were normal incisors, prominent incisors, absence of upper left lateral incisor, severely crowded incisors, and unilateral cleft lip. Eight hundred young adults were shown one of the twenty photographs and asked to estimate the represented individual's social characteristics along a number of bipolar scales. Each photograph was viewed by a different group of forty young adults, equally divided as to sex. Their impressions of the depicted individuals' social attractiveness were recorded on visual analogue scales. The experimental procedure was such that the effect and interaction of different levels of facial attractiveness, different dentofacial arrangements, sex of the photographed individual, and sex of the judge could be analyzed. Faces displaying a normal incisor relationship gained the most favorable ratings for eight of the ten characteristics examined, and in four of these differences across the range of dental conditions were statistically significant. These were perceived friendliness, social class, popularity, and intelligence. The prominent incisor condition was rated highest for compliance and honesty, while the condition representing a unilateral cleft consistently attracted low ratings. Background facial attractiveness of either the male or female stimuli was often more assertive than the individual dental condition.


J Public Health Dent. 2001 Summer;61(3):150-4.

At first glance: social meanings of dental appearance.

Eli I, Bar-Tal Y, Kostovetzki I.

Department of Occlusion and Behavioral Sciences, Maurice and Gabriela Goldschleger

School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. elilana@post.tau.ac.il

OBJECTIVES: An important factor in social interaction is physical appearance. Major elements in the evaluation of physical appearance are the mouth and teeth. The purpose of this study was to evaluate the effect of tooth appearance on the development of a first impression of the other person, with regard to the sex of both the respondent and the target. METHODS: Eight facial photographs of individuals with intact upper teeth were manipulated: one set was left untouched and the other was professionally altered so that the front anterior teeth appeared decayed. The photographs were randomly aligned in sets of eight, each set consisting of four individuals with an original, intact dentition and four other individuals with a "decayed" dentition. The sets of photographs were then presented to 115 respondents (65 males and 50 females). Evaluations were made according to three categories of traits--esthetic, social, and professional. RESULTS: For all three evaluation categories, the difference in scores between decayed and intact dentition given to targets were significantly higher when participants of one sex evaluated targets of the opposite sex, as compared to evaluating targets of their own sex. CONCLUSIONS: The effect of tooth appearance on the physical attractiveness stereotype is more evident when males evaluate females and vice versa, rather than when evaluating their own sex.


Int J Adult Orthodon Orthognath Surg. 1995;10(2):127-35.

Perception of facial attractiveness by patients, peers, and professionals.

Phillips C, Griffin T, Bennett E.

Department of Orthodontics, University of North Carolina School of Dentistry, Chapel Hill 27599-7450, USA.

Self-perception of facial attractiveness of 19 women (15 with Class II malocclusion and four with Class I malocculsion) was compared to the perceptions of the patient's peers, five orthodontists, and five oral surgeons. Each respondent ranked a set of four standardized facial photographs of each patient from most (1) to least (19) attractive. A surgical treatment plan was recommended for all of the Class II patients. However, only nine accepted surgery; six elected to undergo camouflaging orthodontics only. There was a statistically significant difference in the distribution of ranks given to the Class I, Class II camouflage-only, and Class II surgery groups by the panels. Overall, the Class I patients were judged most attractive. The Class II patients who elected to undergo orthodontics only were given mid-ranks, and the patients who elected surgery were ranked least attractive, although the distributions for overjet, point A-nasion-point B, and motivations for treatment were similar in the two groups. The distribution of self-ranks given by the patients were not significantly different among the three groups, although than the Class II patients perceived themselves as less attractive than the Class I patients.


Eur J Orthod. 1997 Jun;19(3):271-7.

Lay attitudes to dental appearance and need for orthodontic treatment.

Stenvik A, Espeland L, Linge BO, Linge L.

Department of Orthodontics, University of Oslo, Norway.

In provision of advice about aesthetic treatment need, visual stimuli as a tool in communication may have some advantages compared with verbal descriptions, in particular when children are addressed. The Aesthetic Component (AC) of the Index of Orthodontic Treatment Need is an illustrated scale for rating of dental attractiveness developed in the UK and based on lay adults' ratings of dental photographs. This scale has also been recommended for use in patient education. The purpose of the present study was to establish a sociocultural standard of reference for Norway related to the AC, in order to examine the applicability of the scale as a tool in patient information. Samples of 137 children, 126 of their parents and 98 young adults were shown the 10 photographs comprising the AC. The subjects were asked to assess the photographs for dental attractiveness and orthodontic treatment need on a four-category rating scale. The findings indicated that, in general, photographs with an increasing scale point were rated as increasingly more unattractive. The majority (80-100 per cent) of the parents and young adults rated the five photographs on the unattractive end of the scale to be in need of treatment. The children were significantly less critical in their aesthetic judgments. Photographs representing borderline need, identified for these groups to be scale points 5 and 6, have a potential in guiding patients and parents in making informed decisions about aesthetic treatment need.


Dent Stud. 1972 Jan;50(4):30-42.

Good teeth improve the Job Corps image.

Williams C.

Spec Care Dentist. 1999 Mar-Apr;19(2):84-8.

Facial attractiveness and the aged.

York J, Holtzman J.

Department of General Dentistry and Community Health, UMDNJ-New Jersey Dental School, Newark, NJ, USA.

This study examined the relationship between dentofacial appearance and judgments of facial attractiveness in a sample of 60 subjects between ages 65 and 75. Subjects completed questionnaires regarding their current dental appearance and level of satisfaction with their facial attractiveness. Subjects then viewed and ranked four sets of five photographs that had been digitally manipulated to simulate common dental defects. Regardless of background facial attractiveness or gender of stimulus photographs, a specific ranking order for dental defects emerged with rank-order correlations in the 90% range. Findings suggest that dental appearance affects judgments of facial attractiveness regardless of gender or background facial attractiveness.

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