The relationship of tooth shade and skin tone and its influence on the smile attractiveness

Objective: The purpose of this clinical study was to determine if skin tone and tooth color had the same influence on smile attractiveness. Materials and Methods: A woman's smile photograph was digitally manipulated to create a range of images with varying colors. The skin shade was modified to create four tones (p1: light, p2: light medium, p3: medium dark, p4: dark) using the L'Oreal True Illusion shade as a guide. The tooth shade was modified in four different tones: A1, A2, A3, A4 using the VITAPAN Classical shade guide to produce 16 images. A sample of 328 participants rated each image for attractiveness by means of a visual analog scale (VAS). Comparison among groups was performed with a 2-way ANOVA adjusted for multiple comparisons with the Bonferroni test (α =.05). Results: Image (p3-a1) showed the highest VAS values, while image (p1-a4) obtained the lowest, (Bonferroni Test: a1 vs a2, a3, a4 P <.001; p3 vs p1, p2, p4 P <.001). Analysis performed for age, sex, level of education, and laypeople/dentists were not statistically significant (P >.05). Conclusions: Variations in tooth and skin tone can significantly influence the perception of smile attractiveness. In the tested conditions, a brighter tooth shade significantly affected the attractiveness of the smile independently from skin tone. Clinical Significance: Understanding patient and dentist perception of the attractiveness of a smile with the important role-played by skin tone, may help clinicians to better identify teeth shade, helping delivery of tailored prostheses and esthetic restorations.