Graduation Date


Document Type

Senior Thesis


Bachelor of Science

Primary Major

Global Public Health

Program Director

Patti Culross, MPH, MD

Thesis Advisor

Michaela George, MPH, PhD



One out of four American adults refrain from smiling attributable to the condition of their dentofacial area. The aim of this study was to analyze the relationship between self-perception of dental esthetics and individual self-esteem among Sonoma and Marin County adults. Analytical concepts and processes were utilized to determine and describe the statistical significance of this plausible association.


In order to assess the interconnection of this relationship from an analytical approach, an observational study design method was utilized consisting of both a quantitative and qualitative analysis. A total of 163 participants consensually responded to an online questionnaire containing questions and statements from the Rosenberg Self Esteem Scale (RSES), and Psychosocial Impact of Dental Esthetics Questionnaire (PIDAQ). Each respondent was verified to be over the age of 18 using an age-specific demographic question, among a few other demographic variables. Smile satisfaction was assessed with a single question on the survey. The Rosenberg Self Esteem Scale was computed through SPSS and calculated to determine high and low self-esteem categories. Questions from the PIDAQ were utilized in the survey in addition to other questions regarding self perception of dental esthetics to compute both the Dental Esthetic Scale (DES), and Self-Perception of Dental Appearance Score (SPDAS). An opt-in was voluntary in the survey to provide email for further contact to continue participating in the study. These participants were contacted via email for interview scheduling, and themes were gathered from each individual interview for qualitative analysis.


Bivariate analysis was performed and results showed that age, gender, and orthodontic history were found to be statistically related to individual self esteem measured using the Rosenberg Self Esteem Scale. By using Binary Logistic regression it was concluded that there was a statistical association found between Smile satisfaction and self-esteem among this population. Smile satisfaction accounted for 15.3% of the variation in this analysis with an R2 value of 0.153. There was no statistical association found between the computed Dental Esthetic Score and individual self-esteem, showing only a 2.5% variation after adjusting for all variables. By performing a secondary binary logistic regression it was concluded that there was a significant relationship found between self-perception of dental appearance (SPDAS) and individual self esteem while taking into account all other variables. For this analysis all variables accounted for 18.4% of the variation between this exposure and outcome with an R2 value of 0.184. A few dominant themes between dental esthetics and appearance that were mentioned during the interviews was the impact on confidence, the importance of the contribution to appearance, and the influential factors of dental esthetic standards.


Within Sonoma and Marin County, there was a positive association found between self esteem and smile satistication. Furthermore, there was an association between self esteem and SPDAS score. On average, the higher the self perception of dental esthetics, the higher the self esteem after controlling for confounders. Although functionality of our oral region is significant to well-being, so is our individual self-esteem, and dental esthetics contribute to physical attributes which can impact self-perception of appearance and have an influence on health.

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