Faces with severe front tooth misalignment are particularly perceived: emotional and social perception and eye-tracking

Objectives Aligned teeth commonly convey a positive impression to other people. This study aimed to examine the effect of malocclusion on adult facial perceptions using self-reported and quantitative measures. Materials and methods Facial photographs of 15 adult patients (11 women; 47.73 years, standard deviation [SD] = 8.86; 12 periodontally compromised) with malocclusion were acquired before (MT0) and after treatment (MT1). The control group (CG) comprised 15 age-matched adults (12 women; 42.93 years, SD = 7.50) without malocclusion. In all, 37 laypersons (18 women; 41.06 years) viewed all pictures. Self-report: Participants rated each face regarding dental condition, smile valence, and friendliness. Eye-tracking: Visual attention was analyzed by entry time and fixation time on predefined face areas. Results MT0 pictures received significantly ( p < 0.001) more negative ratings regarding dental condition, smile valence, and friendliness. Ratings for MT1 were comparable to those of the control group. Compared with the CG, MT0 faces showed faster first fixations on the mouth ( p = 0.005) and had longer fixation durations (36.15%, p < 0.001). After treatment, the difference to the CG decreased significantly (12.38%, p = 0.014). Conclusion Malocclusions have a negative effect on the perception of individuals in terms of gaze behavior and self-reported ratings. These effects decrease after treatment, underlining the effect of orthodontic correction. Clinical relevance Orthodontic treatment improves facial perception and the assessment of oral regions, highlighting the psychosocial significance of orthodontic treatment.