Perceptions and predictors of dental esthetic satisfaction among Turkish dental students: the role of social and professional factors

Abstract

Background

A compelling smile is integral to social interaction, influencing first impressions, self-confidence, and overall psychosocial well-being. As media and evolving beauty standards amplify the importance of dental esthetics, dental students, equipped with academic exposure to esthetic principles, are uniquely affected by these trends. Understanding their self-perception and the factors shaping it is crucial for their professional development and future patient-centered clinical practice.

Methods

This cross-sectional study evaluated dental esthetic self-perception and satisfaction among 481 undergraduate dental students. Data collected via a structured questionnaire captured sociodemographic information, self-reported satisfaction with dental appearance and perceived imperfections (e.g., alignment, color), and the influence of external factors, including social input and professional feedback.

Results

Participants demonstrated a consensus on the professional importance of dental esthetics, with nearly all believing ideal teeth improve quality of life (96.7%) and career prospects (88.4%). A significant majority reported esthetic concerns related to alignment (47.8%) and expressed a strong desire for teeth whitening (66.3%). Gender significantly influenced esthetic expectations: female students reported a higher desire for cosmetic procedures and were significantly more influenced by professional (64.2%) and social media (71.7%) feedback compared to males.

Conclusions

Dental students’ perceptions of their own esthetics are multifaceted, shaped by intrinsic expectations and significantly influenced by social and professional feedback. These findings highlight the need for dental faculties to foster psychosocial awareness and promote empathetic, patient-centered approaches to esthetic care that recognize the impact of societal and clinical ideals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-08414-x.

Introduction

A smile is a primary factor in nonverbal communication and the formation of first impressions [1]. The facial characteristics, particularly the mouth and teeth, profoundly influence perceptions of beauty, confidence, and approachability [1, 2]. Driven by modern media and social networks, the emphasis on personal appearance has heightened the cultural significance of dental esthetics [3, 4]. Consequently, even minor deviations from esthetic norms—such as irregular tooth alignment, discoloration, or asymmetry—can significantly influence an individual’s psychosocial well-being and self-esteem, particularly among young adults and students [1, 3–5].

Research consistently demonstrates a strong association between self-perceived dental esthetics and mental health outcomes, including self-esteem and overall quality of life [3, 6]. Dissatisfaction with dental appearance can lead to self-consciousness, avoidance of smiling, and withdrawal from social interactions, behaviors linked to increased anxiety and potential risk of depression [4, 7, 8]. Conversely, satisfaction with one’s smile is positively correlated with self-confidence, greater ease in social interaction, and improved coping skills [6, 7]. For young people and college students navigating identity changes and new social responsibilities, these appearance concerns become acutely critical due to heightened sensitivity to peer comparison during this developmental phase [8, 9].

Dental students represent a unique and crucial demographic for studying esthetic perceptions. Their curriculum, clinical training, and developing knowledge of ideal dental morphology provide them with distinct perspectives and expectations compared to the general public [5, 10]. However, this specialized education frequently leads to a more critical appraisal of both their own and others’ dental esthetics, potentially resulting in higher levels of personal dissatisfaction [11–14].

External influences significantly shape this self-perception, including feedback from family, friends, peers, and professional authorities like dentists [3, 15]. The pursuit of an “ideal smile” is often underpinned by societal pressures, extending beyond personal vanity to influence perceptions of professionalism, employment prospects, and social acceptance [6]. Recognizing the intricate interplay between these individual and external factors is critical because esthetic dissatisfaction can have enduring psychosocial consequences and may unconsciously affect the future clinical recommendations made by these emerging dental professionals [4, 6].

Despite extensive research, few studies have comprehensively analyzed the concurrent influence of previous treatments, specific esthetic desires, and a full spectrum of social and clinical feedback mechanisms among dental students. Studies focusing specifically on the Turkish student population, where cultural values intersect with global esthetic standards, are particularly limited. Identifying these correlations is vital for enabling dental institutions to develop targeted psychosocial support and educational policies that foster both empathy and resilience in future practitioners [5, 6].

Accordingly, this study aims to evaluate dental esthetic satisfaction and self-perception among Turkish dental students, specifically examining the predictive roles of prior dental treatments, esthetic expectations, and direct exposure to social and clinical feedback factors. By addressing these relationships, we aim to inform the strategic development of educational and psychosocial support systems within dental faculties.

Methods

Study design

This study utilized a cross-sectional descriptive design to evaluate dental esthetic self-perception among undergraduate dental students (n = 481). The research was conducted at Süleyman Demirel University, Faculty of Dentistry, in Turkey, over a one-month period between May and June 2025. All undergraduate dental students enrolled during the 2024–2025 academic year, from the first to the final year, were considered eligible to participate. Inclusion required providing informed consent, and exclusion criteria were failure to complete the questionnaire or declining participation. The large sample of 481 participants was determined to ensure a statistical power of at least 80% with a Type I error rate of 5% for all primary variables investigated.

Data collection tool and validation

Data were collected using a structured, paper-based questionnaire containing 22 items (Supplementary Material, Table 1). The questionnaire was developed by carefully reviewing existing literature and adapting relevant questions concerning dental esthetic self-perception and satisfaction to the Turkish cultural and educational context.

The questionnaire consisted of four main sections:

1. Sociodemographic Characteristics.

2. Dental History and Expectations: Reasons for the latest dental visit, history of prior treatments (whitening, orthodontics), complaints about alignment, and specific desires for esthetic changes (e.g., desire for brighter teeth, whitening).

3. Satisfaction and Impact: Self-reported satisfaction levels with specific features (color, shape, position, chewing efficacy) and broader beliefs regarding the impact of ideal teeth on quality of life, happiness, health, and professional prospects (job interviews).

4. Influencing Factors: Assessment of external influences on self-evaluation (personal, family, friends, media, dentist’s opinion) and factors considered when evaluating others’ smiles (e.g., color, shape, alignment, lip thickness).

Validation and reliability

The development process utilized questions derived from previously published studies in the field of dental esthetics. Pilot testing was performed to ensure the clarity and comprehensibility of the translated questions in the local context. Internal consistency and reliability measures, including Cronbach’s alpha, were applied to the data during subsequent statistical analysis to ensure the rigor of the psychometric measurements. Internal consistency reliability was confirmed (Cronbach’s α = 0.87). For significant categorical associations, effect sizes were calculated to evaluate the strength of relationships.

Missing data

Incomplete questionnaire responses were managed by excluding participants who failed to complete the essential core questions related to the study variables. All analyses presented are based on the data provided by the 481 completed questionnaires, effectively employing complete case analysis.

Ethical considerations

This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Health Sciences Ethics Committee of Süleyman Demirel University (Meeting No: 56, Decision No: 14). Participation in the study was entirely voluntary, and all participants were informed that their responses would remain anonymous and be used solely for scientific purposes. Informed consent was obtained from all participants before data collection.

Statistical analysis

Descriptive statistics were used to characterize the sample profile and responses, expressed as frequencies (n) and percentages (%). Relationships between categorical variables were primarily assessed using the Chi-square test or Fisher’s exact test (for 2 × 2 tables) when sample sizes were small, to determine statistically significant differences in response distribution across groups (e.g., age, gender). A p-value less than 0.05 (p < 0.05) was considered statistically significant. The magnitude of the association (effect size for categorical data) was evaluated descriptively by observing the differences in proportions (percentages) between the comparison groups, as presented in the contingency tables. For significant categorical associations, effect sizes (Cramér’s V) were calculated to evaluate the strength of relationships. All statistical operations were performed using the IBM SPSS statistical software package (Version 26).

Results

A total of 481 undergraduate dental students participated in the study. The majority of participants were aged between 20 and 22 years (50.1%), and there was a slightly higher proportion of female students (57.8%) compared to male students (42.2%). A significant finding was the high prevalence of preventive dental care engagement, with over half of the respondents (52.6%, N = 253) reporting their last dental visit for routine check-ups or cleaning (Table 1). This indicates a strong emphasis on and awareness of oral hygiene and preventative measures within this student population. While a portion of the participants (36.0%) reported general satisfaction with their dental appearance, a substantial number expressed dissatisfaction with specific aspects of their teeth, primarily related to esthetics. Tooth alignment emerged as the most frequent concern, with 47.8% of students indicating dissatisfaction. This was followed by concerns regarding tooth position (30.6%) and tooth color (24.5%). These esthetic dissatisfactions were strongly associated with a desire for esthetic improvements, particularly for brighter teeth (73.0%) and teeth whitening (66.3%). However, a notable gap exists between the expressed desire for teeth whitening and the experience with this procedure, as only 11.9% of participants reported having undergone it. This discrepancy may be attributed to various factors, including cost, lack of accessibility, or apprehension, as financial reasons were cited as the primary barrier (39.5%) for seeking needed interventions. The participation in orthodontic treatment by 27.2% of respondents, while reflecting an acknowledgment of the importance of tooth alignment, also suggests that underlying concerns about alignment and position persist, reinforcing the perceived need for further intervention (Table 1).

Table 1.

Demographic profile, dental history, and esthetic desires of participating dental students (n = 481)

Category	Response Option	N	%
Demographics
Age group	17–19 years	150	31.2
	20–22 years	241	50.1
	23–25 years	90	18.7
Gender	Male	203	42.2
	Female	278	57.8
Latest Dentist Visit Reason
Routine checkup/cleaning teeth		253	52.6
Tooth restoration/replacement/treatment		100	20.8
Pain/swelling		85	17.7
Dentofacial esthetics (esthetic expectations)		43	8.9
Past Dental Treatment History
Orthodontic treatment	Yes	131	27.2
	No	350	72.8
Teeth whitening (bleaching)	Yes	57	11.9
	No	424	88.1
Esthetic Dissatisfaction and Desires
Tooth alignment complaint	Yes	230	47.8
	No	251	52.2
Desire for brighter teeth	Yes	351	73.0
	No	130	27.0
Desire for teeth whitening	Yes	319	66.3
	No	162	33.7
Dissatisfaction: Tooth Position	Reporting Dissatisfaction	147	30.6
Dissatisfaction: Tooth Color	Reporting Dissatisfaction	118	24.5
Dissatisfaction: Tooth Shape	Reporting Dissatisfaction	47	9.8
Dissatisfaction: Smile	Reporting Dissatisfaction	59	12.3
Dissatisfaction: Dry Mouth	Reporting Dissatisfaction	20	4.2
Dissatisfaction: Chewing Efficiency	Reporting Dissatisfaction	23	4.8
Satisfied Overall		173	36.0
Dissatisfaction: Gum Appearance	Reporting Dissatisfaction (Gums only)	41	8.5
	Reporting Dissatisfaction (Both)	19	4.0
Perception of Ideal Teeth
Ideal Teeth or Appearance Prioritization	Appearance	34	7.1
	Having ideal and beautiful teeth	87	18.1
	Both are equally important	360	74.8
Ideal Teeth increase Job Interview Chance	Yes	425	88.4
	No	56	11.6
Ideal Teeth improve Quality of Life	Yes	465	96.7
	No	16	3.3
Impact of Beautiful Teeth on Happiness	Yes	456	94.8
	No	25	5.2
Symbolism of Beautiful Teeth for Good Health	Yes	448	93.1
	No	33	6.9

Gender differences played a significant role in esthetic attitudes. As shown in Table 2, female participants were significantly more likely than males to express a desire for whiter teeth and to undergo whitening treatments. Women also reported greater influence from both dental professionals and social media when forming perceptions of their smile esthetics (Table 3). While both genders considered similar criteria when evaluating others’ smiles - such as tooth shape, color, alignment, gingival display, and brightness - females were significantly more attentive to general dental appearance. Although not statistically significant, a near-threshold p-value for “tooth cleanliness” may indicate a slightly greater attentiveness among women to this aspect.

Table 2.

Comparison of esthetic satisfaction and perception variables by gender (Chi-square test used to assess gender-related differences in responses)

Category of Question	Specific Question/Variable	Female (%) (n = 278)	Male (%) (n = 203)	p-value
Esthetic Dissatisfaction and Desires	Desire for brighter teeth (Yes)	79.5	64	(p < 0.001)
	Desire for teeth whitening (Yes)	70.5	60.6	(p = 0.023)
General Satisfaction	Not satisfied with tooth color	55.1	44.9	(p = 0.492)
	Not satisfied with the shape of the teeth	63.8	36.2	(p = 0.378)
	Not satisfied with tooth positions	58.5	41.5	(p = 0.835)
	Not satisfied with the smile	64.4	35.6	(p = 0.272)
	Not satisfied with dry mouth	45.0	55.0	(p = 0.237)
	Not satisfied with chewing effectiveness	73.9	26.1	(p = 0.109)
	Satisfied (General)	57.2	42.8	(p = 0.849)
Gum and Tooth Appearance Satisfaction	Not satisfied with gum appearance	61.0	39.0
	Not satisfied with tooth appearance	61.1	38.9	(p = 0.786)
	Not satisfied with either gum or tooth appearance	52.6	47.4
	Satisfied with both gum and tooth appearance	56.5	43.5
Gum Treatment Desire	Desire gum treatment (Yes)	50.0	50.0	(p = 0.183)
Anterior Restoration Presence	Presence of anterior restoration (Yes)	57.1	42.9	(p = 0.894)
Unesthetic Anterior Filling Presence	Presence of non-esthetic anterior filling (Yes)	50.0	50.0	(p = 0.372)
Anterior Fracture History	History of anterior fracture (Yes)	58.6	41.4	(p = 0.887)
Anterior Restoration Need	Need for anterior restoration (Yes)	68.0	32.0	(p = 0.051)
Ideal Teeth vs. Appearance	Prioritizing Appearance	47.1	52.9
	Prioritizing having ideal and beautiful teeth	51.7	48.3	(p = 0.147)
	Prioritizing both equally important	60.3	39.7
Ideal Teeth & Job Interview Chances	Ideal teeth increase job chances (Yes)	57.6	42.4	(p = 0.855)
Ideal Teeth & Quality of Life	Ideal teeth improve quality of life (Yes)	58.7	41.3	(p = 0.029)
Beautiful Teeth & Happiness	Beautiful teeth make person look happy (Yes)	58.3	41.7	(p = 0.308)
Beautiful Teeth & Good Health	Beautiful teeth symbolize good health (Yes)	58.5	41.5	(p = 0.262)
Smile Factors (Own Smile): Dentist’s Opinion	Influenced by dentist’s opinion	64.2	35.8	(p < 0.001)
Smile Factors (Own Smile): Social Media	Influenced by social media	71.7	28.3	(p < 0.001)
Assessing Others’ Smiles: Tooth Appearance	Pays attention to tooth appearance	61.7	38.3	(p = 0.025)

Table 3.

Gender differences in factors influencing self-perception and smile evaluation criteria (Chi-square test results)

Factor Category	Factor Name	Female (%) (n = 278)	Male (%) (n = 203)	p-value
Smile Factors (Own Smile)	Personal Opinion	57.1	42.9	(p = 0.263)
	Family Opinion	55.8	44.2	(p = 0.393)
	Friend Testimonial	54.4	45.6	(p = 0.133)
	Peer/colleague opinion	55.7	44.3	(p = 0.377)
	Public opinion	50.8	49.2	(p = 0.249)
	Dentist’s opinion	64.2	35.8	(p < 0.001)
	Idol/celebrity/actor smile	63.8	36.2	(p = 0.378)
	TV broadcast media	55.2	44.8	(p = 0.768)
	Radio	52.6	47.4	(p = 0.642)
	Print media	68.2	31.8	(p = 0.313)
	Advertisements	63.6	36.4	(p = 0.411)
	Social media	71.7	28.3	(p < 0.001)
Factors for Assessing Others’ Smiles	Tooth color	57.9	42.1	(p = 0.916)
	Tooth shape	59.1	40.9	(p = 0.182)
	Thickness of the lips	59.2	40.8	(p = 0.577)
	Tooth alignment	59.6	40.4	(p = 0.162)
	Tooth size	58.7	41.3	(p = 0.582)
	Tooth appearance (General)	61.7	38.3	(p = 0.025)
	Gingival appearance	57.4	42.6	(p = 0.895)
	Teeth cleaning	59.5	40.5	(p = 0.097)
	Tooth brightness	58.7	41.3	(p = 0.615)

Age also emerged as an essential factor in esthetic perception. As illustrated in Fig. 1, participants aged 20–22 years were more strongly influenced by external opinions - including friends (57.3%), colleagues (53.5%), and dentists (51.5%) - when evaluating their own smiles, compared to other age groups. Similarly, Fig. 2 demonstrates that this same age group paid greater attention to a broader range of esthetic criteria when evaluating others’ smiles, including tooth shape, alignment, size, gingival appearance, and cleanliness. These findings suggest that individuals aged 20–22 may have more developed esthetic awareness and be more susceptible to social influences, potentially due to increased peer interaction or emerging professional expectations during this life stage.

Fig. 1.

Influence of smile-related factors across age groups

Fig. 2.

Smile evaluation criteria by age group

Bar graph illustrating the number of participants from three age groups (17–19 years, 20–22 years, 23–25 years) who reported being influenced by various factors when evaluating their smile.

This bar chart illustrates the distribution of participants’ responses based on smile evaluation criteria across three age groups (17–19 years, 20–22 years, and 23–25 years).

A striking and consistent finding throughout the study was the participants’ belief in the broader impact of ideal teeth on life outcomes. As reflected in Table 2, there was near-universal agreement that ideal dental esthetics improve quality of life (~ 97%), enhance perceived happiness and health, and increase the likelihood of success in job interviews (88%). Although both genders largely agreed with these statements, a statistically significant difference was observed in response to whether ideal teeth improve quality of life, with a greater proportion of male participants expressing disagreement.

Discussion

The core finding is a high prevalence of esthetic dissatisfaction coupled with an intense desire for intervention. While 66.3% of students desired teeth whitening, only 11.9% had undergone the procedure. This discrepancy can be attributed to various barriers, such as cost, lack of accessibility, or apprehension, underscoring the need for more affordable and accessible esthetic dental services [16–19]. The strong belief held by participants that ideal teeth positively influence quality of life, happiness, health perception, and career success, particularly in job interviews, further emphasizes the deep-seated psychosocial importance of dental esthetics [20].

Gender differences were evident in esthetic attitudes. Female participants expressed a greater desire for whiter teeth and whitening treatments, and reported higher influence from dental professionals and social media regarding their smile perceptions compared to males [21, 22]. While both genders considered similar criteria when evaluating others’ smiles, females paid more attention to general dental appearance, with a near-significant tendency towards being more attentive to tooth cleanliness. These findings are consistent with other studies indicating that women are generally more aware of and concerned about their dental esthetics than men [23–25]. This heightened awareness might be attributed to societal expectations and pressures that emphasize appearance, particularly for women.

Participants aged 20–22 years showed more substantial influence from external opinions, including friends, colleagues, and dentists, when evaluating their own smiles. This age group also paid greater attention to a wider range of esthetic criteria when assessing others’ smiles [22, 26]. This suggests that individuals in this age bracket may possess a more developed esthetic awareness and be more susceptible to social influences, possibly due to increased peer interaction and evolving professional expectations during their academic careers. The findings emphasize the role of social factors, including peer influence and professional feedback, in shaping esthetic perceptions.

The study found a strong consensus among dental students regarding the significant positive influence of ideal dental esthetics on various aspects of life, including quality of life, happiness, perceived health, and career success. Specifically, the statement “Do Ideal Teeth Increase the Quality of Life?” garnered near-universal agreement, with approximately 97% of participants concurring. Furthermore, 88% of respondents believed that ideal teeth enhance the likelihood of success in job interviews. These findings underscore the deep-seated psychosocial foundation of the demand for dental esthetics, indicating that students perceive their dental appearance as intrinsically linked to their overall well-being and future prospects [27, 28]. While both genders largely agreed with these positive associations, a statistically significant difference was observed in the male participants’ response to the statement about ideal teeth improving quality of life, with a larger proportion disagreeing compared to females. This suggests a potential nuanced perspective on the impact of dental esthetics on quality of life between genders [2, 7, 10].

Dental students, by their education and training, possess a unique perspective on dental esthetics. While their academic journey equips them with a deeper understanding of ideal tooth shapes and proportions, it also appears to foster a more critical appraisal of their own and others’ smiles [2]. Numerous studies have indicated that dental students often have higher knowledge of esthetics compared to laypeople, which can lead to a more discerning view of dental appearance [17]. This enhanced awareness, however, can also result in increased self-criticism regarding their own dental esthetics, potentially contributing to dissatisfaction even when their appearance might be considered acceptable by others [18]. This critical awareness, while potentially leading to a greater desire for esthetic interventions, also positions them to be more informed consumers and future providers of dental care.

These findings are highly relevant for dental education, emphasizing the importance of integrating psychosocial and esthetic awareness into undergraduate training. The heightened self-criticism and social susceptibility observed, particularly among female students and those aged 20–22 years, highlight the need for programs that cultivate psychosocial resilience. Addressing students’ own esthetic anxieties and perfectionistic tendencies early in their academic careers may prepare them to manage high patient expectations without projecting internal biases or unrealistic ideals of beauty [2, 18]. By encouraging reflective practice and emotional self-awareness, dental faculties can help future clinicians maintain psychological well-being while fostering empathy toward patients who experience similar appearance-related concerns.

Another educational implication involves the development of patient-centered communication skills in dental esthetics. Because the dentist’s opinion strongly influences patient perceptions [22], dental curricula should emphasize the psychological and social dimensions of esthetic dissatisfaction. Training should move beyond objective clinical indices to include the exploration of patients’ motivations—such as professional image, self-confidence, or social acceptance—ensuring that treatment planning aligns with patients’ psychological needs as well as clinical outcomes. Cultivating this sensitivity within communication and behavioral sciences courses could help future practitioners deliver more ethical, empathetic, and individualized esthetic care.

Moreover, the disproportionate effect of social media on female students’ esthetic desires underscores the necessity of incorporating media literacy and ethical decision-making into dental education [22]. Students should be trained to recognize and critically evaluate unrealistic esthetic expectations fueled by digital trends. This approach promotes ethical practice that prioritizes health, function, and long-term satisfaction over transient, digitally driven ideals of perfection. Embedding such content within preclinical or professional development modules would prepare students to counsel patients responsibly and to resist external pressures that distort professional judgment.

This study, while offering valuable insights, has several limitations. As a cross-sectional descriptive study conducted within a single university, the results may not be generalizable to all dental students or to other educational or cultural contexts. The reliance on self-reported data introduces the possibility of social desirability bias, as participants may have responded in ways they considered more acceptable. A key limitation is the potential for cultural bias; esthetic perceptions and priorities differ across cultures, and findings from Turkish students may not fully represent attitudes in non-Turkish populations [23, 24]. Direct extrapolation of preferences such as ideal tooth color or alignment to other regions should therefore be approached with caution. The specific response rate for the sample was not documented, although participation was high, supporting the robustness of the dataset. Furthermore, while various social influences were examined, their specific mechanisms and quantitative impacts—such as the distinct roles of social media, peers, and professional feedback—were not measured in depth.

Future research should address these limitations through longitudinal and multicenter designs that capture how esthetic perceptions evolve throughout dental education and into professional practice. Combining objective assessments of dental esthetics with subjective self-perception data could provide a more comprehensive understanding of the psychosocial and cultural determinants of esthetic satisfaction. Comparative research across diverse populations would clarify how cultural norms and social expectations shape dental esthetic ideals. Additionally, examining how exposure to different media platforms influences students’ esthetic values and their subsequent clinical decision-making could offer valuable insights for guiding both educational reform and patient care in the modern digital era.

Conclusion

This study confirms that dental esthetics are a critical component of overall appearance for young adults, significantly impacting their psychosocial well-being, self-esteem, and perceived quality of life [10, 18]. The findings highlight a prevalent dissatisfaction with tooth alignment and color among dental students, alongside a strong desire for esthetic improvements, particularly teeth whitening. Despite high desires, practical barriers like cost and access appear to limit the pursuit of these treatments. The study also underscores the significant influence of gender and age on esthetic perceptions and desires, with women and younger adults (20–22 years) showing greater concern and susceptibility to external influences. These insights are crucial for dental education institutions to develop targeted support strategies and educational policies that foster empathy and resilience among future dental professionals.

Authors' contributions

ÖÖ: Conceptualization, supervision, statistical analysis, manuscript drafting and final manuscript revision.SSG: Data collection, statistical analysis, and manuscript drafting.BA: Literature review, data collection and data entry.All authors read and approved the final manuscript.

Funding

This research was supported by the Scientific and Technological Research Council of Turkey (TÜBİTAK) under the 2209-A Undergraduate Research Projects Support Program.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Süleyman Demirel University Health Sciences Ethics Committee (Meeting No: 56, Decision No: 14). Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.