Introduction

Dental aesthetic satisfaction (smile satisfaction) is a critical element that can impact a person's self-esteem and overall well-being. In societal relationships, facial features and oral aesthetics are considered extremely important [1]. An individual's subjective perception of their oral aesthetics might impact their self-confidence, contentment, physical well-being, mental state, and interpersonal connections [2–4]. People who invest in dental aesthetics enhance their appearance, psychological health, and sense of happiness.

In the modern era, people generally believe that they should possess attractive facial features to create a pleasing aesthetic impression and be viewed as physically appealing. A study reported that the eyes contribute 25%, mouth 18%, face shape 15%, Skin 12%, and the nose 6% to the overall assessment of facial attractiveness [5]. Several recent studies have shown that self-perceived smile and dental aesthetics correlate with low self-esteem [4,6,7]. Furthermore, the appearance of teeth and smiles can significantly affect individuals’ confidence, social interactions, and quality of life (QoL) [8].

A study found that one of the most common dental concerns affecting satisfaction was inadequate restoration of anterior teeth [9]. Dissatisfaction with one's smile has also been attributed to tooth arrangement and position [2]. Malocclusion, particularly involving the anterior teeth, can negatively affect an individual's personality and self-esteem [10,11]. Perceptions of personal appearance may trigger negative social responses and contribute to a poorer self-image [10, 11]. Untreated dental caries, unaesthetic or stained anterior restorations, and missing anterior teeth may also contribute to dissatisfaction with dental appearance [12,13].

Dental practitioners should understand the public's perception of smiles to better grasp their patients’ needs and wants, which can help them create more effective treatment plans and also help manage patients’ expectations [14]. Although numerous studies have been published on this topic, perceptions of beauty and attraction have rapidly evolved in the social media era. There is a need for a deeper understanding of how individuals perceive their dental aesthetics and how this view relates to their satisfaction with smiling. Self-perceptions of dental aesthetics are highly subjective and vary significantly among individuals. Examining this aspect can uncover how people assess their smiles, which may differ from clinical evaluations to objective measurements. Smile satisfaction is therefore a useful measure of an individual’s overall satisfaction with dental appearance. Understanding these perceptions is important for providing aesthetic treatment within biological constraints [15]. Consequently, this study aimed to examine dental aesthetic self-perception, smile satisfaction, and related sociodemographic factors, including age, gender, marital status, education, and occupation, among a sample of the general adult population in Karachi, Pakistan.

Methods

Results

Eight hundred fifty-four individuals participated in the study (276 males, 32.3%; 578 females, 67.7%). More than half of the participants (491, 57.5%) were aged 21–23 years. Other participant characteristics are shown in Table 1.

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Table 1. General characteristics of participants (N = 854).

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Over one-third of the participants (318, 37.2%) were dissatisfied with their smiles, whereas 536 (62.8%) were satisfied. More than two-thirds (595, 69.7%) believed that a smile can affect mental, emotional, and social health, and 665 (77.9%) agreed that it also helps reduce stress. More than half (509, 59.6%) admired other people's smiles, and 251 (29.4%) reported doing so sometimes. A total of 310 (36.3%) had considered changing the way they smile, and 96 (11.2%) reported considering this sometimes. More than two-thirds agreed that people who smile frequently appear more confident (593, 69.4%), and 542 (63.4%) agreed that tooth color influences smile attractiveness. Overall, 335 (39.2%) participants reported always or sometimes avoiding smiling in photographs, whereas 519 (60.8%) did not avoid smiling (Table 2).

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Table 2. Responses from participants to various questions (N = 854).

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Those who avoided smiling while taking pictures had several reasons, as shown in Figure 1.

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Fig 1. Reasons for avoiding smiling while taking pictures among 335 participants.

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The participants’ rating of the aesthetic appearance of their smiles is shown in Figure 2.

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Fig 2. Participants’ responses to the question, “How would you rate the aesthetic appearance of your smile?”.

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Gender-stratified response distribution differed significantly for the perceived effect of a smile on mental, emotional, and social well-being (p = 0.032), admiration of another person’s smile (p = 0.033), and the influence of the tooth color on smile attractiveness (p = 0.034). The findings are reported as overall distributional differences because the proportions across the yes, no, and sometimes or maybe categories did not show a consistently higher response in one gender (Table 3).

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Table 3. Comparison of participant characteristics and questionnaire responses by gender (chi-square test) (N = 854).

https://doi.org/10.1371/journal.pone.0357126.t003

Binary logistic regression showed no significant association between the measured sociodemographic variables and “smile satisfaction” (Table 4).

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Table 4. Associations between sociodemographic variables and smile satisfaction among study participants (binary logistic regression).

https://doi.org/10.1371/journal.pone.0357126.t004

Discussion

Smile aesthetics contribute to perceived facial attractiveness, and many individuals seek orthodontic treatment to improve dental appearance. Smiling is an important form of nonverbal communication and has psychological significance [18]. Several features are considered when assessing a smile, including smile pattern, teeth, buccal corridor, midline, gingival display, maxillary incisor exposure, and smile arc [19].

In this study, 37.2% of the participants were dissatisfied with their smiles, whereas 62.8% were satisfied. The satisfaction estimate was similar to findings from Saudi Arabia (66.5%) and Vietnam (67%) [9,20], lower than 80% reported among Saudi adolescents [21], and higher than the 34% reported in Serbia [2]. In contrast, a Malaysian study reported 62.7% dissatisfaction with dental appearance [22]. Changes in smile aesthetics can sometimes lead to reduced self-confidence and self-esteem, making individuals more reserved, withdrawn, and timid [23]. Differences across South Asian, Middle Eastern, Southeast Asian, and European studies may reflect variation in age, cultural context, study population, sampling method, and measurement instrument. The predominance of female and student participants in the present sample may also have influenced the estimates.

The current study revealed no significant differences in dental aesthetic satisfaction between genders. The literature presents conflicting findings on this topic. Some studies indicate that women tend to be less satisfied with their dental aesthetics than men [24,25], while Ghazi et al. (2023) reported higher levels of dental aesthetic satisfaction among females compared to males [4]. In an Indian study, men expressed greater concern about their smiles and reported higher satisfaction with their dental aesthetics than women [26]. It appears that due to changing societal norms and the impact of beauty product companies’ marketing strategies, men are now just as concerned about their physical appearance and aesthetics as women [26]. The differences in our results compared to those of others may stem from varying cultural backgrounds, age disparities, and the use of different questionnaires.

Female respondents most commonly noticed the smile first (48.6%), followed by the eyes (35.3.6%), hair (9.9%), and nose (6.2%) when meeting someone for the first time. In contrast, male respondents most commonly noticed the eyes first (46%), followed by the smile (42%), hair (7.2%), and nose (4.7%). These findings highlight the significance of nonverbal cues during initial social interactions. The observation that smiles and eyes are the two main facial features noticed first underscores the importance of facial expressions in these encounters. It indicates that facial traits associated with positive emotions and friendliness, such as smiling eyes, influence a person's perception in a first meeting. A previous survey reported that teeth were regarded as the most important facial characteristic, while hairlines and ears were viewed as the least significant features [24]. Another study found women scored higher than men on the importance of teeth and hair, but lower on the significance of the head [27]. The observed gender differences in the present study should be interpreted cautiously because of the unequal numbers of female and male participants.

A majority of participants (59.6%) reported admiring another person's smile, supporting the perceived importance of the smile in interpersonal interactions. This finding is consistent with a Saudi study [24]. Overall, 39.2% of participants reported always or sometimes frequently or occasionally avoiding smiling when photographs were taken, with no significant gender difference. Participants provided various reasons for this behavior, including concerns regarding the appearance of their teeth in terms of size, shape, and color, as well as misalignment and gaps between teeth. These findings align with those of previous studies [2,21,28].

Orthodontic or other appropriate dental treatment may address some causes of dissatisfaction with smile. However, the costs of this treatment are high, not only in Karachi but also globally. This poses a significant financial burden for individuals in middle-class and lower-middle-class countries. Consequently, they may go through life feeling unhappy with their smiles. It is crucial to create a plan that ensures access to orthodontic treatment for those with limited financial resources.

Most participants agreed that people who smile frequently appear more confident and that smiling reduces stress. These findings are compelling and highlight the importance of smiling, not only as a sign of happiness but also as a reflection of confidence. Additionally, a smile is associated with positive traits of an individual's personality; similar results have been reported in another study [8].

Approximately two-thirds of participants (63.4%) agreed that tooth color influences smile attractiveness while a further 22.5% responded ‘may be.’ Tooth discoloration can adversely affect a patient's satisfaction and psychological well-being, leading some to choose cosmetic procedures like teeth whitening [29,30]. Overall level of agreement (85.9%) observed in this study regarding the impact of tooth color on smile attractiveness emphasizes the significance of tooth appearance. This suggests that individuals prioritize the beauty and health of their teeth, explaining the high demand for tooth-whitening procedures in modern society.

More than half of the participants (57.5%) rated the aesthetic appearance of their smiles as attractive or extremely attractive, with no significant gender difference. This indicates a generally positive self-rating of smile appearance and is consistent with several previous studies [7,14,25,31]. Facial aesthetics may contribute to perceived well-being, and individuals concerned about their smiles may benefit from professional dental assessment.

This study revealed no associations between age, sex, occupation, education, marital status, or dental aesthetic satisfaction. However, the literature reports conflicting findings [14,27,32,33]. Multiple factors may explain the contrasting results, including a larger proportion of female participants, cultural disparities, a diverse age range in the population sample, and differences in the inclusion and exclusion criteria.

Several confounding factors that we were unable to examine have been emphasized in the literature as having a significant impact on self-perceived dental aesthetics and psychosocial well-being. One study indicated that university affiliation (private vs. public), study discipline, college, and income levels were all significant factors affecting these perceptions [34]. Another study from Saudi Arabia found that “urban residence, tooth color, crowding, unsatisfactory frontal teeth fillings, broken frontal teeth, red inflamed gums, covering teeth while smiling, and the degree of gum display while smiling” were associated with satisfaction regarding dental aesthetics [9]. Furthermore, a study noted that among laypersons, a positive perception of orofacial appearance was related to general health conditions, higher educational levels, and perceptions of oral health conditions [35].

Our research shows that most individuals surveyed agreed on the significant influence a pleasant smile can have on a person's overall demeanor. This further reinforces the idea that an authentic smile expresses happiness and indicates self-assurance. Smiling serves as a powerful symbol of warmth and connection, which is essential to human communication. As a result, dental aesthetics have become increasingly important in modern society, as they can enhance an individual's facial attractiveness [36]. Cosmetic dentistry offers various solutions designed to help individuals achieve their ideal smile, addressing issues such as tooth discoloration, misalignment, and tooth loss [2].

Conclusion

In this sample, the measured sociodemographic variables were not significantly associated with smile satisfaction, and 62.8% of participants reported being satisfied with their smiles. Most participants believed that smiling reduces stress, enhances personality, and conveys confidence. Because important clinical and psychosocial factors were not measured, the absence of sociodemographic associations should not be interpreted as evidence that unmeasured individual experiences are more influential. Further research using representative sampling, validated instruments, and clinical measures is needed to identify factors associated with smile satisfaction and psychosocial well-being.

Supporting information

Acknowledgments

The authors thank all the study participants for their cooperation. The authors used ChatGPT 5.4 as AI assistance, but it was limited to improving readability, grammar, and syntax. All data, scientific content, research findings, and professional judgments are entirely the authors’ own. The authors take full responsibility for the integrity and originality of the work.