Assessing the Impact of Skin Tone on Tooth Shade Selection: A Cross-Sectional Study

ABSTRACT

Background:

The role of skin tone in determining tooth shade preferences is crucial in aesthetic dentistry. This study aims to evaluate the impact of skin tone on tooth shade selection by comparing preferences between dental professionals and laypersons.

Methods:

A cross-sectional study was conducted with 100 participants, including 50 dental specialists (prosthodontists and endodontists) and 50 laypersons (teachers, engineers, and business owners). Participants were presented with a randomized slideshow of 15 modified images featuring a woman with varying skin tones (fair, medium, dark) and tooth shades (from 00 to 04). Each image was rated on a scale from 1 (Very unattractive) to 4 (Very attractive).

Results:

There were no statistically significant differences in the ratings of dental appearance across different skin tones between dental professionals and laypersons. For fair skin, medium skin, and dark skin tones, the mean scores assigned by both groups were statistically indistinguishable (P > 0.05).

Conclusion:

The study indicates that both dental professionals and laypersons converge in their tooth shade preferences related to skin tone, despite their different backgrounds. This suggests a shared perspective on dental aesthetics and highlights the importance of aligning aesthetic treatments with general preferences.

INTRODUCTION

A smile significantly impacts societal perceptions of beauty, driving the growing interest in aesthetic dentistry.[1] This underscores the need for both laypeople and dental specialists to understand the nuances of dental appearance. While the public often believes that whiter teeth are inherently more attractive, dental professionals recognize that tooth shade is influenced by factors such as age, gender, surrounding tissues, and lighting. Importantly, facial skin color plays a crucial role in selecting tooth shade, with harmony between tooth and skin color being essential for aesthetic appeal.[2] Previous studies on the relationship between skin color and tooth shade have yielded mixed results, with some finding no correlation and others suggesting an inverse relationship.[3,4] Understanding this relationship is valuable for prosthodontists in selecting denture teeth, planning anterior restorations, and determining the appropriate degree of tooth whitening to complement a patient’s facial skin tone. So the aim of the present study is to assess the effect of skin color on tooth shade selection by visual perception.

METHODOLOGY

The study commenced with institutional ethical approval and included 100 participants, split evenly between 50 dental specialists (Prosthodontists and Endodontists) and 50 laypeople, such as teachers, engineers, and business owners with no dental profession affiliation. A questionnaire was administered to gather participants’ name, age, gender, occupation, and for dental specialists, their years in practice. A photograph of a woman with well-aligned teeth and symmetrical tooth size was selected and modified using Adobe Photoshop CS5 (Adobe Systems, San Jose, Calif.). The modifications included altering the skin and lip shades to fair, medium, and dark tones, and adjusting the tooth shade brightness from 00 (brightest) to 04 (darkest), resulting in 15 different images.[5] These images were presented in a randomized slideshow on a black background. Each image was coded, and a five-second blue screen was included between images for eye calibration. Participants independently viewed the slideshow on a 15-inch laptop, advancing at their own pace, and rated each image on a scale from 1 (Very unattractive) to 4 (Very attractive). Once a rating was given, the participant could not return to the previous images.

Statistical analysis

Statistical Software Package SPSS version 22 (IBM SPSS Statistics for Windows, Version 22.0, IBM Corp., released in 2013) was used to perform statistical analysis. Domain-wise [Each skin color] sum score was obtained from the Likert responses for both the lay persons and professionals and further Independent student t test was used to compare the mean sum scores of dental appearance in relative to different skin types between 2 groups.

The Table 1 presents the comparison of mean sum scores of Likert responses concerning dental appearance across different skin types (Fair, Medium, Dark) between laypersons and professionals, analyzed using an Independent Student’s t-test. For fair skin, the mean difference between the two groups is 0.15, with a t-value of 0.230 and a P value of 0.82, indicating no statistically significant difference. For medium skin, both groups had identical mean scores (14.00), resulting in a mean difference of 0.00 and a P value of 1.00, confirming no significant difference. For dark skin, professionals rated slightly higher with a mean difference of -0.40, a t-value of -0.343, and a P value of 0.73, again showing no significant difference. Overall, the results indicate that there are no statistically significant differences between the ratings of laypersons and professionals across all skin types.

Table 1.

Comparison of mean sum scores of likert response of dental appearance in relative to different skin types between the layperson and Professionals using independent t-test

Skin Types	Group	n	Mean	SD	S.E.M	Mean Diff	t	P
Fair skin	Lay Persons	20	14.70	1.84	0.41	0.15	0.230	0.82
	Professionals	20	14.55	2.26	0.51
Med. Skin	Lay Persons	20	14.00	2.71	0.61	0.00	0.000	1.00
	Professionals	20	14.00	2.85	0.64
Dark Skin	Lay Persons	20	12.55	3.59	0.80	-0.40	-0.343	0.73
	Professionals	20	12.95	3.79	0.85

DISCUSSION

Selection of the teeth shade is very meticulous process and one requires a good understanding of different parameters of color such as hue, chroma, value, and translucency. For that, standard procedures must be followed and necessary requirements must be met. It needs to blend with the face and harmonize with the patient’s complexion.[6] The present study sought to evaluate how skin tone influences tooth shade selection among dental professionals and laypersons. Our findings indicate that there are no substantial differences in the ratings of dental appearance across different skin tones between these two groups. For fair skin, medium skin, and dark skin tones, the mean scores assigned by both dental professionals and laypersons were statistically indistinguishable. This suggests that while dental specialists and laypersons may approach dental aesthetics from different perspectives, their preferences regarding tooth shade in relation to skin tone converge.

Our results are consistent with previous research that has investigated the influence of skin tone on perceived dental aesthetics. Vadavadagi SV et al. (2016)[4] found that skin tone affects the perception of artificial tooth shades, but the overall impact on aesthetic judgments was not significantly different between various skin tones. Similarly, Koth et al. (2019)[5] examined how skin color influences perceived dental aesthetics and noted that both professionals and non-professionals generally shared similar views, which aligns with our observation of converging preferences.

The convergence of preferences between dental professionals and laypersons supports the notion that basic aesthetic judgments regarding tooth shade are somewhat universal. Pradhan D (2020).[6] reviewed the impact of facial characteristics on tooth shade selection and observed that aesthetic preferences are influenced by a combination of factors, including skin tone, which reflects a common understanding among different groups. This finding is further supported by Gupta et al. (2020), who discussed how cultural and professional biases influence dental aesthetics but noted that core preferences often align across different demographic groups.[7]

Moreover, Alhammadi Ms (2019) conducted a comparative study of aesthetic preferences and found that despite differing professional insights, there is a general agreement on aesthetic standards, supporting our results that both groups rated tooth shades similarly across skin tones.[8]

These insights are valuable for prosthodontists and other dental professionals in practice. Understanding that both laypersons and professionals converge in their preferences for tooth shade relative to skin tone can help in aligning aesthetic goals with patient expectations. It emphasizes the importance of considering broad aesthetic principles while providing personalized care. It is important to acknowledge the study’s limitations, including the use of a single photograph with manipulated skin and tooth shades, which may not fully represent real-world conditions. Future research should consider larger, more diverse samples and real patient data to explore how these preferences may vary across different populations.

CONCLUSION

In summary, our study reveals that there is no significant difference in tooth shade preferences related to skin tone between dental professionals and laypersons. This convergence suggests a shared perspective on dental aesthetics, highlighting the importance of understanding both universal and individual factors in aesthetic dentistry.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.