Impact of Idealized Online Content on Smile Satisfaction in Young Adults: A Randomized Controlled Trial

ABSTRACT

Background and Aims

The objective of this study was to explore the short‐term impact of a brief, curated exposure to social networking site content on facial and smile dissatisfaction and face‐related self‐discrepancy among young adults. Additionally, the study aims to compare these effects with the use of appearance‐neutral Instagram images.

Methods

A randomized control trial was conducted at Altamash Institute of Dental Medicine for a duration of 1 month. Freshly inducted students with a Bachelor of Dental Surgery (first year) with no prior knowledge of smile parameters were asked questions about their satisfaction with their smiles. They were then divided into groups of 2 where both of the groups were shown images from social media. Half of the group was shown images of an idealized smile (#hollywoodsmile), whereas the other group was kept as control and shown images of nature (#nature). Both groups were asked to fill out the same questionnaire again to note down any difference this experiment made in their perceptions.

Results

The study comprised predominantly female participants in both the experimental (74.1%) and control (70.4%) groups, with a mean age of 19.61 ± 1.86 and the majority (70.9%) spending one to 2 h on Instagram daily. Both groups maintained relatively stable OES scores from pre‐ to post‐exposure, with no significant differences observed. Whereas the experimental group exhibited higher mean SACS scores (4.74 ± 1.75) than the control group (3.28 ± 2.07). Lastly, the SDI analysis of the experimental and control group post‐exposure showed similar results.

Conclusion

Our study suggests that despite frequent engagement with social media, individuals tend to report satisfaction with their smiles.

Trial Registration

The study was registered at clinicaltrials. gov, date: 03/23/2023; identifier NCT05798650.

1. Introduction

In the contemporary digital landscape, the internet stands as the primary form of media consumption for the younger generation. Platforms such as Instagram, Twitter, and Facebook are becoming ubiquitous among both men and women thus making social media (SM) an integral part of modern society [1, 2]. These platforms serve as essential channels for communication, entertainment, and self‐expression, contributing to an unprecedented surge in their influence on various facets of individuals' daily lives [3]. Alongside their benefits, these platforms can amplify issues like cyberbullying and harassment due to the anonymity they offer. Moreover, it can exacerbate feelings of inadequacy through comparison and fear of missing out (FOMO) [4, 5]. SM users often present curated, idealized versions of their lives, leading to increased pressure and self‐doubt among peers. Moreover, SM addiction is significant with users spending excessive time seeking validation through likes and comments, which can detrimentally affect mental health and real‐life relationships [4, 5, 6, 7].

Recent research underscores the significant impact of social media, especially social networking sites (SNS), on body image concerns, particularly among women who frequently compare themselves to others [8]. This tendency towards comparison is strongly associated with increased body dissatisfaction, as individuals often perceive themselves as less attractive than the celebrities, they encounter online [8, 9]. Cohen et al [10] found that exposure to idealized body images on platforms like Instagram and Facebook has been linked to appearance comparisons, contributing to body image concerns and even eating disorders, negative self‐perceptions and decreased self‐esteem., particularly among young adults [10]. Moreover, studies reveal a positive correlation between time spent on SNS and negative mood, highlighting the detrimental effects of prolonged exposure to idealized body images [8, 9, 10, 11]. Social comparison theory further elucidates how individuals, particularly women and young girls, tend to compare themselves unfavorably to idealized images, perpetuating negative perceptions about their bodies [12].

Furthermore, the rise of platforms such as Instagram and Facebook, renowned for their emphasis on visual content, has intensified societal pressure to maintain aesthetically pleasing smiles. Filters and editing tools allow users to enhance their smiles, leading to an idealized standard that can sometimes feel unattainable. Influencers and celebrities often flaunt their flawless smiles, setting aspirational benchmarks and influencing trends in dental care [13]. Moreover, constant exposure to curated images of perfect smiles can contribute to feelings of inadequacy and self‐consciousness among those who don't measure up to these standards. This phenomenon has been linked to negative impacts on mental health, including decreased self‐esteem and body image issues [9, 10, 11, 12, 13, 14, 15]. Instagram stands out as a prominent visual platform where users showcase their aesthetic preferences, including facial features and smiles. Given its large user base, it holds considerable influence over social media engagement, content consumption, and cultural trends among Pakistani users. As of early 2024, it boasted approximately 17.30 million users in Pakistan alone, underlining its profound cultural impact and pervasive presence in daily life [14].

Despite the widespread recognition of social media's influence on body image and self‐perception, there remains a need for research that specifically examines its impact on smile attractiveness among young adults. While previous studies have explored the relationship between social media exposure and body image concerns, fewer have focused specifically on smile aesthetics. This research gap is significant because the smile plays a crucial role in facial attractiveness and is often a focal point of self‐perception and social interaction. Moreover, it is hypothesized that exposure to idealized smile images on social media will lead to higher levels of face‐related dissatisfaction, greater self‐comparison, and self‐discrepancy compared to exposure to neutral images. Therefore, to preliminarily explore this dynamic, we conducted a randomized controlled trial (RCT) aimed at assessing the short‐term effects of brief social media exposure on the perception of facial aesthetics—specifically focusing on facial and smile dissatisfaction, as well as face‐related self‐discrepancy among young adults.

2. Methodology

2.1. Study Setting, Duration and Sample Size

A randomized controlled trial was conducted at the Department of Prosthodontics, Altamash Institute of Dental Medicine for a duration of 1 month, 15th Jan'2023 – 15th Feb'2023. The calculation for sample size was conducted using the OpenEpi software, based on a medium effect size of 0.4 to discern a significant variance in facial satisfaction scores between experimental and control groups, employing an 80% power threshold in a two‐tailed test [15]. It indicated that a participant pool of 100 would be adequate to identify a significant difference, and there was a slight over‐recruitment because subjects were approached concurrently. The final sample size of 108 ensured an ample power for all subsequent analyses conducted in the study.

2.2. Informed Consent and Ethical Consideration

The study was registered at clinicaltrials. gov, first reporting date: 03/23/2023; identifier NCT05798650. Prior approval was taken from the ethical review committee of Altamash Institute of Dental Medicine (AIDM/ERC/01/2021/03). The objective, consent statement for voluntary participation and declarations of anonymity and confidentiality were clarified and sought out for all participants before participation in this study.

2.3. Participants Recruitment

A simple random sampling technique was used for the recruitment of participants. Both male and female, freshly inducted students of Bachelor of Dental Surgery (first year) at Altamash Institute of Dental Medicine, Pakistan with no prior knowledge of smile parameters, aged between 18 and 21 years, and active users of Instagram (SNS) were included. Students who did not consent to the study or, with a history of orthodontic, or aesthetic treatment in the past or psychological conditions that could significantly affect their responses were excluded.

2.4. Image Compilation and Selection

Two image sets were compiled from public Instagram profiles: one featuring attractive smiles (#smile) and the other nature‐themed, appearance‐neutral images (#nature). The first author shortlisted 100 smile images, which were evaluated by a panel (orthodontist, prosthodontist, and restorative dentist) using a 5‐point Likert scale for smile and teeth attractiveness. (1 = very attractive, 5 = very unattractive), image quality (1 = very good quality, 5 = not good quality), general appeal (1 = very appealing, 5 = not at all appealing) and enjoyment (1 = very enjoyable, 2 = not at all enjoyable). Out of 100 images, a total of 50 were selected.

Two distinct Instagram accounts were created, with one dedicated to uploading pictures of attractive smiles, https://www.instagram.com/sns_group1?igsh=MTY3OGh5YjJ0Z2t0ag = = and the other featuring images of nature https://www.instagram.com/sns_group2?igsh=bTBkaGU2ZG9jZGNu.

2.5. Participant Grouping

After obtaining written informed consent, the participants were divided into 2 groups, either an experimental group, which viewed 50 Instagram images of attractive smiles, or a control group, which viewed 50 nature‐themed images, simulating typical real‐time social media browsing.

2.6. Randomization and Allocation Concealment

Randomization was performed using computer‐generated numbers by an independent researcher, with allocation concealed through centralized randomization to prevent bias during recruitment and outcome assessment. This process adhered to the CONSORT reporting guidelines [16].

2.7. Blinding

While it was not feasible to blind participants to the nature of the images they are viewing, efforts were made to minimize bias during participant recruitment and enrollment. The recruiters were blinded to the specific hypotheses of the study and the expected outcomes. Moreover, those involved in assessing the outcomes were blinded to the group assignments of the participants. This means they would not know which participants were exposed to images of attractive smiles and which were exposed to natural images.

2.8. Data Collection

Two sets of questionnaires were developed for participants. Initially, participants completed the pre‐exposure questionnaire, followed by the presentation of images. Subsequently, after viewing the social media pictures within their respective groups, participants filled out the post‐exposure questionnaire. This sequential process aimed to analyze potential changes in individual smile perception influenced by exposure to such images on social media in their daily lives.

The pre‐exposure questionnaire encompassed three sections. The first section gathered general information, including age, gender, and history of orthodontic/aesthetic/psychological treatments. In the second section, three inquiries related to Instagram use were included, focusing on daily hours spent on the platform, the number of individuals followed, and the count of celebrities followed. Additionally, a visual analog scale question measured participants' current feelings about their smile, ranging from 0 (very happy) to 100 (not happy at all).

The third section featured an Orofacial‐esthetic scale [17], consisting of seven items addressing patients' perceptions of specific aesthetic components, such as the appearance of their face, mouth, teeth, and tooth replacement. The questionnaire also included 1 item for the overall impression of orofacial aesthetics. Responses for each item were recorded on an 11‐point numerical rating scale, ranging from 0 (“very dissatisfied”) to 10 (“very satisfied”). The scores of items 1 through 7 could be summed to generate an OES summary score ranging from 0 through 70, with higher scores indicating less‐impaired esthetics. The eighth item was not included in the summation as it represented an overall impression without specifying a particular aesthetic component.

The post‐exposure questionnaire included the visual analog scale question, which measured participants' current feelings about their smiles, ranging from 0 (very happy) to 100 (not happy at all). The second section featured the same Orofacial‐esthetic scale [17], which was filled again after the stimulus to measure facial dissatisfaction.

The third section included the State Appearance Comparison Scale (SACS) [18], developed by Tiggemann and McGill. It utilized three 7‐point Likert scales. Participants indicated the extent to which they thought about their appearance (ranging from 1 = no thought about appearance to 7 = a lot of thought about appearance), compared their overall appearance to the photographs (ranging from 1 = no comparison to 7 = a lot of comparisons), and compared specific body parts/teeth or smile to photographs (ranging from 1 = no comparison to 7 = a lot of comparisons). Scores were averaged to derive a total score for state appearance comparison.

The last section included the state variant of the Self‐Discrepancy Index (SDI) [19], to assess appearance discrepancy. Participants were instructed to list up to five aspects of the physical appearance they wished to alter, rate the extent of difference desired from their current state (on a scale of 1 = a little different to 6 = extremely different), and evaluate the significance of this difference to them (on a scale of 1 = a little important to 6 = extremely important).

2.9. Outcome Measures and Questionnaire Administration

All questionnaires were self‐administered in paper format under supervision.

• Primary outcome: Change in Orofacial Esthetic Scale (OES) scores from pre‐ to post‐exposure

• Secondary outcomes:

• ◦VAS for smile dissatisfaction
• ◦SACS: 3‐item 7‐point Likert scale assessing frequency of appearance‐related thoughts and comparisons to viewed images
• ◦SDI: Participants listed five appearance features they wished to change and rated difference and importance on a 6‐point scale

These validated instruments were selected to capture the psychological and esthetic dimensions of short‐term media exposure relevant to facial and smile perception.

2.10. Data Analysis

Descriptive statistics were used to summarize OES scores at two points (pre‐ and post‐exposure), as well as post‐exposure SACS, SDI, and total scores. Associations between demographic variables and group allocation were evaluated using the Chi‐square (χ²) test. Prior to performing parametric analyses, the assumption of normality was assessed using Shapiro–Wilk and Kolmogorov–Smirnov tests, as well as visual inspection of histograms. As the data met the assumption of normality, parametric tests were employed. Paired t‐tests were used to compare pre‐ and post‐exposure scores within groups. Independent samples t‐tests were used to compare OES and SACS scores between groups. One‐way ANOVA was performed to compare mean scores across groups (experimental vs. control), time points (pre‐ vs. post‐exposure), and their interaction. All statistical tests were two‐sided, with a predefined level of significance set at p < 0.05. Analyses were conducted using IBM SPSS Statistics, version 25.0 (IBM Corp., Armonk, NY, USA). The reporting of statistical methods adheres to the SAMPL (Statistical Analyses and Methods in the Published Literature) [20] guidelines.

3. Results

A total of 230 participants were assessed for eligibility, 14 were excluded as 10 did not meet the inclusion criteria and 4 declined to participate, after randomization on 216 pariticipants, 108 were divided into 2 groups in the study. No participants were lost and allocated as shown in (Figure 1; supporting file 1). In terms of gender, the experimental group included 14 out of 54 males (25.9%) and 40 out of 54 females (74.1%), while the control group included 16 out of 54 males (29.6%) and 38 out of 54 females (70.4%). Overall, 30 out of 108 participants were male (27.8%) and 78 out of 108 were female (72.2%). The chi‐square (χ²) test indicated no significant difference in gender distribution between the experimental group (14 males, 40 females) and the control group (16 males, 38 females) (χ² = 0.598, p = 0.44). Regarding age, the experimental group had a mean age of 18.88 ± 2.71 years, while the control group had a mean age of 20.34 ± 1.03 years. The overall cohort exhibited a mean age of 19.61 ± 1.86 years. The median age for both groups ranged from 18 to 22 years. A Chi‐square test comparing categorical age ranges showed no significant difference in age distribution between the two groups (χ² = 0.072, p = 0.79). Table 1.

Table 1.

The distribution of demographic attributes of the participants.

		Experimental group	Control group	Overall	χ 2	p‐value
Gender	Male	14 (25.9%)	16 (29.6%)	30(27.8%)	0.598	0.44
	Female	40 (74.1%)	38 (70.4%)	78 (72.2%)
Age	Mean ± SD	18.88 ± 2.71	20.34 ± 1.026	19.61 ± 1.86	0.072	0.79
	Median(range)	4 (18–22)	5 (18–23)	4 (18–22)

In terms of daily usage, the majority (70.9%) spend between one to 2 h on Instagram, with smaller proportions spending less than an hour (27.8%), two to 4 h (18.5%), or more than 4 h (11.1%). Regarding the number of people who followed on Instagram, the majority (81.5%) follow fewer than 500 accounts, while smaller percentages follow between 500 and 1000 accounts (13.0%), 1000 to 2000 accounts (1.9%), or more than 2000 accounts (3.7%). When it comes to following celebrities, the majority (70.4%) follow fewer than 50 celebrities, while smaller proportions follow between 50 and 100 celebrities (20.4%), 100 to 200 celebrities (3.7%), or more than 400 celebrities (5.6%). The participants from both groups were moderately active on social media since a larger percentage of the people spend less than 2 h on the social media app and followed fewer celebrities.

3.1. Analysis of Item “How Satisfied Are You With Your Smile” in the Control and Experimental Group

In the experimental group pre‐exposure, 3 out of 54 participants (5.5%) expressed very low satisfaction, with 1 out of 54 (1.9%) reporting dissatisfaction. Conversely, a significant portion of the experimental group indicated satisfaction (24.1%), followed by moderate satisfaction (35.2%) and extreme satisfaction (33.3%). Furthermore, the analysis of post‐exposure satisfaction revealed that 10 out of 54 (18.5%) felt satisfied, 19 out of 54 (35.2%) reported moderate satisfaction, and 16 out of 54 (30.5%) reported extreme satisfaction. Interestingly, only a minimal percentage 4 out of 54 participants (7.4%) indicated very low satisfaction, and another 4 out of 54 participants (7.4%) reported dissatisfaction levels, respectively.

Similarly, in the control group pre‐exposure phase, 11.1% and 7.4% reported very low and low satisfaction, respectively. However, a larger proportion expressed satisfaction (28.8%), with moderate (20.4%) and extreme satisfaction (32.3%) also prevalent. The analysis of post‐exposure satisfaction levels revealed higher levels of satisfaction, with 37.3% expressing extreme satisfaction, followed by 24.2% indicating moderate satisfaction. Additionally, 24.9% reported feeling satisfied. Conversely, a smaller proportion of participants expressed dissatisfaction, with 9.1% feeling somewhat dissatisfied and 4.5% reporting very low satisfaction levels.

Overall, both groups showed a similar pattern of extreme satisfaction being one of the highest response categories. The experimental group experienced a decline in satisfaction levels post‐exposure, particularly in the satisfaction category, while moderate satisfaction remained consistent. In contrast, the control group maintained or slightly improved satisfaction levels post‐exposure, with moderate satisfaction increasing and extreme satisfaction remaining high.

Table 2 presents a comparison of Orofacial Esthetic Scale (OES) and State Appearance Comparison Scale (SACS) scores within the experimental and control groups at different time points. In the experimental group, the mean OES score decreased slightly from 56.18 ± 10.66 (pre‐exposure) to 55.27 ± 10.76 (post‐exposure); however, this change was not statistically significant according to a paired t‐test (t = 1.231, p = 0.22). In the control group, the mean OES score increased marginally from 47.79 ± 16.61 to 48.94 ± 15.08, which was also not statistically significant (t = –0.985, p = 0.33). These results suggest that orofacial esthetic satisfaction remained relatively stable over the intervention in both groups.

Table 2.

Comparison of OES, SACS scores within the groups at different time.

Variables	Mean (CI 95%)
	OES	SACS
Group
Experimental	55.73 ± 10.36 (25.50–70.50)	4.74 ± 1.75 (1.00–7.00)
Control	48.37 ± 15.35 (22–70)	3.28 ± 2.07 (1–7)
Total score	104.86 ± 18.15 (63–139)	8.02 ± 2.74 (2–12.67)
Df	53	53
T	2.957	4.061
p‐value	0.005	< 0.001
Time
Experimental
Pre‐exposure	56.18 ± 10.66 (23–76)
Post‐exposure	55.27 ± 10.76 (27–70)	4.74 ± 1.75 (1–7)
Total score	111.46 ± 20.73 (51–141)
Df	53
T	1.231
p‐value	0.22
Control
Pre‐exposure	47.79 ± 16.61 (21–70)
Post‐exposure	48.94 ± 15.08 (21–70)	3.28 ± 2.07 (1–7)
Total score	98.07 ± 27.93 (42–140)
Df	53
T	−0.985
p‐value	0.33

Note: *SACS was applied in the post‐exposure phase only.

Notably, post‐exposure SACS scores were significantly higher in the experimental group (4.74 ± 1.75) than in the control group (3.28 ± 2.07), indicating a stronger tendency for appearance‐based comparison among participants exposed to idealized smile imagery. Independent samples t‐tests confirmed that the total post‐exposure scores were significantly higher in the experimental group for both OES (t = 2.957, p = 0.005) and SACS (t = 4.061, p < 0.001).

Table 3 compares the mean scores of the Orofacial Esthetic Scale (OES) and State Appearance Comparison Scale (SACS) between the control and experimental groups across two time points. During the pre‐exposure phase, the experimental group had a mean OES score of 56.18 ± 10.66, while the control group scored 47.79 ± 16.61. This difference was not statistically significant based on one‐way ANOVA (F = 1.296, p = 0.27).

Table 3.

Comparison between mean scores of OES, SACS at different time intervals.

Time interval	Group comparison p‐value
	OES	a SACS
Pre‐exposure control vs pre‐exposure experimental	0.27	—
F (df)	1.296
Post‐exposure control vs post‐exposure experimental	0.02	< 0.001
F (df)	2.392	0.323

^a SACS was applied in post‐exposure phase only.

However, following exposure to the visual stimuli, post‐exposure OES scores showed a significant difference between groups: the experimental group scored 55.27 ± 10.76 and the control group 48.94 ± 15.08, with the difference reaching statistical significance (F = 2.392, p = 0.02). This suggests that viewing idealized smile images may have had an effect on participants' perceptions of orofacial esthetics. For the SACS, which was administered only in the post‐exposure phase, the mean score was 4.74 ± 1.75 for the experimental group and 3.28 ± 2.07 for the control group. This difference was statistically significant (t = 4.061, p = 0.001), indicating that participants exposed to idealized smile images exhibited a greater tendency for appearance‐based comparison compared to the control group.

3.1.1. The Response of Item Number 8 in OES

In the pre‐exposure assessment of orofacial esthetics in the control group, the majority of participants expressed satisfaction, with 42.4% indicated satisfaction and 33.3% reporting extreme satisfaction regarding the appearance of their face, mouth, and teeth. Conversely, a smaller percentage indicated dissatisfaction or very low satisfaction levels. Post‐exposure, a similar tendency was observed, with satisfaction levels remaining high, though with a slight decrease in extreme satisfaction. Specifically, 39.4% of participants reported satisfaction and 34.8% indicated extreme satisfaction, highlighting a generally positive perception of their facial aesthetics even after exposure to intervention.

In the pre‐exposure assessment of orofacial aesthetics within the experimental group, a significant portion of participants expressed high levels of satisfaction, with 46.3% indicating satisfaction and an additional 46.3% reporting extreme satisfaction regarding the appearance of their face, mouth, and teeth. Dissatisfaction was minimal, with only 1.9% indicating dissatisfaction. Following exposure, the trend of satisfaction persisted, with 42.6% reporting satisfaction and 46.3% expressing extreme satisfaction. The proportion of participants indicating neutral feelings slightly increased to 11.1%, reflecting a minor shift in perceptions post‐exposure, but overall, satisfaction levels remained notably high within the experimental group.

3.1.2. Self‐Discrepancy Index (SDI) Analysis Experiment Group Post‐Exposure

The majority, 29 out of 54 participants (53.7%) expressed a preference for no changes in their physical appearance. Alternatively, six participants (11.1%) mentioned teeth color, two participants (3.7%) selected teeth color plus alignment, five participants (9.3%) cited teeth alignment, and six participants (11.1%) identified a combination of teeth color, shape, and alignment. These findings suggest a diverse range of concerns, with a substantial proportion of individuals not feeling the need for any alterations.

Regarding the degree of desired difference in appearance, 36 participants (66.7%) expressed a preference for little difference, 11 participants (20.4%) desired a moderate difference, and five participants (9.3%) wanted an extreme difference compared to their current appearance. In terms of the importance of these changes, 31 participants (57.4%) considered them to be of little importance, 15 participants (27.8%) deemed them moderately important, and six participants (11.1%) regarded them as extremely important.

3.1.3. Self‐Discrepancy Index (SDI) Analysis Control Group Post Exposure

In the post‐exposure analysis of the SDI within the control group (n = 54), during the participants' reflections on desired changes in physical appearance 24 out of 54 participants (44.4%) expressed a preference for no alterations in their physical appearance. Among those indicating specific preferences, five participants (9.3%) selected teeth color plus alignment, and 14 participants (25.9%) cited a combination of teeth color, shape, and alignment. In addition, one participant (1.9%) mentioned teeth color alone, one participant (1.9%) selected alignment alone, and three participants (5.6%) indicated teeth shape as an area of concern. These findings highlight the variation in concerns among participants, with a notable proportion reporting no desire for changes, while others identified specific aspects such as color and alignment as relevant to their self‐perceived appearance. Regarding the degree of desired change, 25 participants (46.3%) preferred a little difference, 20 participants (37.0%) desired a moderate difference, and six participants (11.1%) reported wanting an extreme difference compared to their current appearance. Concerning the importance of these desired changes, 22 participants (40.7%) considered them to be of little importance, 11 participants (20.4%) deemed them moderately important, and 18 participants (33.3%) regarded them as extremely important.

4. Discussion

The present study's findings shed light on the complex interplay between social media use and individuals' perceptions of their appearance, highlighting the intricacies of this relationship.

The study's findings reveal a predominance of female participants, comprising 84.2% of the total sample, with an average age of 19.61 ± 1.86. Both the experimental and control groups displayed moderate activity on social media, with a notable proportion spending less than 2 h on social media apps. These observations align with similar trends identified in a study by Laor et al [21] where younger individuals and females were found to be more active users of Instagram compared to males and older age groups. Rozgonjuk et al [22]. noted that most active Instagram users were younger, with an average age of 23.61. In contrast, a study conducted by Pasha et al [23]. reported a more balanced gender distribution, with 48.2% female participants and 51.8% male participants, the majority falling within the age range of 18–21. Regarding social media usage, the findings revealed a wider range of usage patterns. Only 18.5% spent 2 h per day, 49.5% spent 3 to 4 h per day, and 32% spent more than 4 h per day on Instagram while in our study 70.9% spent between one to 2 h on Instagram, two to 4 h (18.5%), or more than 4 h (11.1%). The differences in results between the two studies can be attributed to various factors including cultural disparities, temporal trends, and study context.

In this study, both groups showed a similar pattern of extreme satisfaction being one of the highest response categories. However, the experimental group displayed a minor decline in satisfaction after exposure, whereas the control group either sustained or marginally enhanced satisfaction levels, suggesting a slight adverse effect of the experimental intervention. This finding bears a resemblance to a study conducted by Newton et al [24]., where individuals without a history of seeking orthodontic or orthognathic treatment reported slight dissatisfaction. Conversely, those who were either about to commence or had recently initiated orthodontic treatment, as well as women in the pre‐surgical phase of orthognathic treatment, reported heightened dissatisfaction after being exposed to idealized facial images. Our results contrast with Sampson et al [15]. and Fardouly et al [25]., where exposure to idealized facial images led to increased dissatisfaction with facial appearance and smiles compared to neutral images. These differences in study outcomes may stem from variations in cultural background and discrepancies in the experimental interventions employed across studies. Moreover, individual psychological factors, including self‐esteem and prior experiences with cosmetic procedures, may shape participants' reactions to idealized facial images, impacting study results. Lastly, cultural norms and societal beauty standards further influence participants' perceptions and responses to idealized facial images, contributing to differences in study outcomes.

Moreover, in our study, the experimental group showed a slight decrease in mean OES scores from pre‐ to post‐exposure, although statistically insignificant. Similarly, the control group demonstrated a slight increase in mean OES scores, also statistically insignificant. These findings are consistent with Laus et al [26] research on the impact of positive visual stimuli, such as commercials featuring attractive smiles, versus neutral stimuli, on participants' perceptions of smile aesthetics and psychosocial effects. According to their study, exposure to positive visual stimuli did not significantly alter participants' perceptions of smile aesthetics, satisfaction levels, or psychosocial impacts. Similar findings were observed by Williams et al [27] They also found that viewing ‘idealized’ or ‘average’ faces did not significantly affect satisfaction with self. Additionally, Laus et al. suggested that the psychosocial effects of altered smile aesthetics may not remain consistent over time. They noted that dissatisfaction with smile aesthetics is often mild frustration stemming from unfulfilled desires, rather than a deeply ingrained sentiment. This suggests a potential trend towards decreased self‐criticism and improved acceptance of dentofacial aesthetics over time, independent of dental interventions [24].

The experimental group exhibited higher mean SACS scores than the control group suggesting a greater tendency for appearance comparison within the experimental group. Although the OES scores in the experimental group remained statistically stable pre‐ to post‐exposure, the higher SACS scores observed post‐exposure suggest an important psychological nuance. Participants exposed to idealized smile images engaged in significantly more appearance comparisons, indicating heightened cognitive processing regarding their facial appearance. This disparity implies that while overall satisfaction with orofacial esthetics (as measured by OES) did not decline, the internal pressure of comparing oneself to idealized content increased. This aligns with the notion that social media may subtly influence self‐perception without immediately altering explicit satisfaction scores. These findings are consistent with prior research emphasizing the role of internalized comparison over direct dissatisfaction [15, 24, 28]. This highlights the importance for clinicians to recognize and consider the influence of social media content when assessing patients' emotional responses and opinions regarding their appearance. Understanding these dynamics is crucial for providing comprehensive care and addressing the impact of social media on individuals' perceptions and behavior [2].

Lastly, the SDI analysis in both groups revealed that the majority of participants (experimental: 53.7%, control: 44.4%) reported no desire for changes in their physical appearance. Among those who did the report concerns, most identified specific aspects such as teeth color, alignment, or shape. Importantly, the extent of desired change was generally mild, with over two‐thirds of participants in both groups indicating only a slight preference for change, and the perceived importance of these changes was also predominantly low. This suggests that while some internal appearance concerns existed, they were not deeply internalized or psychologically distressing for most participants. Contrary to expectations based on prior studies [29, 30] the exposure to idealized smile images did not intensify desires for cosmetic changes. These findings may reflect an emerging trend of resilience or critical self‐awareness among younger users, or a short‐term, surface‐level effect of such exposure that does not translate into altered appearance goals.

The limitation of this study was that our study predominantly comprised young female participants, reflecting the demographic profile commonly associated with active social media engagement. However, studies with more diverse participant demographics or specific subgroups may yield different results due to varying cultural norms, beauty ideals, and socialization patterns. In addition, Cultural factors play a significant role in shaping individuals' perceptions of beauty and attractiveness, which, in turn, can influence their responses to social media imagery. Cultural norms regarding facial aesthetics, smiling standards, and the importance of physical appearance may vary across different societies and cultural contexts. Thus, studies conducted in diverse cultural settings may reveal distinct patterns of response to social media content and its impact on smile aesthetics perceptions.

Future research could explore additional variables, such as self‐esteem or social comparison tendencies, to provide a more comprehensive understanding of the mechanisms underlying the influence of social media on self‐perception. Furthermore, investigating cross‐cultural differences in the relationship between social media exposure and smile aesthetics perceptions could uncover culturally specific factors shaping beauty standards and social media effects. Comparative studies conducted in diverse cultural contexts would shed light on the cultural variability of these phenomena and inform culturally sensitive interventions.

4.1. Patient or Public Contribution

This study involved public contribution through the direct participation of first‐year Bachelor of Dental Surgery students who acted as representative individuals from the target population. These participants, with no prior knowledge of smile parameters, provided valuable insights into how young adults perceive their smiles before and after exposure to social media imagery. Their feedback, captured through pre‐ and post‐exposure questionnaires, was crucial in analyzing the psychological impact of idealized beauty standards. Additionally, the participants' perceptions helped shape the interpretation of the data, particularly in assessing effective implications of social media on self‐image.

5. Conclusion

The findings of this study highlighted interesting insights into the complex interplay between social media exposure and individuals' perceptions of smile aesthetics among young adults. The following conclusions were drawn:

• 1.Despite spending considerable time on social media, participants generally expressed moderate to high levels of satisfaction with their smiles.
• 2.Exposure to idealized beauty standards on social media platforms may exacerbate tendencies for self‐comparison regarding facial appearance. However, that may not express a desire for alterations in their physical appearance.
• 3.Future research involving diverse participant samples, objective metrics, and cross‐cultural analyses will advance our understanding of the complexities surrounding social media's impact on self‐perception and well‐being.

Author Contributions

Maria Shakoor Abbasi: conceptualization; methodology; software; investigation; formal analysis; resources; writing – original draft; writing – review and editing; visualization; data collection; supervision. Sandhal Akhtar: conceptualization; visualaization; data collection; formal analysis; methodology. Aleesha Faisal: methodology; data collection; conceptualization; resources; formal analysis; supervision; visualization. Sheheryar Minallah: software; visualization, methodology; writing original draft; resources; writing – review and editing. Sara Altamash: writing – review and editing; resources; investigation; methodology. Naseer Ahmed: conceptualization; formal analysis; writing – review and editing; supervision; resources. Asif Ullah Khan: writing – review and editing; writing original draft; resources; software; validation. Artak Heboyan: conceptualization; software; validation; formal analysis; writing – review & editing; visualization.

Funding

The authors received no specific funding for this work.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The lead author Asif Ullah Khan, Artak Heboyan affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Supporting information

Figure 1: Consort flow diagram of the study.

Data Availability Statement

The data presented in this study and trial protocol are available on request from the corresponding author. The data are not publicly available due to ethical concerns.