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ORAL SELF PERCEPTION OF ESTHETICS AMONG
DENTAL STUDENTS
*
Dr.BASWARAJ M.D.S. ,Dr. JAYASUDHA B M.D.S#., Dr.KUMARSWAMY K. M . M.D.S.$,
Dr. PADMINI M N M.D.S.$, Dr. CHANDRALEKHA B .M.D.S.$
ABSTRACT :
BACKGROUND -The relationship between physical appearance and
perception of an esthetic deviation, and the impact of such deviation
on self-esteem and body image are important issues in determining
the benefits from orthodontic treatment.Studies in social psychology
indicate that physical attractiveness plays a major role in social
interactions and influence the impression of an individual’s social
skill.
AIM - To know the knowledge and attitude towards orthodontic
treatment and compare perceived aesthetic impact of malocclusion among
dental students from first year BDS to Final year, house surgeons and variables
influencing to perceive orthodontic treatment.
MATERIAL &METHODS- The subjects for the study were 230 dental
students of Government Dental College, Bangalore, Karnataka. The entire subject
group consisted of 93 males and 137 females of I, II, III, IV B.D.S. students
and house-surgeons aged between 17 to 23 years. Each class room of the
subjects were visited and the data was collected by asking the student to fill the
lengthy questionnaire form. An analysis of Variance (ANOVA) was done between
the five class groups to test for statistical difference on Mean variable scores
for each group. Categorical variables were evaluated with a Chi-square analysis.
As mentioned above the subject pool was divided by sex for purpose of
analysis.
RESULTS - 75 percent of the students were aware of their dental aesthetics,
17 percent were not aware and 8 percent did not have knowledge about
aesthetics at all. 97 percent of females had very good knowledge about dental
aesthetics compared to 93 percent of males.75 percent of the females were
satisfied with the attractiveness of their teeth while the male percentage was only
69. House surgeons had more positive attitude with the least among the first
year students. Among satisfaction, I year students and House-surgeons were very
much satisfied. III year students were least satisfied.
CONCLUSION – The dental students had very good knowledge about the
orthodontic treatment and had positive attitude towards orthodontic treatment. Dental
attractiveness being the most influencing variable to perceive orthodontic treatment.
Females had very good knowledge, satisfaction and positive attitude compared
to the males regarding dental aesthetics and treatment. House surgeons were
much more aware, very much satisfied and had a more positive attitude which was
decreasing towards I year students.
Key Words : Dental Students, Self Evaluation, Satisfaction,Dental Aesthetics
*Reader, Department of Orthodontics, PDUDC,Solapur, India
#
Reader,Department of Pedodontics, PDUDC,Solapur, India
Department of Orthodontics, Government Dental College & Research Centre,
Bangalore.
$
INTRODUCTION:
Orthodontic treatment is often carried out to improve the patient’s dental
appearance, hence the individual’s attitude to his or her own malocclusion is an
important factor in determining treatment need. The main factors influencing
the decision for treatment are aesthetic improvement and psychological aspect.
Measuring and recording the prevalence of mal-occlusion and treatment need
in a population is useful for the planning of orthodontic services. In addition,
knowledge about the attitude of patients to malocclusion is becoming
increasingly important in orthodontics. Without a satisfactory estimate of the
need and demand for treatment, it is difficult to develop and organize a
meaningful orthodontic services.The orthodontist routinely evaluates his patients
and prescribes treatment plans in order to satisfy the often stated goals of
1) Good dental function
2) Stability of teeth and jaw position, and
3) Dental esthetics.
While the first two considerations have been researched and are
continually discussed in all the specialties of dentistry, the last aspect dental esthetics has escaped research attention. The lack of research material in this
area is due not to a lack of interest in the subject but to the difficulty of
measuring exactly what “Dental esthetics” actually means. There are
quantifiable determinants of good dental function and stability but how does
one measure esthetics? Esthetics is judgmental commodity, and the assumed
variability in individual judgements (beauty is in the eye of the beholder)
makes it difficult to make generalized statements. The aim of this study is to
find out the perception of dental appearance among dental students.
The aim of this study was to find out the perception of self evaluation and
satisfaction of dental appearance among dental students.
MATERIAL &METHODS:
The subjects for the study were 230 dental students of Government
Dental College Bangalore, Karnataka. The entire subject group consisted of 93
males and 137 females of I, II, III, IV B.D.S. students and house-surgeons, aged
between 17 and 23 years. The data for this study were collected visiting to the
class-rooms of subjects, they were required to complete a lengthy questionnaire
form. Embodied in the questionnaire were questions on self-evaluation of their
teeth as well as self-satisfaction with their teeth.
The test items formulated to assess the subjects were
1. Ability to recognise the presence or absence of mal-occlusion.
2. Knowledge to perceive the impact of mal-occlusion among various classes
and sexes.
3. Their opinion about orthodontic treatment.
These questions had been divided into three groups.
1. Q 1 -- 3 is to know about the awareness about their dentition.
2. Q 4 -- 13 is to know about their self-satisfaction .
3. Q 14 – 17 is to know about their attitude towards orthodontic treatment.
Each question had three possible answers, ranging from positive response
to a negative response and these answers were given scores ranging 0-2, the
highest score to the best and the lowest to the worst.
Statistical evaluation of the data set was completed by grouping the
answers to each of the questions into three categories: a negative response, an
average response, and a positive or favorable response. An analysis of Variance
(ANOVA) was then done between the five class groups to test for statistical
difference on Mean variable scores for each group. Categorical variables were
evaluated with a Chi-square analysis. As mentioned above the subject pool was
divided by sex for purpose of analysis.
RESULTS:
Crosstab
Count
40
SEX
VAR00001
Total
1.00
2.00
3.00
4.00
5.00
1.00
22
23
32
27
33
137
Total
25
13
10
17
28
93
47
36
42
44
61
230
30
20
10
Count
.00
SEX
.00
0
1.00
1.00
Table I
V AR00001
Dental Students Males Vs Females
2.00
3.00
Graph I
4.00
5.00
When subjects were asked about their awareness, more than 75 percent of the
students were aware of their dental aesthetics, 17 percent were not aware and
8 percent did not have knowledge about aesthetics at all.
97 percent of females had very good knowledge about dental aesthetics
compared to 93 percent of males. However the difference is statistically not
significant. When asked about self-satisfaction with the attractiveness of their
teeth, this
indicated a fairly objective evaluation of their own dental
malocclusion situation. 43 percent of the subjects were satisfied with the
attractiveness of their teeth,39 percent of the subjects reported negative feeling
towards their teeth, 17 percent of the subjects showed a strong positive feeling
towards their teeth(Table-3 and Graph-3).
Crosstab
60
Count
VAR00001
1.00
2.00
3.00
4.00
5.00
Total
III
2.00
28
24
24
30
48
154
50
3.00
12
5
8
6
7
38
Total
7
7
10
8
6
38
40
47
36
42
44
61
230
30
III
20
1.00
10
2.00
Count
1.00
0
3.00
1.00
Table III
2.00
3.00
4.00
5.00
Graph III
V AR00001
75 percent of the females and 69 percent of males were satisfied with the
attractiveness of their but there was no statistical significance found(Table-4
Crosstab
and Graph-4).
Count
50
1.00
VAR00001
Total
1.00
2.00
3.00
4.00
5.00
4
4
3
4
4
19
39
27
34
31
37
168
40
3.00
Total
4
5
5
9
19
42
47
36
42
44
60
229
30
20
IV
1.00
10
Count
IV
2.00
2.00
0
3.00
1.00
Table IV
V AR00001
2.00
3.00
4.00
5.00
Graph IV
When asked about attitude towards orthodontic treatment, 44 percent had
strong positive attitude,35 percent were satisfied with their attractiveness and
19 percent were not aware of it(Table-5 and Graph-5).
Crosstab
Count
40
1.00
VAR00001
1.00
2.00
3.00
4.00
5.00
Total
10
8
9
9
16
52
3.00
33
26
30
29
35
153
Total
4
2
3
6
9
24
30
47
36
42
44
60
229
20
V
10
1.00
Count
V
2.00
2.00
0
3.00
1.00
Table V
V AR00001
2.00
3.00
4.00
5.00
Graph V
Among females there was almost even split between strongly positive(47
percent) and satisfactory (47 percent) attitude towards orthodontic treatment ,
there was no statistical significance found between males and females. The most
influencing variable was that, the teeth affect the way their face looks, and this
was considered to be the most influencing factor among all the classes.
SATISFACTION Vs ATTITUDE
When asked about how many students were un-satisfied about their
dental attractiveness and had a positive attitude towards orthodontic treatment77 percent of subjects were un-satisfied of which 55 percent had a positive
attitude towards orthodontic treatment.
38 percent of subjects were very much satisfied with the attractiveness
of their teeth and 47 percent of these were having satisfied attitude. This is
Crosstab
highly statistically significant(Table-6
and Graph-6).
Count
40
1.00
VAR00001
Total
1.00
2.00
3.00
4.00
5.00
9
3
8
6
6
32
25
21
23
20
37
126
3.00
Total
13
12
11
18
18
72
47
36
42
44
61
230
30
20
VI
10
1.00
Count
VI
2.00
2.00
0
3.00
1.00
Table VI
V AR00001
2.00
3.00
4.00
5.00
Graph VI
When compared among different class groups about the knowledge of
dental aesthetics ,House- surgeons were very much aware of it followed by
final year students. However there was no statistical significance found among
the various classes. First year students were not aware of dental aesthetics very
much (Table-8 and Graph-8).
Crosstab
Count
50
VIII
1.00
2.00
3.00
4.00
5.00
Total
2.00
5
3
2
1
1
12
3.00
13
13
12
12
20
70
32.00
29
20
27
31
39
146
Total
1
1
47
36
42
44
60
229
40
30
V III
20
1.00
2.00
10
3.00
Count
1.00
VAR00001
0
32.00
1.00
Table VIII
V AR00001
2.00
3.00
4.00
5.00
Graph VIII
When asked among different class groups about satisfaction of dental
aesthetics, House-surgeons were very much satisfied about their teeth followed
by final years. All the class groups were happy with their attractiveness almost
equally. However the House –surgeons and II years were not happy with their
dental aesthetics. This Crosstab
was not statistically significant (Table-9 and Graph-9).
Count
60
1.00
VAR00001
Total
1.00
2.00
3.00
4.00
5.00
9
5
4
2
10
30
38
31
37
40
49
195
3.00
50
Total
1
2
2
5
47
36
42
44
61
230
40
30
IX
20
1.00
10
Count
IX
2.00
2.00
0
3.00
1.00
Table IX
V AR00001
2.00
3.00
4.00
5.00
Graph IX
When the attitude towards orthodontic treatment was compared among
different classes , house surgeons had more positive attitude while first year
students showed the least. Among satisfaction, I year students and House-surgeons
were very much satisfied. III year students were least satisfied. No statistical
significance was found.
DISCUSSION:
During the course of dental surgery it was noticed that there were number
of dental students with minor to moderate malocclusion who have not sought
orthodontic treatment. This prompted us to study the motivation and
psychological factors among the dental students.
These dental students can reflect how much the general population is
aware of orthodontic treatment.
To study Dento-facial aesthetics and assess the patients thought
regarding aesthetics, a long questionnaire was made having options with scores
allotted to each answer.
It had been hypothesized that increased experience with and availability
of orthodontic service should be translated into differences in aesthetics rating
and perception of treatment need(Tulloch et al.,1984). Similar results have
been obtained in our present study where seventy-five percent of the
dental students who were having knowledge about orthodontic treatment were
aware of dental aesthetics.
The decision making process that a person undertakes when judging
his/her own dental aesthetic satisfaction may be broken down into several
steps. First to know about the awareness about their own dentition, after this step
second their self- satisfaction ,and finally their attitude toward orthodontic treatment.
We may postulate that females had very good knowledge about dental aesthetics
compared to the males.
When asked about self- satisfaction of their teeth, the study indicates that the
subjects did make fairly accurate self –evaluation of their own mal-occlusions.
The unsatisfied subjects with their dental aesthetics had positive attitude
towards orthodontic treatment. This is highly statistically significant(p < 0.01).
The highly satisfied subjects with their dental aesthetics were aware of
the attractiveness of their teeth. This is also highly statistically significant.
The sex difference is probably due to the fact that the standards for
acceptable facial form are more clearly delineated for females and thus
deviations in dental form that adversely influence facial outline are more
important to females than males.Similar results were obtained by Sumant Goel et
al, 2002. The subjects who had malocclusion and did not report to the
orthodontic clinic seems to believe that teeth do not affect their aesthetic value
and this appeared to be more of an ignorance and that teeth does significantly
affect facial appearance and lack of knowledge was the main factor that kept
away from treatment.
Heidi Kero Suo et al.,2002; According to their results access to free of
cost orthodontic treatment was likely to affect the treatment rate, where as it
did not seem to influence the self perceived need for treatment.
Similar study conducted by Sven Helm et al., 1985:that certain
malocclusions especially conspicuous occlusal and space anomalies , may
adversely affect body image and self concept not only at adolescence but also
in adulthood. It is in strongest association with study conducted by Kari
Birkeland et al., 2000.that both children and parents rate pleasant aesthetics as
an important factor for psycho-social well-being.
In accordance with Mark J. Bentele et al., 2002.Index of Orthodontic
Treatment Need(IOTN) is a promising teaching aid for improving educational
outcomes for orthodontic referral wherein the dental students are able to diagnose
malocclusion and make appropriate referrals of potential orthodontic patients.
SUMMARY AND CONCLUSION:
A group of dental students (93 males and 137 females),17-23 years of
age were given a questionnaire containing questions which evaluated
knowledge of their teeth, level of self-satisfaction, their attitude towards
orthodontic treatment and the overall perception of dental appearance.
From the study done it was found that the subjects had
1. Very good knowledge about the orthodontic treatment and had positive attitude
towards orthodontic treatment.
2. The teeth affect the way their face looks, dental attractiveness the most
influencing variable to perceive orthodontic treatment.
3. Females had very good knowledge, satisfaction and positive attitude
compared to the males regarding dental aesthetics and treatment.
4. House surgeons were much more aware, very much satisfied and had a more
positive attitude which was decreasing towards I year students.
5. The un-satisfied subjects had positive attitude towards orthodontic treatment.
REFERENCES:
1.Mathew Shue-Te Yeh et al The Relationship of 2 professional occlusal indices
with patients’ perceptions of esthetics, function, speech, and orthodontic treatment
need. Am J Orthod 2000;118:421-8.
2.Mark J. Bentele et al Efficacy of training dental students in the index of
orthodontic treatment need. Am J Orthod 2002 ;122:456-62.
3.N.A.Mandall et al Perceived aesthetic impact of malocclusion and oral selfperceptions in 14-15year old Asian and Caucasian children in Greater
Manchester. Euro J Orthod 1999;21:175-83.
4.Orlagh Hunt et al The Aesthetic component of the Index of Orthodontic
Treatment Need validated against lay opinion. Euro J Orthod 2002;24:53-59.
5.Robert S.Corruccini An Epidemiologic transition in dental occlusion in world
populations. Am J Orthod 1984;11:419-26.
6.Sven Helm, Sven Kreiborg, and Beni Solow Psychosocial implications of
malocclusion :A 15 year follow up study in 30 year old Danes. Am J Orthod
1985;2:110-18.
7.S.M. Cochrane et al Perception of facial appearance by orthodontists and the
general public. J Clin Orthod 1997;3:164-68.
8.Stephen Richmond and Charles P.Daniels
International comparisons of
professional assessments in orthodontics: Part 1-Treatment need. Am J Orthod
1998;113:180-5.
9.Susan P . Mc gorray et al Evaluation of orthodontists’ perception of
treatment need and the Peer Assessment Rating(PAR)Index. Angle Orthod
1999;69(4):325-33.
10.Seppo Jarvinen
Indexes for orthodontic treatment need .Am J Orthod
2001;120:237-9.
11.Sumant Goel et al Orthodontic Treatment Need-An Orthodontist’s and
patient’s
perception. J
Ind
Orthod
Society 2002;35:28-35.
Correspondance
Dr. BASWARAJ
Reader, Department of orthodontics & Dentofacial
Orthopedics
PDUDC Solapur, India
Email : [email protected]