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The Pan African Medical Journal logoLink to The Pan African Medical Journal
. 2021 Jan 14;38:38. doi: 10.11604/pamj.2021.38.38.21422

Perception about tooth colour and appearance among patients seen in a tertiary hospital, South-West, Nigeria

Deborah Mojirade Ajayi 1,&, Shakeerah Olaide Gbadebo 1, Gbenga Emmanuel Adebayo 2
PMCID: PMC7955593  PMID: 33777306

Abstract

Introduction

patients´ satisfaction with their dental appearance and tooth colour is often influenced by certain factors which need to be addressed periodically among different populations.

Methods

a self-administered questionnaire consisting of sociodemographic data, questions on patients´ satisfaction with tooth colour, perceived malalignment of teeth, non-aesthetic anterior tooth-coloured restoration and presence of tooth fracture were distributed. Data collected was analysed using Statistical Package for Social Sciences (IBM, SPSS version 20). Chi square was used to test the statistical differences at a significance of p> 0.05.

Results

a total of 410 patients (M=147, F=263) participated in the study. About 73% had tertiary education while 36.3% were within the modified ISCO-08 Group 2. The respondents that were satisfied with the general dental appearance and tooth shade were 66.3% and 63.5% respectively. More males (65.1%) than females (62.7%) were satisfied with tooth colour while more females (69.1%) were satisfied with dental appearance. The older age group were more satisfied with dental appearance and tooth colour. Awareness of tooth whitening (Over 80%) and the desire to undergo tooth whitening was more among the post-secondary individuals. More of dental patients (73.1%) than medical (59.2%) were satisfied with teeth appearance (p=0.003).

Conclusion

patients are increasingly aware of their dental appearance/tooth colour and the need to improve it with tooth bleaching and/or orthodontic treatment. Female were more dissatisfied with their tooth colour but more satisfied with their dental appearance than the male. Older people were more satisfied with their dental appearance and tooth colour compared to younger age group.

Keywords: Dental appearance, tooth colour, satisfaction, tooth whitening

Introduction

Aesthetics is an important aspect of modern society because it defines one´s personality. Individuals with positive attitude towards their teeth (colour and shape), and smile may show confidence and be extroverts while individuals with discoloured, missing or fractured teeth may on the other hand be withdrawn because of their teeth appearance. Recently in dental treatment, increasing emphasis is being laid on aesthetics [1] with the ultimate objective of creating a beautiful smile. This is to provide teeth of pleasing inherent proportions to one another, and a pleasing tooth arrangement in harmony with the gingiva, lips and face of the patient. Dental appearance being an important determinant in attractiveness of the face plays a key role in human social interactions; and among significant factors affecting the dental appearance are tooth colour, shape, quality of restoration, position and general arrangement of the teeth especially in the anterior region [2]. Natural tooth colour ranges from greyish white to yellowish white, however, a lot of people desire brighter white teeth, which shows that tooth colour is a very important factor determining patients´ satisfaction with dental appearance [2,3]. Also, the outward appearance and colour of teeth, both natural and artificial may be determined by the face and lips. Studies amongst adult population in UK, [2] USA, [4] and China [5] reported varying percentages of people´s dissatisfaction with their colour and appearance which ranged from 28% to 52.6%, however, a study [6] conducted in Nigeria showed that 79.4% of the studied population was satisfied with their dental appearance. Though various groups of patients have different attitudes towards the appearance of their teeth, studies [7,8] have found out that females care more about their dental appearance than males making males to be more satisfied with their teeth appearance than females.

The arrangement of teeth, shape and form, untreated dental caries and non-aesthetic or discoloured anterior teeth restorations as well as missing anterior teeth lead to dissatisfaction with dental appearance. [3,9] Though tooth misalignments are not regarded as serious enough dental problem to necessitate treatment by some people, [10,11] others show high need for rearrangement of their teeth to boost their appearance [12]. Similarly, different treatments being sought to improve dental aesthetic such as bleaching/tooth whitening, aesthetic restoration in anterior teeth have been found to increase patient quality of life and psychological status [13,14]. When a patient´s smile is destroyed by dental diseases which include tooth fracture, discoloration, malalignments, caries etc., the result often is loss of self-esteem and possibly damage to his or her overall physical and mental health. It is thus paramount to assess in any population the view or perception of individuals about their dental appearance in order to improve and/or restore their lost self-esteem and improve their quality of life. The assessments of patients´ satisfaction with their dental appearance, and teeth colour as well as the determination of the factors that influence these variables were the objectives of this study.

Methods

This was a questionnaire-based cross-sectional study, which made use of the modified version of the questionnaires used by Tin OO et al. [1] and Poonam [8]. The self-administered questionnaire consisted of questions on sociodemographic, including gender, age, and level of education, as well as question on patients´ satisfaction with current general dental appearance including satisfaction with tooth colour, perceived malalignment of teeth (crowding, poorly aligned or protruding), presence of caries in anterior teeth, non-aesthetic anterior tooth-coloured restoration and presence of tooth fracture. Study participants included all patients attending 2 outpatient clinics at the University College Hospital Ibadan; the General Out Patient clinic (GOPD) and Dental Centre (a first point of call and sorting out clinic for patients presenting for the first time with non-emergency medical ailments/diseases and the first point of call for all dental cases presenting in the University College Hospital respectively). All completed questionnaires were retrieved from the two clinics. Grossly inadequately filled questionnaires were excluded. A modified socioeconomic class grouping based on International Standard Classification of Occupation 2008 (ISCO-08) [15] was used for occupational stratification. The modified socioeconomic class categorization consisted of 4 groups: group I - chief executives, managers, professionals and high-profile businessmen. Group II - technicians (pharmacy, engineering, and medical) Information Communication Technologists, clerks, secretaries and skilled agricultural workers. Group III - cooks, waiters, all artisans, casual workers and traders. Group IV - unemployed graduates, dependents and housewives.

Ethical approval was obtained from the University of Ibadan/University College Hospital Institutional Review Board (UI/UCH IRB) with approval number: UIUCH/EC0155. The data collected was analysed using Statistical Package for Social Sciences (IBM, SPSS version 20). Descriptive statistics was employed and chi square used to test the statistical differences of some responses at a significance of p= 0.05.

Results

Four hundred and ten patients participated in the study (M=147, F=263) with a mean age of 36.8±14.03 years. Although there were more females than males generally, the M: F among the dental patients was 1: 2.5 compared to 1: 1.3 among the medical patients. The highest proportion (73%) had tertiary education while most of the participants (36.3%) were within the modified ISCO-08 Group 2 which comprised of Technicians, Clerks, Secretaries, Skilled Agricultural workers (Table 1). The findings as shown in Figure 1 revealed that not all the 410 patients in this survey responded to all the questions probing their satisfaction with dental appearance and colour. About 66.3% of those that responded (404) were satisfied with the general dental appearance and almost equal proportion 63.5% of 406 were satisfied with tooth shade. When asked about the teeth arrangement, 26.7%, 17.1% and 14.7% respectively felt that their teeth were crowded, poorly set and had anterior teeth proclination. Relating the gender to the different variables studied as presented in Table 2, more males than females were satisfied with tooth colour (65.1% versus 62.7%), felt teeth were crowded (19.6% versus 15.7%), poorly set (28.3% versus 15.7%), protruding/bulging in the anterior region (16.4% versus 13.8%); had holes (26.7% versus 16.2%, p=0.01); had fractured or missing anterior teeth. However, more females were satisfied with dental appearance (69.1% versus 61.4%) and knew discoloured teeth could be whitened (82.5% versus 79.0). Nevertheless more males had desires to undergo either restorative orthodontic or aesthetic treatment. The wish to have fractured anterior teeth restored was the most common desired among the patients (M=67.4%, F= 68.0 %).

Table 1.

sociodemographic characteristics of the patients

Total (N=410) Dental (N=212) Medical (N=198)
N % N % N %
Gender
Male 147 35.9 60 28.3 87 43.9
Female 263 64.1 152 71.7 111 56.1
Age Group
≤ 20 48 11.7 22 10.4 26 13.1
21-40 208 50.7 112 52.8 96 48.5
41-60 121 29.5 69 32.5 52 26.3
≥ 61 21 5.1 5 2.4 16 8.1
No response 12 2.9 4 1.9 8 4.0
Educational status
Primary 32 7.8 22 10.4 10 5.1
Secondary 50 12.2 30 14.2 20 10.1
Post-Secondary 24 5.9 14 6.6 10 5.1
Tertiary 292 73.4 140 66.0 152 76.8
No response 12 2.9 6 2.8 6 3.0
Occupational Status
Group 1 modified ISCO-08 49 12 16 7.5 33 16.7
Group 2 modified ISCO-08 149 36.3 84 39.6 65 32.8
Group 3 modified ISCO-08 80 19.5 54 25.5 26 13.1
Group 4 modified ISCO-08 129 31.5 56 26.4 73 36.9
Missing 3 0.7 2 0.9 1 0.5
Religion
Christianity 323 78.8 153 72.2 170 85.9
Islam 82 20.0 56 26.4 26 13.1
Others 5 1.2 3 1.4 2 1.0
Tribe
Yoruba 314 76.6 159 75.0 155 78.3
Igbo 68 16.6 34 16.0 34 17.2
Hausa 4 1.0 4 1.9 0 0
Nigerian/others 4 1.0 1 0.5 3 1.5
Missing 20 4.9 14 6.6 6 3.0
Marital Status
Single 181 44.1 83 39.2 98 49.5
Married 209 51.0 120 56.6 89 44.9
Separated 4 1.0 1 0.5 3 1.5
Divorced 1 0.2 6 2.8 1 0.5
Widowed 10 2.4 2 0.9 4 2.0
Missing 5 1.2 - 3 1.5

Figure 1.

Figure 1

patients' satisfaction with dental appearance and colour

Table 2.

dental appearance and tooth colour among gender

Variable Gender X2 P Value
Male Female
n % n %
Satisfied with teeth appearance YES 89 61.4 179 69.1 2.489 0.115
NO 56 38.6 80 30.9
Satisfied with tooth colour YES 95 65.1 163 62.7 0.228 0.633
NO 51 34.9 97 37.3
Felt teeth were crowded YES 27 19.6 40 15.7 0.953 0.329
NO 111 80.4 215 84.3
Felt teeth were poorly set YES 41 28.3 67 25.9 0.275 0.600
NO 104 71.7 192 74.1
Felt front teeth were protruding /bulging YES 23 16.4 35 13.8 0.505 0.478
NO 117 83.6 219 86.2
Felt dental caries/holes in teeth YES 39 26.7 42 16.2 6.527 0.011
NO 107 73.3 218 83.8
Had non aesthetic restoration in the anterior teeth YES 11 7.60 16 5.8 0.294 0.588
NO 133 92.4 241 94.2
Perceived fractured front teeth YES 32 21.9 38 14.5 3.626 0.057
NO 114 78.1 224 85.5
Had missing front teeth YES 18 12.3 22 8.4 1.607 0.205
NO 128 87.7 239 91.6
Wish to restore back fractured teeth YES 95 67.4 170 68.0 0.016 0.899
NO 46 32.6 80 32.0
Do you know discoloured teeth can be whitened YES 113 79.0 207 82.5 0.710 0.399
NO 30 21.0 44 17.5
Wish to undergo orthodontic treatment YES 60 46.2 83 35.6 3.876 0.049
NO 70 53.8 150 64.4
Wish to undergo tooth whitening treatment YES 89 63.1 142 57.5 1.181 0.277
NO 52 36.9 105 42.5
Wish to have dental crown if needed YES 43 32.6 63 28.1 0.787 0.375
NO 89 67.4 161 71.9
Wish to have tooth colour fillings YES 51 37.5 75 32.1 1.137 0.286
NO 85 62.5 159 67.9
Wish to have missing teeth replaced YES 46 33.8 65 27.8 1.497 0.221
NO 90 66.2 169 72.2

It seems the older the age, the greater is the satisfaction with either the dental appearance or tooth colour. The feeling of having protruded anterior teeth was seen more among the youngest age group studied (< 20) compared to other age groups, this was found to be statistically significant (p=0.005). The desire to undergo orthodontic treatment was equally high among the very young and the very old. However, the knowledge of tooth whitening was highest among the youngest age group (Table 3). The association between different educational levels and satisfaction with dental appearance, tooth colour, feeling of presence of crowded teeth as well as presence of missing anterior teeth were all statistically significant (p= 0.013, 0.001, 0.000, 0.031 respectively) with greater tendency to have satisfaction with dental appearance and colour seen among the primary and secondary school holders respectively while feeling of crowded teeth and presence of missing anterior teeth were more in those with post-secondary. The least percentage of missing anterior teeth was seen in people with tertiary education. Over 80% of those with post-secondary/tertiary education knew discoloured teeth could be whitened, however, the desire to undergo orthodontic treatment, tooth whitening and crowning was more among the post-secondary individuals than the others (Table 4). Satisfaction with dental appearance and tooth colour was more prevalent among the occupational group 3, so also was the desire to undergo tooth whitening, dental crowning, tooth colour fillings (p=0.02) and replacement of missing teeth. Comparing dental appearance with tooth colour satisfaction level of dental and medical patients, there were significant differences only with the general dental appearance (p=0.003), the feeling of having poorly set teeth, (0.000), and feeling of having bulging or protruding teeth (p=0.001) between these two groups of patients. More of dental patients (73.1%) than medical (59.2%) were satisfied with teeth appearance whereas more of medical than dental felt they had poorly set teeth (Medical= 35.6%, Dental=18.6%), protruding front teeth (Medical=20.5% Dental =9.3%). Fractured front teeth (Medical=22.3%, Dental 12.3%) (Table 5). The wish to undergo orthodontic treatment crowning of teeth and missing tooth replacement was greater among the medical patients and these associations were statistically significant (p=0.018, 0.009, 0.000 respectively). The perception of fractured front teeth was also significantly more among the medical patients (p=0.005) (Table 6).

Table 3.

dental appearance, tooth colour and desired aesthetic treatment among age groups

Variable Age Group X2 P Value
≤ 20YRS 21 - 40YRS 41 - 60YRS ≥ 61YRS
n % n % n % n %
Satisfied with teeth appearance YES 24 51.1 144 69.9 79 66.4 16 80.0 7.742 0.052
NO 23 48.9 62 30.1 40 33.6 4 20.0
Satisfied with tooth colour YES 27 56.2 135 65.5 76 63.9 15 71.4 1.963 0.580
NO 21 43.8 71 34.5 43 36.1 6 28.6
Felt teeth were crowded YES 12 25.5 32 15.9 16 13.9 6 33.3 6.643 0.84
NO 35 74.5 169 84.1 99 86.1 12 66.7
Felt teeth were poorly set YES 15 31.9 57 27.8 24 20.0 7 35.0 4.245 0.236
NO 32 68.1 148 72.2 96 80.0 13 65.0
Felt front teeth were protruding/ bulging YES 14 29.2 24 12.1 17 14.8 0 00.0 12.755 0.005
NO 34 70.8 175 87.9 98 85.2 20 100.0
Felt dental caries/holes in teeth YES 4 8.30 43 21.0 25 20.8 7 33.3 6.578 0.087
NO 44 91.7 162 79.0 95 79.2 14 66.7
Had non aesthetic restoration in the anterior teeth YES 4 8.30 12 5.90 8 6.90 2 9.5 0.699 0.873
NO 44 91.7 192 94.1 108 93.1 19 90.5
Perceived fractured front teeth YES 7 14.6 33 16.0 22 18.2 7 33.3 4.294 0.231
NO 41 85.4 173 84.0 99 81.8 14 66.7
Had missing front teeth YES 4 8.5 20 9.70 12 10.0 3 15.8 0.570 0.903
NO 43 91.5 187 90.3 108 90.0 18 84.2
Wish to restore back fractured teeth YES 32 68.1 134 67.3 75 65.8 15 78.9 1.297 0.730
NO 15 31.9 65 32.7 39 32.2 4 21.1
Do you know discoloured teeth can be whitened YES 42 91.3 164 81.2 89 76.7 16 84.2 4.712 0.194
NO 4 8.70 38 18.8 27 23.3 3 15.8
Wish to undergo orthodontic treatment YES 19 44.2 74 39.4 36 35.3 8 44.4 1.309 0.727
NO 24 55.8 114 60.6 66 64.7 10 55.6
Wish to undergo tooth whitening treatment YES 27 58.7 119 60.1 65 57.5 11 57.9 0.212 0.976
NO 19 41.3 79 39.9 48 42.5 8 42.1
Wish to have dental crown if needed YES 11 26.2 62 34.6 26 24.8 4 22.2 4.017 0.260
NO 31 73.8 117 65.4 79 75.2 14 77.8
Wish to have tooth colour fillings YES 10 23.3 61 32.4 40 37.0 9 47.4 4.365 0.225
NO 33 76.7 127 67.6 68 63.0 10 52.6
Wish to have missing teeth replaced YES 11 25.6 58 30.7 31 28.7 9 50.0 3.891 0.274
NO 32 74.4 131 69.3 77 71.3 9 50.0

Table 4.

self-reported dental appearance, teeth colour satisfaction and desired aesthetic among different educational level

Variable Educational level X2 P Value
Primary Secondary Post-Secondary Tertiary
n % n % n % n %
Satisfied with teeth appearance YES 24 77.4 35 74.5 9 39.1 192 66.0 10.735 0.013*
NO 7 22.6 12 25.5 14 60.9 99 34.0
Satisfied with tooth colour YES 26 74.3 40 80.0 10 41.7 174 60.4 16.331 0.001*
NO 6 25.5 10 20.0 14 58.3 114 39.6
Felt teeth were crowded YES 9 30.0 12 26.1 8 40.0 35 12.2 18.711 0.000*
NO 21 70.0 34 73.9 12 60.0 252 87.8
Felt teeth were poorly set YES 9 28.1 16 32.7 9 39.1 72 25.0 3.113 0.374
NO 23 71.9 33 67.3 14 60.9 216 75.0
Felt front teeth were protruding bulging YES 7 21.9 8 17.8 4 18.2 38 13.4 2.228 0.526
NO 25 78.1 37 82.2 18 81.8 246 86.6
Felt dental caries/holes in teeth YES 6 18.8 5 10.2 6 26.1 61 21.0 3.715 0.2943
NO 26 81.2 44 89.8 17 73.9 229 79.0
Had non aesthetic restoration in the teeth YES 3 9.40 1 2.10 4 17.4 18 6.20 6.345 0.96
NO 29 90.6 47 97.9 19 82.6 270 93.8
Perceived fractured front teeth YES 4 12.5 5 10.0 6 33.3 53 18.3 3.582 0.310
NO 28 87.5 45 90.0 18 66.7 237 81.7
Had missing front teeth YES 5 16.1 6 12.2 6 25.0 23 7.90 8.882 0.031*
NO 26 83.9 43 87.8 18 75.0 268 92.1
Wish to restore back fractured teeth YES 17 58.6 32 68.1 15 62.5 193 68.7 1.501 0.682
NO 12 41.4 15 31.9 9 37.5 88 31.3
Do you know discoloured teeth can be whitened YES 21 70.0 38 79.2 17 85.0 234 82.4 3.043 0.385
NO 9 30.0 10 20.8 3 15.0 50 17.6
Wish to undergo Orthodontic treatment YES 14 48.3 15 40.5 11 52.4 98 36.7 3.258 0.353
NO 15 51.7 22 59.5 10 47.6 169 63.3
Wish to undergo treatment tooth whitened YES 18 60.0 27 56.2 16 72.7 163 58.6 1.885 0.597
NO 12 40.0 21 43.8 6 27.3 115 41.4
Wish to have dental crown if needed YES 5 17.9 13 28.9 9 47.4 75 29.5 4.752 0.191
NO 23 82.1 32 71.1 10 52.6 179 70.5
Wish to have tooth colour fillings YES 14 48.3 16 34.0 10 47.6 82 45.3 5.309 0.151
NO 15 51.7 31 66.0 11 52.4 181 54.7
Wish to have missing teeth replaced YES 13 46.4 17 37.0 5 22.7 73 27.7 5.906 0.116
NO 15 53.6 29 63.0 17 77.3 191 72.3
*

Statistically significant

Table 5.

occupational level among dental and medical patients

Variable Occupation X2 P Value
Group 1 Modified ISCO-08 Group 2 Modified ISCO-08 Group 3 Modified ISCO-08 Group 4 Modified ISCO-08
n % n % n % n %
Satisfied with teeth appearance YES 29 59.2 99 66.9 56 72.7 81 63.8 2.901 0.407
NO 20 40.8 49 33.1 21 27.3 46 36.2
Satisfied with tooth colour YES 29 60.4 87 59.2 56 70.9 83 64.3 3.260 0.353
NO 19 39.6 60 40.8 23 29.1 46 35.7
Felt teeth were crowded YES 4 8.30 18 12.4 13 18.6 30 23.6 8.895 0.031*
NO 44 91.7 127 87.6 57 81.4 97 76.4
Felt teeth were poorly set YES 11 22.9 33 22.8 20 25.0 42 32.8 4.075 0.253
NO 37 77.1 112 77.2 60 75.0 86 67.2
Felt front teeth were protruding bulging YES 5 10.2 18 12.8 11 15.1 22 17.2 1.845 0.605
NO 44 89.8 123 87.2 62 84.9 106 82.8
Felt dental caries/holes in teeth YES 13 26.5 29 19.1 14 17.7 23 17.8 1.933 0.586
NO 36 73.5 117 80.1 65 82.3 106 82.2
Had non aesthetic restoration in the teeth YES 3 6.10 7 4.90 6 7.9 11 8.5 1.644 0.649
NO 46 93.9 137 95.1 70 92.1 118 91.5
Perceived fractured front teeth YES 11 22.4 27 18.2 11 13.8 21 16.4 1.777 0.620
NO 38 77.6 121 81.8 69 86.2 107 83.6
Had missing front teeth YES 5 10.2 10 6.70 13 16.5 11 8.70 5.830 0.120
NO 44 89.8 139 93.3 66 83.5 116 91.3
Wish to restore back fractured teeth YES 36 75.0 90 63.8 50 69.4 86 67.7 2.224 0.527
NO 12 25.0 51 36.2 22 30.6 41 32.3
Do you know discoloured teeth can be whitened YES 40 81.6 112 78.9 59 77.6 106 85.5 2.617 0.455
NO 9 18.4 30 21.1 17 22.4 18 14.5
Wish to undergo Orthodontic treatment YES 16 38.1 50 63.0 30 45.5 45 38.5 1.397 0.706
NO 26 61.9 85 37.0 36 54.5 72 61.5
Wish to undergo tooth whitening treatment YES 25 53.2 87 61.3 47 64.4 70 56.9 2.025 0.567
NO 22 46.8 55 38.7 26 35.6 53 43.1
Wish to have dental crown if needed YES 15 34.1 37 29.4 23 34.3 30 25.9 1.917 0.590
NO 29 65.9 89 70.6 44 65.7 86 74.1
Wish to have tooth colour fillings YES 16 35.6 43 31.9 34 47.9 30 25.9 9.883 0.020*
NO 29 64.4 92 68.1 37 52.1 86 74.1
Wish to have missing teeth replaced YES 12 28.6 42 30.7 27 38.0 28 23.7 4.465 0.215
NO 30 71.4 95 69.3 44 62.0 90 76.3

ISCO-08: International Standard of Classification of Occupations 2008 *Statistically significant

Table 6.

self-reported satisfaction, presence of dental anomalies and desire to undergo aesthetic treatment among dental and medical patients

Variable Dental Patients Medical Patients X2 P Value
n % n %
Satisfied with teeth appearance YES 152 73.1 116 59.2 8.72 0.003*
NO 56 26.9 80 40.8
Satisfied with tooth colour YES 131 62.4 127 64.8 0.255 0.344
NO 79 37.6 69 35.2
Felt teeth were crowded YES 34 16.7 33 17.5 0.44 0.470
NO 170 83.3 156 82.5
Felt teeth were poorly set YES 39 18.6 69 35.6 1.87 0.00*
NO 171 81.4 125 64.4
Felt front teeth were protruding bulging YES 19 9.3 39 20.5 9.85 0.001*
NO 185 90.7 151 79.5
Felt dental caries/holes in teeth YES 39 18.5 42 21.6 0.592 0.26
NO 172 81.5 153 78.5
Had non aesthetic restoration in the teeth YES 10 5.30 17 8.80 2.47 0.85
NO 179 94.7 177 91.2
Perceived fractured front teeth YES 26 12.3 44 22.3 7.19 0.005*
NO 185 87.7 153 77.7
Had missing front teeth YES 16 7.50 24 12.3 2.49 0.79
NO 195 92.5 172 87.8
Wish to restore back fractured teeth YES 129 63.9 136 72.0 2.93 0.54
NO 73 36.1 53 28.0
Do you know discoloured teeth can be whitened YES 166 80.2 154 82.4 0.300 0.338
NO 41 19.8 33 17.7
Wish to undergo Orthodontic treatment YES 63 33.9 80 45.2 4.874 0.018*
NO 123 66.1 97 54.8
Wish to undergo tooth whitening treatment YES 122 60.1 80 45.2 0.056 0.447
NO 81 39.9 97 54.8
Wish to have dental crown if needed YES 45 24.1 61 36.1 6.145 0.009*
NO 142 75.9 108 63.9
Wish to have tooth colour fillings YES 68 34.9 58 33.1 0.123 0.405
NO 12 65.1 117 66.9
Wish to have missing teeth replaced YES 41 21.1 70 39.8 15.266 0.00
NO 153 78.9 106 60.2
*

Statistically significant

Discussion

Dental aesthetics has increasingly become a concern among patients and clinicians. This is because physical appearance plays a key role in social interaction and the smile and teeth are important features in determining facial attractiveness [16]. Evaluating the level of satisfaction with dental appearance and tooth shade by the patients though subjective, may give an idea of how much individuals place on their dental aesthetics. The present study revealed that the level of satisfaction with dental appearance and aesthetics among the participants was 66.3%. This finding is similar to what was recorded by Qualtruogh et al. [2] (62.7%) but higher than the observation of Tin-Oo et al. [1] (47.2%), Akarslan et al. [9] (57.3%) and Strajnic et al. [17] (58.1%). However Azodo et al. [6] in Nigeria reported 79.4% and Meng et al. [18] in Florida and Alkhatib et al.[19] in the UK found it to be 76% and 75% respectively. In Nigeria, many people tend to be satisfied with their teeth appearance, possibly due to financial incapability or unaffordability of aesthetic dental treatment. On the other hand, people in developed countries like USA and UK with stable economy could afford orthodontic treatment and other aesthetic procedures early enough to correct any teeth derangement and discolouration, and therefore will more likely be satisfied with their dental appearance at a later age. Furthermore, this disparity in satisfaction in different population may also be possibly related to the fact that the perception of dental appearance may be influenced by cultural factors and can even be changed within the same population over time [20]. The dissatisfaction with tooth shade in this study was found to be 36.5% which is closely related to 34% seen in adults in the USA [4] and 31.6% seen in North America [21]. The main reason for dissatisfaction with dental appearances among participants in some studies [1,3,22] was tooth colour dissatisfaction. This factor in addition to improved awareness of tooth bleaching may have contributed to increasing prevalence of the population seeking tooth whitening. Our finding of higher prevalence of dissatisfaction with tooth colour among females than male is in agreement with previous studies [1,9,17]. Though in contrast, the satisfaction with dental appearance was higher in females than in males. This latter finding is in agreement with previous authors [3] but in disparity with most studies where females were found to be less satisfied with dental appearance [1,7,17]. No significant difference was found in some studies [5,9,20]. However, psychological research on general body satisfaction has found females to be more sensitive regarding their own appearance than males [23].

It could be deduced that the higher dissatisfaction with dental appearance among males could be due to tooth arrangement problems as more males than females, felt that their front teeth were crowded, poorly set or bulging consequently, they were more willing to undergo orthodontic, restorative or any aesthetic treatment. This is not unexpected since malocclusion could also determine dental appearance. Teeth arrangement is a factor correlated to a harmonious smile and attractiveness [24] and divers types of malocclusion could produce dissatisfaction with dental appearance [25]. The findings from this study is in agreement with some previous studies [19,18] which reported that the older patients were more satisfied with their dental appearance or tooth colour. This is probably due to the fact that older people may care less about their appearance, placing priority or emphasis on other issues of life which they might count to be of more importance. Meng et al. [18] found that 75% of older respondents were satisfied with appearance and colour. Therefore, age had an impact on dissatisfaction with dental aesthetics, with younger age groups being more dissatisfied, probably as a result of cognitive factors other than social and cultural ones [19]. This may also be caused by media influences, since the young adults are more vulnerable to the effects of the media than older generations [16]. The greater tendency to have satisfaction with both dental appearance and tooth colour seen among the primary and secondary school holders could be due to the low level of exposure. This finding is however not in agreement with the previous studies [5,9] where patients with high level of education were found to be more satisfied with the colour of their teeth, though study by Tin OO et al. [1] did not observe any impact of education on satisfaction with tooth colour or dental appearance. As expected, those with tertiary education had the least number of missing anterior teeth. Spaces created by missing anterior teeth could be so unsightly that this should be a major concern to people irrespective of level of education. Nevertheless, individual´s perception of what contributes to facial attractiveness differs. Furthermore, patients with post-secondary education had the greatest desire to undergo orthodontic treatment, tooth whitening and crowning possibly because of the greater perception of crowded teeth, poorly set teeth, carious anterior teeth, fractured and missing anterior teeth. This felt need may motivate them to willingly undergo the dental treatment if they have the economic power.

This study also evaluated the correlation between occupation and the parameters studied which may not have been previously recorded. It was found that 59.2% of the executives and high-profile professionals and business tycoons were satisfied with their teeth appearance as compared to 72.7% in Group 3. One reason for this may be the caliber of people or the company of peoples those in Group I are likely to be relating with. Though the occupational group 4 had many features of unacceptable occlusion the desire to undergo orthodontic treatment was very low (38.5%) among them and this may not be unconnected to their possible low economic status. Findings in this study also show that there were significant difference in the satisfaction of dental and medical patients as more of dental patients than medical patients were satisfied with teeth appearance. More of medical patients felt they had poorly set and protruding front teeth. These observations pointed to the fact that the dental health of the dental patients appeared to be better than that of those patients that were attending the hospital for medical reasons. This is probably because the dental patients are more aware and possibly have started receiving aesthetic dental treatments that have improved their dental appearance to certain extent.

Conclusion

Within the limitations of this study, it could be concluded that: patients are increasingly aware of their dental appearance/tooth colour and the need to improve it with tooth bleaching and/or orthodontic treatment; female are more dissatisfied with their tooth colour but more satisfied with their dental appearance than the male; older people are more satisfied with their dental appearance and tooth colour compared to the younger age group.

What is known about this topic

  • Studies have shown that males are more satisfied with their tooth colour and appearance whereas females are more conscious and difficult to satisfy;

  • Dental treatments that improve anterior teeth aesthetics have been found to improve the quality of life and psychosocial well-being of people.

What this study adds

  • Satisfaction with dental appearance is better in patients that are aware and seek dental treatment than those that are not;

  • In this study, medical patient showed a greater desire to have dental treatment that will improve aesthetic such as restoration and orthodontic treatment. Thus, this shows the need for more dental education and information in our environment.

Acknowledgments

We acknowledged the cooperation of the Department of Family Medicine during the data collection process from the Medical patients. We also appreciate the assistance of Mr Ighaede S. Anakhe in typesetting of the manuscript.

Footnotes

Cite this article: Deborah Mojirade Ajayi et al. Perception about tooth colour and appearance among patients seen in a tertiary hospital, South-West, Nigeria. Pan African Medical Journal. 2021;38(38). 10.11604/pamj.2021.38.38.21422

Competing interests

The authors declare no competing interests.

Authors' contributions

Deborah Mojirade Ajayi and Shakeerah Olaide Gbadebo both conceptualized the idea, were involved in data collection, data analysis and interpretation, manuscript writing, review, final drafting and approval of version to be published. Gbenga Emmanuel Adebayo assisted in data collection, analysis and write up. All the authors have read and approved the final version of this manuscript.

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