Self-perceptions of Smile and Facial Attractiveness among Dentistry Students

Introduction

Beauty is defined as “a state of harmony – a balance of facial proportions – a balanced relationship among skeletal structures, teeth, and soft tissue or as the relative measure of balance and harmony” [1, 2]. This harmonic and proportionate distribution of different parts of the face should provide pleasure to the senses and mind and should act in harmony in the static and dynamic face. Many factors are known to influence individuals’ understanding and awareness about their orofacial beauty, including age, sex, social and educational level [3]. Furthermore, scientific advances, improved technology and tools used for determining the ideals for individual and customized beauty designs at reduced treatment cost have also contributed to the rising demand for cosmetic procedures [2].

Today’s generation pay particular attention to their aesthetic appearance. As a result of this increasing social demand for improved facial characteristics, today’s dentists have also started to be aware of how to produce the most required and pleasing esthetic outcome, which has become one of the most desirable, rewarding and interesting aspects of today’s dentistry [4]. Numerous comparative smile assessment studies on laypeople and dentists have used photographs and virtual software images to assess different features of teeth and gingiva regarding size, shape, colour of the teeth and interdental papilla and midline diastema plus the relationship of gingiva to teeth and lips. From these studies the important fact emerged that dentists are more aware of and familiar with the elements of oral esthetic and features of the orofacial region than the patients [5, 6]. It is, therefore, expected that dentists might have greater influence on decision making while planning esthetics treatment with the patient [7].

While facial esthetic remain the essential demand for patients requesting cosmetic procedures, there is a concomitant focus on preserving the ethnic identity of the facial features that exhibit racial characteristics [8], Dürer stated that despite the concept of facial beauty being viewed subjectively, the assessment of facial proportions could be assumed objectively. He also assumed that disproportionate human faces are unesthetic; however, proportionate features could provide acceptable facial characteristics even if they are not beautiful [9]. Which leads to the conclusion that characteristics and ideals of beauty are influenced by genetics, racial and environmental factors [10]? However, objective measurements remain the fundamental values for esthetic evaluation [11].

As dentists, it is essential for us to know about the ideals of dental esthetic and to transfer this knowledge to dental students during their university study years. We also needed to understand our students’ views about their own smile and their opinions regarding the implications of each facial component contributing to a beautiful face. Besides, we tried to identify if these perceptions of their smile’s appearance would produce negative social behaviours, for example, hiding their smiles. Hence, this study aims to identify dental students’ perceptions about their own smile and their understanding about ideals of facial beauty.

Results

Thirty-six forms were excluded from a total 349 because of missing or incorrect data. Among 313 respondents, 127 (40.6%) were males, and 186 (59.4%) were females, with an age range of (19-25) years. The answers to questions 6 and 8 were binary and not subjected to a normality test. values of the remaining answers were subjected to (Shapiro-Wilk) test [12].

Table 1 shows the mean value and the standard deviation of the students’ responses to the questions regarding their own smile characteristics, with significance levels of differences between the age and sex groups. The results reported almost no significant differences between the two groups’ responses.

Considering the features of an attractive face, the students’ scores were around 50-80 mm on VAS measurements and there were significant differences between males and females in most aspects, as shown in Table 2. The most significant differences related to the eyes, eyebrows, nose, lips, and chin (p = 0.008, 0.01, 0.037, 0.001, and 0.006, respectively). The scale levels were higher for females than males for all facial structures. There were no significant differences for age group for any of the features of an attractive face except for the shape of the chin (p = 0.004).

Regarding questions on perceptions of their own smile, the majority of the responses were significantly related, including the responses or factors relating to hiding the teeth when taking selfie photos, as shown in Table 3. Similarly, strong associations were noted for the answers relevant to the different face structures, as shown in Table 4.

Discussion

Esthetic has become of vital concern within the modern society and have caused an increased demand for esthetic treatments [13]. Facial esthetic has been associated with harmony between smile elements within the facial structures. Smile harmony is dependent on several factors, such as tooth colour, shape, size and position; lip position allowing tooth visibility and gingival colour, shape and amount of gingival display [14]. Lack of proportion between these structures leads to lack of an attractive smile, potentially influencing self-esteem and damaging the person’s psychological and physical health [15].

The results in Table 1 show that students scored around 50-70 on VAS levels. There were no significant differences between the age and sex groups, except for the question related to the look of their gingiva, where a significant difference was found between males and females (p = 0.036). Although question No. 5 related to the appearance of the gums, without further questioning on the form and amount of gingival display, we deduce that females have more tendency than males toward excessive gingival display, which is one of today’s marked esthetic problems. Tjan, et al. reported that approximately 7% of men and 14% of women have excess gingival display in full smile [16, 17]. As the current questionnaire was conducted among dental students, it is reasonable to expect them to have some professional skill regarding their own smile evaluation; therefore, the non-significant differences between males and females in responses to all the remaining questions might be related to their knowledge and close age proximity.

Taking selfies with mobile cameras and sharing them on social media has become a phenomenon of modern life [18]. We added this question purposely to link their real actions with the preceding questions as a cause and effect relation. Except for their teeth shade, significant relations were found between showing their teeth during selfie taking and the factors related to smile expression like smile satisfaction, shape of lips, and evenness of teeth. This reflects that unmasking teeth during smiling is a multifactorial action and not limited to a single factor. About 46% of the students have hidden their teeth during selfie taking. The percentage is close to the result in a previous study by Silva et al. which that found 44% of the respondents would hide their smile with their hands [19]. In contrast, a study by Akarslan, et al. found 22% of smile hiding among 1014 patients [20].

However, the significant differences between male and female responses on the importance of certain facial features of an attractive face might be related to males having different visions compared to females of facial attractiveness or beauty, which could be based on overall or general features of the face. Females usually have different preferences for specific elements of beauty and assess each element individually and independently. Beauty appraisal can be mainly explained as a simple additive method of appraising isolated facial attributes. In a study by Mark, et al. on subjective and objective facial attractiveness ratings and gender differences in objective appraisals of female faces, female patients presenting to a dermatology office rated themselves as more attractive than did judges who viewed photographs of the subjects. Age and marital status were significant factors, and male judges rated attractiveness lower than female judges [21, 22].demographic variables, and how men versus women judge female facial attractiveness. METHODS: Sixty-five women (mean 42 years In the current study, male students rated all questions related to facial attractiveness lower than female students, and the majority of differences between males and females were significant.

The ideal of beauty is always changing; today it is more inclusive than ever, technology has put the power to define beauty in the hands of the people. Mobile phones allow people greater control of their image and include applications that come with filters used for fun, enhancing appearance, and entertainment. Regarding the two age groups, as there were no age gradations the two groups and the age range was so small, answers were similar between the two groups and showed no statistical differences (P>0.05).

Another important relationship was recorded regarding responses on the importance of different face elements to facial esthetic, as the concept of esthetic is not related to a single face element, but rather depends on all facial structures. These structures are very interdependent in constituting a beautiful face.

We should remember that perception of self-beauty does not reflect the actual attributes of beauty. People usually underestimate their own beauty compared to the reality. In another meaning, people tend not to be satisfied with their own appearance and are eager to be better looking. That is why we see gross relationships between the second set of questions which are related to their objective views compared to the subjective assessment applied to their own smile in the first set of questions.

Conclusion

The results of this survey about the students’ perceptions of the attractiveness of their own smiles and ideals of facial attractiveness showed non-significant differences in the students’ responses between the two age groups or between males and females. However, answers to facial attractiveness questions mostly showed significant differences between male and female students but non-significant differences between the two age groups. The outcome of the current study indicates that male and female students have different outlooks toward facial beauty and attractiveness.

Ethical Compliance Section

a. Funding: No finding devoted for this research. b. Ethical Approval: the research proposal was registered with the scientific committee of the college of dentistry and formal ethical approval was obtained after submitting the research proposal to the Ethics and Scientific Committees of the University of Sulaimani. c. Conflict of interest: The authors declare no conflict of interest with this study. d. Consent form: Not required N/A.

Acknowledgment

The Authors forward their appreciation to the scientific committee and department of periodontics, College of Dentistry University of Sulaimani for their kind support during conducting this study.