Reasons for Widespread Aspiration of Esthetics Veneers "Hollywood Smile": A Survey among Five Gulf Countries.

Purpose: This study aims to assess the factors that determine the aspiration for "Hollywood smile" among the residents in five Gulf countries. Materials and
Methods: A survey was conducted among subjects aged 18-60 years. A self-designed 19 items questionnaire was prepared which consisted of multiple choices and open-ended questions. The first part of the survey included demographic questions. The second part included questions related to Hollywood smile. Descriptive statistics were calculated, and the association between different variables was assessed by Chi-square test where P ≤ 0.05 was considered statistically significant.
Results: A total of 2061 subjects participated in the survey. The majority of participants were females (76.81%), 97.28% of them were aware of the term "Hollywood smile," and social media was the source of information. Statistically significant difference was noted among participants who underwent treatment according to residency place, age, educational level, and socioeconomic status (SES) and participants who were willing to undergo treatment in future according to gender, age, and SES.
Conclusion: Subjects of younger age, higher education level, and higher SES underwent treatment. However, 23.83% of people were willing to undergo treatment. This reflects the increasing demand for esthetic treatment in future. Copyright:

INTRODUCTION

Dental appearance has been evaluated to be an important indicator when evaluating facial attractiveness.[1] Likewise, the smile is an important aspect of facial aesthetics.[2] A beautiful smile and harmonic facial esthetics are attributes that contribute to the well-being of any person.[1] However, the definition of dental esthetics varies widely among continents, countries, different regions, and populations.[3]

Nowadays, the focus on facial esthetics as an indicator of social value has increased.[2] Esthetic dentistry also plays a special role in patients' lives, especially currently where media promotes the attractiveness in perfect faces and ideal smiles[4] and social media continually attracts patients' attention for cosmetic dentistry. This results in increasing patients' requests to get an ideal smile.[5] However, social media is not the only factor behind the widespread demand for esthetic dentistry; many researches have shown that the education level, social status, and cultural differences all can impact the individual's esthetic evaluation.[67]

From a professional point of view, achieving patient satisfaction alongside successful treatment outcomes is the key to an esthetically attractive smile. The perception of smile attractiveness is also affected by the persons' social environment and their own experiences. Hence, esthetic satisfaction is a complex process, variable from one person to another and considered subjective.[8]

For many years, dental veneers have been used to improve the esthetics of teeth and gain patient satisfaction in cosmetic dentistry. Veneers have been popularly known as “Hollywood Smile” by the general population. There are no studies published regarding the demand for “Hollywood smile” among the population of Gulf countries. This study aims to assess the factors that determine the aspiration for “Hollywood smile” among the residents in five Gulf countries.

MATERIALS AND METHODS

This survey was conducted among residents of Gulf countries. The research project was approved by the Institutional Review Board, Riyadh, Kingdom of Saudi Arabia (KSA) (Log Number: 19-0252). A self-designed 19 items questionnaire was prepared which consisted of multiple choices and open-ended questions. The questionnaire was designed on the Google forms. There was a choice between two languages: English and Arabic. A brief explanation and pictures about veneers “Hollywood smile” were presented. The consent form was attached at the beginning of the survey form. The first part of the survey included six demographic questions related to gender, age, place of residence, socioeconomic level, and education. The second part included 13 questions related to Hollywood smile. A pilot study was conducted to know the comprehension of the questionnaire among 10 subjects. The questionnaire was given to another 10 subjects twice to assess reliability. The reliability was found to be 94%. The survey was shared online through social media. The sample size was estimated to be around 1800. This roughly accounts for 0.0001% of the total population (18–60 years) of the five countries. Quota sampling technique was used. The survey was open on social media for 3 months. The data obtained were transferred to Excel sheet and analyzed using JMP 14.2.0 (SAS Institute Inc. Cary, NC 27513-2414, USA). Descriptive statistics were calculated, and association between different variables was assessed by Chi-square test where P ≤ 0.05 was considered statistically significant.

RESULTS

A total of 2061 subjects completed the survey. Sociodemographic details are depicted in Table 1. The female response rate was thrice compared to males. Around 80% of the responses were from KSA and from subjects aged 18–30-year-old.

Table 1

Sociodemographic variables of the study subjects

Variables	n (%)
Gender
Female	1583 (76.81)
Male	478 (23.19)
Place of residence
KSA	1701 (82.53)
Oman	118 (5.73)
Emirates	111 (5.39)
Kuwait	100 (4.85)
Bahrain	31 (1.50)
Age group (years)
18-30	1610 (78.12)
31-40	249 (12.08)
41-50	141 (6.84)
51-60	61 (2.96)
Socioeconomic status
Low	93 (4.51)
Average	1746 (84.72)
High	222 (10.77)
Educational level
Primary school	13 (0.63)
Middle school	24 (1.16)
High school	439 (21.30)
Bachelor	1442 (69.97)
Master or above	143 (6.94)

KSA: Kingdom of Saudi Arabia

Information regarding the participants' knowledge, treatment details is provided in Table 2. Around 97% of them had previous knowledge about esthetic veneers treatment “Hollywood smile.” Around 5% underwent veneers treatment. Seventy-nine percent of the treatment plans were decided by the participants themselves. More than 95% of the treatments were performed in private clinics. The most common reasons to undergo treatment were discoloration followed by fractured teeth. The majority of them were satisfied with the treatment. Although only 5% of the participants underwent the treatment, almost 24% of the remaining participants were planning to undergo the treatment.

Table 2

Factors associated with the treatment decision

Variables	Options	n (%)
Previous knowledge about veneers	Yes	2005 (97.28)
	No	56 (2.72)
Source of information	Social media	1372 (66.57)
	Friends/family	440 (21.35)
	Dentist	249 (12.08)
Underwent veneers treatment	Yes	99 (4.80)
	No	1962 (95.20)
Year of treatment	Before 2015	12 (12.12)
	2015-2016	18 (18.18)
	2017-2018	41 (41.41)
	2019-2020	28 (28.28)
Treatment decision made by	Participant	78 (78.79)
	Dentist	21 (21.21)
Dentist’s response regarding the patient’s request	Agreed	87 (87.88)
	Not recommended	12 (12.12)
Place of treatment	Private	95 (95.96)
	Government	4 (4.04)
Main reasons for undergoing the treatment	Discoloration	45 (45.45)
	Fractured teeth	27 (27.27)
	No specific reason	8 (8.08)
	Following the trend	7 (7.07)
	Follow recommendation	5 (5.05)
	Change the smile design	4 (4.04)
	Spaces closure	3 (3.03)
Satisfaction with treatment	Satisfied	81 (81.82)
	Not satisfied	18 (18.18)
Problems with the treatment	Yes	42 (42.42)
	No	57 (57.58)
Reasons behind nonsatisfaction	Shape, size, and color of the teeth	14 (77.78)
	Unpleasant smell	2 (11.11)
	Work quality	1 (5.56)
	Poor-fitting	1 (5.56)
Participants planning to undergo veneer treatment	Yes	468 (23.83)
	No	1496 (76.17)
The main reasons for planning the treatment	Discoloration	276 (58.97)
	No specific reason	75 (16.03)
	Fractured teeth	69 (14.74)
	Following the trend	19 (4.06)
	Change the smile design	13 (2.78)
	Follow recommendation	6 (1.28)
	Spaces closure	5 (1.07)
	Crowding	5 (1.07)

Statistically significant difference was noted among the participants who underwent treatment according to the place of residence, age, education level, and socioeconomic status (SES) (P < 0.001–P = 0.0072). Whereas no difference was found with gender (P = 0.99). The participants who were willing to undergo treatment in future according to gender, age as well as SES showed difference which was statistically significant (P < 0.001–P = 0.04). However, there was no difference with residency place and education level (P = 0.2, P = 0.8) [Table 3].

Table 3

Sociodemographic factors determining the treatment decision

	Undergone treatment, n (%)	No treatment, n (%)	P	Planning treatment, n (%)	Not planning treatment, n (%)	P
Residency place
KSA	72 (72.73)	1629 (83.03)	0.0015*	386 (82.48)	1245 (83.22)	0.2013
Emirates	10 (10.10)	101 (5.15)		20 (4.27)	81 (5.41)
Oman	4 (4.04)	114 (5.81)		35 (7.48)	79 (5.28)
Kuwait	12 (12.12)	88 (4.49)		23 (4.91)	65 (4.34)
Bahrain	1 (1.01)	30 (1.53)		4 (0.85)	26 (1.74)
Gender and the treatment
Female	76 (76.77)	1507 (76.81)	0.9923	343 (73.29)	1164 (77.81)	0.0436*
Male	23 (23.23)	455 (23.19)		125 (26.71)	332 (22.19)
Age group
18-30	47 (47.47)	1563 (79.66)	<0.0001*	356 (76.07)	1208 (80.75)	0.0013*
31-40	28 (28.28)	221 (11.26)		72 (15.38)	150 (10.03)
41-50	17 (17.17)	124 (6.32)		34 (7.26)	90 (6.02)
51-60	7 (7.07)	54 (2.75)		6 (1.28)	48 (3.21)
Educational level and the treatment
Primary	2 (2.02)	11 (0.56)	<0.0001*	3 (0.64)	8 (0.53)	0.8007
Middle	2 (2.02)	22 (1.12)		6 (1.28)	16 (1.07)
High	9 (9.09)	430 (21.92)		111 (23.72)	319 (21.32)
Bachelor	69 (69.70)	1373 (69.98)		317 (67.74)	1058 (70.72)
Master or above	17 (17.17)	126 (6.42)		31 (6.62)	95 (6.35)
Socioeconomic status and the treatment
Low	5 (5.05)	88 (4.49)	0.0072*	36 (7.69)	52 (3.48)	0.0004*
Average	74 (74.75)	1672 (85.22)		391 (83.55)	1282 (85.70)
High	20 (20.20)	202 (10.30)		41 (8.76)	162 (10.83)

*Statistically significant. KSA: Kingdom of Saudi Arabia

DISCUSSION

The main factors contributing to the widespread aspiration for esthetic veneer treatment among residents of five Gulf countries were evaluated. There are no studies published which assess the demand for esthetic treatment among the population across Gulf countries. Esthetic treatment is commonly known as “Hollywood smile” among the general population.

Maximum respondents were from Saudi Arabia, females and in the age group of 18–30 years. Almost everyone had heard about the veneers, and the most common source was social media as everyone has access to social media in today's world. Only 5% of them had undergone treatment. Seventy percent of them had undergone treatment in the past 3 years, which shows increasing trend in recent years. Around 80% of them reported that they made the decision about treatment on their own. For esthetic treatment which requires minor changes usually dentist may not recommend it, and the patient may demand it on their own. Most of them had undergone treatment in private hospitals as elective esthetic treatments are usually not recommended at government hospitals. Discoloration and fracture were the most common causes reported as a reason for treatment. Around 80% of them were satisfied with the treatment. Twenty-four percent of them had planned to undergo treatment in future, which shows increasing aspiration to undergo treatment. Association between the place, age, education, SES, and treatment completed was statistically significant.

This study showed that the majority of participants were 18–30 years of age group. Similarly, the previous research indicated higher dental esthetic dissatisfaction rates in the age group of 19–39 years.[9] This age group reflects many related important points that might influence the patients to seek a completely new smile or to seek some changes in their smile to gain self-confidence through social acceptance. One of these points is the social life that is influenced by social media. Few studies have reported that the elevated esthetic treatment demand is the impact of social media.[1011] The results of the present study show consistency with their results. This study also reported social media as the main source of information when the participants were asked about veneers treatment. Thus, the relationship among age, social media, and Hollywood smile demand was established.

Women are more concerned about their appearance than men.[12] This point was also reflected in this study through the high percentage of female participants who were planning to change their smile using veneer esthetic treatment. Although gender is an important variable, the place of residence is also a key variable. It reveals some points such as the level of population's interaction with social media advertisement and it may also reflect the flexibility and ability of the individuals to accept and follow new ideas. Furthermore, place of residence with high dental cosmetic treatment score may indicate some regional dental issues such as fluorosis.[13] A study has shown the relation between SES, education level, and treatment decisions.[14] With the rise in the education level, the satisfaction with the normal tooth color increased.[10]

Statistically significant association with age, SES, was noted among those who were planning to undergo treatment. Although the sample size was sufficient in the present study, the data were collected through social media, and the authors could not have control over the subjects answering the questionnaire. Hence, the results should be extrapolated with caution.

CONCLUSION

This study revealed that although most of the participants were aware of “Hollywood smile,” only 5% of the total participants had undergone esthetic treatment. With increasing awareness regarding esthetic treatment through social media, there could be increased demand and aspiration for the treatment in future. The results of this study may benefit the dentists to prepare for increased demand in esthetic treatment by the patients.

Financial support and sponsorship

This research was funded by the Deanship of Scientific Research at Princess Nourah Bint Abdulrahman University through the Fast-track Research Funding Program.

Conflicts of interest

There are no conflicts of interest.