The Psychosocial Impact of Dental Esthetics and Its Association with Self-Esteem among Dental Students: A Cross-sectional Study

Shana Ibrahim Sola; Sherzad Ali Ismael

doi:10.55489/njcm.170620266305

Authors

Shana Ibrahim Sola Dental Public Health Department, Kurdistan Higher Council of Medical Specialties, Erbil, Iraq
Sherzad Ali Ismael Public Health Department, Kurdistan Higher Council of Medical Specialties , Erbil, Iraq

DOI:

https://doi.org/10.55489/njcm.170620266305

Keywords:

Dental Esthetics, Oral Health-Related Quality of Life, Self-esteem, Dental students, Erbil, Iraq

Abstract

Background: Dental aesthetics can influence psychological well-being and self-esteem, especially in professional dentistry students. This study examined these relationships in Erbil, Kurdistan, Iraq.

Methods: This cross-sectional study included 271 students (153 females, 118 men; mean age 21.1 ± 1.8) from Tishk International University, Hawler Medical University, and Cihan University. The Rosenberg Self-Esteem Scale (RSES) measured self-esteem, while the PIDAQ measured psychosocial impact. Spearman correlation, ordinal regression, and nonparametric tests were used.

Results: The mean RSES was 26.7 ± 6.8 (median 27 [22-32]) and the mean PIDAQ was 2.33 ± 0.80 (median 2.26 [1.55-2.97]), indicating minimal psychological impact. There was a moderate negative correlation between RSES and PIDAQ (ρ = -0.433, p < 0.001). Gender and academic year have minimal effect on scores. HMU students were 68% more likely than TIU to experience heightened psychosocial effect (OR = 1.68, 95% CI 1.05-2.69, p = 0.031). Dental alignment or lip morphology dissatisfaction, desires for orthodontic or prosthetic treatments, and financial restrictions or fear were linked to higher psychological consequences and worse self-esteem (p < 0.001).

Conclusion: Higher self-esteem is associated with lower psychosocial impact. Unmet treatment needs, dissatisfaction with dental appearance, and institutional affiliation contribute to psychosocial distress, highlighting the need for targeted support.

References

World Health Organization. Constitution of the World Health Organization. Geneva: WHO; 1948.

Aldegheishem A, Alfayadh HM, AlDossary M, Asaad S, Eldwakhly E, Refaei NAHA, et al. Perception of dental appearance and aesthetic analysis among patients, laypersons, and dentists. World J Clin Cases. 2024;12(23):5354-65. PMID: 39156080.

Baiju RM, Peter E, Varghese NO, Sivaram R. Oral health and quality of life: current concepts. J Clin Diagn Res. 2017;11(6):ZE21-6. doi: 10.7860/JCDR/2017/25866.10110.

Bos A, Hoogstraten J, Prahl-Andersen B. Expectations of treatment and satisfaction with dentofacial appearance in orthodontic patients. Am J Orthod Dentofacial Orthop. 2003;123(2):127-32. doi: 10.1067/mod.2003.84.

Mourad AME, Shamrani AA, Mohaimeed MA, Sougi SA, Ghanem SA, Manie WA. Self-perception of dental esthetics among dental students at King Saud University and their desired treatment. Int J Dent. 2021;2021:6671112. doi: 10.1155/2021/6671112.

Alsulaiman OA, Alghannam MI, Almazroua DM, Alamri AS, Shahin SY, Nassar EA, et al. Mental Health and Malocclusion: A Comprehensive Review. Clin Pract. 2025;15(3):44. doi: 10.3390/clinpract15030044.

Sardenberg F, Martins MT, Bendo CB, Pordeus IA, Paiva SM, Auad SM, et al. Malocclusion and oral health-related quality of life in Brazilian schoolchildren. Angle Orthod. 2013;83(1):83-9. doi: 10.2319/010912-20.1.

Ayaz SG, Kececi G, Citaker OK. Psychosocial impact and self-esteem in patients seeking dental aesthetic treatment: a cross-sectional study using PIDAQ and RSES. Front Psychol. 2026;17:1745236. doi: 10.3389/fpsyg.2026.1745236.

Manipal S, Adusumilli P, Ahmed A, Anand Mohan C, Cholan P, Kumar D. The importance of dental aesthetics among dental students: assessment of knowledge. J Int Soc Prev Community Dent. 2014;4(1):48-51. doi: 10.4103/2231-0762.131266.

Mehl C, Wolfart S, Vollrath O, Wenz HJ, Kern M. Perception of dental esthetics in different cultures. Int J Prosthodont. 2014;27(6):523-9. doi: 10.11607/ijp.3908.

Alhammadi MS, Halboub E, Al-Mashraqi AA, Al-Homoud M, Wafi S, Zakari A, et al. Perception of facial, dental, and smile esthetics by dental students. J Esthet Restor Dent. 2018;30(5):415-26. doi: 10.1111/jerd.12405.

Aldeeri AA, Alhababi KA, Algahtani FA, Tounsi AA, Albadr KI. Perception of altered smile esthetics by orthodontists, dentists, and laypeople in Riyadh, Saudi Arabia. Clin Cosmet Investig Dent. 2020;12:563-70. doi: 10.2147/CCIDE.S272226.

Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Designing clinical research. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2013.

Klages U, Claus N, Wehrbein H, Zentner A. Development of a questionnaire for assessment of the psychosocial impact of dental aesthetics in young adults. Eur J Orthod. 2006;28(2):103-11. doi: 10.1093/ejo/cji083.

Rosenberg M. Society and the adolescent self-image. Princeton, N.J.: Princeton University Press; 1965. xi, 326 p.

Schmitt DP, Allik J. Simultaneous administration of the Rosenberg Self-Esteem Scale in 53 nations: exploring the universal and culture-specific features of global self-esteem. J Pers Soc Psychol. 2005;89(4):623–42. doi: 10.1037/0022-3514.89.4.623.

Venete-Trillo-Lumbreras A, Romero-Maroto M, Labaig-Rueda C, Montiel-Company JM. Relationship between the psychosocial impact of dental aesthetics and perfectionism and self-esteem. J Clin Exp Dent. 2017;9(12):e1453-8. doi: 10.4317/jced.54481.

Afroz S, Rathi S, Rahman S. Dental Esthetics and Its Impact on Psycho-Social Well-Being and Dental Self Confidence: A Campus Based Survey of North Indian University Students. J Indian Prosthodont Soc. 2013;13(4):455-60. doi: 10.1007/s13191-012-0247-1.

Lone MM, Adnan S, Habib ME, Lone MA, Sajjad I, Ishtiaq M, et al. Empathy unmasked: the compassion quotient of dental students. BMC Med Educ. 2024;24(1):1108. doi: 10.1186/s12909-024-06093-8.

Tin-Oo MM, Saddki N, Hassan N. Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics. BMC Oral Health. 2011;11:6. doi: 10.1186/1472-6831-11-6.

Ellakany P, Fouda SM, Alghamdi M, Bakhurji E. Factors affecting dental self-confidence and satisfaction with dental appearance among adolescents in Saudi Arabia: A cross-sectional study. BMC Oral Health. 2021;21:149. doi: 10.1186/s12903-021-01509-z.

Stojilković M, Čapo N, Krumić J, Sekulić S, Marić B, Nikolić M, et al. Evaluating the influence of dental aesthetics on psychosocial well-being and self-esteem among students of the University of Novi Sad, Serbia: a cross-sectional study. BMC Oral Health. 2024;24(1):277. doi: 10.1186/s12903-024-04002-5.

Al-Zarea BK. Satisfaction with appearance and the desired treatment to improve aesthetics. Int J Dent. 2013;2013:912368. doi: 10.1155/2013/912368.

Feu D, de Oliveira BH, Almeida MA, Kiyak HA, Miguel JA. Oral health-related quality of life and orthodontic treatment seeking. Am J Orthod Dentofacial Orthop. 2010;138(2):152-9. doi: 10.1016/j.ajodo.2008.09.033.

Alharbi A. Psychological effects of orthodontics treatment in adolescent and adults. Bioinformation. 2024;20(9):1196-9. doi: 10.6026/9732063002001196.

Zhang M, McGrath C, Hägg U. The impact of malocclusion and its treatment on quality of life: a literature review. Int J Paediatr Dent. 2006;16(6):381-7. doi: 10.1111/j.1365-263X.2006.00768.x.

Rehman K, Karim AA, Mohiuddin S, Zaidi AB. Psychometric assessment of dental phobia and treatment deferral among undergraduate students of health sciences: a cross sectional study. Khyber Med Univ J. 2020;12(3):216-20. doi: 10.35845/kmuj.2020.18992.

Polychronopoulou A, Divaris K. A longitudinal study of Greek dental students' perceived sources of stress. J Dent Educ. 2010;74(5):524-30. doi:10.1002/j.0022-0337.2010.74.5.tb04896.x

Kovačić I, Miloš M, Kurkutović M, Čelebić A, Petričević N. Influence of education level and gender of dental students on perception of dental aesthetics. BMC Oral Health. 2024;24(1):398. doi: 10.1186/s12903-024-04115-x.