Perception of Smile Attractiveness in Excessive Gingival Display: A Cross-Generational Observational Study

Objectives: Excessive gingival display (EGD), or “gummy smile,” is one of the most common esthetic issues among the young generation. However, the influence of age on the perception of gummy smile acceptance remains unclear. Hence, the current study aimed to evaluate whether smile attractiveness ratings for gingival display differ across generations and among observers. Materials and methods: A smiling photograph of a 24-year-old female was obtained and digitally modified in Photoshop to create six different images with gingival exposures. Participants aged 18–80 years evaluated the images, presented in randomized and repeated order, on an 11-point Likert scale (0 = not attractive; 10 = extremely attractive) and by sex, student status, and medical or dental affiliation using mixed-model repeated-measures ANOVA. Intra-rater reliability was assessed using test–retest, with intraclass correlation. Results: A total of 115 participants were included in the current cross-sectional study. Attractiveness varied significantly across the six different conditions (p < 0.05). The highest mean rating was obtained for 1 mm of tooth coverage (8.20 ± 1.48) and the lowest for 5 mm of gingival exposure (4.60 ± 2.25). Ratings did not differ significantly between age groups. Observer sex showed no significant main effect, although a small but significant sex × condition interaction was observed (p = 0.007). Student status and medical or dental affiliation showed no significant between-group main effects. Test–retest reliability was moderate to good (ICC 0.53–0.87; overall ICC = 0.82). Conclusions: Within the limitations of the current study, it could be concluded that perceived smile attractiveness is primarily influenced by the amount of gingival display. Neither age nor observer sex showed a significant main effect on attractiveness ratings, although the rating pattern across conditions varied slightly by sex. Gingival exposure of ≤3 mm was perceived as attractive, whereas 5 mm was consistently judged least attractive across all demographic subgroups.