Evaluating and Establishing Ideal Smile Esthetics : Beauty is More than Skin Deep
Cultural Influences on the Perceptions of Smile Esthetics

We know from artwork and historic references that ideals of attractiveness have changed over time and may vary based upon cultural norms. While we may identify certain factors as universally appealing, facial attractiveness and smile esthetics are influenced by the individuals judging the ultimate result—the patients. Dental healthcare professionals, including surgeons, orthodontists, and restorative dentists, and plastic surgeons have a higher standard for facial esthetics than laypersons with similar demographics and socio-economic status.^62,63 Other factors that influence whether individuals are perceived as having facial attractiveness include age, gender, geographic local esthetic norms, and cultural norms. It is well-established that men and older individuals being more tolerant of certain deviations from esthetic standards than women and younger individuals.^64-69 Patients’ self-perception and their social reference groups, including peer groups and social media, affect preferences regarding the importance of smile esthetics. These influences are weighted more heavily than the opinion of dental healthcare providers.⁷⁰ Lastly, even in our modern age, esthetic ideals continue to evolve and parameters of ideal smile esthetics can be influenced by mass media, including television, films, magazines, fashion, advertisements and social media.^71,72 For example, trends in facial plastic surgery indicate that the mean age for many facial plastic surgery techniques is decreasing, which has been attributed to the increased popularity of selfies and filters on social media.⁷³ The popularity of lip fillers in younger populations has resulted in an increase in the number of individuals with an “over-enhanced” appearance to their lips.⁷³

Many things influence the perception of facial attractiveness; thus, it is critically important for dental healthcare providers to thoroughly assess patients’ chief complaints and consider reversible and/or technological interventions to demonstrate potential outcomes prior to irreversible interventions. Because ideal attractiveness is difficult to define, assessment of individual patient satisfaction with likely outcomes of therapy and management patient expectations to ensure that they are in line with predictable results is critical to ensure that patients expectations are met.