1. Introduction

Modern society is placing increasing value on physical esthetics, with dental esthetic procedures gaining prominence for their ability to complement facial beauty [1, 2]. The positive psychosocial effect of pleasant facial esthetics is a major reason for patients (especially young individuals) to seek corrective dental treatment [3, 4]. The need for esthetic facial changes is often self-perceived and can influence an individual’s self-confidence and quality of life [5–9].

Among the many dental principles on facial proportion, several are directed toward anterior teeth since they are critical for a pleasant smile [10, 11]. In addition to smile design, esthetic dentistry has other aspects, such as facial symmetry, occlusion, the role of the buccal corridor, the “golden proportion,” and appearance of the gingiva––all of which positively or negatively influence a patient’s smile, confidence, and beauty [12–17]. The perception of beauty is distinct for each individual; this subjectivity might influence their degree of concern toward esthetics, depending on their gender, age, ethnicity, socioeconomic status, marital status, level of education, occupation, familial influence, cultural exposure, and social media [18–22].

Esthetic treatments are designed to combine several dental specialties, including restorative, orthodontic, prosthodontic, and surgical treatments [23]. Therefore, dental students, who are exposed to all branches of dentistry, should be educated about the available esthetic treatments and their respective indications; this reflects the competency of a new dentist [2].

The dental esthetic requirements of the general population have been studied in detail, and dental students worldwide have also been surveyed [24, 25]. It is important that dental students have adequate knowledge and awareness of the differences in how dental professionals and laypeople perceive dental esthetics; this may ultimately help them to better understand their patients’ needs and expectations and formulate optimal treatment plans. However, only few studies have been conducted on dental students’ perception of their esthetics and desired treatment in Saudi Arabia [23, 26, 27]. Furthermore, no Saudi Arabian studies have compared the self-perception of their own dental esthetics among male and female dental students with respect to factors such as their academic year, GPA, and monthly household income. To address this research gap, we aimed to evaluate self-perceived esthetics among male and female dental students from different academic years at our university and assess the effect of their perception on the desired esthetic treatment.

2. Materials and Methods

A cross-sectional study was conducted among 450 male and female dental students aged 17–23 years at King Saud University, Riyadh, Saudi Arabia. First, second, third, fourth, and fifth-year dental students were recruited; 45 male and 45 female students were included from each academic year. The institutional review board of our university approved the study protocol (approval number: E-18-2808), and informed consent was obtained from each participant.

Data were collected using structured questionnaires that were randomly distributed among the students. These questionnaires were prepared in English and translated to Arabic for easier understanding. The questions were based on a previous study with modifications [18]. The questionnaire comprised a covering page that described the project and confirmed the subjects’ confidentiality, followed by four sections: section A comprised the gender, current academic year, grade point average (GPA) range of the previous academic year, and monthly household income range of the student (Table 1); section B comprised “yes/no” questions that included 15 items pertaining to self-perception of dental esthetics (Tables 2 and 3) [18]; section C comprised multiple-answer questions on the desired esthetic treatments (Table 4) [23]; and section D allowed the students to select their preferred tooth shade using the BlueLine shade guide (Ivoclar Vivadent, Schaan, Liechtenstein, Germany) (Table 5) [23]. We included the most commonly used shades in clinical practice: A1, A2, A3, B1, B2, B3, and BL1 [28]. The shade codes were hidden and numbered randomly to ensure that the students’ knowledge of the shades did not affect their selection [29]. A pilot experiment was conducted at the beginning of the study by distributing the questionnaire to eight students to ensure its clarity and comprehensibility.

Data were analyzed using the SPSS 21.0 software (IBM Inc., Chicago, USA). Subject characteristics and outcome variables were presented using descriptive statistics (frequencies, percentages, mean, and standard deviation). Pearson’s chi-square test was used to compare the distribution of categorical responses in relation to the categorical study variables. The level of statistical significance was set at a p-value of 0.05.

3. Results

Of the 450 total subjects, 385 responded to the questionnaire (response rate = 85.5%). Gender was approximately equally distributed: 51.9% of subjects were females, and 48.1% were males. We intended to enroll an equal number of subjects from each academic year, but the number of responses from the 4th- and 5th-year students was marginally less. Approximately 70.1% of subjects had a GPA of 4.5–5, and 64.4% had a monthly household income of over 20,000 SAR (Table 1).

Among the 15 questions on the self-perception of esthetics, the question “Is there someone you believe has a better smile than you?” received the highest number of “yes” responses (88.6%). We recorded valid “no” responses for the following questions: “Are you satisfied with the way your gums look?” (21.3%); “Are you self-confident about smiling?” (20.5%); “Do you like the way your teeth are shaped?” (19.5%). The remaining 11 questions had “yes” responses ranging from 17.9 to 70.6% (Table 2). We compared these responses to the characteristics of the subjects (gender, academic year, GPA, and monthly household income) and recorded the following results.

4. Discussion

Having pleasing facial features is essential for an individual to form their esthetic perception and value their physical attractiveness [30]. Eyes, followed by the smile, are the most prominent features in a person’s facial appearance [31]. The self-perceived image of dental esthetics can influence a person’s self-confidence, satisfaction, quality of life, psychological condition, and social interactions [32–39]. Moreover, evaluating a patient’s dental esthetic perception is crucial for dentists to understand their needs and manage their expectations regarding the treatment outcomes [40].

In this study, we observed that 79.5% of male and female respondents were confident about their smiles, with no statistically significant difference with respect to gender. This result is in accordance with those of previously published articles [15, 18, 23]. Women are more aware of and concerned about their dental esthetics as compared with men [22, 40–44]; we observed a similar phenomenon where most of our female subjects frequently covered their mouths with their hands and preferred to be photographed from the “good” side of their face. This may be because females pay more attention to their dental appearance than males and tend to be more critical when assessing their smile esthetics [40]. Most of our subjects were satisfied with the appearance of their gums, with females being more satisfied as compared to males. This finding is consistent with that of a previous study where the majority of female dental students were satisfied with their gums [23].

Dental students with a GPA of 4.5–5.0 reported lower levels of satisfaction with their smiles. This might be because students who perform well academically might undergo a more rigorous critical appraisal regarding their smile esthetics [15].

Esthetic color perception is subjective and depends on an individual’s gender, experience, social circumstances, and educational background [31]. Several previous studies have compared tooth-color esthetic perception between laypersons and dental practitioners [18, 30, 40, 41, 43]. In our study, we observed that 1st-year students preferred “BL1” to whiten their teeth. This might be because the media emphasizes extremely white teeth as attractive and aspirational for most people [23]. The 1st-year students’ opinions were closer to those of laypersons due to their insufficient knowledge and experience in analyzing a smile correctly and professionally [41]. In contrast, older students were more realistic and preferred the appearance of natural teeth, which resulted in them showing more satisfaction regarding their current tooth color [31, 45]; this was particularly true for 5th-year students. This finding is in line with that of another study, wherein a low percentage of 5th-year students were found to desire whiter teeth [15]. In terms of a gender-based shade preference, we observed that a significantly higher percentage of females chose the “B1” shade as compared with male subjects. On the other hand, Ansari et al. [46] reported that male subjects were more interested in procuring the whitest shade of teeth as compared to the female subjects.

We found that the level of academic experience (academic year in dental school) directly correlated with the students’ knowledge of treatment options. This result is similar to that of a previous study, where treatment knowledge was related to awareness of facial attractiveness, higher education level, and more clinical experience [23].

In terms of desired dental treatment, we recorded that 66.5% of our subjects preferred posterior tooth-colored restorations despite knowing that amalgam and gold restorations have higher survival rates. Another study showed similar results; it demonstrated that 69.2% of dental students preferred composite restorations over amalgam in posterior teeth, indicating that dental students place a high level of importance on the appearance of their teeth [23, 27].

Teeth whitening was the most desired treatment, followed by orthodontic treatment. This can be attributed to the students’ desire to conform to an “attractive” image of straight and white teeth since they are more sensitive than laypersons in detecting deviations from the “ideal” dental appearance [41]. These findings are similar to the results reported in the study of Subait et al. [27].

Orthodontics was the most desired treatment among 4th-year students. Male students demonstrated a higher need for orthodontic treatment and ceramic veneers. The demand for orthodontic treatment has been increasing among adolescents and young adults due to increased concerns about appearance and esthetics, which makes it one of the most desired treatments in the general population [47–52]. On the contrary, da Silva et al. [18] found that most dental students in their study were satisfied with the shape and alignment of their teeth; this finding was attributed to the fact that most students had undergone orthodontic treatment before their enrollment in dental school.

Lastly, we observed that students with a household income of less than 10,000 SR had a greater preference for tooth-colored restorations. This is because low-income populations would tend to seek affordable yet esthetic dental treatment.

A limitation in this study was the use of only one of the available approaches for assessing dental esthetic perception, as there has not yet been a consensus regarding an optimal, standardized, and objective evaluation method. Future investigations should consider the use of objective clinical examinations to evaluate students’ perception of their smile esthetics.

5. Conclusions

The majority of dental students in our study were confident about their smiles. Females were more aware and concerned about their dental esthetics than males. Younger students preferred whiter teeth; however, older students in higher academic years tended to be more satisfied with the natural appearance of their teeth. The most desired treatment options were teeth whitening and orthodontics.

Additional Points

Clinical Significance. The concept of an ideal smile differs for dental professionals and laypersons. We recommend that this difference be considered each time a dentist designs a treatment plan since patients may often have exaggerated expectations of treatment outcomes (e.g., having unnaturally white and straight teeth). Understanding this difference in perception will help dental practitioners recognize their patients’ needs, manage their expectations, participate in their decision-making process, and design effective treatment plans to produce better outcomes.

Disclosure

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of Interest

The authors declare that they have no known conflicts of interest or personal relationships that could have influenced the work reported in this paper.