Perception of Dental Aesthetics among Dental Students; a Cross-sectional Study in Riyadh, Kingdom of Saudi Arabia

Background: Dental aesthectics is now a necessary area in the field of dentistry, and new graduates' perceptions should be investigated. Hence the present cross-sectional study aimed to assess the perception about dental aesthetics among clinical interns, dentistry interns, and preclinical interns in dental colleges on Saudi Arabia. Materials and Methods: The study subjects comprises of all above three (clinical interns, dentistry interns, and pre-clinical interns) groups volunteered from different colleges. Perception about dental aesthetics was measured using a 14 item questionnaire. Chi-square test was performed on SPSS to determine the statistically significant differences (p<0.05) across gender and dentistry level. Results: Findings revealed 61% of the participants were male while 39% were female. Among them, 26% were pre-clinical interns, 41% were dental interns and 33%were clinical students. All the Original Research Article Alanazi et al.; JPRI, 33(51A): 200-209, 2021; Article no.JPRI.77348 201 particiants reported some kind of dissatisfaction with appearance of their teeth and males were more satisfied and confident about their teeth and smile than females. Conclusion: To conclude, in the present study male participants and clinical students were confident about their smile as compared to female while dental interns thought others have good smile. The study reported the significant gender differences on looking at magazines, having whiter teeth, they way gums look and putting hand over mouth while non-significant differences across dentistry level.


INTRODUCTION
Several orthodontic concepts on face symmetry are centred on primary dentition, which is essential for a healthy smile. Aside from smile design, other aspects of aesthetic dentistry include facial bone structure, occlusal, the importance of the mandibular arcade, the "golden proportion," and gingiva appearance--all of which can affect the participant's face, pleasure, and attractiveness [1][2][3]. Physical aesthetics are becoming increasingly important in modern culture, and among which dental aesthetic procedures gaining popularity for their potential to enhance face attractiveness [4].
The psychological benefits of attractive facial aesthetics are a key reason why patients (particularly young individuals) seek corrective dental treatment. The desire to make cosmetic alterations to one's face is typically selfperceived, and it can have an impact on one's self-confidence and quality of life [5]. Aesthetic treatments include restorative, orthodontic, prosthodontic, and surgical procedures. In conclusion, dentistry graduates exposed to all aspects of dental care must be educated about the various cosmetic procedures and their prescriptions; this in turn demonstrates a fresh doctor's knowledge [6].
As innovation advances, individuals are keener on knowing how dentistry might assist them with working on their grins. Sophisticated or corrective dentistry means to mix excellence and capacity while considering the qualities and requirements of every individual patient. Medicines include more than just smile rebuilding; it is additionally concerned about changes in facial profile and jaw amendment. Hence, style assumes a fundamental part in an individual's life by boosting confidence. Stylish dentistry is a gift by human intelligence since it changes a unacceptable dentition into a marvel. Everybody needs to be seen by others, and dental feel permits them to do so [4].
Zawawi, K.H, and partners in 2013 said that the teeth characterize smile style, which is outlined by the lips, the state of the gums, and the number of holes and voids. The bend of the smile, the extent of the teeth, the presence of a midline shift and changes in pivotal tendency, buccal halls, gingival stature and shapes, the presence of a diastema, and the shade of the teeth all add to a attractive smile's agreement and evenness [7]. Although each aspect may be evaluated alone, all components must work together to generate the integrity that results in the ultimate aesthetic impression. In addition, patients' smiles are becoming increasingly significant, and they seek orthodontic treatment with more precise goals in mind. Thus, while settling on orthodontic treatment, it is fundamental to get what the way of life thinks fits as far as smilling attributes [8]. The European Relationship for Dental Training and the North American Dental Schooling Affiliation have characterized fundamental and supporting dental capacities that graduate dentistry understudies ought to have, like the ability to perceive a patient's stylish necessities and assess the degree to which such requirements or wishes might be fulfilled [9].
Dental students are typically forced to repair patients' front teeth with aesthetically restorative or prosthetic treatments during their undergraduate studies. Given their lack of practical expertise and lack of a skilled and alert eye that can quickly spot asymmetry or imbalances, knowledge of aesthetic criteria and standards is essential to help them in giving therapy. Education appears to substantially impact aesthetic perception and subsequent treatment recommendations [10]. Every individual's view of magnificence is remarkable; this subjectivity might impact their measure of tasteful consideration dependent on sexual orientation, age, race, monetary position, conjugal status, level of training, work, familial impact, social openness, and social standing [11]. Hence the aim of the study was to determine the knowledge and perception of senior dental students regarding the perception of dental aesthetics and to compare the responses on the basis of dentistry year and gender.

MATERIALS AND METHODS
The participants in this cross-sectional observational study were from the Saudi Arabia region.
Study Design: This was a cross sectional study conducted among the senior dental students of Riyadh using an online survey.
Study Sample: 154 students from clinical levels were utilized in this study. A minimum sample of (N=150) was considered based on the prevalence of dental caries in upper anterior dentition and acceptable margin of error of 5%, a confidence level of 95%.
Study Instrument: Online questionnaire was constructed consisting of questions related to demographic data followed by questions including knowledge and perception towards the dental aesthetics.

Instrument Validity and Reliability:
A pilot study was conducted by sending the survey to 20 participants and the data will be inserted in SPSS version 22 to determine the reliability by using Chronbach's coefficient alpha (value: 0.712).
Validity of the questionnaire was tested by sending it to experienced researchers in REU where no changes were made.
Statistical Analysis: Collected data was analyzed using SPSS version 22, where descriptive as well as inferential statistics were conducted. Comparisons between groups were made with the value of significance kept under 0.05.

RESULTS
In the present study on perception of dental aesthetic among dental students, 61% of the participants were male while 39% were female. Among them, 26% were pre-clinical interns, 41% were dental interns and 33% were clinical students. 60.4% of them were confident about smiling, 22.1% not confident and the remaining were not sure of either of the above two options. 51.9% responded that they look at magazines and wish to smile like models, 31.8% said no while remaining were uncertain of both. 55.2% see defects in their gums, and 63.6% want their teeth to be whiter. 51.9% are satisfied with the appearance of their gums, and 55.8% show either too many or too few teeth while smiling. 47.4% believe their teeth are too wide or narrow, while 33.1% do not think about this. 53.2% think their teeth are too square or too round, 51.3% like the way their teeth are shaped. 43.5% show too little gum while smiling, and 51.9% think their teeth are too long or short. 42.9% put a hand over mouth while smiling, and 47.4% photograph better from one side of their face (Table 1). In Table 2, differences are explored across gender through chi-square. Findings reported that more female and male students were dental interns. More male participants think that others may have a better smile than them as compared to female participants. 61 males are confident about smile while 32 females are confident. An almost equal number of participants from both groups look at a magazine and think they might have a smile like models. 53 males while 32 females looks at the mirror and see defects in their gums. Asking upon having whiter teeth, both groups responded yes in higher proportion. More males were satisfied with the way their gums look as compared to female participants. A higher percentage of males showed either too many or too few teeth while smiling than females, same stats on both teeth too wise or too narrow and teeth too square or too round-both groups like the way their teeth are shaped while a significant number disagree also. Males did not put a hand over mouth while smiling while females do this. Both groups photographed better from one side of their face. Table 3 tells us about the differences across the dentistry level mentioned above.

DISCUSSION
The present study was aimed to examine the perception of dental aesthetics among dental students. Data were analyzed through SPSS using chi-square as primary analysis along with frequency measure. The frequency measure analysis reported that 61% of the participants were male while 39% were female. Among them, 26% were pre-clinical interns, 41% were dental interns and 33%were clinical students.  [12]. Literature also reports the findings similar to the above study as 92 per cent of the participants said they felt confident. Conversely, 90% feel someone else has a nicer smile, 44% have already concealed their smile with their hands, 52% desire to have a smile as beautiful as the models in magazines, 73% detect flaws in gums and teeth, 71% wish their teeth were whiter, and 42% dislike intensely the form of their teeth. The mean satisfaction indexes in the first and third semesters were 6.1 and 6.4, respectively, while the score in the tenth semester was 5. There were no statistically significant variations in aesthetic assessment across semesters of the course (p = 0.6). On the other hand, substantial gender disparities were discovered, with women exposing themselves to be unhappy with their smiles than males. The desire for whiter teeth (question 8) was more popular in the first semesters and less so in the latter ones. When asked if they liked the way their teeth were shaped (question 15), 70% of the students said YES [11].
In subsequent analysis, gender differences were examined on study variables and revealed that more female and male students were dental interns. More male participants think that others may have a better smile than female participants. 61 males were confident about smile while 32 females are confident. An almost equal number of participants from both groups look at the magazine and think they might have a smile like models. 53 male while 32 female looks at the mirror and see defects in their gums. Asking upon having whiter teeth, both groups responded yes in higher proportion. More males were satisfied with the way their gums look as compared to female participants. A higher percentage of males showed either too many or too few teeth while smiling than females, same stats on both teeth too wise or too narrow and teeth too square or too round-both groups like the way their teeth are shaped while a significant number disagree also. Males does not put a hand over mouth while smiling while females do this. Both groups photographed better from one side of their face. Literature reports that almost a number of male students thought that others had a nicer smile, whereas females were more confident in their smiles (p=0.17). A year of study enhanced the sensation of having a nicer grin (p=0.20). There was no significant difference in self-confidence in smiling between gender or years of study. However, the majority (56.4 per cent) of participants felt confident with their smiles. Smiling as attractive models were regarded positively by just 42.9 per cent of those polled, and there was no significant difference based on gender or year of research. The majority of students (59.3 per cent) desired their teeth to be brighter and were happy with the appearance of their gums (61.4 per cent). Although most students appreciated the form of their teeth, there were no significant variations in tooth size, shape, or length between grades of study or gender [12].
In the following analysis, differences across dentistry levels were explored. Findings reported that a higher number of dental interns consider that others have a better smile, followed by preclinical and clinical students. Clinical students were more confident about smiling dental interns and pre-clinical students. The majority of dentistry interns thought to smile like models while looking at models and seeing defects in gums when looking at the mirror compared to the other two groups. Dental interns wanted to have whiter teeth, followed by clinical students and pre-clinical students. Dental interns thought they showed too many teeth to few teeth while smiling, and also that their teeth were more comprehensive compared to the other two groups but were most satisfied with the appearance of their gums. The results of the present study was in accordance to El Mourad et al [13]. Higher dental interns think that their teeth are too square or too round while showing too much or too little gums when they smile, and they like the way their teeth are shaped; clinical students have a higher number. Dental interns thought their teeth as too long or too short and had a better photo from one side of the face while putting a hand over mouth while smiling; clinical students have a higher number. Literature also reports that half of the first and third semesters of female students thought their faces were unattractive, but the findings were more vital in the fifth-semester group. Almost all female students said that teeth were an essential aspect of facial beauty, and all respondents were satisfied with the look of their gums. Only thirdsemester students indicated that more than half of respondents were happy with their oral aesthetics. Moreover, half of first-and fifthsemester students said they liked the colour of their teeth.
In comparison, only one-third of third-semester students stated that they were satisfied. The majority of responders were also confident in their grins and did not hide their teeth when smiling. Furthermore, the media and technology have a considerable influence on dental perception and aesthetics. More than half of female students anticipated to have excellent teeth like celebrities. More than a quarter of those questioned were pleased with the look of their teeth. In this study, the first semester had the fewest positive perceptions, with just 55.89 per cent satisfied with their oral aesthetics. Meanwhile, the third semester had the highest percentage of favourable responses, 73.5% [14].

CONCLUSION
To conclude the present study based on perception of dental aesthetics among dental students, when data analyzed through SPSS using chi-square test, male participants and clinical students were confident about their smile as compared to female while dental interns thought others have good smile. The study reported the significant gender differences on looking at magazines, having whiter teeth, they way gums look and putting hand over mouth while non-significant differences across dentistry level.

CONSENT
As per international standard or university standard, respondents' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
Riyadh Elm University's ethical review board granted permission to conduct the study.