jin-Keun Dong, DDS, \iSD, PhD'

Tai-Hofin, DDS, MSD, PhD'

The Esthetics of the Smile: Hye-Won Cbo, DDS, MSD, PhD''
A Review of Some Recent Studies Sang-Chun Oh, DDS, MSD, PbD^

Purpose: This article reviews recent research on the esthetics of the smile, covering tiie
attractiveneçç of the 5miie, the effect of aging on the smile, orai condition and the smiie,
personality and smile, and smile exercises. Material and Methods: The subjects were
Koreans wiih normal occlusion. Photographs of a fuli smile were taken and the esthetic
quality of the subjects' smiies was estimated. Smiie scores were correiated with oral
condition, personality, the practice of smiie exercises, and elements of the smile, such as
the position of the lip in a smile. The personality of the subjects was assessed by means of
a Sixteen Personality Factor Questionnaire. Gibson's smile exercises were used to
investigate the effect of smile exercise. Results: In an attractive smile, the fuli shape of the
maxillary anterior teeth was shown between the upper and lower iip, the upper lip
curved upward or was straight, the maxillary anterior incisai curve was paraliel to the
lower lip, and teeth were displayed to the first moiar. The amount of maxillary incisai
exposure gradually decreased with age, accompanied by a gradual increase in
mandibuiar incisai exposure. Personality traits such as warmth, calmness, extroversion,
and low anxiety were closely related to an attractive smiie. Smile exercises were an
effective means of improving the esthetic level of the smile if patients exercised
continuously. Conclusion: An attractive smile is important for esthetic treatment. The iip
position, oral condition, personality traits, and smile exercise affect the esthetics of the
smile, intj Prosti^odont 1999;!2:9-19.

w hen a patient visits a dental clinic for es-

thetic reasons, dentists usually consider not
'Professor. Department of Prosthodontics, Wonkwang
University School of Dentktry, Iksan, South Korea.
''Associate Professor. Department of Prostbodontics, Wor^kwang is, the desire to look more attractive by improving
University School of Oentistry, tiisan. South Korea.
•"Assistant Professor, Department ot Prosthodontics, Wonkwang
University School ot Dentistry, Iksan, South Korea.
Reprint requests: Dr jin-Keun Dong, Department of
Prosthodontics, Wonkwang University School of Dentistry,
tksan. South Korea 570-749. Fax: 0653-857-4824. E-maii:
dong^wonnms-wonkwang.ac.iir
This article was presented under the title "An Attractive Smile: The summary phrase 'what is beautiful is good,' " These
Coal of Esthetic Dentistry" al the meeting of the international
College of Prosthodontists, Malta, 29 Octoher-I November 1997.
only the chief complaint, such as tooth form, tooth
position, or tooth color, but also the adjacent teeth
and soft tissue and the overall harmony of the face.
However, an attractive smile should be the goal of
esthetic dentistry, A large number of individuals
seek dental care because of esthetic reasons, that
their smiles,* The importance of an attractive smile
and its effect on positive self-image cannot be
overemphasized.'-^ More recent studies of beauty
and social image make more balanced assertions,
such as that by Eagly et al,^ which concluded that
"the physical attractiveness stereotype,,,is not as
strong or general as is suggested by the often-used
studies show that esthetics "serves as a strong cue

Volume 12, N u m b e d , 1999 The IntemaHonal Journal ol Prosthodontii

 Esthetics of the Smile: Review of Recent Studies
for assumption of social ease but has little effect on
perceptions of honesty, virtue, helpfulness, po-
tency, or general emotional adjustment.'"*
While the limits of esthetic dentistry should be
kept in mind, the fact is that most patients want lo
improve their appearance. Many investigators have
tried to discover the secret of the smile. Frush and
Fisher^ bave directed attention toward the "smile
line"—the harmony between the curvature of the
incisai edges of the maxillary anterior teeth and tbe
upper border of the lower lip. Hulsey'' found that
the smile line ratio—the congruency of the arc of
curvature of the upper border of the lower lip and
the arc of curvature of the incisai edges of tbe max-
illary anterior teeth—appeared to be important in
an attractive smile, and tbe most attractive smile
displayed a smile line ratio of 1.00:1.25. Tjan et aP
reported tbat an average smile exhibits the full
length of tbe maxillary anterior teeth, displays an
incisai curve of the maxillary teeth that is parallel
to the inner curvature of the lower lip, and displays
the 6 maxillary anterior teeth and the premolars.
There has been considerable recent research on
tbe esthetics of tbe smile at Wonkwang University
in Korea.^'"^ This article reviews work on 5 aspects
of esthetics: (1) the attractiveness of the smile." (2j
tbe effect of aging on the smile,''•"^ (3) orai condi-
tion and the s m i l e , " (4) personality and the
smrle,'^ and (5)sm']\e exercises.'-''"
Attractiveness of the Smile
Tbe smile is expressed by muscular action around
the lips in the inferior third of tbe face and by a
brightening of the eyes. The pleasing smile is one
of our special forms of nonverbal communication,
and it expresses ¡oy.'^
Yoon et al^ studied the attractiveness of the smile
by investigating the esthetic criteria of the smile.
Familiarity with these criteria can help us improve
the esthetic condition of tbe oral and maxillofacial
region. The subjects were 240 university students
[129 male. 111 female) with normal occlusion. No
subjects were missing teeth or had experienced or-
thodontic or prosthodontic treatment. Photographs
of a full smile were taken. Five elements of tbe
smile were analyzed: (1) the upper lip position, (2)
the upper lip curvature, (3) the parallelism of the
anterior incisai curve with the lower lip, (4) the re-
lationship between tbe maxillary anterior teeth and
the lower lip, and (5) the number of teeth displayed
in a smile. Five dentists and five fine arts professors
estimated the esthetic quality of the subjects' smiles
(smile score) using a scoring system of five grades.
al Journal of Proilhodunlii
Dong el al
When evaluating the smiles, the judges saw the
lower Vi of the face only.
Upper Lip Position
Upper lip position was divided into 3 categories (Fig
1). A high smile reveals the total cervicoincisal
length of the maxillary anterior teeth and a contigu-
ous band of gingiva. An average smile reveals 75%
to 100% of the maxillary anterior teeth and the in-
terproximai gingiva only. A low smile displays less
than 75% of the anterior teeth.
An average smile was most common (56%).
Comparatively few subjects had high (29%) or low
(15%) smiles. The mean esthetic rank of the aver-
age smile was higher than that of the low smile
(P<0.05).
Upper Lip Curvature
Upper lip curvature was divided into 3 categories
(Fig 2). Upward means that the corner of the
mouth is higher than the center of the lower border
of the upper lip. Straight means that the corner of
the mouth and tbe center of the lower border of
the upper lip are on a straight line. Downward
means that the corner of the mouth is lower than
the center of tbe lower border of tbe upper lip.
An upward smile was rare f12%). Straight (45%)
and downward (43%) smiles were relatively numer-
ous. Respondents ranked upward and straight smiles
as more esthetic than tbe downward smile (P< 0.05).
Parallelism of f/ie Maxiiiary Anterior Incisai Curve
with the Lower Lip
The parallelism of the maxillary anterior incisai
curve with the lower lip was divided into 3 cate-
gories (Fig 3). Parallel means that tbe incisai edges
of the maxillary anterior teeth are parallel to the
upper border of the lower lip. Straight means that
the incisai edges of the maxillary anterior teeth are
in a straight line. Reverse means that tbe incisai
edges of the maxillary anterior teeth curved in re-
verse to the upper border of the lower lip.
Tbere were many subjects with a parallel smile
(60%), some with a straight smile (34%), and only
a few subjects with a reverse smile (5%). Parallel
and straight smiles received higher esthetic ranks
than reverse smiles {P< 0.05).
10 ! 12, [dumber I, 1999
 Dong et al Esthetics of tbe Smile: Review of Recent Studies

Fig 1 Number of subjects and

mean esthetic rank by upper lip
position. 1—1 No. of subjects
- • - Mean estlietic rank

140
120 • —"-^
^ 100

5 80
° 60
o
^ 40
20

Higfi Average Low

Fig 2 Number of subjects and

mean esthetic rank by upper iip
curvature. CZ3 No. of subjects
- • - Mean esthetic rank
180
160
140
^ 120
'S 100
^ 80
o
d 60
^ 40 ^ ^
20
0

Upward Straight Downv^ard

V o l j n i e l 2 , Number 1,1999 H The International Journai of Frosthoclontics

 Esthetics of the Smile: Review of Recent Studies Dong et a

Fig 3 Number ot subjects and

mean esthetic rank by parallel-
JHo ol subjects ism ot the maxillary antenor m-
ttiU
-Mean esthetic rank cisal ojrve with the lower lip.

120

00

80

60
40
20

Straight

Fig 4 Number ot subjects and

mean estiietic rank by the rela-
r—-íNn. ot Subjects
tionstiip between the maxillary
- • - M e a n esthetic rank anterior teeth and iower lip.
140
120
¡2 100

•5 60
i 40
20
0

Slightly covered Touching Not touctiing

Relationship Between Maxillary Anterior Teeth
and Lower Lip
The relationship between maxillary anterior teeth
and lower lip was divided into 3 categories (Fig 4).
Slightly covered means that the incisai edge of the
maxillary anterior teeth was slightly covered by the
lower lip. Touching means that the incisai edge of
the maxillary anterior teeth just touched the lower
lip. Not touching means that the incisai edge of
the maxiiiary anterior teeth did not touch the
lower lip.
In all, 25 subjects (10%) had slightly covered
smiles, 86 subjects (36%) had touching smiles, and
129 subjects (54%) had not-touching smiles.
Respondents found touching and not-touching
smiles more esthetic than slightly covered smiles
(P<0.05).
The Teeth Displayed in a Smile
The study also measured which teeth were dis-
played in a smiie. Most subjects (57%) displayed
to the second premolar. Only 2 subjects displayed

The Internationa 1 of Prosthodüntii Voliimel2,Number 1, 1999

12
 Dong et al Esthetics of the 5rniie: Review of Recent Studies

Fig 5 Number of subjects and

mean esthetic rank by the teeth
displayed in a smile. IZD No. of subjects
- • - Mean esthetic rank

140

120
^ ^
g 100
'.a
Z 80
o
° 60
40

20

Canine First Second First Second

premolar p re moiar molar molar

Fig 6 Exposure of maxillary

central incisors by age in resting
and smiling positions.
8 Q Resting

1
7 • Smiling

1 •
Exposure of central ilicisoriä(mm)

4
1 1 1
I I I 1
I 1
1
11AX I
3

-1 50-59 60-69
20-29 30-39 40-49
-2 • Age

only to the canines. Tbe mean esthetic rank of the To investigate changes in the smile caused by
subjects wbo tdisplayed to tbe first moiar was the aging, Choi et al^ measured the exposure of the
highest and the mean esthetic rank of the subjects maxillary and mandibular central incisors in both
who displayed to the canine was the lowest (Fig 5). resting and smiling positions in 230 subjects (103
male, 127 female) 20 to 69 years of age. They re-
"Hie Effect of Aging on fhe Smile ported that the amount of maxillary incisai expo-
sure gradually decreased with age; this was ac-
Oral structures sucb as teetb, periodontium, and companied by a gradual increase in mandibular
lips are changed by aging. In the resting position, incisai exposure in the smiling position {Figs 6
aging gradually decreases the amount of maxillary and 7), The mean amount of incisai exposure was
centra! incisor exposure and gradually increases 5,92 mm in the maxilla and 2.78 mm in the
mandibular tootb exposure.'^ mandible.

Volume12, Numberl, 1999 The Internationai lournai oí Pioslliodontics

13
 Estlietits of ttie Smile: Review of Recent Studies Dong et al

Fig 7 Exposure of mandibular

central incisors by age m resting
and smiling positions.
r U Resting
7 • Smiling
_ 6
-
1 5
g 4
os ure of cen rai ir

—•

UI
-1
1
m , 1m , 1m . 150-59 U B
20-29 30-39 40-49 60-69
-2
Age

Fig 8 Mean rank ot smiie score

and statistical significance by
oral ccnditicn. Hcrizontal lines
connect values that are not sig-
niticantiy difterent (P< 0.05¡.

Malaiigned Missing

Oral Condition and Smile
Ko et a l " investigated the effect of missing teeth,
prostheses, and malaiignment, such as crowding and
spacing, on the smile. This study took photographs of
a full smile and examined subjects' oral condition.
Of 145 subjects, 42 had a normal condition, 13 had
missing teeth, 21 had prostheses, and 69 had mal-
aiigned teeth. In the subjects who were missing teeth,
all bad only 1 or 2 missing teeth in the posterior re-
gion. The investigators then estimated the esthetic
score of the smile and analyzed the data statistically.
The normal group had the highest mean smile
score and the missing teeth group had the lowest
(Fig 8). The scores of the normal group and the re-
stored (prosthesis) group were not significantly dif-
ferent (P > 0.05), But the scores of the normal group
were significantly different from the malaiigned
group and the missing teeth group (P < 0,05),
These results reveal that missing or malaiigned
teeth impair tbe smile. But if the missing teeth are
restored, the esthetic level of tbe smile improves.

I of Pros tliodon tics 14 • 11, Number I, T999

 Dong et al Estinetics of the Smile: Review of Recent Studies

Table 1 Correlation Between Primary Personality Traits and Smile Score

Personality traits Correlation
=actor Low score High score Total Wale Female
Warmth Coo) Warm 0,427' 0.144 0.627-
inteiligence Concrete thinking Abstract thinking 0.150 0.128 0.059
Emotional stability Easily upset Calm 0.3711 0.182 0,391*
Dominance Not assertive Dominant 0.001 0.036 -0.031
Impulsiveness Sober Enthusiastic 0.369* 0.290 0.245
Conformity Expedient Conscientious 0.034 0.068 -0,038
Boldness Stiy Venturesome 0.321Í 0.284 0.260
Sensitivity Tojgh-minded Sensitive 0.107 0.168 0.129
Suspiciousness Trusting Suspicious -0.051 0.061 -0.118
Imagination Practical Imag native -0.049 -0.051 -0,026
Stirewdness Forthright Shrewd 0.153 -0.034 0.226
1 insecurity Self-assured Seif-doubting -0.280* -0.152 -0,365*
Radicalism Conservative Experiment ng -0.031 -0.028 -0.138
Se It-sufficiency Group-oriented Self-sufficient -0.300* -0.262 -0.408*
Self-discipline Undisciplined Self-discip lined 0.103 0.110 0.032
Tension Rela!<ed Tense -0.309* -0.260 -0.290
Pearson's correlation doeffic i ants: 0.001,'P< 0.01; *P<0.05

Table 2 Correlation Between Seconid-Order Personality Traits and Smile Score

Personality traits Correlation
Low score High score Total Male Female
Introversion Extroversion 0.482' 0.354 0.574-
Low anxiety High anxiety -0.431 • -0.274 -0.493t
Emotional sensitivity Tough poise -0.080 -0.064 -0.133
Subduedness Independence 0.107 0.272
Low superego High superegc 0.021 0.045 -0.055
Low creativity High creativity -0.089 -0,075
Pearson's correlation coefficients: *P< 0,001, ' P * 0.01.

Personality and Smile a Sixteen Personality Tactor (16PF) Questionnaire.'^

The facial expression commonly referred to as "the
smile" in tact is not a single category of facial be-
havior. Duchennc'^ noted that the emotion of
frank ¡oy is expressed on the face by the combined
contraction of the zygomaticus major muscle and
the inferior portion of the orbJcularis oculi muscle.
The first muscle obeys the will, but the second is
put into play only by the appropriate emotions.
Fake joy or a deceitful laugh cannot provoke the
contraction of tbe latter muscle.
Kim et al'2 investigated the correlation between
personality factors and tbe smile, assuming that smile
esthetics are closely related to an individual's physi-
cal condition and psychologic state. The subjects
were 30 male and 30 female students who had no
missing teeth, no experience of orthodontic or pros-
thodontic treatments, and good dentition. Tbe per-
sonalities of the subjects were assessed by means of
Kim et aP^ took standardized frontal photographs of
tbe subject's face during a full smile and estimated
tbe smile score. Then they assessed the statistical re-
lation between smile score and personality.
There are 16 primary traits in the Personality
Factor Questionnaire (Table 1 ), Warm, calm, enthu-
siastic, venturesome, self-assured, group-oriented,
and relaxed personality traits are correlated witb an
attractive smile.
Of the second-order personality factors derived
from the primary personality traits (Table 2), extrover-
sion and low anxiety are correlated to an attractive
smile. Interestingly, women's personalities are corre-
lated to attractive smiles but men's personalities are
not. The esthetic levels of women's smiles were cor-
related at statistically significant levels to 4 primary
and 2 second-order personality traits. But for men,
there were no statistically significant relationships be-
tween personality traits and smile esthetics.

Volume 12, Number 1,1999 The Internalionai lournal of Proslliodontii

15
 Esthetics of tbe SmiJe: Review of Recent Studies

Fiq g Dr Gibson's first smile

exercise. The patient progresses
from a small smile to larger ones
and then reverses tfie process.

Fig 10 Dr Gibson's second

smiie exercise. The patient
makes a big, fuli smile and holds
the corners of the mouth firmly
with the fingers. Then the patient
siowly cioses the iips back to no
smiie, against tfie resistance of
the fingers.

Smile Exercise
A beautiful smjie radiates health and self-confi-
dence. Many patients with missing, malaligned,
discolored, or chipped teeth hold their hand over
their mouth when they smile or use a closed-lip
smile to conceal their unsightly teelh. Smile exer-
cises are necessary if these patients retain this habit
following the correction of tbeir dental problems,
Gibson'^ deveioped the smile exercise program
in 1989 as a teaching program to develop and con-
trol facial muscles to improve a smile. In Gibson's
first smile exercise, the patient stands or sits before
a mirror and goes through a process of smiling.
The patient progresses from a small smile to larger
ones and then reverses the process (Fig 9). Each
position is held for 10 seconds and repeated sev-
eral times. In this isotonic exercise, the muscles are
taken repeatedly through their entire range of
movement.
The second exercise is an isometric exercise that
involves closing the smile against the resistance of
the fingers, which increases the tone and strength
of the muscles around the mouth. The patient

I ol Prostliodonli< 16 Volume 12, Number 1, 1999

 Dong et al
Fig 11 Changes in smile
scores betöre, during, and atter
smile exercise program.
5^
Smile score
'=•?
Before
makes a big, full smile and holds the corners of the
mouth firmly with the fingers (Fig 10). Then he
slowly closes the lips back to no smile, against the
resistance of the fingers,
Kim et al'^ and Dong and Kim'"* investigated the
effect of smile exercises in 29 subjects, students
who had good dentition and well-restored teeth.
The researchers explained Gibson's smile exercise
method. The subjects trained their perioral muscles
for 4 weeks at home. Photographs were taken of a
full smile at regular intervals: f/) before smile exer-
cises, {2) after 2 weeks of exercising, {3} after 4
weeks of exercising, and Í4) 1 year later, after smile
exercises had been discontinued. Ten appraisers
estimated the estbetic levels of tbe smile (smile
score) from photograpbs, and these scores were
analyzed. Smile scores were increased by smile ex-
ercises ¡Fig 11, P< 0.05), but the smile exercise ef-
fect was not durable without continuous smile ex-
ercise (P< 0.05).
Discussion
The studies reported here build on previous work
in the field but pusb ahead in new directions. For
example, the method we used of estimating the es-
thetic quality of smiles by having a panel give
scores has long been used in the fine arts and
sports and has been borrowed by other dental re-
searchers such as Hulsey.^ The judgments of the
panelists are very important in this system of sub-
jective evaluation. We selected a panel composed
of 2 groups—dentists and fine arts professors.
Volume 12, N u m b e n , 1999
Esthetics ot the Smile: Review of Recent 5tudi(
/ \
Atter 2 weeks Atter 4 weeks 1 year atter
discontinuing
Because we found few differences in the scoring of
the 2 groups, we have high confidence in our eval-
uations of smile attractiveness.
Yoon et aCs findings^ on the desirable teeth and
lip position of the smile were similar to those of
Frush and Fisher,^ Hulsey,^ and Tjan et al.''
Hulsey^ reported that the most attractive smiles
have nearly perfect harmony between the arcs of
curvature of the incisai edges of the maxillary in-
cisor and the upper border of the lower lip, and
that the upper lip came to the height of the gingival
margin of the maxillary central incisor. Yoon et al^
found that in an attractive smile, the full shape of
the maxillary anterior teeth was displayed between
the upper and lower lip, the upper lip curved up-
ward or was straight, the maxillary anterior incisai
curve was parallel to the lower lip, and the teeth
were displayed to the first molar.
Choi et al's finding^ that maxiiiary incisai tooth
exposure decreases with age was similar to that of
Vig and Brundo.'^ Choi et al's study expands on
Vig and Brundo's research in that it measures the
amount of tooth exposure not only when the face
is in a resting position but also when it is actively
smiling.
The fact that Yoon et al^ and Choi et al's^ find-
ings were similar to those of other studies con-
ducted in the West shows that the Korean concept
of an attractive smile does not differ significantly
from that of Westerners. However, a recent inter-
national multicenter study comparing assessments
of dental appearance in 6 countries found substan-
tial differences for some variables.^°
17 The international jouri
 Esthetics of the Smile: Review of Recent Studies
Kim et aP^ and Dong and Kim^'' were the first to
test empirically the effectiveness of Gibson's smile
exercises. Gibson'^ argued that the smile exercises
should be done for 3 minutes every day for 30
days. He asserted tbat there should be a noticeable
difference by tbe end of this period and did not en-
courage exercising beyond 30 days. However, Kim
et aP ' and Dong and Kim^'' found that while
Gibson's smile exercises are effective in improving
the attractiveness of the smile, the effects are
durable oniy as long as the smile exercises are
continued. Persistent motivation and follow-up are
important for successful smile exercises.
Ko et al's study," taken together with that of
Yoon et al,^ also bas implications for clinical prac-
tice. Because Ko et a l " demonstrated the dramatic
effect of missing teeth and Yoon et al^ showed that
tbe ideal smile displays to the first molar, dentists
must be sure to extend their concerns to posterior
teeth to maximize smile attractiveness.
Perhaps the most original study reported here is
that of Kim et al'^ on personality and the smile.
They show that desirable personality traits are posi-
tively correlated witb smile scores. When evaluat-
ing the findings of Kim et al'^ on personality and
Kim et al'-* and Dong and Kim''* on smile exer-
cises, perhaps we can conclude that successful
smile exercises would be even more effective if not
only muscles were stretched but emotions were
"exercised." Certainly Kim et al's findings'^ suggest
new directions of research into tbe relationship be-
tween neurologic states and dental esthetics.
Many people come to dentists seeking an attrac-
tive smile, believing that a better smile will improve
their social lives. The research here at Wonkwang
University has added to our empirical knowledge of
how to make a smile more attractive. But the ques-
tion remains: just how important is an attractive
smile? There is a growing controversy about this
issue. Shaw et aP' reported that dentofacial appear-
ance has a very strong influence on young adults
and their preference for friends. In contrast, other
studies like Eagly et al's^ show no correlation be-
tween the physical attractiveness of a subject and
the tendency of others to attribute positive virtues to
tbe subject.
Clearly, esthetic dentistry performs a service
many people want, and some social benefits of an
attractive smile can be empirically documented.
But tbe value of an attractive smile should not be
overestimated or oversold. The dentist's desire to
do good in esthetics should not overrule the pa-
tient's right to make clear, informed decisions.'^
Esthetics is also subjective. It has also been shown
that differences exist between patients' and dentists'
lournai of Proîthodontics
Dünget
evaluations of dental appearanees.^° Therefore, tbe
practicing dentist should examine the patient's mo-
tives for seeking esthetic treatment and offer treat-
ment only if the patient clearly indicates that he or
she has esthetic concerns. Practitioners should fully
explain the advantages and disadvrntages of es-
thetic services and obtain informed consent for all
procedures.
Conclusion
An attractive smile is important for facial esthetics.
Tbe esthetics of the smile are affected by the upper
lip position, the upper lip curvature, the paral-
lelism of the anterior incisai curve with the lower
lip, the relationship between maxillary anterior
teeth and tbe lower lip, and the number of teeth
displayed in a smile. An attractive smile has no
missing or malaligned teeth. Personality traits such
as warmth, calmness, extroversion, and low anxi-
ety are closely correlated to an attractive smile.
Smile exercises are an effective means of improv-
ing the esthetic level of the smile if patients exer-
cise continuously.
Acknowledgments
The authors would like to eNpresi their thaniiS to Drs Min-Eui
Voori, Teak-Rim Choi, Joon-Won Ko, Hyun-Seong Kim, Hyeon-
Soo Kim, ¿ind |eong-Hoi Kim for their important contribution to
these studies, and to Drs |ong-Sun Park, Jae-Sun Chi, Sang-Ho
Eum, Vu-Ri Kim, Jong-il Parii, and all of the members of the
Department of Prosthodontics, School of Dentistry, Wonkwang
University, for heip with the studies. In addition, we would like
to thank Professor Sang-Woo Oh, Department of Neuropsy-
chiatry, School of Medicine, Wonkwang University, for advice
on the Sixteen Personality Factor Questionnaire and Dr Dennis
Florig not oniy for editorial correction but also for his advice on
this manuscript.
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Literature Ahstract-

The relationship between satisfaction with mouth and number of teeth.

T h e difficuit question ot hom many teeth we need for acceptabie function in the masticatory sys-
tem is analyzed in this review article based on 118 reterences. It is divided into 3 sections The
first deals with oral function in relation to number and position of natural teeth, tbe second with
the relationship between dental condition and orai heaith, and the third with subjective percep-
tion in relation to oral status. The main conclusion is that less than 28 teeth can satisfy the de-
mands of oral tunotion. tvlissing postenor teeth are not very important from a subiective point ot
view, although many dentists have tirmly maintained that they are. The position of teetli in the
mouth is important when it comes to replacement. Peopie are more concemed about missing
anterior teeth and replacing anterior rather than posterior teeth. Esthetics are more important
than function for many people. Sociodemographic factors can be of importance in Ihe subiective
perception concerning repiacement ot missing teeth. Some studies have assessed the social
and psychoiogio impacts on oral health status. Even large numbers of missing posterior teeth did
not cause pain and dystunctton in the temporomandibuiar joint. There is an obvious discrepancy
between the professionais' and the patients' definition of orai health, and this difference seems to
increase with age. In 1 study, the examiners judged that 7 8 % of the elderly subjects needed
some form of dentai treatment, whereas subjectively 4 2 % of the subjects thought that they
needed it, and oniy 1 9 % bad tried to obtain dental treatment. Another study concluded that clini-
cal criteria had limited relevance to individuals in evaiuating their orai health status.

Ellas AC Sheiham A. J Oral ñe)iaM 1998;Z5:649-661. References: t IB. Reprints: Prof A. Sheiham,
Department of Dental Public Health, University College London Medical School and St Bartholome«- s and
Ttie Royal London School ot [Medicine and Dentistry, 1-19 Tanington Place, London WCIE 6BT, England,
UK—AW

Tlie International journal of Frosthodontics

Volume12, Number!, 1999 19