Young adults care more about even teeth color than bright white smiles, study finds

Smooth and even color seems to matter more than blinding whiteness when teeth are in question. That is the bottom line of a massive Swedish study in which thousands of young adults were asked to criticize photos of teeth with varying defects in color. The results suggest patches, spots, or stains on front teeth cause far more harsh criticism than non-movie-star-brightness of smile.

The study obtained opinions from more than 2,000 Swedes aged between 18 and 30. They were approached through social media advertising and completed an online questionnaire. The sample was approximately 55 percent women and had a mean age of 25. Half lived in big cities, while the remainder were from towns of differing sizes.

Seven sets of upper front tooth photographs were shown to participants. Photos varied from normal enamel issues like white spot lesions, fluorosis, and molar incisor hypomineralization. All ranked the teeth from "Very Bad" to "Very Good" and explained what influenced their perception. Researchers also used digital measurements as a means of calculating the size of tooth surface affected by discoloration and thus helped to detect whether patch size mattered.

Most of the respondents were content with their own tooth shade. Around 77 percent were content, and there was no notable difference between men and women. Whitening procedures were a different matter. Women reported that they whitened their teeth more than men—around 22 percent and 13 percent, respectively. Older respondents were more likely to have experience whitening, possibly because it is not allowed for those younger than 18 years of age in Sweden.

The survey also demonstrated the impact of irregular color on self-image. More than one-third of the subjects reported perceiving that they had a conspicuous spot or patch on a front tooth. Of those, nearly half saw the abnormality as objectionable. Those who perceived a patch were roughly twice as likely to have a negative rating of their overall tooth color. While only a few 10 percent of this population had yet been treated, more than half said they would like to be treated.

When they critiqued pictures of other people's teeth, reactions were even stronger. Nearly every participant rejected at least one photo as unattractive, and several rejected multiple photos. Brown-stained fluorosis was the worst, with the almost 94 percent of participants rejecting it as unacceptable. Next were large white spot lesions, then other forms of mottling and hypomineralization.

Only a few participants criticized the control photo of healthy teeth. This consistency suggests that what most really grabs attention isn't whiteness of the teeth, but whether or not there's a visible irregular patch interrupting the surface. Informatsts often spoke of the patch looking "too white" or "too brown," while the underlying color of the tooth was often evaluated "too yellow." For many, the difference from the rest of the enamel made the flaw look worse.

When asked directly which mattered more, people gave a clear answer: uniform color outweighed brightness. On an 11-point scale, evenness scored an average of 8.0, while whiteness scored 7.3. The preference held across all ages, genders, and hometown sizes. Interestingly, individuals who were already satisfied with their own tooth color also evaluated whiteness and evenness as very important more frequently, whereas men and residents of small towns also evaluated whiteness as not important at all more frequently.

Lead author of the study and postgraduate student Laura Ståhl of the University of Gothenburg described how the findings reveal the extent to which young adults perceive mismatch in color. "What we found was that the participants are sensitive to uneven tooth color, and it is something that is perceived negatively," she said. "Oral health is not only about having a healthy mouth, but also about being able to smile, laugh, and be able to present self-confidence with each smile.".

The computer analysis confirmed what interviewees were saying: more irregularities were more likely to be criticized. In a couple of cases, like pigmented fluorosis, the spot was in excess of 70 percent of the surface area of the tooth. The smaller lesions reached barely 13 percent, but they were also criticized by the majority of the respondents. As soon as an irregularity took up most of a tooth, tolerance dropped drastically.

The research accounts for rising pressure to possess immaculate smiles, especially in the era of social media. Many young people can feel embarrassed about spots or stains and thus approach experts seeking assistance. Nina Sabel, associate professor at the University of Gothenburg and study co-author, highlighted the importance of professional treatment when choosing whitening or corrective treatment.

"Teeth are seen as a critical part of appearance, and many youths are bothered by the fact that there is a deviant colour on part of a tooth," she stated. "Different colour deviations have different reasons, which require different types of treatment. It is also important not to over-bleach, since once your teeth are neon white, you can't reverse it."

This research states that dentists should care less about making ultra-white teeth and more about helping patients achieve an even, natural look. Treatments that blend or reduce patches—especially those due to fluorosis—may do the most to enhance how people feel about their smile. For patients, the good news is reassuring: you don't have to have the whitest teeth to be beautiful, but maybe you will feel more at ease about your smile if it is even.

The study also stresses the importance of ethical dental practice. Cosmetic procedures should be motivated by professional consultation to avoid harm and to ensure treatments align with the actual cause of the asymmetry. Public health messages prioritizing natural, even smiles over excessive whiteness can help reduce unnecessary procedures and enhance self-esteem in a better way.

Molar-Incisor-Hypomineralization (MIH) - a poorly understood condition that weakens enamel, causing tooth sensitivity and white, yellow, or brown discoloration on molars and sometimes front teeth.

Dental Fluorosis (F) - a condition caused by excessive fluoride intake during early childhood, often from drinking water, which leads to white or brown discolorations of tooth enamel.

White Spot Lesions (WSL) - a condition often appearing as white spots along the gum line, develops from poor oral hygiene and is commonly seen around fixed braces during orthodontic treatment.

Research findings are available online in the journal Acta Odontologica Scandinavica.

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