Attitudes toward Dental Appearance in 50- and

60-Year-Old Subjects Living in Sweden

GUNNAR E. CARLSSON, LDS, ODONT DR/PHD*
ANDERS JOHANSSON, LDS, ODONT DR/PHD†
ANN-KATRIN JOHANSSON, LDS, ODONT DR/PHD‡
SVEN ORDELL, LDS§
GUNNAR EKBÄCK, LDS¶
L E N N A R T U N E L L , L D S , O D O N T D R / P H D ||

ABSTRACT
Background: Attitudes toward the importance of general appearance have varied much, not only
over time but also among groups of individuals of different age and other characteristics.
Whether the situation is similar regarding dental appearance does not seem to have been studied.
Purpose: The aim was to study the differences in attitudes toward dental appearance between
two large samples of 50- and 60-year-old subjects.
Materials and Methods: Identical questionnaires were sent to all subjects born in 1942 and 1952
living in two Swedish counties in 2002 (N = 17,444; N50 = 8,881, N60 = 8,563). The final
response rate was 72.2% (N = 12,599). In this study, responses to four statements on the impor-
tance of dental appearance have been analyzed with respect to gender and age.
Results: Many of the responses to the four statements differed with gender and age. To the first
statement (“To have beautiful and perfect teeth is very important for how you are treated by
other people”), 73% agreed at age 60 compared with 64% at age 50 (p < 0.001). Approximately
90% of the subjects agreed with the second statement (“Minor esthetic imperfections of the teeth
have no importance, only they function well”). Logistic regression indicated that several vari-
ables were significantly associated with the statements. Besides age and gender, education and
self-assessed dental problems were most important.
Conclusion: Attitudes toward the importance of dental appearance differed both between
genders and age groups in these population samples living in Sweden.

CLINICAL SIGNIFICANCE
The varying attitudes toward dental appearance in the population must be acknowledged in
treatment decisions.
(J Esthet Restor Dent 20:46–56, 2008)

*Professor emeritus, Department of Prosthetic Dentistry, Göteborg University, Göteborg, Sweden

†Professor, Department of Oral Sciences—Prosthodontics, Faculty of Dentistry,
University of Bergen, Norway
‡Associate professor, Department of Oral Sciences—Cariology, Faculty of Dentistry,
University of Bergen, Norway
§Consultant, Östergötland County Council, Linköping, Sweden
¶Consultant, Örebro County Council, Örebro, Sweden
||Associate professor, Department of Oral Public Health, Malmö University, Malmö, Sweden

© 2008, COPYRIGHT THE AUTHORS

JOURNAL COMPILATION © 2008, BLACKWELL PUBLISHING
46 DOI 10.1111/j.1708-8240.2008.00148.x
 CARLSSON ET AL

INTRODUCTION often a discrepancy between the MATERIALS AND METHODS

A ttitudes toward the importance

of our general appearance
have shown rapid changes over the
dentist’s and the patient’s percep-
tion of treatment need and opinions
on dental esthetics.14–17 In a study
Population and Response Rate
In 2002, a questionnaire was
mailed to all 50- and 60-year-old
past decades. Differences have been first performed in one country and subjects in two Swedish counties,
found not only over time but also then extended to six countries, it Örebro and Östergötland (N =
with respect to age, gender, and was demonstrated that assessment 17,444; N50 = 8,881, N60 = 8,563).
various groups of individuals.1–3 of the significance of dental Individuals not responding within 2
Whether the situation is similar appearance varied widely among weeks were given a reminder by
regarding dental appearance does dentists, dental technicians, and letter. If they still did not answer, a
not seem to have been studied, even laymen/patients between, as well as new questionnaire was sent. The
though interest in dental esthetics within, countries.18,19 final response rate was 72.2% (N =
has increased rapidly during the last 12,599), with some age (50-year-
few decades among both patients Opinions on the attractiveness of olds = 70.2%, 60-year-olds =
and dentists. To create a natural attributes such as style of clothes, 75.5%) and gender variation
facial and dental appearance has hairdressing, and makeup show (Table 1).
become an important task in rapid changes with time as well as
prosthodontics and in restorative between different age groups.20 There was some variation in the
dentistry. New materials and clini- Whether there are similar changes response rate for the four state-
cal methods have given dentists a in opinion on dental appearance ments on dental appearance ana-
potential for improving the dental does not seem to have been studied. lyzed in this study (Table 2).
appearance of their patients.4 The purpose of this study was to
Numerous articles and books have compare opinions on dental Analysis of Nonresponse
appeared on the dental market to appearance in two population The nonresponse has been analyzed
correspond to the demand, but samples of 50- and 60-year-old previously in a part of the sample.
there are conflicting opinions on subjects. It was hypothesized that For the total group born in 1942
the treatment alternatives.5,6 Even if (1) the younger subjects (50-year- and 1952, only the gender, age, and
the development of new esthetic olds) would emphasize the impor- county of the nonresponders could
restorations is of great value for tance of dental appearance more be analyzed. There was no signifi-
clinical dentistry and patients, it also than the older ones (60-year-olds), cant difference between the nonre-
has a “dark side,” and overtreat- and (2) women would emphasize sponders with regard to county. In
ment and other ethical complica- the importance of dental appear- the total population, there were
tions have been discussed.7–10 ance more than men do. 50.6% men and 49.4% women.

Studies have indicated associations TABLE 1. AGE AND GENDER DISTRIBUTION (%) OF THE ORIGINAL SAMPLE AND
THE PARTICIPANTS IN THE STUDY.
between dental appearance and
Sample Women Men 50-Year-Old 60-Year-Old
quality of life and general well-
being.11,12 It has also been sug- Original sample* 8,539 (49.3%) 8,774 (50.7%) 8,836 8,502

gested that judgments concerning Participants 6,573 (52.4%) 5,961 (47.6%) 6,160 6,374
the personal characteristics of *N = 17,444; some data were lost during transfer from the official register to our data set:
131 regarding gender, 106 regarding birth year; this explains the small discrepancies between
others are influenced by dental numbers in the text and this table.
appearance.13 However, there is

VOLUME 20, NUMBER 1, 2008 47

 ATTITUDES TOWARD DENTAL APPEARANCE

TABLE 2. STATEMENTS, NUMBER OF RESPONDERS (N), AND RESPONSE RATE (%) Statistical Methods
TO EACH STATEMENT.
All statistical analyses were per-
Women (50 and Men (50 and
Statement 60 Years Old) 60 Years Old) formed using the Statistical Package
1. To have beautiful and perfect teeth 6,417 (75.8%) 5,809 (67.0%) for Social Sciences (Release 14,
is very important for how you are SPSS, Inc., Chicago, IL, USA) on an
treated by other people. IBM personal computer (Dell Corp.
2. Minor esthetic imperfections of the 6,187 (73.1%) 5,806 (67.0%) Ltd., Bracknell, Berks, UK). The
teeth have no importance, only they Chi-squared test was used for
function well. assessing the differences between
3. A tooth loss that is visible is something 6,374 (75.3%) 5,797 (66.8%) ages 50 and 60 and between men
to be ashamed of. and women. For logistic regression,
4. It does not matter how you look, only 6,400 (75.6%) 5,786 (66.7%) the forward conditional method
that you can chew what you like.
was adopted. Each of the four
statements was, after dichotomiza-
tion, used as a dependent variable
However, there was an overrepre- and oral conditions (e.g., satisfac- in the logistic regression model. The
sentation of women who answered tion with teeth and dental appear- statements were all dichotomized
the questionnaire—that is, 46.2% ance, oral problems, oral hygiene with “agree completely” and “agree
men and 53.8% women (p < habits, number of teeth). This study to a large extent,” set as 1, and “do
0.001). The response rate for those has focused on answers to four not fully agree” and “do absolutely
born in 1942 (60-year-olds) was statements on the importance of not agree,” set as 2. All 26 vari-
significantly higher than those born dental appearance (Table 2). All of ables listed in Table 3 were entered
in 1952 (50-year-olds) (p < 0.01). these statements should be as independent variables in each of
Previous analyses of nonresponse answered by marking one of four the four models. The results of
performed on those born in 1942 alternatives: “agree completely,” these analyses were given as odds
demonstrated some minor deviation “agree to a large extent,” “do not ratios (OR) with 95% confidence
from a random distribution, for fully agree,” or “do absolutely not intervals (CI) and adjusted p values.
example, an overrepresentation of agree.” In some of the analyses, the With respect to the large samples
women and individuals with low responses have been dichotomized analyzed, which entails that even
education and fewer teeth.21,22 by combining the first two to very small differences and weak
Thus, some caution is advisable in “agree” and the last two to associations can reach statistical
interpreting the data. “do not agree.” significance, the significance level
was set to 1% (p < 0.01).
Questionnaire The complete questionnaire design,
The questionnaire comprised 53 originally used in a study of 50- RESULTS

questions, with altogether 123 year-old subjects in 1992, has Responses to the four statements
items. The questions were divided previously been described.23 related to dental appearance exhib-
into socioeconomic conditions (e.g., Descriptions of the 10-year ited relatively small, but mainly
age, gender, occupation), general follow-up examinations of statistically significant, differences
health (e.g., physician visits, these subjects in 2002 have also between the 50- and 60-year-old
tobacco habits, drug consumption), been published.22,24 subjects (Figures 1–4). For three of

© 2008, COPYRIGHT THE AUTHORS

48 JOURNAL COMPILATION © 2008, BLACKWELL PUBLISHING
 CARLSSON ET AL

TABLE 3. DICHOTOMIZATION OF INDEPENDENT VARIABLES (DESCRIPTIONS 1 AND 2) USED IN THE STEPWISE LOGISTIC
REGRESSION MODELS.
Variable Number Variable Description 1 Description 2

1 Gender Man Woman

2 Birth year 1942 1952
3 Social group Worker All others
4 Place of birth Nordic countries Outside Nordic countries
5 Place of living Densely populated area Countryside
6 Social contacts/week 1–5 contacts >5 contacts
7 Working hours Full-time Less than full-time
8 Education Elementary/lower school High school/university
9 Healthy Yes/on the whole No/absolutely not
10 Refrain from dental care Yes, cannot afford Never refrained
11 Dentist type Private Public dental health
12 Dental fear in childhood Yes No
13 Tooth grinding/clenching No or some problems Rather great/great problems
14 Color of teeth No or some problems Rather great/great problems
15 Form of teeth No or some problems Rather great/great problems
16 Overbite/overjet No or some problems Rather great/great problems
17 Crowding of teeth No or some problems Rather great/great problems
18 Spacing of teeth No or some problems Rather great/great problems
19 Pain in TMJ region No or some problems Rather great/great problems
20 Smoking Daily Not daily
21 Smokeless tobacco Daily Not daily
22 Alcohol Use alcohol Never use alcohol
23 Dry mouth at night Yes often and sometimes Seldom or never
24 Oral hygiene habits Brush teeth £2 times/day Brush teeth >2 times/day
25 Number of teeth All or almost all remaining Many missing and no teeth
26 Removable denture No Yes

the four statements (1, 3, 4), there compared with 64% at age 50 60-year-old subjects (Figure 2).
were statistically significant (Figure 1). Women disagreed more The men were slightly more
differences between the opinions often with the statement than the critical to the statement than the
of women and men in both men did, both at age 50 (p < 0.01) women, but the difference
age groups. and 60 (p < 0.001). decreased with increasing age
(at age 50, p < 0.05 and at age
The 60-year-old subjects agreed Approximately 90% of both 60, nonsignificant).
more with the first statement (“To women and men agreed with the
have beautiful and perfect teeth is second statement (“Minor esthetic The response to the third statement
very important for how you are imperfections of the teeth have no (“A tooth loss that is visible is
treated by other people”) than the importance, only they function something to be ashamed of”)
50-year-old subjects, similar in both well”). There were small, but signif- demonstrated evident differences
genders (p < 0.001). In the total icant (p < 0.001), differences in between the age groups (Figure 3).
sample, 73% agreed at age 60 attitudes between the 50- and The proportion of those who

VOLUME 20, NUMBER 1, 2008 49

 ATTITUDES TOWARD DENTAL APPEARANCE

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0%
Age 50 women Age 50 men Age 60 women Age 60 men Age 50 women Age 50 men Age 60 women Age 60 men

Agree completely Agree to a large extent Agree completely Agree to a large extent
Do not fully agree Do absolutely not agree Do not fully agree Do absolutely not agree

Figure 1. Distribution (%) of the responses to the Figure 2. Distribution (%) of the responses to the
statement “To have beautiful and perfect teeth is very statement “Minor esthetic imperfections of the teeth have
important for how you are treated by other people” among no importance, only they function well” among 50-year-old
50-year-old (women, N = 3,246; men, N = 2,780) and (women, N = 3,252; men, N = 2,780) and 60-year-old
60-year-old subjects (women, N = 3,171; men, N = 3,029) subjects (women, N = 3,161; men, N = 3,026) examined in
examined in 2002 (N = 6,200). 2002.

100% 100%

80% 80%

60% 60%

40% 40%

20% 20%

0% 0%
Age 50 women Age 50 men Age 60 women Age 60 men Age 50 women Age 50 men Age 60 women Age 60 men

Agree completely Agree to a large extent Agree completely Agree to a large extent
Do not fully agree Do absolutely not agree Do not fully agree Do absolutely not agree

Figure 3. Distribution (%) of the responses to the Figure 4. Distribution (%) of the responses to the
statement “A tooth loss that is visible is something to be statement “It does not matter how you look, only that you
ashamed of” among 50-year-old (women, N = 3,223; men, can chew what you like” among 50-year-old (women, N =
N = 2,774) and 60-year-old subjects (women, N = 3,151; 3,235; men, N = 2,771) and 60-year-old subjects (women,
men, N = 3,023) examined in 2002. N = 3,147; men, N = 3,015) examined in 2002 (N = 6,162).

agreed with the statement was sensitive to a visible tooth loss than old subjects, with the fourth state-
greater in both genders at age 60 the younger ones, and women more ment (“It does not matter how you
than at age 50, and at both occa- so than men. look, only that you can chew what
sions women agreed more often you like”) (Figure 4). The disagree-
than men did (p < 0.001 for all The great majority did not agree, ment with the statement was more
comparisons). This indicated that and there were only small differ- frequent among the women than
the older subjects were more ences between the 50- and 60-year- among the men (p < 0.001 both at

© 2008, COPYRIGHT THE AUTHORS

50 JOURNAL COMPILATION © 2008, BLACKWELL PUBLISHING
 CARLSSON ET AL

TABLE 4. RESULTS (p < 0.01) OF LOGISTIC REGRESSION (FORWARD CONDITIONAL regarding the color of their teeth,
METHOD) FOR THE FIRST STATEMENT (“TO HAVE BEAUTIFUL AND PERFECT TEETH
IS VERY IMPORTANT FOR HOW YOU ARE TREATED BY OTHER PEOPLE”) AS respectively, to agree with the state-
DEPENDENT VARIABLE AND THE 26 VARIABLES LISTED IN TABLE 3 AS
INDEPENDENT VARIABLES (N = 8,138).
ment. Subjects with higher educa-
Independent Variable OR 95% CI for OR p tion and those who had to refrain
Male 1.32 1.20–1.46 <0.001 from dental care because of eco-
60 years old 1.44 1.30–1.59 <0.001 nomic reasons were more inclined
Born outside the Nordic countries 2.04 1.39–2.97 <0.001 to agree with the statement than
High school/university education 1.30 1.17–1.43 <0.001 those with lower education and
Refrained from dental care 1.64 1.37–1.96 <0.001 those who never had refrained from
Problems with color of teeth 1.92 1.43–2.57 <0.001
dental care, respectively.
Problems with spacing of teeth 2.63 1.37–4.95 <0.01
OR = odds ratio; CI = confidence interval.
OR denotes those who agreed with the statement. In the second model, only three
independent variables reached the
significance level of p < 0.01
TABLE 5. RESULTS (p < 0.01) OF LOGISTIC REGRESSION (FORWARD CONDITIONAL (Table 5). For example, there was a
METHOD) FOR THE SECOND STATEMENT (“MINOR ESTHETIC IMPERFECTIONS OF
THE TEETH HAVE NO IMPORTANCE, ONLY THEY FUNCTION WELL”) AS DEPENDENT
significantly greater chance that
VARIABLE AND THE 26 VARIABLES LISTED IN TABLE 3 AS INDEPENDENT those who reported no or only
VARIABLES (N = 8,380).
Independent Variable OR 95% CI for OR p
small problems with the form of
their teeth, compared with those
50 years old 1.30 1.10–1.52 <0.01
No problems with the form of the teeth 2.14 1.38–3.31 <0.01 with rather great or great such
Brush teeth £2 times/day 1.35 1.10–1.66 <0.01 problems, agreed with the state-
ment “Minor esthetic imperfections
OR = odds ratio; CI = confidence interval.
OR denotes those who agreed with the statement. of the teeth have no importance,
only they function well.”

ages 50 and 60). However, the dif- people” as dependent variable, the There were significant associations
ference between women and men differences between men and between several independent vari-
was slightly greater at age 50 (81 women and between the two age ables and the third statement, but
and 75%, respectively) than at age groups were verified (Table 4). The OR was, in general, low (Table 6).
60 (78 and 74%, respectively). highest OR was for spacing of teeth The highest OR (1.5) was for the
(2.6). There was a significantly variable “refrain from dental care.”
Logistic Regression greater chance that a person report-
Several variables were significantly ing rather great or great problems There was a greater chance (OR =
associated with the statements regarding spacing of teeth agreed 1.9) for subjects who reported no
(Tables 4–7; in the tables, only with the first statement in compari- or only some problems with the
associations with a significance son with those without this prob- color of their teeth, in comparison
level of p < 0.01 or better have been lem. Similarly, there were greater with those with such problems, to
listed). In the first model, with the chances for individuals born out- agree with the statement “It does
statement “To have beautiful and side, rather than within the Nordic not matter how you look, only that
perfect teeth is very important for countries, and those with, com- you can chew what you like”
how you are treated by other pared with those without, problems (Table 7). A cross-table

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 ATTITUDES TOWARD DENTAL APPEARANCE

TABLE 6. RESULTS (p < 0.01) OF LOGISTIC REGRESSION (FORWARD CONDITIONAL difference among the men, whereas
METHOD) FOR THE THIRD STATEMENT (“A TOOTH LOSS THAT IS VISIBLE IS
SOMETHING TO BE ASHAMED OF”) AS DEPENDENT VARIABLE AND THE 26 the 50-year-old women considered
VARIABLES LISTED IN TABLE 3 AS INDEPENDENT VARIABLES (N = 7,460).
dental appearance more important
Independent Variable OR 95% CI for OR p
than the 60-year-old women, in
Female 1.28 1.17–1.41 <0.001 accordance with the hypothesis. It
60 years old 1.31 1.19–1.44 <0.001
is possible that the attitudes would
Elementary/lower school 1.25 1.14–1.38 <0.001
Refrained from dental care 1.49 1.27–1.75 <0.001 have differed more if the age differ-
Problems with tooth grinding/clenching 1.41 1.14–1.77 <0.01 ence had been greater, for example,
Not a daily smoker 1.22 1.08–1.39 <0.01 between 20- and 60-year-old
Alcohol users 1.29 1.12–1.48 <0.001 subjects. This would be of interest
OR = odds ratio; CI = confidence interval. to investigate.
OR denotes those who agreed with the statement.

The 60-year-old subjects were born

in 1942, during the World War II,
TABLE 7. RESULTS (p < 0.01) OF LOGISTIC REGRESSION (FORWARD CONDITIONAL
METHOD) FOR THE FOURTH STATEMENT (“IT DOES NOT MATTER HOW YOU LOOK, which stretched the economy of the
ONLY THAT YOU CAN CHEW WHAT YOU LIKE”) AS DEPENDENT VARIABLE AND THE
26 VARIABLES LISTED IN TABLE 3 AS INDEPENDENT VARIABLES (N = 5,711). country. During the childhood of
Independent Variable OR 95% CI for OR p these subjects, dental health was, in
£5 social contacts/week 1.33 1.10–1.61 <0.01 general, poor, and their parents
Elementary/lower school 1.34 1.18–1.52 <0.001 usually had lost teeth replaced by
Not healthy 1.30 1.12–1.51 <0.01 removable dentures. Both country
No problems with color of teeth 1.94 1.38–2.72 <0.001 and family economy improved
Brush teeth £2 times/day 1.31 1.11–1.55 <0.01
rapidly after the war, and the situa-
OR = odds ratio; CI = confidence interval. tion was quite different already in
OR denotes those who agreed with the statement.
1952, when the 50-year-olds were
born. Not only the different age,
TABLE 8. DISTRIBUTION (%) OF ANSWERS FROM 8,073 SUBJECTS TO THE FOURTH but also the varying experiences
STATEMENT (“IT DOES NOT MATTER HOW YOU LOOK, ONLY THAT YOU CAN CHEW
WHAT YOU LIKE”).
from childhood and adolescence to
Color of Teeth Agree Disagree adulthood for these two birth
No/small problems 34.6 65.4 cohorts, might partly explain the
Rather great/great problems 28.3 71.7 differences in attitudes toward den-
tal appearance found between 50-
and 60-year-olds.
demonstrates the distribution of subjects would be more sensitive to
answers to the fourth statement statements on the importance of The second hypothesis was based
(Table 8). dental appearance than the older on the common belief that women
ones. In contrast to this hypothesis, are more interested in their appear-
DISCUSSION the 60-year-olds emphasized the ance than men are, and that this
The first hypothesis of the study importance of dental appearance would also apply to dental appear-
was based on the rapidly increasing more than the 50-year-olds for the ance. However, this hypothesis had
interest in dental esthetics, and it first three statements. For the to be rejected for the first two state-
was thought that the younger fourth statement, there was no age ments because the men emphasized

© 2008, COPYRIGHT THE AUTHORS

52 JOURNAL COMPILATION © 2008, BLACKWELL PUBLISHING
 CARLSSON ET AL

the importance of dental appear- lost teeth. A study of the attitudes of the present study of individuals
ance more than the women. For the of male Saudi patients toward living in Sweden would apply to
last two statements, the women replacement of lost teeth demon- similar aged populations in other
were more sensitive to deficiencies strated that subjective perceptions countries. As demonstrated in this
in dental appearance, consistent of esthetic and functional treatment study, many background factors are
with the hypothesis. needs were highly variable.16 important for the attitudes toward
Several studies have shown relatively dental appearance. For example,
The great majority of those who low levels of agreement between the differences in culture, education,
answered the questions agreed that patients’ perceived need and the economy, traditions, and dental
beautiful and perfect teeth are very dentists’ recommendation of treat- care systems between various coun-
important in how you are treated ment.14–17,25,26 The varying attitudes tries might result in still greater
by other people. This supports found in the present study are thus variation in attitudes. Related issues
the findings of an experimental consistent with previous findings. were investigated in an interna-
study using computer-aided manip- tional study, and both similarities
ulation of images to ascertain the Statements 2 and 4 tried to explore and differences were found.19 Three
influence of visible dental decay on opinions on the relative importance quarters of participating dentists,
the subjective ratings of personal of esthetics versus function. The dental technicians, and patients in
characteristics. In comparisons results were seemingly divergent. that study judged good function of
between individuals with and with- However, it should be noted that the teeth as more important than beau-
out dental decay, the participants wording of the statements was quite tiful teeth. However, there were dif-
judged those without decay to be different. Approximately 90% ferences between the professional
more socially competent, show agreed that minor esthetic imperfec- groups and the patients as well as
greater intellectual achievement, tions of the teeth have no impor- between countries and between cen-
and have better psychological tance; they only have to function ters in the same country. Also in the
adjustment.13 There seems to be well. On the other hand, less than present study, the country of birth
universal agreement on the impor- 25% agreed with the statement that was associated with the attitude
tance of dental appearance. In a it does not matter how you look; toward the importance of dental
study performed in six countries, only that you can chew what you appearance (Table 4). After exten-
approximately 95% of the partici- like. Most people obviously con- sive immigration during the last
pants answered “very important” sider that there are limitations of decades, approximately 20% of
or “important” to the question esthetic imperfections that can be people living in Sweden today were
“How important is the appearance accepted. Women were more critical born in other countries. It would be
of your teeth to you?”19 to the statement than the men were, of interest to conduct a similar
which is consistent with a study study in other countries.
There was wide variation in the assessing the preference between
answers to the statement “A tooth appearance and function: more Even if the attitude differences
loss that is visible is something to women (30%) than men (18%) pre- between the 50- and 60-year-old
be ashamed of” (Figure 3). It might ferred beautiful to functional teeth.18 subjects as well as between women
be of interest to compare these and men were relatively small,
results with those regarding the In this context it would be appro- practically all of them were statisti-
need and demand of replacement of priate to discuss whether the results cally significant. The sample size

VOLUME 20, NUMBER 1, 2008 53

 ATTITUDES TOWARD DENTAL APPEARANCE

has a great influence on the analy- dental problems. This should be con- 2. Chignell A. Beauty as a symbol of natural
systematicity. Br J Aesthet
ses, and since given that these sam- sidered in clinical decision-making. 2006;46:406–15.
ples are large, the statistical p level
3. UF College of Dentistry. Dress Code—
was set as high as 1%. CONCLUSIONS International Students. Available at:
www.dental.ufl.edu:1180/Offices/Extra-
There were several significant dif- mural/Students/Dress_code.html
The logistic regression analyses indi- ferences between women and men (accessed September 18, 2007).
cated significant associations as well as between 50- and 60-year- 4. Carlsson GE, Omar R. Trends in
between several variables and the old subjects regarding attitudes prosthodontics. Med Princ Pract
2006;15:167–79.
answers to the four statements, toward the importance of dental
although most of them exhibited low appearance. However, the great
5. Öwall B, Carlsson GE, Glimstedt B, et al.
Esthetic and cosmetic dentistry: new and
OR. Besides the age and gender dif- majority of the responders agreed unique or a development of old methods?
ferences described above, people Tandläkartidningen 2005;97(5):46–52.
that beautiful and perfect teeth are [in Swedish, with an English summary]
with low education agreed more with very important for how you are
two of the four statements than those 6. Sadowsky SJ. An overview of treatment
treated by other people. Regarding considerations for esthetic restorations:
with higher education (Tables 6 and the relative importance of esthetics a review of the literature. J Prosthet Dent
7). Self-assessment of dental prob- 2006;96:433–42.
and function, approximately 90%
lems was associated with attitudes considered that minor esthetic 7. Christensen GJ. I have had enough!
J Esthet Restor Dent 2004;16:83–6.
toward all four statements. Not sur- imperfections of the teeth have no
prisingly, people who reported prob- importance, only they function 8. Jenson L. Restoration and enhancement:
is cosmetic dentistry ethical? J Am Coll
lems with spacing and color of their well. Logistic regression indicated Dent 2005;72:48–53.
teeth assessed dental appearance as that several background factors 9. Hermerén G, Carlsson GE, Nilner K,
more important than those without could influence attitudes toward the et al. Ethics in aesthetic dentistry. Tan-
these dental problems (Table 4). It importance of dental appearance.
dläkartidningen 2006;98(15):62–6. [in
Swedish, with an English summary]
was striking that those without such Besides age and gender, education
dental problems agreed more with 10. Heymann HO. Perspectives (editorial).
and self-assessed dental problems J Esthet Restor Dent 2007;19:1–2.
the statements that function was were most important. The study
more important than appearance 11. Davis LG, Ashworth PD, Spriggs LS.
was performed on subjects living in Psychological effects of aesthetic dental
than those who had such dental Sweden five years ago, and it treatment. J Dent 1998;26:547–54.
problems (Tables 5 and 7). Those remains to be investigated how well 12. Wolfart S, Quaas AC, Freitag S, et al.
who reported that they had to the results apply to current popula- General well-being as an important co-
factor of self-assessment of dental
refrain from dental care because of tions in other countries. appearance. Int J Prosthodont
economic problems agreed more 2006;19:449–54.
with the statements regarding the 13. Newton JT, Prabhu N, Robinson PG.
DISCLOSURE
importance of dental appearance The impact of dental appearance on the

than those without this problem The authors do not have any finan- appraisal of personal characteristics. Int J
Prosthodont 2003;16:429–34.
(Tables 4 and 6). These findings sug- cial interest in the companies whose
products are included in this article. 14. Elias AC, Sheiham A. The relationship
gest that attitudes toward the impor- between satisfaction with mouth and
tance of dental appearance show number and position of teeth. J Oral
Rehabil 1998;25:649–61.
great individual variation and are REFERENCES
1. Holm S. Changes to bodily appearance: 15. Trovik TA, Klock KS, Haugejorden O.
related to many different background
the aesthetics of deliberate intervention. Predictors of Norwegian adult patients’
variables including self-assessed J Med Ethics 2000;26:43–8. perceived need for replacement of teeth

© 2008, COPYRIGHT THE AUTHORS

54 JOURNAL COMPILATION © 2008, BLACKWELL PUBLISHING
 CARLSSON ET AL

at the time of extraction. Community 20. Betts K, editor. Looking into the future 25. Smith JM, Sheiham A. Dental treatment
Dent Health 2002;19:79–85. of 21st century style. Time Style & needs and demands of an elderly popula-
Design. Time Supplement 2007 tion in England. Community Dent Oral
16. Akeel R. Attitudes of Saudi male patients May 3;33–41. Epidemiol 1980;8:360–4.
toward the replacement of teeth. J Pros-
thet Dent 2003;90:571–7. 21. Stahlnacke K, Soderfeldt B, Unell L, et al. 26. Wänman A, Wigren L. Need and demand
Perceived oral health: changes over 5 for dental treatment: a comparison
17. Tortopidis D, Hatzikyriakos A, Kokoti years in one Swedish age-cohort. between an evaluation based on an epi-
M, et al. Evaluation of the relationship Community Dent Oral Epidemiol demiologic study of 35-, 50-, and 65-
between subjects’ perception and profes- 2003;31:292–9. year-olds and performed dental treatment
sional assessment of esthetic treatment of matched age groups. Acta Odontol
needs. J Esthet Restor Dent 22. Johansson A, Unell L, Carlsson GE, et al. Scand 1995;53:318–24.
2007;19:154–62. Risk factors associated with symptoms of
temporomandibular disorders in a popu-
18. Wagner I-V, Carlsson GE, Ekstrand K, et lation of 50- and 60-year-old subjects.
al. A comparative study of assessment of J Oral Rehabil 2006;33:473–81.
dental appearance by dentists, dental
technicians, and laymen using computer- 23. Unell L. On oral disease, illness and Reprint requests: Dr. Gunnar E. Carlsson,
aided image manipulation. J Esthet Dent impairment among 50-year-olds in two Institute of Odontology, Sahlgrenska Acad-
1996;8:199–205. Swedish counties. Swed Dent J emy, Göteborg University, Box 450, SE 405
1999;(Suppl 135):1–45. 30, Göteborg, Sweden. Tel.:+46-(0)31-786
19. Carlsson GE, Wagner I-V, Ödman P, 3191; Fax:+46-(0)31-786 3193; e-mail:
et al. An international comparative 24. Unell L, Johansson A, Carlsson GE, et al. [email protected]
multicenter study of assessment of dental Changes in reported orofacial symptoms A preliminary report of this study was pre-
appearance using computer-aided image over a ten-year period as reflected in two sented at the meeting of the International
manipulation. Int J Prosthodont cohorts of fifty-year-old subjects. Acta College of Prosthodontists in Fukuoka,
1998;11:246–54. Odontol Scand 2006;64:202–8. Japan, September 6, 2007.

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