Background: Understanding the importance, value and self-image that the smile represents in the daily life of the individual remains a subject of high scientific interest. Aim: The present qualitative and exploratory study aims at understanding the importance of the self-perception of the mouth and smile on the mental representation of self-image and the well-being of the individual. Materials and Methods: The convenience sample consisted of 151 children and youngsters of both genders, ages 8 - 24 years, who used an orthodontic appliance and were invited to draw two portraits of their mouth/smile. Results: The results suggest differences in the mental representation of the mouth and the smile, namely in the investment of the drawings before and after the use of the orthodontic appliance, as well as in the expressiveness and manifestation of emotions. Discussion and Conclusions: The results suggest that the main reason that leads participants to the treatment is related to aesthetic and functional issues in which the maximizing of the mental representation of the Orthodontic Smile emerges as a new categorization of the perfect smile.
The face is the part of the human body that portrays intended actions and expressions, denoting or externalizing feelings and emotions [
Among these facial expressions is the smile [
Thus, a panoply of analytical principles regarding the “smile” category need to become incorporated in the field of Dental Medicine Orthodontics [
Indeed, in spite of the numerous references found in the literature review that highlight the importance of the functional and biomechanical determinants of malocclusion as a symptomatic diagnosis, there is still a shortage of empirical studies that combine the problem of malocclusion to the subject’s self-image perception of the face in terms of the individual’s psychosocial context [
The present study addresses this gap, aiming at understanding the importance of the self-perception of the mouth and smile in the mental representation of the individual’s self-image perception of the face and in his well-being.
An empirical study of descriptive and exploratory nature was carried out to access the self-perception of the mouth and smile in the mental representation of the individual. The methodological strategy was of the qualitative kind, through the content analysis of a collection of Patients’ drawings, combined with quantitative parameters.
The convenience sample consisted of 151 children and youngsters [
According to the selected sample, 302 valid drawings were collected and analyzed, 151 of which representing M1 (“What was your mouth like before you had the orthodontic appliance?”) and 151 of which representing M2 (“How do you think your mouth will look like when you remove the orthodontic appliance?”). A qualitative content grid for the analysis of the 302 drawings was originally designed, to study its pictorial representations. Four categories were created in the content analysis grid, e.g., 1) smile, 2) drawing of the figure, 3) appearance and 4) teeth. To further detail the content analysis, twelve subcategories were created, e.g., 1) size, 2) contours/limits, 3) opening of the mouth, 4) lips, 5) jaw, 6) with detail, 7) fractured, 8) with diastema, 9) crooked, 10) straight, 11) in saw and 12) well positioned.
With the purpose of knowing which smiles denounced Patients’ affection and well-being, the categorization of the smile of Freitas-Magalhães was used [
The statistic treatment of the descriptive data was analyzed using the software SPSS―Statistical Package for the Social Sciences IBM SPSS Statistics 23 for Windows.
The use of drawings a projective technique (instrument) in this empirical study was chosen as a preferred methodological strategy, insofar as drawings could be considered as the first form of cognitive-emotional expression and a basic and universal form of intrapsychic language. The use of the “pictorial drawing” instrument for research purposes of qualitative nature has been used as a methodological guideline of choice in research projects conducted in the field of Health Sciences’ Studies [
As a criterion of objectivity with regard to the task proposed to the selected subjects, they were asked to portray in their drawings only the mouth/smile and not other parts of the face, as to limit the appeal to draw the face, thus centering the analysis’ object empirical focus on the smile [
The results suggest differences in the mental representation of the mouth and the smile, namely in the investment of the drawings before (M1) and after (M2) the use of the orthodontic appliance, as well as in the expressiveness and manifestation of emotions in these two moments.
According to the appearance category, namely in the opening of the mouth subcategory, there was a decrease in the pictorial representation of the semi open mouth in M2, evidenced in drawings with more pronounced labial commissures at the level of the lips and showing a complete visualization of the upper and lower dental arches. Such is corroborated by the teeth and drawing of the figure categories (
The results also suggest that the main reason that led Patients to orthodontic treatment is related rather to functional issues than aesthetic ones, contrary to the results obtained in two studies carried out by Gonçalves and Torres at the University Clinic Egas Moniz-Portugal, which pointed to the aesthetic component and the quest for the “perfect smile” as the leitmotiv for the demand of orthodontic treatment in Dental Medicine [
After the completion of the content analysis of the written answers to the question “Why do you use an orthodontic appliance?”, in which a total of 103 written answers were collected (68.67%), results suggest the main reason for the use of orthodontic appliance to be related to the functional well-being of the oral cavity. This seems to be corroborated by the content analysis of drawings in M2, revealing the presence of a broad smile (M2 = 86.1%) and well-being (
The results also reveal differences in the self-perception of the mouth after the use of the orthodontic appliance (M2), namely by more invested drawings, more detailed and complete drawings and drawings with straight mouths and more aligned teeth. This fact may be connoted to the timing of the questionnaire in the treatment pathway (6 M - 1 Y) suggesting that subjects may have a clinically induced speech about the Orthodontic Smile.
Likewise, the results point to the fact that the smile category (
In this line of thought, the execution of the task (focused on the teeth category) was correctly perceived by the sample subjects, supported by the fact that only one of the subjects has drawn the teeth category with an orthodontic appliance applied.
Regarding the subcategory opening of the mouth, the results obtained suggest a decrease of the mouth percepts that were drawn as semi-open (M1 = 41.1%, M2 = 27.8%) and closed (M1 = 13.2%, M2 = 25.2%), which means that in M2 the labial commissures are drawn in a clearly more pronounced way at the level of the lips (
In relation to the lips subcategory, the percentage of the upper and lower lips pictorially represented by the subjects shows an increase of 2.7% from M1 to M2. There was also a decrease in the representation of fine lips (M1 = 6.6%, M2 = 2%) and thick lips (M1 = 4%, M2 = 2.6%) compensated by a notorious increase in the representation of normal lips (M1 = 16.5%, M2 = 21.9%) in the percepts drawn by the subjects in M2.
The teeth category is the one that shows the most significant changes between M1 and M2. The most striking changes are reflected at the level of the fractured, with diastema, crooked, straight and well positioned subcategories. Moreover, the fractured and straight subcategories (
In parallel, there is a considerable percentage decrease from M1 to M2 in the with diastema (M1 = 17.9%, M2 = 1.3%), crooked teeth (M1 = 45.7%, M2 = 2.6%) and well-positioned (M1 = 91.4%, M2 = 17.2%) (
The aesthetic harmony that the smile provides is of the utmost importance for Patients, since having an attractive face promotes the individual’s acceptance in his psychosocial context. It should be noted that when subjects were submitted to Orthodontic treatment, they seemed to associate the smile category to the social display of a look with Perfect Teeth―the so-called Orthodontic Smile―in clear contradiction to the Perfect Smile, which was connoted to the subcategory lips.
These results present a contribution to the understanding of the importance of the Mouth and Smile in the self-image and psychic well-being of the individual, in which the broadening of the mental representation of the Orthodontic Smile emerges as a new form of categorization of the perfect smile.
The authors declare no conflicts of interest regarding the publication of this paper.
do Rosário Dias, M., Naben, L.G., Monteiro, A.L., Ferreira, A., Alves, V.P. and Delgado, A. (2018) When the Silence Speaks: The Smile. Journal of Biosciences and Medicines, 6, 13-20. https://doi.org/10.4236/jbm.2018.611002
Frequency | Percentage (%) | |
---|---|---|
Gender | ||
Female | 75 | 49.7 |
Male | 75 | 49.7 |
Not applicable | 1 | 0.7 |
Total 151 | 100 | |
Age | ||
8 | 4 | 2.6 |
9 | 1 | 0.7 |
10 | 8 | 5.3 |
11 | 7 | 4.6 |
12 | 18 | 11.9 |
13 | 11 | 7.3 |
14 | 22 | 14.6 |
15 | 21 | 13.9 |
16 | 13 | 8.6 |
17 | 12 | 7.3 |
18 | 11 | 7.9 |
19 | 6 | 4.0 |
20 | 6 | 4.0 |
21 | 3 | 2.0 |
22 | 2 | 1.3 |
23 | 2 | 1.3 |
24 | 4 | 2.6 |
Total 151 | 100 |