Patients' satisfaction with dental esthetics

Abstract

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

Full text

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 dissatis-
faction (133 [89.3 percent] of 149 subjects), followed by poor tooth align-
ment (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, struc-
ture 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.
JADA 2007;138(6):805-8.
Until recently, restorative
dentistry considered
mostly functional
demands (for example,
repairing the destructive
effects of dental caries). However,
with the decrease in caries preva-
lence,1-3 the focus has shifted gradu-
ally 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 treat-
ment needs perceived by patients
and those assessed by dental profes-
sionals.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’ sat-
isfaction with dental esthetics and
the impact of basic dental treat-
ments on their satisfaction with
their dental appearance.
SUBJECTS, MATERIALS
AND METHODS
The study population consisted of
407 adults (242 men [59.4 percent],
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Dr. Samorodnitzky-Naveh is a clinical instructor, Department of Oral Rehabilitation, The Maurice and
Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel, and Medical Corps, Israel
Defense Forces.
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@post.tau.ac.il”.
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Patients’ satisfaction with dental esthetics
Gili R. Samorodnitzky-Naveh, DMD; Selly B. Geiger, DMD; Liran Levin, DMD
RESEARCH
JADA, Vol. 138 http://jada.ada.org June 2007 805
Copyright ©2007 American Dental Association. All rights reserved.

esthetic treatments such as orthodontic
treatment, tooth whitening and ante-
rior restorations. The survey also asked
patients to report impairments in tooth
appearance (for example, crowding,
dental caries, restorations, malalign-
ment, tooth fractures). To ensure
anonymity, the clinic staff did not
record subjects’ names on the question-
naires. All subjects answered the ques-
tionnaire (for a 100 percent response
rate).
We collected and analyzed the data
by using statistical software (SPSS ver-
sion 11.0, SPSS, Chicago).
RESULTS
As shown in Table 1, more than 60 per-
cent of subjects were satisfied overall
with their dental appearance. Never-
theless, only 175 subjects (43 percent)
were satisfied with their tooth color.
Table 1 also shows subjects’ responses
with regard to specific esthetic con-
cerns, 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 frac-
tured anterior teeth (21.9 percent
versus 15.7 percent, respectively;
P= .03). Overall, 56 subjects (13.8 per-
cent) reported that they hid their teeth
when smiling.
Table 2 shows subjects’ previous
esthetic dental treatments. One hun-
dred ten subjects (27 percent) reported having
received orthodontic treatment, with more women
than men reporting that they received this treat-
ment (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, respec-
tively; P< .03). When asked about dental treat-
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 socioeco-
nomic 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
RESEARCH
806 JADA, Vol. 138 http://jada.ada.org June 2007
TABLE 1
Subjects’ self-reported estimation of tooth
appearance.
QUESTION PERCENTAGE OF SUBJECTS (N = 407)
Yes No
Are you satisfied with your
tooth appearance?
Are you satisfied with your
tooth color?
Do you feel your teeth are
crowded?
Do you feel your teeth are
poorly aligned?
Do you feel your teeth are
protruding?
Do you suffer from dental
caries in your anterior
teeth?
Do you have nonesthetic
restorations in your anterior
teeth?
Do you have fractures in
your anterior teeth?
Are you hiding your teeth
while smiling?
62.7
43.0
18.8
23.2
16.4
22.8
15.0
19.7
13.8
37.3
57.0
81.2
76.8
83.6
77.2
85.0
80.3
86.2
TABLE 2
Subjects’ self-reported previous esthetic
dental treatments.
PREVIOUS TREATMENT PERCENTAGE OF SUBJECTS (N = 407)
Yes No
Orthodontic Treatment
Tooth Whitening
Crowns on Anterior Teeth
Anterior Tooth Implant
Root Canal Treatment in
Anterior Teeth
27.0
13.1
9.9
3.9
15.2
73.0
86.9
90.1
96.1
84.8
Copyright ©2007 American Dental Association. All rights reserved.

ments they would like to receive (Table
3), most subjects were interested in
improving their tooth appearance and
in whitening their teeth. Of the sub-
jects who reported being dissatisfied
with the general appearance of their
teeth, 88.2 percent said they would like
to have their teeth whitened.
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 reflec-
tion of dissatisfaction, not a cause of it.
DISCUSSION
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 disas-
trous.4Clinicians 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, peri-
odontics 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. Dif-
ferences in esthetic perceptions among dentists,
dental students and laypeople have been exam-
ined 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 col-
leagues26 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 dif-
ferent attitudes toward the appearance of their
teeth. In our study, subjects’ self-reported satis-
faction 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 per-
cent). Nevertheless, 13.8 percent of subjects
reported that they hid their teeth when smiling.
A major goal of dental treatment should be to re-
establish esthetics and enable patients to feel con-
fident 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
RESEARCH
JADA, Vol. 138 http://jada.ada.org June 2007 807
TABLE 3
Subjects’ desired esthetic dental treatments.
TREATMENT PERCENTAGE OF SUBJECTS (N = 407)
Yes No
Improvement in Tooth
Appearance (General)
Tooth Whitening
Teeth Alignment
Crowns on Anterior Teeth
77.4
81.8
31.5
13
22.6
18.2
68.4
87
TABLE 4
Factors influencing general dissatisfaction
with tooth appearance.
FACTOR ODDS RATIO
P
VALUE
Are you satisfied with your tooth
color? (Answered “No”)
Do you feel your teeth are poorly
aligned? (Answered “Yes”)
Are you hiding your teeth while
smiling? (Answered “Yes”)*
Do you suffer from dental caries in
your anterior teeth? (Answered “Yes”)
13.1
6.5
3.2
2
< .001
< .001
.003
.03
* Hiding teeth while smiling is a reflection of dissatisfaction, not a cause of it.
Copyright ©2007 American Dental Association. All rights reserved.

esthetic treatments.)
Tooth whitening was the most desirable treat-
ment reported by subjects in this study. This is a
simple and safe procedure. Because of the
increasing demand for improved esthetics, den-
tists should consider the procedure in patients’
overall treatment plans.
CONCLUSIONS
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 con-
sider, along with the patient, esthetic objectives
in addition to function, structure and biology.
This requires the clinician to rely on several disci-
plines in dentistry to deliver the highest level of
dental care, which can lead to a higher level of
patient satisfaction. ■
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Copyright ©2007 American Dental Association. All rights reserved.