Associations among Personality, Satisfaction, and Maxillary Incisors Shape: A Cross-Sectional StudyABSTRACT
Objective: To investigate the association between satisfaction with maxillary incisors’ shape and personality types determined through a physiological instrument and the association between tooth shape preferred by patients and tooth morphology determined by dentists.
Material and Methods: Thirty-nine male and 85 female patients answered a 3-stage questionnaire to determine their personality (Enneagram Test), satisfaction with incisors’ shape, and preferred shape for maxillary teeth. Six experienced dentists independently evaluated photographs of the patients to determine their incisor’s morphology. The associations among variables were analyzed using the Chi-square test (p<0.05).
Results: The associations between personality types and tooth shapes preferred by patients (p=0.642) or tooth morphologies determined by the dentists were not significant (p=0.096). A total of 96 (77.4%) and 28 (22.6%) patients were respectively satisfied and dissatisfied with their maxillary incisors’ shape. A significant association was observed between satisfied patients (36) who preferred a tooth shape that matched their tooth morphologies determined by dentists (p=0.028); however, the association between dissatisfied patients (7) who preferred a tooth shape that matched their tooth morphologies determined by dentists was not significant (p=0.391).
Conclusion: The patient’s personality does not seem to influence his/her own or the dentist’s perception of tooth morphology. Considering distinctive perceptions of incisors’ shape that may lead to different expectations, patients and dentists must corroborate during dental esthetic planning.
Keywords:
Personality; Esthetics; Patient Satisfaction; Smiling
Introduction
A customized dental treatment plan has become mandatory to meet the ever-increasing patient’s high esthetic expectations [1-3]. Although facial, lip, and tooth parameters have been traditionally used for smile design [4], the dissatisfaction reported by some patients can be related to other underestimated particularities such as personality [5,6]. The influence of personality on esthetic satisfaction was suggested in 1964 by the psychologist Carl Jung through the symbols of the collective unconscious called archetypes. Since people unconsciously give meaning to everything visible, any object or image can become an archetypal symbol and be directly influenced by an individual personality [7].
Some authors suggest using visagism to increase esthetic treatment predictability and patient satisfaction [8,9]. Visagism respectively correlates choleric, bloody, melancholic, and phlegmatic temperaments to rectangular, triangular, oval, and square tooth shapes; however, this concept is strictly related to the patient’s temperament [10]. On the other hand, personality is determined by the individual's cognitive, affective, and physical characteristics. Although formed mainly during childhood by taking into account temperament and experiences, personality is dynamic, adaptable, and changeable [11,12]. Since temperament and personality are not synonyms, the misuse of these concepts observed in both clinical and scientific fields can lead to false promises. To the author’s best knowledge, the only study on the relation between personality and smile satisfaction used the Dutch Personality Index, which is more niche and primarily used in organizational psychology for evaluating traits related to job performance, teamwork, and leadership [13].
Furthermore, patients and dentists can have distinctive perceptions of tooth shapes that can lead to different expectations and dental treatment outcomes [14]. Therefore, this study aimed to investigate (1) the association between satisfaction with maxillary incisors’ shape and personality types determined through a worldwide-recognized physiological instrument and (2) the association between tooth shape preferred by patients and tooth morphology determined by dentists. The null hypotheses tested were that (1) personality does not have a significant influence on satisfaction with tooth shape and (2) tooth shapes preferred by patients are not different from tooth morphologies determined by dentists.
Material and Methods
Study Design and Ethical Clearance
This observational analytical cross-sectional study was approved by the Ethics Committee for Human Research of the Federal University of Santa Catarina (Opinion no. 3.232.542).
Participants
Individuals with four maxillary incisors and without extensive restorations were selected, while those with fractured teeth, orthodontic treatment needs, and severe tooth wear were excluded. Dentists were also excluded since their level of knowledge could bias the results. A total of 39 males and 85 females between 17 and 46 years old (mean 23.6±4.4) who seek esthetic dental treatment at the specialization course in Esthetic and Restorative Dentistry.
Data Collection
The research instrument comprised a 3-stage questionnaire. First, each patient selected one paragraph from each group of three statements at the online Enneagram Personality Test (https://enneagramtest.com) [15]. The combination of both paragraphs represented one of the personality types (Table 1). Next, the patients were requested to report their satisfaction or dissatisfaction with their maxillary incisors’ shape. Finally, the patients visualized images of oval-, square-, and triangular-shaped maxillary teeth models and indicated their preferred tooth shape (Figure 1). The images were gathered from Hajtó [16] and standardized in terms of length and width to highlight different tooth shapes.
Furthermore, an intraoral photograph of the smile of each patient was taken with a digital camera (EOS Rebel T5i, Canon Inc., Tokyo, Japan) coupled to a 100-mm lens (EF 100mm f/2.8 Macro USM, Canon Inc., Tokyo, Japan) and circular flash unit (MR-14EX II Macro Ring Lite, Canon Inc., Tokyo, Japan). Then, six dentists specialized in esthetic and restorative dentistry with at least 3 years of clinical experience independently evaluated the photographs to determine the tooth morphology of each patient (Figure 2).
Examples of intraoral photographs evaluated by experienced dentists to determine the actual tooth morphologies of the patients.
Data Analysis
The associations between personality types and both tooth shapes preferred by patients and tooth morphologies determined by the dentists, as well as the associations between tooth shapes preferred by patients and tooth morphologies determined by dentists within satisfied or dissatisfied patients were analyzed using the Chi-square test at a significance level of p<0.05 (SPSS 25.0, IBM Corp., Chicago, IL, USA).
Results
The Enneagram personality types of the patients were enthusiast (20%), loyalist (14%), challenger (14%), helper (11%), peacemaker (11%), achiever (9%), individualist (8%), investigator (7%), and perfectionist (5%). The associations between personality types and tooth shapes preferred by patients (p=0.642) or tooth morphologies determined by the dentists were not significant (p=0.096), and are shown in Table 2.
Associations between personality types and tooth shapes preferred by patients or tooth morphologies determined by dentists.
A total of 96 (77.4%) and 28 (22.6%) patients were respectively satisfied and dissatisfied with their maxillary incisors’ shape. Overall, 55 (44%), 52 (42%), and 17 (14%) patients, respectively, choose oval, square, and triangular incisors shape as their preferred tooth shape. A significant association was observed between the number of satisfied patients (36) that preferred a tooth shape that matched their actual tooth morphologies determined by dentists (p=0.028) (Table 3). Twenty out of 36 matches were recorded for the oval shape.
Number (percentage) of satisfied and dissatisfied patients that preferred oval, square, and triangular tooth shapes within their tooth morphologies determined by dentists.
Conversely, the association between the number of dissatisfied patients (7) that preferred a tooth shape that matched their actual tooth morphologies determined by dentists was not significant (p=0.391) (Table 3). Four out of 28 matches were recorded for the oval shape.
Discussion
The results of this study showed that neither the tooth shapes preferred by the patients nor the tooth morphologies determined by the dentists were significantly associated with the personality types; thus, the first null hypothesis had to be rejected. These findings may be related to the broad distribution of the patients among the nine personality types suggested by the Enneagram Personality Test; however, the lack of studies on this subject does not allow further comparisons. This worldwide-known instrument was used in this study due to its simplicity and ease of interpretation [17]. Although manifestations of more than one personality type can be observed in the same individual, the Enneagram indicates the main trait that best represents the greatest dilemmas and modes of expression of an individual.
Since the tooth morphologies determined by dentists were significantly associated with the tooth shapes preferred by satisfied patients but not significantly associated with dissatisfied patients, the second null hypothesis had to be partially rejected. The results suggested that satisfied patients tended to prefer their actual tooth morphology. It was reasonable to expect that patients dissatisfied with their tooth shapes would intuitively prefer distinct tooth morphologies.
Overall, triangular was the most frequent (53%) tooth shape chosen by patients, followed by oval (34%), and square (13%). Indeed, laypeople are prone to perceive their maxillary central incisors as triangular in a smile context [18]. Patients usually observe their teeth from a limited frontal view in the mirror, in which central incisors may appear more triangular due to the teeth taper toward the incisal borders and the illusion of more angular edges in certain light and shadow conditions. Although the patients were requested to indicate their preferred shape of maxillary teeth by visualizing standard pictures of grayscale teeth models that highlighted the tooth shapes without bias regarding size, color, or lip position, most of the patients still perceived their incisors as triangular-shaped teeth.
In contrast, triangular tooth morphology was the least frequent (14%), as determined by the dentists, while oval and square morphologies showed similar percentages (44% and 42%, respectively). These findings corroborate previous studies that reported similar percentages [6,19,20]. Although the determination of the tooth morphology of each patient was based on frontal intraoral photographs of a smile, dentists are usually trained (even more for at least 3-year experienced specialists) to focus on specific anatomical details and proportions of teeth by visualizing multiple angles, particularly from a slightly lateral as well as incisal perspective. Then, maxillary incisors often appear more oval-shaped due to the rounded contours of the incisal edges [21].
Therefore, the results of this study are in agreement with two previous researches that evidenced the need for patients’ participation in dental esthetic planning to achieve satisfactory outcomes [22,23]. Dentists must consult the patients regarding their preferences and explain tooth morphologies to meet their expectations. Although this original study may contribute to improving dental esthetic planning and increasing the satisfaction level of patients after treatment, its insights must be observed with caution. The sample randomly consisted of patients who sought esthetic dental treatment, which was not balanced in terms of gender as well as no power statistical calculation was previously determined. Since different preferences on tooth shape have been reported among women and men [24], further studies with a more balanced and statistically powered sample size are encouraged.
Conclusion
The patient’s personality does not seem to influence his/her own or the dentist’s perception of tooth morphology. Considering distinctive perceptions of incisors’ shape that may lead to different expectations, patients and dentists must corroborate during dental esthetic planning.
-
Financial Support
None.
Data Availability
The data used to support the findings of this study can be made available upon request to the corresponding author.
References
-
[1] Ellakany P, Fouda SM, AlGhamdi MA, Aly NM. Influence of dental education on esthetics self-perception and shade selection. Int J Environ Res Public Health 2022; 19(18):11547. https://doi.org/10.3390/ijerph191811547
» https://doi.org/10.3390/ijerph191811547 -
[2] Mannaa AI. Knowledge and attitude toward esthetic dentistry and smile perception. Cureus 2023; 15(9):e46043. https://doi.org/10.7759/cureus.46043
» https://doi.org/10.7759/cureus.46043 -
[3] Sorrentino R, Zarone F, Cantile T, Mastrosimone A, Cervino G, Ruggiero G. The use of digital tools in an interdisciplinary approach to comprehensive prosthodontic treatments. Prosthesis 2024; 6(4):863-870. https://doi.org/10.3390/prosthesis6040062
» https://doi.org/10.3390/prosthesis6040062 -
[4] Ahmed N, Khalid S, Vohra F, Halim MS, Al-Saleh S, Tulbah HI, et al. Analysis of recurrent esthetic dental proportion of natural maxillary anterior teeth: A systematic review. J Prosthet Dent 2024; 131(2):187-196. https://doi.org/10.1016/j.prosdent.2021.11.035
» https://doi.org/10.1016/j.prosdent.2021.11.035 -
[5] Frush JP, Fisher RD. How dentogenic interprets the personality factor. J Prosthet Dent 1956; 6(4):441-449. https://doi.org/10.1016/0022-3913(56)90089-0
» https://doi.org/10.1016/0022-3913(56)90089-0 -
[6] Pedrosa VO, França FMG, Flório FM, Basting RT. Study of the morpho-dimensional relationship between the maxillary central incisors and the face. Braz Oral Res 2011; 25(3):210-216. https://doi.org/10.1590/s1806-83242011005000010
» https://doi.org/10.1590/s1806-83242011005000010 -
[7] Sorge GVR. The theory of the 'mana personality' in Jung's works: A historic-hermeneutic perspective. Part II [published correction appears in J Anal Psychol 2020; 65(5):957. https://doi.org/10.1111/1468-5922.12645]. J Anal Psychol 2020; 65(3):519-537. https://doi.org/10.1111/1468-5922.12598
» https://doi.org/10.1111/1468-5922.12645» https://doi.org/10.1111/1468-5922.12598 - [8] Paolucci B, Calamita M, Coachman C, Gürel G, Shayder A, Hallawell P. Visagism: The art of dental composition. Quintessence Dent Technol 2012; 35:187-200.
-
[9] Sharma A, Luthra R, Kaur P. A photographic study on Visagism. Indian J Oral Sci 2015; 6:122-127. https://doi.org/0.4103/0976-6944.171078
» https://doi.org/0.4103/0976-6944.171078 -
[10] Rambabu T, Gayatri C, Sajjan GS, Varma PVK, Srikanth V. Correlation between dentofacial esthetics and mental temperament: A clinical photographic analysis using visagism. Contemp Clin Dent 2018; 9(1):83-87. https://doi.org/10.4103/ccd.ccd_788_17
» https://doi.org/10.4103/ccd.ccd_788_17 -
[11] Herrera A, Martín J, Pérez F, Bonafé E, Reis A, Loguercio Dourado A, et al. Is personality relevant in the choice of bleaching? Clin Oral Investig 2016; 20(8):2105-2111. https://doi.org/10.1007/s00784-015-1701-3
» https://doi.org/10.1007/s00784-015-1701-3 -
[12] Bonafé E, Rezende M, Machado MM, Lima SNL, Fernandez E, Baldani MMP, et al. Personality traits, psychosocial effects and quality of life of patients submitted to dental bleaching. BMC Oral Health 2021; 21:7. https://doi.org/10.1186/s12903-020-010370-6
» https://doi.org/10.1186/s12903-020-010370-6 -
[13] Van der Geld P, Oosterveld P, Van Heck G, Kuijpers-Jagtman AM. Smile attractiveness. Sef-perception and influence on personality. Angle Orthod 2007; 77(5):759-765. https://doi.org/10.2319/082606-349
» https://doi.org/10.2319/082606-349 -
[14] Parrini S, Rossini G, Castroflorio T, Fortini A, Deregibus A, Debernardi C. Laypeople's perceptions of frontal smile esthetics: A systematic review. Am J Orthod Dentofacial Orthop 2016; 150(5):740-750. https://doi.org/10.1016/j.ajodo.2016.06.022
» https://doi.org/10.1016/j.ajodo.2016.06.022 -
[15] Enneagram Personality Test. Available from: https://enneagramtest.com [Accessed on June 10, 2022].
» https://enneagramtest.com - [16] Hajtó J. Anteriores - Naturally beatiful front teeth: Theory, practice & design criteria. Kulmach: MGO Fachverlage; 2015. 272p.
-
[17] Blose TM, Yeates AC, Som M, Murray KA, Vassar M, Stroup J. The Enneagram and its application in medical education. Proc 2022; 36(1):54-58. https://doi.org/10.1080/08998280.2022.2132591
» https://doi.org/10.1080/08998280.2022.2132591 -
[18] Del Monte S, Afrashtehfar KI, Emami E, Abi Nader S, Tamimi F. Lay preferences for dentogingival esthetic parameters: A systematic review. J Prosthet Dent 2017; 118(6):717-724. https://doi.org/10.1016/j.prosdent.2017.04.032
» https://doi.org/10.1016/j.prosdent.2017.04.032 -
[19] Paranhos LR, Jóias RP, Velasco LG, Bérzin F, Júnior ED. Prevalence of the different maxillary central incisor shapes in individuals with natural normal occlusion. Braz J Oral Sci 2010; 9(2):104-107. https://doi.org/10.20396/bjos.v9i2.8641865
» https://doi.org/10.20396/bjos.v9i2.8641865 -
[20] Wolfart S, Menzel H, Kern M. Inability to relate tooth forms to face shape and gender. Eur J Oral Sci 2004; 112(6):471-476. https://doi.org/10.1111/j.1600-0722.2004.00170.x
» https://doi.org/10.1111/j.1600-0722.2004.00170.x - [21] An KY, Lee JY, Kim SJ, Choi JI. Perception of maxillary anterior esthetics by dental professionals and laypeople and survey of gingival topography in healthy young subjects. Int J Periodontics Restorative Dent 2009; 29(5):535-541.
-
[22] Mehl CJ, Harder S, Kern M, Wolfart S. Patients' and dentists' perception of dental appearance. Clin Oral Investig 2011; 15(2):193-199. https://doi.org/10.1007/s00784-010-0393-y
» https://doi.org/10.1007/s00784-010-0393-y -
[23] Sriphadungporn C, Chamnannidiadha N. Perception of smile esthetics by laypeople of different ages. Prog Orthod 2017; 18(1):8. https://doi.org/10.1186/s40510-017-0162-4
» https://doi.org/10.1186/s40510-017-0162-4 -
[24] Magne P, Salem P, Magne M. Influence of symmetry and balance on visual perception of a white female smile. J Prosthet Dent 2018; 120(4):573-582. https://doi.org/10.1016/j.prosdent.2018.05.008
» https://doi.org/10.1016/j.prosdent.2018.05.008
Edited by
-
Academic Editor:
Alessandro Leite Cavalcanti
