Influence of dental esthetics on social perceptions of adolescents judged by peers


The relationship between physical appearance and social attractiveness is well established in the literature. The purpose of this study was to determine whether dental esthetics influenced the perceptions of teens when judging a peer’s athletic, social, leadership, and academic abilities.


The frontal-face smiling photographs of 10 teenage volunteers were each altered to create 1 image with an ideal arrangement of teeth and 1 with a nonideal arrangement. Two parallel surveys were constructed with 1 photo displaying either an ideal or a nonideal smile image of each subject. If the ideal smile image appeared in 1 survey, then the nonideal smile appeared in the other. Two hundred twenty-one peer evaluators sucessfully rated the pictures in 1 of the surveys by indicating their perception of each subject’s athletic, social, leadership, and academic abilities.


The subjects’ photographs with ideal smile esthetics were consistently rated higher on average than the same subjects’ images with nonideal smile esthetics. The differences in ratings between ideal and nonideal smiles were significant for perceptions of athletic performance ( P = 0.0141), popularity ( P <0.0001), and leadership ability ( P <0.0001), but not for academic performance ( P = 0.0548).


On average, ratings for the ideal smiles in perceived athletic, social, and leadership skills were about 10% higher than those given for images with nonideal smiles. Based on these findings, it would be expected that orthodontic treatment resulting in improved smile esthetics can provide modest social benefits for adolescent patients.

There is a strong relationship between physical appearance and social attractiveness that is well documented in the literature. The “what is beautiful is good” concept is that attractive people derive social benefits attributable to their appearance because of physical stereotyping. For example, several studies have demonstrated that better-looking persons are perceived to be more intelligent and more qualified at job interviews. People assume that attractive persons are more likely to get higher-paying and more prestigious jobs, and have happier marriages. In addition, appearance can affect the verdict and sentencing of trial defendants.

Satisfactory peer relationships, especially during childhood, are important for successful emotional and social development. Based on “what is beautiful is good,” it is logical to believe that more physically attractive children have an advantage over their less attractive peers. Young and Cooper studied the influence of 33 personal and social characteristics on popularity in 9- to 13-year-old American children. Of the diverse characteristics evaluated, “attractive facial appearance” was the most influential for the achievement of real-life popularity. Whereas adults were apparently more sensitive to behavioral variations, Young and Cooper concluded that young adolescents were primarily influenced by appearance in determining peer acceptance. Kleck et al showed photographs of unacquainted peers to a group of 9- to 14-year-old boys and asked them to choose who would be more desirable as friends based on appearance alone. The boys whose photographs were chosen actually turned out to be more well accepted socially after 2 weeks of genuine interaction at summer camp, demonstrating that appearance was the primary factor in determining real-life popularity in this peer group.

In many cases, the perceptions of others can produce an environment that might affect a person’s social and intellectual development. Teachers have been shown to view the behavioral transgressions of attractive children as less serious than those of unattractive children. Unattractive children were found more likely to be the victims of bullying in English schools. The responses of those around them experienced by children can influence their future behavior. When the expectations that facial appearance creates are actually realized, this is termed the “self-fulfilling prophecy effect.” For example, physically unattractive American college students were perceived to be less socially attractive and, subsequently, were objectively found to be less socially skilled. For young adults, it has been shown that the more attractive ones are judged subjectively as more socially adept and actually do enjoy richer social lives. These instances demonstrate that the perceptions of others can influence the way a person acts and even result in long-term developmental changes. Some people have been shown to have the ability to focus on achieving goals based on the way others perceive them.

Facial appearance plays a significant role in the determination of overall physical attractiveness. In the face, Goldstein found that the eyes and the mouth were the most important factors in a hierarchy of characteristics for determining esthetic perceptions. However, Tatarunaite et al reported that overall facial attractiveness does not depend on any 1 feature. They found that the cheeks, chin, eyes, hair, lips, nose, skin, and teeth all contributed equally. Nevertheless, most Americans believe that dental appearance is “very important” in social interactions. Several studies have shown that poor dental esthetics is considered to be less attractive overall. Shaw demonstrated that the faces of children with normal incisal arrangement were seen as significantly more attractive than the same faces showing any other dental condition.

A 2001 study found that orthodontists and general dentists agreed that the psychosocial gains derived from orthodontic treatment were more significant than the dental health gains. Improvement in attractiveness was the benefit most often cited by orthodontists and was also highly rated by general dentists. The assumption might be that improved attractiveness achieved through orthodontic treatment could also result in other social benefits. The purpose of this study was to determine whether dental esthetics influenced the perception of adolescents when judging a peer’s athletic, social, leadership, and academic abilities.

Material and methods

Institutional review board approval was obtained from Virginia Commonwealth University to conduct this study. With consent from selected subjects and their parents, 10 orthodontic patients between the ages of 10 and 16 years volunteered to participate. Each subject was asked to specify his or her race as African American, Asian, Hispanic, white, or other. If no answer was given, they were labeled as other. For 9 of the subjects, the frontal face smiling photograph was digitally altered to create 2 images: 1 with ideally aligned teeth (ideal smile), and 1 with a nonideal arrangement of teeth (nonideal smile). All other facial features were left undisturbed. One patient (subject 7) was only given a nonideal smile and served as the control.

Two parallel surveys were constructed by using Access 2000 (version 9.0.2720, Microsoft, Redmond, Wash). Each contained 1 photo of each subject, some with ideal smiles and some with nonideal smiles. If a subject’s ideal smile appeared in survey 1, then his or her nonideal smile was used in survey 2. The photo of subject 7 was the control and had a nonideal smile in both surveys. The characteristics of the photos in the 2 surveys are shown in Table I . Examples of the ideal and nonideal smile photographs are given in Figure 1 .

Table I
Image smile characteristics
Subject Race Sex Survey group
1 2
1 African American Male Nonideal Ideal
2 Other Female Nonideal Ideal
3 White Female Ideal Nonideal
4 African American Female Ideal Nonideal
5 White Female Nonideal Ideal
6 White Female Ideal Nonideal
7 White Female Nonideal
8 White Male Nonideal Ideal
9 Other Male Ideal Nonideal
10 Asian Male Nonideal Ideal

Subject 7 with a nonideal smile image was shown to both groups of evaluators.

Fig 1
Images of subjects: A and B, images of 1 subject with an ideal smile (survey 1) and a nonideal smile (survey 2); C and D, images of another subject with a nonideal smile (survey 1) and an ideal smile (survey 2); E and F, images of a third subject with an ideal smile (survey 1) and a nonideal smile (survey 2).

A total of 226 evaluators rated the pictures in 1 or 2 surveys by indicating their agreement or disagreement with the following statements: (1) this person is good at sports, (2) this person is popular, (3) this person is a good leader, and (4) this person is smart.

The evaluators were asked to participate if they were between the ages of 10 and 16 years in the peer group of the patient volunteers. There were no other inclusion or exclusion criteria. Evaluators were recruited outside a movie theater approximately 30 miles from Richmond, Va. In exchange for their participation, evaluators were given a $5 movie voucher. They were not told that the study was related to dental appearance. Each evaluator received either survey 1 or survey 2, chosen randomly.

Evaluators received directions on how to complete the survey. They were asked to state their age, race, and sex. The remainder of the survey consisted of the patients’ pictures. Under each photograph were the 4 statements accompanied by a visual analog scale (VAS) from 0 to 100 mm for each. A sliding bar was moved digitally along the scale starting from 50 (neutral), with completely disagree (0) and completely agree (100) as the anchors. The corresponding numeric value was recorded in an Excel 2000 (version 9.0.2720, Microsoft) file. There were 10 photographs in each survey, each with 4 questions, for a total of 40 ratings by each evaluator. At no time was any evaluator shown both the ideal smile and nonideal smile photographs of the same subject, since those images appeared in different surveys.

The ratings for the 4 questions accompanying the control photograph of patient 7, which was the same in both surveys, were compared between surveys 1 and 2 by using analysis of variance (ANOVA). The primary research interest was to determine whether evaluators rated the patients with a nonideal smile differently than those with an ideal smile for the 4 characteristics: athletic performance, popularity, leadership ability, and academic performance. In addition, evaluator characteristics such as sex, race, and age, as well as patient characteristics such as sex, race, and picture number, were considered when testing for ideal vs nonideal differences. This was accomplished by using repeated-measures mixed-model analysis software (version 9.1; SAS Institute, Cary, NC).


A total of 221 evaluators successfully completed 1 of the 2 surveys. The other 5 evaluators were excluded from further analyses because they had minimal or no variability in their responses on the 100-mm VAS; their ratings for the questions were all 50, meaning that they viewed the photos but did not provide judgment. Not all evaluators provided all demographic information, but the characteristics of those who did are summarized in Table II . There were no significant differences in the sex ( P >0.05) or race ( P >0.05) distributions between the evaluators who answered surveys 1 or 2. Overall, half of the evaluators were female, and half were male; 38% were African American, 42% were white, and each of the other ethnic groups comprised less than 10% of the total respondents. The mean age of the evaluators who completed the study was 14.4 ± 1.6 years.

Table II
Description of evaluators
Variable Survey group
1 (n = 113) 2 (n = 108)
Female (n) 46 59
Male (n) 60 45
African American (n) 40 40
Asian (n) 4 6
Hispanic (n) 7 5
White (n) 40 48
Other (n) 14 6
n 105 105
Mean (y) 14.42 14.42
SD (y) 1.55 1.62

The image of subject 7 with a nonideal smile, used as a control, was identical in both surveys. There were no significant differences between the ratings given for the 4 questions accompanying the control photo by the respondents to surveys 1 and 2 ( P >0.05).

As shown in Figure 2 and detailed in Table III , the subjects’ photographs with ideal dental esthetics were consistently rated higher on average than the same subjects’ photographs with nonideal dental esthetics. The differences in ratings between ideal and nonideal smiles were significant for judgments on athletic performance ( P = 0.0141), popularity ( P <0.0001), and leadership ability ( P <0.0001). Differences in ratings for perceived academic performance were not statistically significant ( P = 0.0548). The effects of the subject and the evaluator characteristics on ratings for athletic performance, popularity, leadership ability, and academic performance are shown in Table IV .

Fig 2
Ratings for perceived social characteristics between ideal and nonideal smiles.

Table III
Differences in ratings between images with ideal and nonideal smiles
Image Smile Estimate SE 95% CI P value
Athletic performance
Nonideal 49.88 1.18 47.55 52.20
Ideal 53.30 1.25 50.84 55.76
Difference 3.42 1.39 0.69 6.15 0.0141
Nonideal 49.09 1.25 46.63 51.55
Ideal 57.36 1.30 54.79 59.92
Difference 8.26 1.31 5.69 10.84 <0.0001
Leadership ability
Nonideal 52.12 1.22 49.72 54.53
Ideal 58.05 1.28 55.54 60.55
Difference 5.92 1.31 3.35 8.50 <0.0001
Academic performance
Nonideal 59.00 1.20 56.63 61.36
Ideal 61.58 1.27 59.09 64.08
Difference 2.59 1.35 −0.05 5.23 0.0548
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Apr 11, 2017 | Posted by in Orthodontics | Comments Off on Influence of dental esthetics on social perceptions of adolescents judged by peers
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