Children's perceptions of other children with enamel defects

Background: Developmental enamel defects may affect an individual’s dento-facial appearance, impacting on their psycho-social status and on how other people view them. Aim: To determine whether, or not, young people make value judgements, or ascribe certain social attributes, to other young people with visible enamel defects. Methods: Initially, focus groups with children were used to determine what terminology or judgements they used in relation to people with visible differences to their dentition. Subsequently, year 7 (11-12 year-olds) and year 10 (14-15 year-olds) pupils were recruited from two contrasting schools. Half the participants were given full-face photographs of a male and female subject without an enamel defect and the other half were given the same two photographs with the subject’s incisors digitally modified to display enamel opacity. Participants completed a child-centred attribute questionnaire to rate the photographic subjects according to six positive and five negative descriptors using a four-point Likert scale. The potential total attribute score (TAS) ranged from 11 (most negative) to 44 (most positive). Results: 547 children took part in the study; test-retest reliability and internal consistency of the attribute questionnaire was excellent (ICC≥0.75 and Cronbach’s alpha≥0.8 respectively). Mean TAS was significantly lower for photographic subjects with an enamel defect compared to the same subject without an enamel defect (p<0.001, one sample t-test). Linear regression analysis showed that female raters gave a significantly higher mean TAS than their male counterparts for photographic subjects both with and without an enamel defect (p≤0.002). Age and socio-economic status did not predict TAS. Conclusion: Young people make negative psycho-social judgements about other young people on the basis of their having visible enamel defects. These may negatively impact on the affected individual’s self-esteem, social interactions and prospects. Public health funding should support dental interventions for children, where dental appearance is of aesthetic concern.