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J Am Dent Assoc, Vol 138, No 6, 805-808. © 2007 American Dental Association

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	ABSTRACT

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Background. Esthetics has become an important issue in modern society, as it seems to define one’s character. In the past, functional demands were the main consideration in dental treatment. Today, with the decrease in caries prevalence, the focus has shifted toward dental esthetics. The authors conducted a study to evaluate the factors influencing patients’ satisfaction with their dental appearance and with the results of esthetic treatment.

Methods. The authors surveyed a population of 407 adults (mean age, 21 years). They distributed a questionnaire regarding satisfaction with current dental esthetics and previous esthetic treatments.

Results. Of the 407 subjects, 152 (37.3 percent) were dissatisfied with their dental appearance. Tooth color was the primary reason for dissatisfaction (133 [89.3 percent] of 149 subjects), followed by poor tooth alignment (36 [23.7 percent] of 152 subjects), although 110 (27 percent) of the 407 subjects had received orthodontic treatment. The authors found no correlation between patients’ satisfaction with their dental appearance and having undergone any procedure to whiten their teeth. Nevertheless, 134 (88.2 percent) of the dissatisfied subjects reported that they would like to undergo this procedure.

Conclusions. Tooth color was a major factor with regard to dental esthetics. Most subjects were interested in improving their appearance and whitening their teeth.

Clinical Implications. When planning treatment, dentists should take into consideration esthetic objectives in addition to function, structure and biology. This requires the clinician to rely on several disciplines in dentistry to deliver the highest level of dental care, which should lead to a higher level of patient satisfaction.

Key Words: Esthetics; tooth whitening; tooth fracture; orthodontic treatment; caries

Until recently, restorative dentistry considered mostly functional demands (for example, repairing the destructive effects of dental caries). However, with the decrease in caries prevalence,^1–3 the focus has shifted gradually from functional dentistry per se to esthetic dentistry. As a result, the perception of tooth appearance in modern society could influence the changes in patients’ needs.⁴

Several authors have reported discrepancies between the treatment needs perceived by patients and those assessed by dental professionals.^5–9 Osterberg and colleagues¹⁰ reported that esthetic rather than functional factors determine a patient’s subjective need to replace missing teeth. Many patients find the six anterior teeth indispensable but will accept edentulous spaces in posterior regions.^11–17 In our beauty-conscious society, a smile has great impact. When a patient’s smile is destroyed by dental disease, the result often is loss of self-esteem and damage to his or her overall physical and mental health.¹⁸

Because most areas of dentistry deal increasingly with esthetics, we conducted this study to evaluate the factors that influence patients’ satisfaction with dental esthetics and the impact of basic dental treatments on their satisfaction with their dental appearance.

	SUBJECTS, MATERIALS AND METHODS

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The study population consisted of 407 adults (242 men [59.4 percent], 165 women [40.5 percent]), 18 through 26 years of age (mean [± standard deviation] age, 21 ± 3.5 years), who had appointments at a military dental clinic. There was no common background regarding place of birth, education or socioeconomic setting. The Ethics Committee of the Medical Corps, Israel Defense Forces, approved the study.

The survey addressed patients’ satisfaction with regard to dental esthetics issues, such as satisfaction with tooth appearance, color and alignment, as well as satisfaction with previous esthetic treatments such as orthodontic treatment, tooth whitening and anterior restorations. The survey also asked patients to report impairments in tooth appearance (for example, crowding, dental caries, restorations, malalignment, tooth fractures). To ensure anonymity, the clinic staff did not record subjects’ names on the questionnaires. All subjects answered the questionnaire (for a 100 percent response rate).

We collected and analyzed the data by using statistical software (SPSS version 11.0, SPSS, Chicago).

	RESULTS

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As shown in Table 1, more than 60 percent of subjects were satisfied overall with their dental appearance. Nevertheless, only 175 subjects (43 percent) were satisfied with their tooth color. Table 1 also shows subjects’ responses with regard to specific esthetic concerns, such as tooth malalignment. Among the 152 subjects (37.3 percent) who were dissatisfied with their dental appearance, 133 (89.3 percent) of 149 reported that tooth color was the reason. Women were more satisfied than men with their general tooth appearance (65.4 percent versus 59.8 percent, respectively; P = .04). More men than women reported having fractured anterior teeth (21.9 percent versus 15.7 percent, respectively; P = .03). Overall, 56 subjects (13.8 percent) reported that they hid their teeth when smiling.

 
Table 2 shows subjects’ previous esthetic dental treatments. One hundred ten subjects (27 percent) reported having received orthodontic treatment, with more women than men reporting that they received this treatment (36.5 percent versus 19.6 percent; P < .001). Thirty-six (23.7 percent) of the 152 subjects who were dissatisfied with their dental appearance reported being dissatisfied with the alignment of their teeth (26 of these subjects reported having received orthodontic treatment). More women than men reported that they had undergone tooth whitening (17 percent versus 11.2 percent, respectively; P < .03). When asked about dental treatments they would like to receive (Table 3), most subjects were interested in improving their tooth appearance and in whitening their teeth. Of the subjects who reported being dissatisfied with the general appearance of their teeth, 88.2 percent said they would like to have their teeth whitened.

View this table: [in this window] [in a new window]   TABLE 2 Subjects’ self-reported previous esthetic dental treatments.

 

View this table: [in this window] [in a new window]   TABLE 3 Subjects’ desired esthetic dental treatments.

 
Stepwise logistic regression revealed that subjects’ general dissatisfaction with the appearance of their teeth was influenced mostly by tooth color (odds ratio = 13.1; P < .001), followed by self-reported poorly aligned teeth, hiding teeth when smiling and self-reported caries in anterior teeth (Table 4). We should point out, however, that hiding teeth when smiling is a reflection of dissatisfaction, not a cause of it.

View this table: [in this window] [in a new window]   TABLE 4 Factors influencing general dissatisfaction with tooth appearance.

 

	DISCUSSION

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Esthetics has become an important aspect of dentistry. Until about the last two decades, clinicians considered esthetics to be far less important than function, structure and biology. Today, however, if a treatment plan does not include a clear view of its esthetic impact on the patient, the outcome could be disastrous.⁴ Clinicians should begin a treatment plan with well-defined esthetic objectives, and they then should consider the impact of the planned treatment on function, structure and biology. Such planning requires the clinician to rely on several disciplines (such as prosthodontics, periodontics and orthodontics) to deliver the highest level of dental care to the patient.

The main objective of our study was to report patients’ esthetic perceptions of their teeth. Differences in esthetic perceptions among dentists, dental students and laypeople have been examined in the literature. Generally, studies have found that dentists are more sensitive with regard to identifying deviations from the so-called ideal appearance than are laypeople.^9,19–24 Carlsson and colleagues²⁵ and Wagner and colleagues²⁶ found that people who were not dentists had a stronger preference for white teeth than did dentists. In addition, Vallittu and colleagues²⁷ reported that various groups of patients had different attitudes toward the appearance of their teeth. In our study, subjects’ self-reported satisfaction with the general appearance of their teeth was influenced mainly by tooth color.

We found that women were more satisfied with the general appearance of their teeth than were men. In a survey of attitudes regarding dental esthetics, Vallittu and colleagues²⁷ found that tooth appearance was more important to women than to men. We should point out, however, that our cohort consisted of more men than women because of the military setting of the study.

We conducted this study in a young cohort (mean age, 21 years) of subjects who arrived at the dental clinic for a scheduled meeting. We can assume that most of the subjects had received dental treatment in the past. This might have contributed to the discrepancy we found between overall satisfaction with tooth appearance (62.7 percent) and satisfaction with tooth color (43 percent). Nevertheless, 13.8 percent of subjects reported that they hid their teeth when smiling. A major goal of dental treatment should be to reestablish esthetics and enable patients to feel confident about smiling without having to hide their teeth. (However, it is possible that some patients may be overly sensitive about the appearance of their teeth and do not need whitening or other esthetic treatments.)

Tooth whitening was the most desirable treatment reported by subjects in this study. This is a simple and safe procedure. Because of the increasing demand for improved esthetics, dentists should consider the procedure in patients’ overall treatment plans.

	CONCLUSIONS

TOP ABSTRACT SUBJECTS, MATERIALS AND METHODS RESULTS DISCUSSION CONCLUSIONS REFERENCES

 
Subjects in this study considered tooth color to be a major factor with regard to dental esthetics. Most subjects reported that they were interested in improving their tooth appearance and whitening their teeth. Their general satisfaction with tooth appearance was influenced mainly by tooth color, followed by self-reported malaligned teeth, hiding teeth when smiling and self-reported caries in anterior teeth.

When planning treatment, dentists should consider, along with the patient, esthetic objectives in addition to function, structure and biology. This requires the clinician to rely on several disciplines in dentistry to deliver the highest level of dental care, which can lead to a higher level of patient satisfaction.

	FOOTNOTES

Dr. Geiger is a lecturer, Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel.

Dr. Levin is a clinical instructor, Department of Oral Rehabilitation, The Maurice and Gabriela Gold-schleger School of Dental Medicine, Tel Aviv University, Israel, and Unit of Periodontology, Department of Oral and Dental Sciences, Rambam Medical Center, Haifa, Israel. Address reprint requests to Dr. Levin, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel 69978, e-mail "liranl{at}post.tau.ac.il".

	REFERENCES

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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Samorodnitzky-Naveh, G. R. Articles by Levin, L. Search for Related Content PubMed PubMed Citation Articles by Samorodnitzky-Naveh, G. R. Articles by Levin, L. Related Collections Esthetics