Patient satisfaction and aesthetic concern are important factors that must be considered for a successful dental treatment [11]. The present study investigated the perception of dental appearance satisfaction among Saudi adolescents and its relation to DSC, SI, PI and AC using PIDAQ. The results of the present study showed that tooth color and alignment, gender and parents’ educational level affected the psychosocial impact of dental esthetics thus the null hypothesis was rejected.
The results of the current study showed that 80% of students were satisfied or somewhat satisfied with their smiles. The main reasons for smile dissatisfaction were, related to teeth alignment (34%), followed by teeth color (33%), and then teeth shape (22%), while the rest of students didn’t have any problem with their smiles. Similar results were mentioned in previous studies which showed that patients feel better and safer when they are pleased with the alignment and shape of their teeth, as teeth crowding causes negative psychosocial effects [11–14]. Therefore, malocclusion affects facial appeal causing an aesthetic impact on daily living of adolescents that could affect their quality of life [14] due to the link between appearance and social status and acceptability [15].
In line with our results, several studies found that patients’ satisfaction with their dental appearance was affected by tooth color [7,11–13,16,17]. Thus, tooth discoloration could decrease patient’s self-fulfillment and adversely affect his emotional state, which is why patients are seeking cosmetic treatments such as tooth whitening [16]. Contrary to our findings, Höfel et al. [18] reported that tooth color is not related to perceptions of facial attractiveness and thus satisfaction with dental appearance may not be related to facial attractiveness. This might be due to difference in the study design regarding age and the level of education of participants as they were dental experts in Höfel et al. [18].
Our results showed that females had higher PIDAQ and AC compared to males and lower DSC. Similarly, previous studies found higher dental concern and oral demands from females than males who are more comfortable with their dental appearance. This might be related to males’ social life style [19,20]. Also, it was suggested that psychosocial factors are the main motivation that make females require esthetic treatment, therefore they had significantly higher psychological and social impact than males [20,21].
Other studies didn’t find significant differences between males and females in regards to PIDAQ [22,23]. While Afroz et al. [5] determined that Indian men were significantly more concerned about their smile compared to women, and women were more satisfied with their dental aesthetics. The authors suggested that changes in the society and the impact of marketing made men concerned as women with their beauty and their physical appearance [5,22]. The diversity between these findings and the present study could have resulted from differences in age of participants and study methods [19] or due to the ethnic and cultural differences between the studied populations [24].
Obvious malocclusion, tooth color, and being a female are among the factors that increase AC [12]. These findings are in line with the present study which reported higher AC among females in comparison to males, as well as the effect of tooth alignment and color on patients’ dissatisfaction with their smile.
Additionally, participants’ fathers’ university education was statistically significantly associated with a higher psychosocial impact of dental aesthetics (PIDAQ), high psychological impact (PI) and aesthetic concern (AC). Similarly, previous study suggested that individuals with higher education are aware of the effect of dental esthetics on social acceptance [25,26]. But these findings are in contrast to Akarslan et al. [17], who reported an association between the increase in education level and decreased dissatisfaction with dental aesthetics this might be related to difference in age and cultural attitude of participants.
In case of DSC, the results showed that females and participants with mothers’ having university education expressed less positive DSC and high SI. These results are in agreement with previous reports that observed less self-confidence of girls compared to boys [27,28]. In contrast, Chen et al. [26] found that males compared to females, showed more adverse aesthetic attitude and dental self-confidence when anterior teeth were missing, and higher improvement of the social impact, aesthetic attitude and dental self-confidence after implantation [26]. This can be explained by the opinion that males are generally less stable psychologically and live more stressful social life than females [26].
Romero et al. [29] found that participants with university degrees presented higher scores on self-confidence than participants with school education. This might be attributed to the increase in maturity with age and knowledge which is in agreement with our results as our participants were from intermediate and high schools. But their parents’ education might have raised the participants’ needs and aesthetic expectations and decreased their smile satisfaction as participants are looking to reach the best esthetic outcome like their parental role models [30].
There is a strong correlation between dental treatment needs, especially esthetic treatments, and psychological satisfaction with dental appearance that is affected by poor tooth color and alignment [12,13], as this will have an important clinical significance in comprehending treatment needs of this age group particularly when planning cosmetic dental treatment satisfying patient’s needs and expectations [12]. This comes in agreement with our results which showed that causes of smile dissatisfaction were related mainly to improper tooth alignment, color and shape.
The strengths of this study include the high response rate of participants from different areas of the Eastern Province. Hence, the results are representative of the adolescent population in the area of study. However, this study was limited to testing dental appearance satisfaction among adolescents therefore; the results of this study do not represent the older age groups and cannot be generalized to the whole population.
Further Long-term longitudinal studies are required to evaluate the effect of age, level of education, income, social status, and different conditions (physical and psychological) on the dental appearance satisfaction and Psychosocial impact of dental aesthetics.