Laypersons’ esthetic assessment of teeth with de- or hypomineralization – a web-based survey

Authors

  • Laura Ståhl Department of Orthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Folktandvården Topas, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
  • Nina Sabel Department of Pediatric Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • Julia Naoumova Department of Orthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Specialist Clinic for Orthodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden

DOI:

https://doi.org/10.2340/aos.v84.44231

Keywords:

Dental esthetics, developmental defects of enamel, dental caries, surveys and questionnaires

Abstract

Objective: To investigate young individuals’ esthetic perception of color on the buccal surface of maxillary anterior teeth, self-perception of own tooth color, and general dental esthetic estimates by using a web-based survey.

Methods: A digital questionnaire was advertised on social media in 2024, targeting 18–30-year-olds in Sweden. The questionnaire included attitudes toward own tooth color, cases with molar incisor hypomineralization (MIH), fluorosis (F), white spot lesions (WSL), and general dental esthetic estimates. Chi2 assessed differences between groups, and the independent sample T-test calculated mean differences in responses. Statistical significance was set at p < 0.05.

Results: Out of 2,082 respondents (55% women, 43% men, mean age 25.1 years), 77% rated their tooth color as acceptable, with no gender or age differences (p > 0.05). Pigmented fluorosis was rated as nonacceptable by 94% of the respondents, followed by cases with WSLs. At least 90% cited deviant color on a part of a tooth (DCP) as a reason for nonacceptance. Even tooth color (mean, standard deviation [SD]: 8.02, 2.36) was rated more important than white teeth (mean, SD: 7.25, 2.04), p < 0.001.

Conclusion: De- and hypomineralization on maxillary anterior teeth are perceived negatively by young individuals in terms of dental esthetics. An even tooth color was valued higher than white teeth. 

Downloads

Download data is not yet available.

References

Sabel N, Toft E, Johansson E, Naoumova J. Aesthetic assessment of maxillary lateral and canine implant-supported crowns by laypersons and orthodontists. Acta Odontol Scand. 2024;83:362–70. https://doi.org/10.2340/aos.v83.40738 DOI: https://doi.org/10.2340/aos.v83.40738

Josefsson E, Bjerklin K, Lindsten R. Self-perceived orthodontic treatment need and prevalence of malocclusion in 18- and 19-year-olds in Sweden with different geographic origin. Swed Dent J. 2010;34(2):95–106.

Zaugg FL, Molinero-Mourelle P, Abou-Ayash S, Schimmel M, Brägger U, Wittneben JG. The influence of age and gender on perception of orofacial esthetics among laypersons in Switzerland. J Esthet Restor Dent. 2022;34(6):959–68. https://doi.org/10.1111/jerd.12906 DOI: https://doi.org/10.1111/jerd.12906

Dion K, Berscheid E, Walster E. What is beautiful is good. J Pers Soc Psychol. 1972;24(3):285–90. https://doi.org/10.1037/h0033731 DOI: https://doi.org/10.1037/h0033731

Thompson L, Malmberg J, Goodell N, Boring R. The distribution of attention across a talker’s face. Discourse Process. 2004;38:145–68. https://doi.org/10.1207/s15326950dp3801_6 DOI: https://doi.org/10.1207/s15326950dp3801_6

Eli I, Bar-Tal Y, Kostovetzki I. At first glance: social meanings of dental appearance. J Public Health Dent. 2001;61(3):150–4. https://doi.org/10.1111/j.1752-7325.2001.tb03382.x DOI: https://doi.org/10.1111/j.1752-7325.2001.tb03382.x

Newton JT, Prabhu N, Robinson PG. The impact of dental appearance on the appraisal of personal characteristics. Int J Prosthodont. 2003;16(4):429–34.

Al-Omari I, Al-Bitar Z, Hamdan AM. Do various degrees of tooth decalcification affect orthodontists’, general dentists’ and laypersons’ ratings of smile esthetics? Angle Orthod. 2020;90(3):405–10. https://doi.org/10.2319/080619/515.1 DOI: https://doi.org/10.2319/080619/515.1

Alkhatib MN, Holt R, Bedi R. Age and perception of dental appearance and tooth colour. Gerodontology. 2005;22(1):32–6. https://doi.org/10.1111/j.1741-2358.2004.00045.x DOI: https://doi.org/10.1111/j.1741-2358.2004.00045.x

Suckling GW. Developmental defects of enamel – historical and present-day perspectives of their pathogenesis. Adv Dent Res. 1989;3(2):87–94. https://doi.org/10.1177/08959374890030022901 DOI: https://doi.org/10.1177/08959374890030022901

Weerheijm KL, Jälevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Res. 2001;35(5):390–1. https://doi.org/10.1159/000047479 DOI: https://doi.org/10.1159/000047479

Dean HT. Classification of mottled enamel diagnosis. J Am Dent Assoc (1922). 1934;21(8):1421–6. https://doi.org/10.14219/jada.archive.1934.0220 DOI: https://doi.org/10.14219/jada.archive.1934.0220

Horowitz HS, Driscoll WS, Meyers RJ, Heifetz SB, Kingman A. A new method for assessing the prevalence of dental fluorosis – the Tooth Surface Index of Fluorosis. J Am Dent Assoc. 1984;109(1):37–41. https://doi.org/10.14219/jada.archive.1984.0268 DOI: https://doi.org/10.14219/jada.archive.1984.0268

Fejerskov O. Concepts of dental caries and their consequences for understanding the disease. Community Dent Oral Epidemiol. 1997;25(1):5–12.https://doi.org/10.1111/j.1600-0528.1997.tb00894.x DOI: https://doi.org/10.1111/j.1600-0528.1997.tb00894.x

Gorelick L, Geiger AM, Gwinnett AJ. Incidence of white spot formation after bonding and banding. Am J Orthod. 1982;81(2):93–8. https://doi.org/10.1016/0002-9416(82)90032-X DOI: https://doi.org/10.1016/0002-9416(82)90032-X

Lopes LB, Machado V, Mascarenhas P, Mendes JJ, Botelho J. The prevalence of molar-incisor hypomineralization: a systematic review and meta-analysis. Sci Rep. 2021;11(1):22405. https://doi.org/10.1038/s41598-021-01541-7 DOI: https://doi.org/10.1038/s41598-021-01541-7

Oliveira Chagas F, Rocha Valadas LA, Sorazabal A, Dayo A, Botelho Dantas TCF, Squassi A. Fluoride in drinking groundwater and prevalence of fluorosis in children and adolescents: a systematic review. Acta Odontol Latinoam. 2023;36(3):169–76. https://doi.org/10.54589/aol.36/3/169 DOI: https://doi.org/10.54589/aol.36/3/169

SSalerno C, Cagetti MG, Cirio S, Esteves‑Oliveira M, Wierichs RJ, Kloukos D, et al. Distribution of initial caries lesions in relation to fixed orthodontic therapy: a systematic review and meta‑analysis. Eur J Orthod. 2024;46:cjae008. https://doi.org/10.1093/ejo/cjae008 DOI: https://doi.org/10.1093/ejo/cjae008

Rodd HD, Abdul-Karim A, Yesudian G, O’Mahony J, Marshman Z. Seeking children’s perspectives in the management of visible enamel defects. Int J Paediatr Dent. 2011;21(2):89–95. https://doi.org/10.1111/j.1365-263X.2010.01096.x DOI: https://doi.org/10.1111/j.1365-263X.2010.01096.x

Sakaryalı Uyar D, Uyar T. Do hypomineralized teeth affect parents’ emotional states and attitudes more than other discoloration conditions? J Clin Pediatr Dent. 2023;47(5):162–9.

Van der Geld P, Oosterveld P, Van Heck G, Kuijpers-Jagtman AM. Smile attractiveness. Self-perception and influence on personality. Angle Orthod. 2007;77(5):759–65. https://doi.org/10.2319/082606-349 DOI: https://doi.org/10.2319/082606-349

Glick M, Williams DM, Kleinman DV, Vujicic M, Watt RG, Weyant RJ. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. J Am Dent Assoc. 2016;147(12):915–7. https://doi.org/10.1016/j.adaj.2016.10.001 DOI: https://doi.org/10.1016/j.adaj.2016.10.001

Sweden S. Folkmängd efter ålder, kön och år. År 1968 – 2023. 2024. Available from: https://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__BE__BE0101__BE0101A/BefolkningNy/ [cited 2024-07-15]

Statista. Social media usage in Sweden. 2024. Available from: https://www.statista.com/study/38898/social-media-usage- in-sweden-statista-dossier/ [cited 2025-03-19]

Sweden S. Statistikdatabasen, Levnandsföhållanden, Befolkningens IT användning Användning av internet. 2024. Available from: https://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__ LE__LE0108__LE0108D/ [cited 2025-03-15]

Reis HT, Wilson IM, Monestere C, Bernstein S, Clark K, Seidl E, et al. What is smiling is beautiful and good. Eur J Soc Psychol. 1990;20(3):259–67. https://doi.org/10.1002/ejsp.2420200307 DOI: https://doi.org/10.1002/ejsp.2420200307

Godinho J, Gonçalves RP, Jardim L. Contribution of facial components to the attractiveness of the smiling face in male and female patients: a cross-sectional correlation study. Am J Orthod Dentofacial Orthop. 2020;157(1):98–104. https://doi.org/10.1016/j.ajodo.2019.01.022 DOI: https://doi.org/10.1016/j.ajodo.2019.01.022

Qualtrough AJ, Burke FJ. A look at dental esthetics. Quintessence Int. 1994;25(1):7–14.

Baik KM, Anbar G, Alshaikh A, Banjar A. Effect of social media on patient’s perception of dental aesthetics in Saudi Arabia. Int J Dent. 2022;2022:4794497. https://doi.org/10.1155/2022/4794497 DOI: https://doi.org/10.1155/2022/4794497

European Union. Council Directive 2011/84/EU of 20 September 2011 amending Directive 76/768/EEC, concerning cosmetic products, for the purpose of adapting Annex III thereto to technical progress.: Official Journal of the European Union; 2011. p. 36-8. Luxembourg.

Conway DI, MacPherson LM, Stephen KW, Gilmour WH, Petersson LG. Prevalence of dental fluorosis in children from non-­water-fluoridated Halmstad, Sweden: fluoride toothpaste use in infancy. Acta Odontol Scand. 2005;63(1):56–63. https://doi.org/10.1080/00016350510019748 DOI: https://doi.org/10.1080/00016350510019748

Sonesson M, Twetman S, Bondemark L. Effectiveness of high-­fluoride toothpaste on enamel demineralization during orthodontic treatment-a multicenter randomized controlled trial. Eur J Orthod. 2014;36(6):678–82. https://doi.org/10.1093/ejo/cjt096 DOI: https://doi.org/10.1093/ejo/cjt096

Fragelli C, Barbosa TS, Bussaneli DG, Restrepo M, Cordeiro RCL, Santos-Pinto L. Aesthetic perception in children with molar incisor hypomineralization. Eur Arch Paediatr Dent. 2021;22(2):227–34. https://doi.org/10.1007/s40368-020-00541-x DOI: https://doi.org/10.1007/s40368-020-00541-x

Hasmun N, Vettore MV, Lawson JA, Elcock C, Zaitoun H, Rodd HD. Determinants of children’s oral health-related quality of life following aesthetic treatment of enamel opacities. J Dent. 2020;98:103372. https://doi.org/10.1016/j.jdent.2020.103372 DOI: https://doi.org/10.1016/j.jdent.2020.103372

Zotti F, Albertini L, Tomizioli N, Capocasale G, Albanese M. Resin infiltration in dental fluorosis treatment—1-year follow-up. Medicina (Kaunas). 2021;57(1):22. https://doi.org/10.3390/medicina57010022 DOI: https://doi.org/10.3390/medicina57010022

Athayde GDS, Reis P, Jorge RC, Americano GCA, Fidalgo T, Soviero VM. Impact of masking hypomineralization opacities in anterior teeth on the esthetic perception of children and parents: a randomized controlled clinical trial. J Dent. 2022;123:104168. https://doi.org/10.1016/j.jdent.2022.104168 DOI: https://doi.org/10.1016/j.jdent.2022.104168

Clark DC, Hann HJ, Williamson MF, Berkowitz J. Aesthetic concerns of children and parents in relation to different classifications of the Tooth Surface Index of Fluorosis. Community Dent Oral Epidemiol. 1993;21(6):360–4. https://doi.org/10.1111/j.1600-0528. 1993.tb01099.x DOI: https://doi.org/10.1111/j.1600-0528.1993.tb01099.x

Hawley GM, Ellwood RP, Davies RM. Dental caries, fluorosis and the cosmetic implications of different TF scores in 14-year-old adolescents. Community Dent Health. 1996;13(4):189–92.

Williams DM, Chestnutt IG, Bennett PD, Hood K, Lowe R. Characteristics attributed to individuals with dental fluorosis. Community Dent Health. 2006;23(4):209–16.

İnce-Bingöl S, Kaya B. The impact of dentofacial characteristics and malocclusions on dissatisfaction with dentofacial appearance. Clin Oral Investig. 2024;28(12):661. https://doi.org/10.1007/s00784-024-06060-z DOI: https://doi.org/10.1007/s00784-024-06060-z

Huang X, Qin D, Ngan P, Cao L, Hua F, He H. White spot lesion-related perception of aesthetics and treatment satisfaction among orthodontic patients, orthodontists and other dental specialists. Orthod Craniofac Res. 2024;27(4):626-34.. DOI: https://doi.org/10.1111/ocr.12776

Rattan R, D’Cruz L. Ethical and medico-legal considerations with aesthetic dentistry involving the aesthetic zone. Prim Dent J. 2023;12(2):64–8. https://doi.org/10.1177/20501684231175955 DOI: https://doi.org/10.1177/20501684231175955

Thornton L, Batterham PJ, Fassnacht DB, Kay-Lambkin F, Calear AL, Hunt S. Recruiting for health, medical or psychosocial research using Facebook: systematic review. Internet Interv. 2016;4:72–81. https://doi.org/10.1016/j.invent.2016.02.001 DOI: https://doi.org/10.1016/j.invent.2016.02.001

Whitaker C, Stevelink S, Fear N. The use of Facebook in recruiting participants for health research purposes: a systematic review. J Med Internet Res. 2017;19(8):e290. https://doi.org/10.2196/jmir.7071 DOI: https://doi.org/10.2196/jmir.7071

Wright KB. Researching internet-based populations: advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. J Comput Mediat Commun. 2017;10(3). JCMC1034. https://doi.org/10.1111/j.1083-6101.2005.tb00259.x DOI: https://doi.org/10.1111/j.1083-6101.2005.tb00259.x

Ali SH, Foreman J, Capasso A, Jones AM, Tozan Y, DiClemente RJ. Social media as a recruitment platform for a nationwide online survey of COVID-19 knowledge, beliefs, and practices in the United States: methodology and feasibility analysis. BMC Med Res Methodol. 2020;20(1):116. https://doi.org/10.1186/s12874-020-01011-0 DOI: https://doi.org/10.1186/s12874-020-01011-0

Tsaltskan V, Sanchez Baez R, Firestein GS. Cost-effectiveness of social media advertising as a recruitment tool: a systematic review and meta-analysis. J Clin Transl Sci. 2023;7(1):e180. https://doi.org/10.1017/cts.2023.596 DOI: https://doi.org/10.1017/cts.2023.596

Andrade C. The limitations of online surveys. Indian J Psychol Med. 2020;42(6):575–6. https://doi.org/10.1177/0253717620957496 DOI: https://doi.org/10.1177/0253717620957496

Becker R. Gender and survey participation: an event history analysis of the gender effects of survey participation in a probability-based multi-wave panel study with a sequential mixed-mode design. Methods Data Anal. 2022;16(1):3–32.

Singh S, Sagar R. A critical look at online survey or questionnaire-based research studies during COVID-19. Asian J Psychiatr. 2021;65:102850. https://doi.org/10.1016/j.ajp.2021.102850 DOI: https://doi.org/10.1016/j.ajp.2021.102850

Chandler J, Sisso I, Shapiro D. Participant carelessness and fraud: consequences for clinical research and potential solutions. J Abnorm Psychol. 2020;129(1):49–55. https://doi.org/10.1037/abn0000479 DOI: https://doi.org/10.1037/abn0000479

Additional Files

Published

2025-08-19