Introduction

“A smile is the shortest distance between two people.” -Victor Borge A smile has widely been labeled as a universal greeting that transcends languages and customs. Smiling individuals are viewed as more pleasant and trustworthy, where individuals who experience facial neuromuscular disorders that impair their ability to smile demonstrate more severe self-reported depressive symptoms. The act of smiling releases endorphins that have been shown to improve the mood of both the person who smiles and individuals who see them smiling! Given these widespread social, physical, psychological, financial, and other impacts, a smile is critical to an individual’s wellbeing and is a fundamental component to perceived beauty. As dental healthcare professionals, the impact that we can have on our patients through the creation, maintenance, and enhancement of their smiles is powerful and our understanding of the current and evolving “gold standards” of beauty is critical to our ability to impact our patients and their esthetics positively. An ideal smile is composed of individual components that interact in a harmonic manner. The three primary aspects of an ideal smile are: the teeth, lips, and gingiva. While beauty may be in the eye of the beholder, there are established guidelines to which we should adhere when assessing and creating overall ideal smile esthetics. Factors that contribute to smile assessment include: - Tooth width/height ratio - Tooth shape - Tooth position - Quality and color of restoration(s) - Tooth alignment - Lip fullness and position - Buccal corridor display - Tooth display - Gingival display While all these factors are important individually, their overall interaction and harmony is critically important when assessing ideal esthetics. This course seeks to describe the current evidence assessing ideal smile components and the impact of age, gender, and race/ethnicity on how smiles are judged as attractive or unattractive.

Many scientists agree that a smile can positively impact patients and those who interact with them. A smile is generally considered to be a key component of an individual’s attractiveness and, further, can positively impact social and psychological well-being. Evolving beauty standards as well as the impact of media and digital editing have thrust optimizing smile esthetics to the top of patient requests among dental procedures for many more patients. Combined with a decline in the incidence of dental caries in adults have resulted in overall increases in patient’s dissatisfaction with smile esthetics. The American Association of Orthodontists evaluated patient satisfaction with their smile esthetics and found that more than one-third of US adults are unhappy with the way that their smile looks.¹ They also found that 36% of those who were unhappy with their smile believe that improved smile esthetics would positively impact their social life.¹These impacts were more pronounced in younger individuals. 48% of younger Americans (18-24 years old) report that they have untagged a picture of themselves on social media due to a negative perception of their smile!¹

The three main components of the smile, the teeth, lips, and gingival scaffold, and their perceived harmony are the critical building blocks of a pleasing smile.²Factors associated with these three primary components that contribute to smile assessment include: 1) tooth width/height ratio, 2) tooth shape, 3) tooth position, 4) quality and color of restoration(s), 5) tooth alignment, 6) lip fullness and position, 7) buccal corridor display, 8) tooth display, and 9) gingival display.^3-5 The harmony and balance between these factors contribute to whether a smile is considered attractive or unattractive. This course will evaluate the current evidence regarding the perception of an esthetic smile and assess how the characteristics associated with smile esthetics and their interaction create ideal esthetics.