Year : 2009 | Volume
: 20 | Issue : 2 | Page : 195--200
Dental esthetic satisfaction, received and desired dental treatments for improvement of esthetics
Zuhre Zafersoy Akarslan1, Burak Sadik2, Hulya Erten2, Erdem Karabulut3,
1 Department of Oral Diagnosis and Radiology, Gazi University, Faculty of Dentistry, Ankara, Turkey
2 Department of Operative Dentistry and Endodontics, Gazi University, Faculty of Dentistry, Ankara, Turkey
3 Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
Zuhre Zafersoy Akarslan
Department of Oral Diagnosis and Radiology, Gazi University, Faculty of Dentistry, Ankara
Aim: The purposes of this research were to investigate factors influencing patients«SQ» satisfaction with their present dental esthetic, received previous dental treatments on anterior teeth and basic treatments that they wanted to undergo to improve their dental appearance.
Materials and Methods: A total of 1014 patients who attended a dental school in a major city in Turkey participated in the study. The participants were surveyed with a questionnaire containing questions about gender, age, education level, self-reported tooth appearance, received previous dental treatments on anterior teeth and desired basic esthetic dental treatments. Statistical analysis of the verifying data was made with descriptive statistics, χ2 test and multiple logistic regression analyses.
Results: According to the analyses of the verifying data, 55.1% of the patients were dissatisfied with the color of their teeth, 42.7% with dental appearance, 29.9% with crowding of anterior teeth, 23.3% were hiding teeth while smiling, 16.1% had non-esthetic restorations and 11.9% thought that their anterior teeth were protruding. Esthetic restoration was found to be the most-performed treatment recently (29.0%) and whitening of teeth was the most-desired dental treatment (49.0%). Gender, age and education level had an effect on satisfaction and received previous and desired dental treatments for improvement of esthetics.
Conclusion: Many of the Turkish patients surveyed in the study were dissatisfied and desired the improvement of dental esthetics. Therefore, dentists should consider this as an important dimension in their practice.
|How to cite this article:|
Akarslan ZZ, Sadik B, Erten H, Karabulut E. Dental esthetic satisfaction, received and desired dental treatments for improvement of esthetics.Indian J Dent Res 2009;20:195-200
|How to cite this URL:|
Akarslan ZZ, Sadik B, Erten H, Karabulut E. Dental esthetic satisfaction, received and desired dental treatments for improvement of esthetics. Indian J Dent Res [serial online] 2009 [cited 2019 Dec 13 ];20:195-200
Available from: http://www.ijdr.in/text.asp?2009/20/2/195/52902
Esthetics has become as important as function, structure and biology, until about the last two decades, in dental practice  as current advertising and the media in general emphasize the effect of a pleasant appearance because of its importance in many everyday situations.  This fact leads to changes in patients' esthetic needs and consequence of dental treatment priority. 
Numerous factors are related with dental esthetics, such as the color and the shape of the teeth and the shape of the dental arch. These factors are affected by individual preferences, cultural factors and sociodemographic factors. The viewer's perception of a visual experience could be pleasant and beautiful by one individual and culture, while it could be seen as nasty in another. , The appearance of the teeth could be influenced by gender, age and education level. Females are reported to be more sensitive than males for the appearance of teeth and the importance of teeth decreases with ageing and higher education levels.  Perceived dental treatments on anterior teeth also have an impact on dental esthetics, which is affected by individual preferences and cultures. Unfortunately, in some cases, dentists may develop an esthetic appearance differing from the patient's concepts, resulting in communication problems and unanticipated difficulties. 
As esthetics is an important dimension in dental practice and could be related to individual preferences, cultures, sociodemographic factors and perceived dental treatments, the aims of this study were to evaluate the factors influencing patients' satisfaction with dental esthetics, self-reported received previous dental treatments on anterior teeth and the basic treatments that are required to be undergone by the patient to improve their present dental appearance among a group of Turkish patients attending a dental school in Ankara, a major city in Turkey.
Materials and Methods
A total of 1014 patients attending the Oral Diagnosis Department of a dental school in Ankara in Turkey participated in the present study. The participants consisted of 551 females and 463 males, with an age range of 16-70 (mean 31.8, SD 12.7). After an explanation given by a dentist about the questions (especially about the procedure of received previous treatments and desired treatments), the participants were surveyed with a questionnaire [page 197] containing questions about gender, age, education level and self-reported tooth appearance, received previous treatment(s) on anterior teeth and the basic treatment(s) they wanted to undergo to improve their present dental appearance [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5]. Any questions about the questionnaire were answered by a dentist. Patients who wanted to undergo bleaching, esthetic restoration(s), orthodontic treatment and prosthetic restoration(s) were referred to the operative, orthodontic and prosthetic treatment departments of the dental school, respectively. Statistical analyses of the verifying data were made with descriptive statistics, χ2 test and multivariate logistic regression analyses.
According to the results of the study, 55.1% of the patients were dissatisfied with the color of their teeth, 42.7% were dissatisfied with dental appearance, 29.9% were thinking that their anterior teeth were crowded, 23.3% were hiding their teeth while smiling, 16.1% were thinking of having a non-esthetic restoration(s) and 11.9% were thought that their anterior teeth were protruding.
The most self-reported received previous esthetic dental treatment was found to be as esthetic restoration(s) (29.0%) followed by root canal treatment(s) (16.9%), prosthetic restoration(s) (14.0%), whitening of teeth (9.1%) and orthodontic treatment (8.0%). In spite of the high dissatisfaction percentages of tooth color and tooth alignment, the percentages of patients who received tooth whitening and orthodontic treatment were low.
The most-desired basic treatment for the improvement of dental esthetics was found to be whitening of teeth (49.0%), following esthetic restoration(s) (25.4%), orthodontic treatment (24.5%) and prosthetic restoration(s) (16.9%).
Gender, age and education level had an effect on dental esthetic satisfaction, received previous dental treatments on anterior teeth and desired treatments for improvement of esthetics.
A significant difference was present between males and females who were dissatisfied with the color of their teeth, thinking their teeth were crowded and hiding their teeth when smiling (P 0.05). Details are given in [Table 1].
A significant difference was present between different age groups and dissatisfaction with color, thinking that anterior teeth were crowded, protruding, having non-esthetic restorations and hiding teeth while smiling (P 0.05), but a significant difference was present for having esthetic restoration(s), prosthetic restoration(s), root canal treatment(s) and undergoing orthodontic treatment. The age range that had the highest number of self-reported esthetic restorations was found to be 40-49 years. The presence of prosthetic restorations increased with advanced age. Adults were found to have the highest ratings for undergoing whitening of teeth in the past (13.1%). A significant difference between age and desired treatments was also present for whitening of teeth, orthodontic treatment and prosthetic restoration (P  reported that general satisfaction with dental esthetics in an Israel population was influenced mainly by tooth color, followed by self-reported misaligned teeth and hiding teeth when smiling. Although participants were from different cultures, our results show similarity with their results.
Individual preference, cultural background and social stratum can all influence the subjective recognition of tooth color. , According to our results, 55.1% of the patients were dissatisfied with the color of their teeth. It was reported that 31.6% of the participants in a study conducted in North America,  34% in United States  and 52.6% in China  were dissatisfied with their tooth color. Although the participants in the recent studies and in the present study were from different cultures, dissatisfaction rates show similarity with people in China, but higher with people from America. The color of the present teeth was not determined as it was not an aim of the study.Therefore we could not determine whether the patients actually had discoloration and required bleaching or not. It is a well-established phenomenon that some people who have normal color of teeth have a high expectation for tooth color and are potential clients for the procedure. In such situations, the dentists should give an explanation to these patients as the treatment will be unnecessary and costly. 
Gender had an impact on the general appearance of dental esthetics. In the present study, females were more dissatisfied with the general appearance of their tooth compared with males, but the difference was found to be non-significant. The higher dissatisfaction level for females could be related to the idea that the self-esteems of females could be affected from physical injuries more than males.  Vallittu et al.,  indicated similar results with our findings from Eastern Finland. On the other hand, Samorodnitzky-Naveh et al.,  reported that females were more satisfied with the general appearance of their teeth from males in Israel; however, the cohort consisted of more males than females as the participants were selected from patients attending a military clinic.
Age had an impact on dissatisfaction with dental esthetics. Adolescents and young adults (  showed that older people were more satisfied with their dental appearance in the United Kingdom. These findings show some agreement with the descriptive outcome of the present study.
Age had an effect on satisfaction with tooth color. Young patients, aged between  Thus, older people may be more accepting of poorer dental appearance, incorporate it in their self-image and have less desire to make changes. Aging is not necessarily associated with negative self-precipitation of dental appearance or tooth color. Greater dissatisfaction with dental appearance or color in younger ages may suggest that perceived appearance is linked to cognitive factors other than social and cultural ones. 
Education level did not lead to changes in dissatisfaction in general appearance but led to a change in satisfaction with tooth color in the present study. With the increase in the education level, the dissatisfaction with tooth color deceased. Education is one way by which self-esteem may be enhanced. Thus, it is possible that the attainment of higher education may indirectly improve self-satisfaction with tooth color. Xiao et al.,  reported that dental esthetic satisfaction in a Chinese population was correlated with education level, but not with age and gender.
A major goal of dentistry should be to reestablish esthetics and enable patients to feel confident about smiling without having to hide their teeth.  A great decrease in the percentage of hiding teeth while smiling was observed with the increase in education level, showing that education is an important factor for feeling confident while smiling.
Studies have shown a positive relationship between the self-satisfaction of tooth appearance and the number of teeth present in the oral cavity. This was a limitation of our study as we did not evaluate the number of present teeth, but it may be evaluated in another study. ,,,
The most self-reported received previous esthetic dental treatment was found to be esthetic restoration(s) followed by root canal treatment(s), prosthetic restoration(s), whitening of teeth and orthodontic treatment. As the reasons for received previous treatments were not recorded, the indications of treatments could not be evaluated but the high rates of the presence of esthetic restoration(s) and root canal treatment(s) and the low rates for whitening of teeth and orthodontic treatment could be related with Turkish patients having had received esthetic treatments for treatment of tooth disease, such as caries, pulpitis and fractures rather than cosmetic.
The most-desired basic treatment for the improvement of dental esthetics was found to be whitening of teeth. This could be explained by the fact that most of the patients were not satisfied with their tooth color and many of them had not made any attempt toward tooth whitening in the past. Before performing whitening of teeth, the dentist must ascertain and plan treatment to meet the expectations of the patient. , Therefore, self-acknowledgment of tooth color plays a key role in the demand for the whitening procedure.  Samorodnitzky-Naveh et al.,  reported that most of the subjects were interested in the improvement of their tooth appearance and whitening of teeth in Israel. Our results show consistency with their results. As bleaching is a simple and safe procedure and is desired by approximately half of the participants in this study, it has an important place in esthetic dental procedures.
Orthodontic treatment was found to be the least-desired treatment for improvement of esthetics. This could be due to the anesthetic and long treatment procedure, but as the reasons for the desired treatment decisions were not evaluated as clarified above, this is only an estimation. This is a limitation of the study and could be evaluated in further research.
Sociodemographic factors have an influence on desired treatments. When we evaluate the factors separately, it was found that only age had an impact on desiring whitening of teeth and orthodontic treatment, while both age and education had an impact on desiring prosthetic restorations and both gender and education had an impact on desiring esthetic restorations.
In the present study, no attempt was made to compare the effect of different materials used for dental treatment, such as different bleaching agents, composites and porcelains, on patients' dental esthetic satisfaction. Further research could be made on this topic.
Evidence suggests that a high number of the studied Turkish patients were not satisfied with the present esthetic of their dental appearance and color of their teeth. Although a correlation was not present between dissatisfaction of tooth color and undergoing whitening of teeth recently, many of the patients desired to whiten their teeth. Gender, age and education level had an effect on dissatisfaction and received and desired esthetic treatments. Understanding the prevalence of dissatisfaction of present esthetic and desired treatments for the improvement of esthetics can be a guide for strategies for intervention to improve esthetics.
|1||Samorodnitzky-Naveh GR, Geiger SB, Levin L. Patients' satisfaction with dental esthetics. J Am Dent Assoc 2007;138:805-8.|
|2||Vallittu PK, Vallittu AS, Lassila VP. Dental aesthetics: A survey of attitudes in different groups of patients. J Dent 1996;24:335-8.|
|3||Lombardi RE. The principles of visual perception and their clinical application to denture esthetics. J Prosthet Dent 1973;29:358-82.|
|4||Marunick MT, Chamberlain BB, Robinson CA. Denture aesthetics: An evaluation of laymen's preferences. J Oral Rehabil 1983;10:399-406.|
|5||Brisman AS. Esthetics: A comparison of dentists' and patients' concepts. J Am Dent Assoc 1980;100:345-352.|
|6||Odioso LL, Gibb RD, Gerlach RW. Impact of demographic, behavioral, and dental care utilization parameters on tooth color and personal satisfaction. Compend Contin Educ Dent Suppl 2000;29:S35-41.|
|7||Shulman JD, Maupome G, Clark DC, Levy SM. Perceptions of desirable tooth color among parents, dentists and children. J Am Dent Assoc 2004;135:595-604.|
|8||Xiao J, Zhou XD, Zhu WC, Zhang B, Li JY, Xu X. The prevalence of tooth discolouration and the self-satisfaction with tooth colour in a Chinese urban population. J Oral Rehabil 2007;34:351-60.|
|9||Alkhatib MN, Holt R, Bedi R. Age and perception of dental appearance and tooth colour. Gerodontology 2005;22:32-6.|
|10||Elias AC, Sheiham A. The relationship between satisfaction with mouth and number, position and condition of teeth: Studies in Brazilian adults. J Oral Rehabil 1999;26:53-71.|
|11||Rosenoer LM, Sheiham A. Dental impacts on daily life and satisfaction with teeth in relation to dental status in adults. J Oral Rehabil 1995;22:469-80.|
|12||Locker D, Slade G. Association between clinical and subjective indicators of oral health status in an older adult population. Gerodontology 1994;11:108-14.|
|13||Matthias RE, Atchison KA, Lubben JE, De Jong F, Schweitzer SO. Factors affecting self-ratings of oral health. J Public Health Dent 1995;55: 197-204.|
|14||Preston JD. Current status of shade selection and color matching. Quintessence Int 1985;16:47-58.|
|15||Ashley M, Lamb DJ, Ellis B. Defects of dental appearance assessed by patient and dental student groups. J Oral Rehabil 2001;28:1116-21.|
|16||Jun S. Communication is vital to produce natural looking metal ceramic crowns. J Dent Technol 1997;14:15-20.|