Rethinking Lip Aesthetics: Do Orthodontists, Dentists, and Laypersons Agree on Attractiveness?

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Katie Mccormack, Juhi Dwivedi, Anika Samee, Flavio Copello This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8681202/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Introduction: We aim to investigate the proposed standards of ideal lip proportions and compare those standards to what different people view as most attractive. Methods: A 16-question survey was distributed via Qualtrics to orthodontists, general dentists, and laypersons asking demographics as well as opinion-based questions regarding a series of facial photographs. Photographs were digitally altered using Adobe Photoshop to produce different dimensions of the lips from both profile and frontal views. Participants were asked to rate the perceived attractiveness of the lips shown. Results: Regardless of occupation, individuals preferred the appearance of slightly protrusive or thicker lips. Retrusive and thin lip varieties had the lowest median attractiveness scores. Average values for lip projection and thickness were not found to be mutually agreed upon across occupation types (p<0.05) and average lip thickness was not mutually agreed upon between age groups of orthodontists (p=0.004). Conclusion: Based on the results of this study, care should be taken not to produce retrusive or thin lips during orthodontic treatment. Acceptance of a slightly thick or protrusive lip profile may be a more esthetic or well-accepted patient outcome. Figures Figure 1 Figure 2 INTRODUCTION Dentofacial esthetics is a major consideration in orthodontic treatment planning. Treatment plans must account for the position of the anterior teeth and degree of protrusion, as these factors directly influence lip posture and facial profile esthetics. Orthodontists rely on several cephalometric reference lines and measurements to assess lip position in relation to the face, including the Rickett’s esthetic line [ 16 , 17 ], the Steiner line [ 15 ], the Merrifield Z-angle [ 11 ], the Burstone esthetic line [ 2 ], and the Holdaway profile [ 5 ]. Currently, lip position in orthodontics is evaluated using standards established decades ago. One study in young Caucasians proposed an ideal upper-to-lower lip height ratio of 1:1.6 [ 6 ], while another suggested the upper lip should measure 75–80% of the lower lip height [ 19 ]. Developed primarily in Caucasian populations during the 1950s–60s, these analyses may not reflect contemporary beauty standards or cultural preferences. To address this discrepancy, several studies have examined ethnic and racial variations in esthetic preferences. Among Nigerian orthodontists, trainees, and students, slightly protrusive lips were preferred, and nearly half of respondents rated the ‘normal’ Ricketts’ esthetic line as unattractive [ 12 ]. In a Chinese population, retrusive profiles were rated more favorably than by Caucasian judges, with − 1 mm behind the E-line considered most esthetic [ 4 ]. In contrast, a study conducted in Salvador found preferences closely aligned with Ricketts’ original norms, although slightly convex and concave profiles were also accepted [ 3 ]. These findings suggest that esthetic standards vary across populations and may influence extraction decisions and treatment planning. The effects of aging on the lips and nose are also important considerations in orthodontic treatment planning [ 18 ]. Lip enhancements and augmentations have gained popularity not only in plastic surgery but also in dentistry, reflecting increased attention to perioral esthetics and age-related changes [ 14 ]. As individuals age, lips tend to flatten and lose vermillion display [ 16 ], with maximum lip thickness typically reached during adolescence [ 10 , 12 ]. Fuller lips are therefore often associated with youth and attractiveness, whereas thin lips may be perceived as indicative of aging or fragility [ 9 ]. Photographic analyses of fashion magazines throughout the twentieth century demonstrate a progressive preference for fuller and more anteriorly positioned lips, a trend observed in both Caucasian and African American female profiles [ 1 , 21 ]. While societal influences shape beauty ideals, esthetic preferences are ultimately multifactorial. This study aims to evaluate whether traditional orthodontic lip standards continue to represent current societal preferences for lip esthetics among orthodontists, general dentists, and laypersons. MATERIALS AND METHODS The Institutional Review Board (IRB) at the University of Maryland, Baltimore reviewed this study under the application HP-00104133 and approved the referenced protocol as exempt under 45 CFR 46.104(d) from IRB review. Survey design This study was modeled partly from previous surveys on lip and profile esthetics [ 3 , 8 ]. The first block of the survey included demographic questions (ex. occupation, education level, age, race or ethnicity, and US zip code). Inclusion criteria consisted of adults (over 18 years of age) that identify as orthodontists, general dentists, or laypersons (defined as any occupation not in the dental field). The survey was only offered in the English language. The second and third blocks of the survey consisted of a randomized order of facial photographs of varying lip proportions and asked survey participants to evaluate for perceived lip attractiveness. Individuals were asked to rate their opinions on Visual Analog Scale (VAS) from not attractive (0) to very attractive (100). The VAS is a validated system to rate survey photographs and this method was modeled after its use in previous studies on lip and smile esthetics [4,3,20–22]. Frontal and side profile photographs were identified of a patient with close to ideal proportions, based on current orthodontic standards. Adobe Photoshop desktop (version 23.5, Adobe Inc., USA) was used for the digital enhancement and alteration of photographs for this study to produce lips with varying proportions. The frontal photograph was mirrored horizontally, to account for any facial asymmetry. The images were scaled based on clinically observed anatomic measurements. Care was taken to ensure only the size of the lips were being altered. For the side profile images, 0 mm represents ideal Ricketts’ E-line measurements (Fig. 1 ). Both the upper and lower lips were retracted to − 1 mm and − 2 mm of the ideal Ricketts’ E-line for the retrusive images and advanced + 1 mm and + 2 mm for the protrusive images. For the frontal facial images, 0 mm indicates the average lip height. Both the upper and lower lip heights were decreased − 1 mm and − 2 mm for the thin images and increased + 1 and + 2 mm for the thick images. Blurring around the lips was utilized to make it difficult to decipher which images had been altered. Survey distribution and data collection A preview study was sent to the IRB committee at the University of Maryland, who subsequently approved the application. The study was critiqued by several members of the University of Maryland orthodontic clinic, including faculty and residents, who were asked to provide feedback. An independent review on the Qualtrics software was performed and the survey was evaluated by an internal ‘Expert Review’, which determined a survey strength of ‘great’ and 0 recommendations given for adjustment. The 16-question survey was administered through the Qualtrics survey platform, approved by the University of Maryland, Baltimore, Institute for Clinical & Translational Research. The survey link was distributed to orthodontic program directors across the U.S., through online orthodontic forums, to clinical directors in the departments of general dentistry at University of Maryland, through dental online forums and Facebook groups, and via iPad to patients at the University of Maryland. Sample size calculation The sample size calculation was performed based on a previous study [ 3 ] using the PANDIS formula using the following parameters: the power of the test was 80% (β = 0.20), the error was 5% (α = 0.05), the relevant clinical difference adopted was 12 points in the mean VAS score and the standard deviation was 24.49 (VAS). A minimum sample size of 65 subjects per group was determined. For all analyses, the level of significance was 5%. The normality of the sample was verified by the Shapiro-Wilk test. The ANOVA one-way test was performed for samples with normal distribution and the Kruskal-Wallis test was used for non-parametric distributions. Statistical analysis The statistical analysis was performed using SPSS (Version 23.0, SPSS Inc., USA). The normality of the sample was verified by the Kolmogorov-Smirnov test (α = 0.05). When the occupation was used as the main factor to analyze each question, the sample did not show a normal distribution. Therefore, the Kruskal-Wallis test was performed to analyze the effect of the groups (General dentists, Orthodontists and Laypersons) on the questionnaire answers (α = 0.05). Once a statistically significant difference was found, it was preceded by a pairwise multiple comparison test with Bonferroni correction (α = 0.016) to verify between which group the significant statistical result was found. When analyzing the effect of age only between Orthodontists, the sample showed a normal distribution. So, the one-way ANOVA test was performed with Tukey Post hoc test to analyze the difference between the groups of age (α = 0.05). RESULTS There were 296 total survey responses. One respondent declined consent, one did not meet inclusion criteria, and 81 surveys were incomplete. These 83 responses were excluded, resulting in 213 responses included in the analysis. Participant demographics are summarized in Table 1 . Group differences in median attractiveness scores across occupation types are summarized in Table 2 . Questions 3 (0 mm, average thickness) and 8 (0 mm, average lip projection) demonstrated statistically significant differences between groups (p < 0.05). Pairwise comparisons identifying specific group differences are shown in Table 3 . Age-related differences among orthodontists are presented in Table 4 . For question 1 (− 2 mm, thin), the youngest orthodontist group (25–34 years old) reported the lowest mean attractiveness scores, which were significantly lower than those of the 55–64-year-old group (p = 0.004). Similarly, for question 3 (0 mm, average thickness), younger orthodontists rated attractiveness significantly lower than the three oldest age groups (p = 0.004). For question 9 (+ 1 mm, slightly protrusive), all age groups rated the profile favorably; however, 55–64-year-old orthodontists assigned significantly higher scores than the youngest group (p = 0.008). Table 1 Frequencies and percentages of included responses. What is your occupation? Frequency Percent Orthodontists 72 33.8 General dentists 74 34.7 Laypersons 67 31.5 Total 213 100.0 What is the highest level of education you have completed? Some high school or less 1 0.5 High school diploma or GED 6 2.8 Some college, but no degree 4 1.9 Associates or technical degree 1 0.5 Bachelor’s degree 23 10.8 Graduate or professional degree (MA, MS, MBA, PhD, JD, MD, DDS, etc.) 177 83.1 Prefer not to say 1 0.5 Total 213 100.0 How old are you? 18–24 years old 3 1.4 25–34 years old 98 46.0 35–44 years old 43 20.2 45–54 years old 21 9.9 55–64 years old 28 13.1 65 + years old 20 9.4 Total 213 100.0 Please select the race or ethnicity that best describes you. White/Non-Hispanic 151 70.9 Black or African American 8 3.8 Hispanic 8 3.8 American Indian/Native American or Alaska Native 1 0.5 Asian 25 11.7 Middle Eastern 13 6.1 Native Hawaiian or Other Pacific Islander 0 0.0 Other 3 1.4 Prefer not to say 4 1.9 Total 213 100.0 Table 2 Descriptive statistics for the difference between groups (VAS) on the questionnaire. Groups Questions (Median ± Interquartile Range) Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Orthodontists 40 ± 31 50 ± 38 70 ± 29 80.5 ± 20 78 ± 26 49.5 ± 30 60 ± 31 72 ± 32 72.5 ± 24 54 ± 33 General dentists 30 ± 29 40 ± 26 50.5 ± 31 75 ± 26 76 ± 24 31.5 ± 33 44.5 ± 33 60 ± 25 71 ± 25 66 ± 27 Laypersons 33 ± 41 43 ± 44 60 ± 35 73 ± 34 70 ± 31 41 ± 40 48 ± 35 64 ± 28 73 ± 18 73 ± 22 P-value 0.152 0.079 0.002* 0.025* 0.312 0.007* 0.002* 0.003* 0.275 0.002* * Indicates statistical significance between the groups verified by the Kruskal-Wallis test (α = 0.05) Table 3 Post hoc test pairwise multiple comparisons between the groups for the questions with statistical difference. Multiple comparisons Sig. Q3 General dentists Laypersons 0.258 General dentists Orthodontists < 0.001* Laypersons Orthodontists 0.027 Q4 General dentists Laypersons 0.590 General dentists Orthodontists 0.039 Laypersons Orthodontists 0.011* Q6 General dentists Laypersons 0.102 General dentists Orthodontists 0.002* Laypersons Orthodontists 0.144 Q7 General dentists Laypersons 0.299 General dentists Orthodontists < 0.001* Laypersons Orthodontists 0.016 Q8 General dentists Laypersons 0.388 General dentists Orthodontists < 0.001* Laypersons Orthodontists 0.018 Q10 General dentists Laypersons 0.087 General dentists Orthodontists 0.062 Laypersons Orthodontists < 0.001* * Indicates statistical significance between the groups. The Bonferroni correction was applied (α = 0.016) Table 4 Descriptive statistics for the difference between the age groups in the Orthodontists group (VAS). Questions (Mean ± Standard Deviation) Age Q1 Q2 Q3 Q4 Q5 25–34 years old 24.92 ± 14.305 a 25.33 ± 13.446 a 48.83 ± 23.354 a 70.50 ± 18.725 a 68.50 ± 16.284 a 35–44 years old 33.89 ± 16.528 ab 44.78 ± 19.228 ab 62.28 ± 17.603 ab 76.06 ± 13.414 a 77.94 ± 15.660 a 45–54 years old 45.54 ± 24.562 ab 53.08 ± 23.041 b 72.38 ± 19.290 b 82.85 ± 12.144 a 69.00 ± 19.434 a 55–64 years old 52.00 ± 20.214 b 61.22 ± 20.812 b 72.22 ± 13.273 b 78.06 ± 17.966 a 75.67 ± 18.705 a 65 + years old 39.55 ± 21.030 ab 54.36 ± 16.008 b 69.91 ± 13.509 b 85.18 ± 11.965 a 73.45 ± 18.013 a P-value 0.004* < 0.001* 0.004* 0.154 0.525 * Indicates statistical significance between the groups verified by the one-way ANOVA (α = 0.05) Different letters indicate statistically significant differences among groups (one-way ANOVA/Tukey test) (p < 0.05) Table 4 (Cont.). Descriptive statistics for the difference between the age groups in the Orthodontists group (VAS). Questions (Mean ± Standard Deviation) Q6 Q7 Q8 Q9 Q10 30.33 ± 14.164 a 42.50 ± 21.365 a 58.33 ± 19.956 a 60.50 ± 16.801 a 54.17 ± 22.376 ab 43.28 ± 20.858 ab 53.67 ± 23.349 a 65.06 ± 18.841 a 77.56 ± 13.343 ab 63.28 ± 20.213 b 43.62 ± 23.454 a 58.00 ± 22.520 a 74.69 ± 13.512 a 74.31 ± 22.585 ab 50.15 ± 22.678 ab 57.78 ± 15.090 b 63.83 ± 14.026 a 72.61 ± 16.375 a 80.06 ± 14.707 b 61.89 ± 14.418 ab 57.36 ± 25.905 b 60.82 ± 21.752 a 77.00 ± 19.401 a 63.73 ± 14.698 ab 40.64 ± 23.863 a 0.003* 0.081 0.059 0.008* 0.033* * Indicates statistical significance between the groups verified by the one-way ANOVA (α = 0.05) Different letters indicate statistically significant differences among groups (one-way ANOVA/Tukey test) (p < 0.05) As illustrated in Fig. 2 , median attractiveness scores generally increased with greater lip thickness. A similar pattern was observed for lip projection, although orthodontists demonstrated a more bell-shaped response curve. Orthodontists most frequently preferred slightly thick and slightly protrusive lip profiles, general dentists favored thick and slightly protrusive profiles, and laypersons preferred slightly thick and protrusive profiles. Across all groups, thin lips and retrusive profiles consistently received the lowest attractiveness ratings. Overall, younger orthodontists tended to provide lower attractiveness scores than older age groups. For thin lips (Q1) and average lip thickness (Q3), younger orthodontists rated attractiveness significantly lower than older cohorts (p = 0.004). No significant age-related differences were observed for slightly thick or thick lips (Q4 and Q5). For protrusive lips (Q10), orthodontists aged 65 years and older assigned significantly lower scores compared to the 35–44-year-old group (p = 0.033). DISCUSSION The importance of this study is centered on the ongoing evolution of facial esthetics. We are currently in an era of anti-aging treatments and facial harmonization, where elective procedures are increasingly performed to modify facial features for enhanced esthetics. Botox and dermal fillers exemplify this trend and have gained popularity within the dental field. The primary objective of this study was to evaluate whether orthodontists, general dentists, and laypersons share a consensus regarding ideal lip size and proportions. A secondary objective was to explore whether current orthodontic standards remain appropriate or if more individualized guidelines should be considered during treatment planning. To assess whether the Ricketts’ esthetic analysis continues to represent an ideal standard, particular attention was given to images depicting average or traditionally “ideal” lip thickness and projection. Questions 3 and 8, designed to capture these values, demonstrated statistically significant differences in median attractiveness scores among occupational groups. This finding indicates a lack of agreement regarding ideal lip thickness and E-line positioning. Notably, disagreement was observed between orthodontists and general dentists for both the average lip thickness image and the ideal Ricketts’ esthetic position, highlighting differences in professional training and esthetic standardization within dentistry. Across most questions, younger orthodontists (25–34 years old) tended to provide lower attractiveness scores than older age groups, particularly for thin, slightly thin, and retrusive lip profiles. These lip characteristics received the lowest scores in the study, suggesting a strong aversion to thin lips among younger orthodontists. This trend may reflect greater exposure to contemporary esthetic influences, including social media and current beauty standards that favor fuller lips. For average lip thickness, statistically significant differences were observed between the youngest orthodontists and older age groups, reinforcing that even within the orthodontic profession, a universal esthetic standard does not exist. These findings support the need to reassess traditional orthodontic norms, which may no longer reflect contemporary perceptions of facial esthetics. The results support the primary hypothesis that perceptions of ideal lip attractiveness differ among orthodontists, general dentists, and laypersons. However, the secondary hypothesis—that younger individuals across all occupational groups prefer fuller and more protrusive lips—was not fully supported. While age-related differences were evident among orthodontists, it remains unclear whether similar trends exist among general dentists or laypersons. Potential sources of bias include the possibility that respondents considered other facial features, such as the nose or chin, when evaluating lip attractiveness. This is inherent to lip analyses, including the Ricketts’ esthetic line, which relates lip position to adjacent facial structures, despite instructions directing participants to focus solely on the lips. Several limitations should be acknowledged. These include a relatively small sample size, uneven demographic distribution, English-only survey administration, and the lack of gender-based demographic data. Additionally, the majority of respondents identified as White, Non-Hispanic, limiting generalizability. Another limitation is the use of a single subject for image evaluation, which may have influenced esthetic judgments. Although this approach aligned with the study’s aim of evaluating traditional Caucasian-based lip standards, future studies should include multiple subjects of diverse backgrounds and larger sample sizes to improve generalizability. Future research may focus on refining or redefining orthodontic lip standards based on contemporary esthetic preferences. Incorporating images of patients who have undergone esthetic enhancements, such as lip filler, may further improve understanding of current patient-driven esthetic demands. CONCLUSION Given the lack of mutual agreement among orthodontists, general dentists, and laypersons regarding the current accepted norms for lip and profile esthetics, it is important to establish new educational standards that are based on evidence-based research. The study's findings suggest that orthodontic treatment should prioritize avoiding retrusive or thin lips to achieve more esthetically pleasing outcomes for patients. Thus, orthodontists should consider accepting a slightly thick or protrusive lip profile, which is often more well-received by patients. Declarations This research received no external funding. Author Contribution Garret, K, contributed to conception, design, data acquisition, analysis and interpretation, drafted and critically revised the manuscript; Copello, F, contributed to conception, design data analysis and interpretation, drafted and critically revised the manuscript; Samee, A and Dwivedi, J contributed to the literature review and manuscript revision. References Proffit WR. Contemporary Orthodontics - E-Book: Contemporary Orthodontics - E-Book . 6th ed. Mosby; 2018. Ricketts RM. Esthetics, environment, and the law of lip relation. Am J Orthod . 1968;54(4):272-289. doi:10.1016/S0002-9416(68)90278-9 Premkumar S. Textbook of Craniofacial Growth . 1. ed. Jaypee Brothers Med. Publ; 2011. Merrifield LL. The profile line as an aid in critically evaluating facial esthetics. 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Influence of upper lip curvature on smile attractiveness in patients with different degrees of gingival smiles: A cross-sectional study with opinions from oral health providers and laypersons. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod . 2021;159(4):e321-e329. doi:10.1016/j.ajodo.2020.10.022 Krishnan V, Daniel ST, Lazar D, Asok A. Characterization of posed smile by using visual analog scale, smile arc, buccal corridor measures, and modified smile index. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod . 2008;133(4):515-523. doi:10.1016/j.ajodo.2006.04.046 Parekh SM, Fields HW, Beck M, Rosenstiel S. Attractiveness of variations in the smile arc and buccal corridor space as judged by orthodontists and laymen. Angle Orthod . 2006;76(4):557-563. doi:10.1043/0003-3219(2006)076[0557:AOVITS]2.0.CO;2 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 Jan, 2026 Editor assigned by journal 24 Jan, 2026 Submission checks completed at journal 24 Jan, 2026 First submitted to journal 23 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8681202","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":580112896,"identity":"6f807d12-155d-477a-b7d1-5d108d038392","order_by":0,"name":"Katie Mccormack","email":"","orcid":"","institution":"University of Maryland, Baltimore","correspondingAuthor":false,"prefix":"","firstName":"Katie","middleName":"","lastName":"Mccormack","suffix":""},{"id":580112897,"identity":"5c32ee55-af67-415f-b9c4-dc16f9da7bd5","order_by":1,"name":"Juhi Dwivedi","email":"","orcid":"","institution":"University of Maryland, Baltimore","correspondingAuthor":false,"prefix":"","firstName":"Juhi","middleName":"","lastName":"Dwivedi","suffix":""},{"id":580112898,"identity":"6138af5b-f33c-493a-b724-4a6849cafd66","order_by":2,"name":"Anika Samee","email":"","orcid":"","institution":"University of Maryland, Baltimore","correspondingAuthor":false,"prefix":"","firstName":"Anika","middleName":"","lastName":"Samee","suffix":""},{"id":580112899,"identity":"424c65b4-9ed9-4735-b5b1-b1c2d5cf349d","order_by":3,"name":"Flavio Copello","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYBAC9gYQWWDBwA/hWwBxAgMDDx4tPAdApIEEgyRYL4MECVoMDhCthf3wsQcfDCTkjG9kJ36ubJOQN2dPYHzwtg2PFp60dMMZBhLGZjdyN0uebZMw3NnzgNlwLh4t9hI8ZtI8BhKJ227kbpBsbJNg3HAjgU2aF58tIC1/gFo2z8jd/BOoxR6ohf03QS1A7ydukMjdBrIlEWQLM14tIL/0AP0icebtNsuGcxLJG848bJaccw6PFlCI/aiwkeNvz918s6HMxnbD8eSDH96U4dYCBGwIJiOYzdiAVz2qFoY/hBSPglEwCkbBSAQAi69OMm2MED4AAAAASUVORK5CYII=","orcid":"","institution":"University of Maryland, Baltimore","correspondingAuthor":true,"prefix":"","firstName":"Flavio","middleName":"","lastName":"Copello","suffix":""}],"badges":[],"createdAt":"2026-01-23 16:38:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8681202/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8681202/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101872783,"identity":"9a3badab-dcbc-46f5-8a63-11209318b92c","added_by":"auto","created_at":"2026-02-04 13:41:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":495881,"visible":true,"origin":"","legend":"\u003cp\u003eShowing a series of 10 images that were adjusted in lip thickness and projection. Images were adjusted in ±1mm increments from average.\u003c/p\u003e","description":"","filename":"Picture1.png","url":"https://assets-eu.researchsquare.com/files/rs-8681202/v1/a83cbc53aba8e79cc9444581.png"},{"id":101872886,"identity":"df83238b-b0e8-4288-b7ae-d31e1493ddaf","added_by":"auto","created_at":"2026-02-04 13:42:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":122878,"visible":true,"origin":"","legend":"\u003cp\u003eMedian attractiveness scores (VAS) for degrees of lip thickness and projection across occupation types.\u003c/p\u003e","description":"","filename":"Picture2.png","url":"https://assets-eu.researchsquare.com/files/rs-8681202/v1/c49df1b8c8e3a5b56210214f.png"},{"id":101872920,"identity":"55dcf38b-3641-4680-b1a0-7a28655f70f9","added_by":"auto","created_at":"2026-02-04 13:42:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1391752,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8681202/v1/4da2d101-9f0e-43e5-84a0-f4223d94d4de.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Rethinking Lip Aesthetics: Do Orthodontists, Dentists, and Laypersons Agree on Attractiveness?","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDentofacial esthetics is a major consideration in orthodontic treatment planning. Treatment plans must account for the position of the anterior teeth and degree of protrusion, as these factors directly influence lip posture and facial profile esthetics. Orthodontists rely on several cephalometric reference lines and measurements to assess lip position in relation to the face, including the Rickett\u0026rsquo;s esthetic line [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the Steiner line [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], the Merrifield Z-angle [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], the Burstone esthetic line [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and the Holdaway profile [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, lip position in orthodontics is evaluated using standards established decades ago. One study in young Caucasians proposed an ideal upper-to-lower lip height ratio of 1:1.6 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], while another suggested the upper lip should measure 75\u0026ndash;80% of the lower lip height [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Developed primarily in Caucasian populations during the 1950s\u0026ndash;60s, these analyses may not reflect contemporary beauty standards or cultural preferences.\u003c/p\u003e \u003cp\u003eTo address this discrepancy, several studies have examined ethnic and racial variations in esthetic preferences. Among Nigerian orthodontists, trainees, and students, slightly protrusive lips were preferred, and nearly half of respondents rated the \u0026lsquo;normal\u0026rsquo; Ricketts\u0026rsquo; esthetic line as unattractive [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In a Chinese population, retrusive profiles were rated more favorably than by Caucasian judges, with \u0026minus;\u0026thinsp;1 mm behind the E-line considered most esthetic [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In contrast, a study conducted in Salvador found preferences closely aligned with Ricketts\u0026rsquo; original norms, although slightly convex and concave profiles were also accepted [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These findings suggest that esthetic standards vary across populations and may influence extraction decisions and treatment planning.\u003c/p\u003e \u003cp\u003eThe effects of aging on the lips and nose are also important considerations in orthodontic treatment planning [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Lip enhancements and augmentations have gained popularity not only in plastic surgery but also in dentistry, reflecting increased attention to perioral esthetics and age-related changes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As individuals age, lips tend to flatten and lose vermillion display [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], with maximum lip thickness typically reached during adolescence [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Fuller lips are therefore often associated with youth and attractiveness, whereas thin lips may be perceived as indicative of aging or fragility [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Photographic analyses of fashion magazines throughout the twentieth century demonstrate a progressive preference for fuller and more anteriorly positioned lips, a trend observed in both Caucasian and African American female profiles [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. While societal influences shape beauty ideals, esthetic preferences are ultimately multifactorial.\u003c/p\u003e \u003cp\u003eThis study aims to evaluate whether traditional orthodontic lip standards continue to represent current societal preferences for lip esthetics among orthodontists, general dentists, and laypersons.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e The Institutional Review Board (IRB) at the University of Maryland, Baltimore reviewed this study under the application HP-00104133 and approved the referenced protocol as exempt under 45 CFR 46.104(d) from IRB review.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurvey design\u003c/h2\u003e \u003cp\u003eThis study was modeled partly from previous surveys on lip and profile esthetics [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The first block of the survey included demographic questions (ex. occupation, education level, age, race or ethnicity, and US zip code). Inclusion criteria consisted of adults (over 18 years of age) that identify as orthodontists, general dentists, or laypersons (defined as any occupation not in the dental field). The survey was only offered in the English language. The second and third blocks of the survey consisted of a randomized order of facial photographs of varying lip proportions and asked survey participants to evaluate for perceived lip attractiveness. Individuals were asked to rate their opinions on Visual Analog Scale (VAS) from not attractive (0) to very attractive (100). The VAS is a validated system to rate survey photographs and this method was modeled after its use in previous studies on lip and smile esthetics [4,3,20\u0026ndash;22].\u003c/p\u003e \u003cp\u003eFrontal and side profile photographs were identified of a patient with close to ideal proportions, based on current orthodontic standards. Adobe Photoshop desktop (version 23.5, Adobe Inc., USA) was used for the digital enhancement and alteration of photographs for this study to produce lips with varying proportions. The frontal photograph was mirrored horizontally, to account for any facial asymmetry. The images were scaled based on clinically observed anatomic measurements. Care was taken to ensure only the size of the lips were being altered.\u003c/p\u003e \u003cp\u003eFor the side profile images, 0 mm represents ideal Ricketts\u0026rsquo; E-line measurements (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Both the upper and lower lips were retracted to \u0026minus;\u0026thinsp;1 mm and \u0026minus;\u0026thinsp;2 mm of the ideal Ricketts\u0026rsquo; E-line for the retrusive images and advanced\u0026thinsp;+\u0026thinsp;1 mm and +\u0026thinsp;2 mm for the protrusive images. For the frontal facial images, 0 mm indicates the average lip height. Both the upper and lower lip heights were decreased\u0026thinsp;\u0026minus;\u0026thinsp;1 mm and \u0026minus;\u0026thinsp;2 mm for the thin images and increased\u0026thinsp;+\u0026thinsp;1 and +\u0026thinsp;2 mm for the thick images. Blurring around the lips was utilized to make it difficult to decipher which images had been altered.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurvey distribution and data collection\u003c/h3\u003e\n\u003cp\u003eA preview study was sent to the IRB committee at the University of Maryland, who subsequently approved the application. The study was critiqued by several members of the University of Maryland orthodontic clinic, including faculty and residents, who were asked to provide feedback. An independent review on the Qualtrics software was performed and the survey was evaluated by an internal \u0026lsquo;Expert Review\u0026rsquo;, which determined a survey strength of \u0026lsquo;great\u0026rsquo; and 0 recommendations given for adjustment.\u003c/p\u003e \u003cp\u003eThe 16-question survey was administered through the Qualtrics survey platform, approved by the University of Maryland, Baltimore, Institute for Clinical \u0026amp; Translational Research. The survey link was distributed to orthodontic program directors across the U.S., through online orthodontic forums, to clinical directors in the departments of general dentistry at University of Maryland, through dental online forums and Facebook groups, and via iPad to patients at the University of Maryland.\u003c/p\u003e\n\u003ch3\u003eSample size calculation\u003c/h3\u003e\n\u003cp\u003eThe sample size calculation was performed based on a previous study [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] using the PANDIS formula using the following parameters: the power of the test was 80% (β\u0026thinsp;=\u0026thinsp;0.20), the error was 5% (α\u0026thinsp;=\u0026thinsp;0.05), the relevant clinical difference adopted was 12 points in the mean VAS score and the standard deviation was 24.49 (VAS). A minimum sample size of 65 subjects per group was determined. For all analyses, the level of significance was 5%. The normality of the sample was verified by the Shapiro-Wilk test. The ANOVA one-way test was performed for samples with normal distribution and the Kruskal-Wallis test was used for non-parametric distributions.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe statistical analysis was performed using SPSS (Version 23.0, SPSS Inc., USA). The normality of the sample was verified by the Kolmogorov-Smirnov test (α\u0026thinsp;=\u0026thinsp;0.05). When the occupation was used as the main factor to analyze each question, the sample did not show a normal distribution. Therefore, the Kruskal-Wallis test was performed to analyze the effect of the groups (General dentists, Orthodontists and Laypersons) on the questionnaire answers (α\u0026thinsp;=\u0026thinsp;0.05). Once a statistically significant difference was found, it was preceded by a pairwise multiple comparison test with Bonferroni correction (α\u0026thinsp;=\u0026thinsp;0.016) to verify between which group the significant statistical result was found. When analyzing the effect of age only between Orthodontists, the sample showed a normal distribution. So, the one-way ANOVA test was performed with Tukey Post hoc test to analyze the difference between the groups of age (α\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThere were 296 total survey responses. One respondent declined consent, one did not meet inclusion criteria, and 81 surveys were incomplete. These 83 responses were excluded, resulting in 213 responses included in the analysis. Participant demographics are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eGroup differences in median attractiveness scores across occupation types are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Questions 3 (0 mm, average thickness) and 8 (0 mm, average lip projection) demonstrated statistically significant differences between groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Pairwise comparisons identifying specific group differences are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAge-related differences among orthodontists are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e. For question 1 (\u0026minus;\u0026thinsp;2 mm, thin), the youngest orthodontist group (25\u0026ndash;34 years old) reported the lowest mean attractiveness scores, which were significantly lower than those of the 55\u0026ndash;64-year-old group (p\u0026thinsp;=\u0026thinsp;0.004). Similarly, for question 3 (0 mm, average thickness), younger orthodontists rated attractiveness significantly lower than the three oldest age groups (p\u0026thinsp;=\u0026thinsp;0.004). For question 9 (+\u0026thinsp;1 mm, slightly protrusive), all age groups rated the profile favorably; however, 55\u0026ndash;64-year-old orthodontists assigned significantly higher scores than the youngest group (p\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequencies and percentages of included responses.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat is your occupation?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the highest level of education you have completed?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSome high school or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school diploma or GED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSome college, but no degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociates or technical degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate or professional degree (MA, MS, MBA, PhD, JD, MD, DDS, etc.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow old are you?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;24 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;54 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e55\u0026ndash;64 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026thinsp;+\u0026thinsp;years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlease select the race or ethnicity that best describes you.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite/Non-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack or African American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmerican Indian/Native American or Alaska Native\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle Eastern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative Hawaiian or Other Pacific Islander\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrefer not to say\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics for the difference between groups (VAS) on the questionnaire.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c11\" namest=\"c3\"\u003e \u003cp\u003eQuestions (Median \u0026plusmn; Interquartile Range)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQ5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eQ6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eQ7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eQ9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eQ10\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrthodontists\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 \u0026plusmn; 31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 \u0026plusmn; 38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70 \u0026plusmn; 29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80.5 \u0026plusmn; 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78 \u0026plusmn; 26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49.5 \u0026plusmn; 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60 \u0026plusmn; 31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e72 \u0026plusmn; 32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e72.5 \u0026plusmn; 24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e54 \u0026plusmn; 33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeneral dentists\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 \u0026plusmn; 29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 \u0026plusmn; 26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.5 \u0026plusmn; 31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75 \u0026plusmn; 26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76 \u0026plusmn; 24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31.5 \u0026plusmn; 33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44.5 \u0026plusmn; 33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e60 \u0026plusmn; 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e71 \u0026plusmn; 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e66 \u0026plusmn; 27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaypersons\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 \u0026plusmn; 41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 \u0026plusmn; 44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 \u0026plusmn; 35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73 \u0026plusmn; 34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70 \u0026plusmn; 31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41 \u0026plusmn; 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e48 \u0026plusmn; 35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e64 \u0026plusmn; 28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e73 \u0026plusmn; 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e73 \u0026plusmn; 22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.025*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.007*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e* Indicates statistical significance between the groups verified by the Kruskal-Wallis test (α\u0026thinsp;=\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePost hoc test pairwise multiple comparisons between the groups for the questions with statistical difference.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMultiple comparisons\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eQ3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eQ4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.590\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.011*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eQ6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eQ7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eQ8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eQ10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaypersons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOrthodontists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* Indicates statistical significance between the groups. The Bonferroni correction was applied (α\u0026thinsp;=\u0026thinsp;0.016)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics for the difference between the age groups in the Orthodontists group (VAS).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eQuestions (Mean \u0026plusmn; Standard Deviation)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQ5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e25\u0026ndash;34 years old\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.92 \u0026plusmn; 14.305\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.33 \u0026plusmn; 13.446 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.83 \u0026plusmn; 23.354 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70.50 \u0026plusmn; 18.725 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.50 \u0026plusmn; 16.284 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e35\u0026ndash;44 years old\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.89 \u0026plusmn; 16.528 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.78 \u0026plusmn; 19.228 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.28 \u0026plusmn; 17.603 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.06 \u0026plusmn; 13.414 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77.94 \u0026plusmn; 15.660 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e45\u0026ndash;54 years old\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.54 \u0026plusmn; 24.562 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.08 \u0026plusmn; 23.041 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.38 \u0026plusmn; 19.290 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82.85 \u0026plusmn; 12.144 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69.00 \u0026plusmn; 19.434 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e55\u0026ndash;64 years old\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.00 \u0026plusmn; 20.214 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.22 \u0026plusmn; 20.812 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.22 \u0026plusmn; 13.273 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.06 \u0026plusmn; 17.966 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75.67 \u0026plusmn; 18.705 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e65\u0026thinsp;+\u0026thinsp;years old\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.55 \u0026plusmn; 21.030 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.36 \u0026plusmn; 16.008 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.91 \u0026plusmn; 13.509 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.18 \u0026plusmn; 11.965 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73.45 \u0026plusmn; 18.013 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.004*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Indicates statistical significance between the groups verified by the one-way ANOVA (α\u0026thinsp;=\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDifferent letters indicate statistically significant differences among groups (one-way ANOVA/Tukey test) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e(Cont.). Descriptive statistics for the difference between the age groups in the Orthodontists group (VAS).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eQuestions (Mean \u0026plusmn; Standard Deviation)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQ8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQ9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ10\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30.33 \u0026plusmn; 14.164 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.50 \u0026plusmn; 21.365 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.33 \u0026plusmn; 19.956 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.50 \u0026plusmn; 16.801 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54.17 \u0026plusmn; 22.376 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e43.28 \u0026plusmn; 20.858 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.67 \u0026plusmn; 23.349 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.06 \u0026plusmn; 18.841 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.56 \u0026plusmn; 13.343 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.28 \u0026plusmn; 20.213 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e43.62 \u0026plusmn; 23.454 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.00 \u0026plusmn; 22.520 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.69 \u0026plusmn; 13.512 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.31 \u0026plusmn; 22.585 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.15 \u0026plusmn; 22.678 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e57.78 \u0026plusmn; 15.090 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.83 \u0026plusmn; 14.026 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.61 \u0026plusmn; 16.375 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.06 \u0026plusmn; 14.707 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.89 \u0026plusmn; 14.418 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e57.36 \u0026plusmn; 25.905 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.82 \u0026plusmn; 21.752 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.00 \u0026plusmn; 19.401 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.73 \u0026plusmn; 14.698 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40.64 \u0026plusmn; 23.863 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.003*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.008*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.033*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Indicates statistical significance between the groups verified by the one-way ANOVA (α\u0026thinsp;=\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDifferent letters indicate statistically significant differences among groups (one-way ANOVA/Tukey test) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003cp\u003eAs illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, median attractiveness scores generally increased with greater lip thickness. A similar pattern was observed for lip projection, although orthodontists demonstrated a more bell-shaped response curve. Orthodontists most frequently preferred slightly thick and slightly protrusive lip profiles, general dentists favored thick and slightly protrusive profiles, and laypersons preferred slightly thick and protrusive profiles. Across all groups, thin lips and retrusive profiles consistently received the lowest attractiveness ratings.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOverall, younger orthodontists tended to provide lower attractiveness scores than older age groups. For thin lips (Q1) and average lip thickness (Q3), younger orthodontists rated attractiveness significantly lower than older cohorts (p\u0026thinsp;=\u0026thinsp;0.004). No significant age-related differences were observed for slightly thick or thick lips (Q4 and Q5). For protrusive lips (Q10), orthodontists aged 65 years and older assigned significantly lower scores compared to the 35\u0026ndash;44-year-old group (p\u0026thinsp;=\u0026thinsp;0.033).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe importance of this study is centered on the ongoing evolution of facial esthetics. We are currently in an era of anti-aging treatments and facial harmonization, where elective procedures are increasingly performed to modify facial features for enhanced esthetics. Botox and dermal fillers exemplify this trend and have gained popularity within the dental field. The primary objective of this study was to evaluate whether orthodontists, general dentists, and laypersons share a consensus regarding ideal lip size and proportions. A secondary objective was to explore whether current orthodontic standards remain appropriate or if more individualized guidelines should be considered during treatment planning.\u003c/p\u003e \u003cp\u003eTo assess whether the Ricketts\u0026rsquo; esthetic analysis continues to represent an ideal standard, particular attention was given to images depicting average or traditionally \u0026ldquo;ideal\u0026rdquo; lip thickness and projection. Questions 3 and 8, designed to capture these values, demonstrated statistically significant differences in median attractiveness scores among occupational groups. This finding indicates a lack of agreement regarding ideal lip thickness and E-line positioning. Notably, disagreement was observed between orthodontists and general dentists for both the average lip thickness image and the ideal Ricketts\u0026rsquo; esthetic position, highlighting differences in professional training and esthetic standardization within dentistry.\u003c/p\u003e \u003cp\u003eAcross most questions, younger orthodontists (25\u0026ndash;34 years old) tended to provide lower attractiveness scores than older age groups, particularly for thin, slightly thin, and retrusive lip profiles. These lip characteristics received the lowest scores in the study, suggesting a strong aversion to thin lips among younger orthodontists. This trend may reflect greater exposure to contemporary esthetic influences, including social media and current beauty standards that favor fuller lips. For average lip thickness, statistically significant differences were observed between the youngest orthodontists and older age groups, reinforcing that even within the orthodontic profession, a universal esthetic standard does not exist. These findings support the need to reassess traditional orthodontic norms, which may no longer reflect contemporary perceptions of facial esthetics.\u003c/p\u003e \u003cp\u003eThe results support the primary hypothesis that perceptions of ideal lip attractiveness differ among orthodontists, general dentists, and laypersons. However, the secondary hypothesis\u0026mdash;that younger individuals across all occupational groups prefer fuller and more protrusive lips\u0026mdash;was not fully supported. While age-related differences were evident among orthodontists, it remains unclear whether similar trends exist among general dentists or laypersons.\u003c/p\u003e \u003cp\u003ePotential sources of bias include the possibility that respondents considered other facial features, such as the nose or chin, when evaluating lip attractiveness. This is inherent to lip analyses, including the Ricketts\u0026rsquo; esthetic line, which relates lip position to adjacent facial structures, despite instructions directing participants to focus solely on the lips.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. These include a relatively small sample size, uneven demographic distribution, English-only survey administration, and the lack of gender-based demographic data. Additionally, the majority of respondents identified as White, Non-Hispanic, limiting generalizability. Another limitation is the use of a single subject for image evaluation, which may have influenced esthetic judgments. Although this approach aligned with the study\u0026rsquo;s aim of evaluating traditional Caucasian-based lip standards, future studies should include multiple subjects of diverse backgrounds and larger sample sizes to improve generalizability.\u003c/p\u003e \u003cp\u003eFuture research may focus on refining or redefining orthodontic lip standards based on contemporary esthetic preferences. Incorporating images of patients who have undergone esthetic enhancements, such as lip filler, may further improve understanding of current patient-driven esthetic demands.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eGiven the lack of mutual agreement among orthodontists, general dentists, and laypersons regarding the current accepted norms for lip and profile esthetics, it is important to establish new educational standards that are based on evidence-based research.\u003c/p\u003e \u003cp\u003eThe study's findings suggest that orthodontic treatment should prioritize avoiding retrusive or thin lips to achieve more esthetically pleasing outcomes for patients. Thus, orthodontists should consider accepting a slightly thick or protrusive lip profile, which is often more well-received by patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThis research received no external funding. \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eGarret, K, contributed to conception, design, data acquisition, analysis and interpretation, drafted and critically revised the manuscript; Copello, F, contributed to conception, design data analysis and interpretation, drafted and critically revised the manuscript; Samee, A and Dwivedi, J contributed to the literature review and manuscript revision.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eProffit WR. \u003cem\u003eContemporary Orthodontics - E-Book: Contemporary Orthodontics - E-Book\u003c/em\u003e. 6th ed. Mosby; 2018.\u003c/li\u003e\n \u003cli\u003eRicketts RM. Esthetics, environment, and the law of lip relation. \u003cem\u003eAm J Orthod\u003c/em\u003e. 1968;54(4):272-289. doi:10.1016/S0002-9416(68)90278-9\u003c/li\u003e\n \u003cli\u003ePremkumar S. \u003cem\u003eTextbook of Craniofacial Growth\u003c/em\u003e. 1. ed. Jaypee Brothers Med. Publ; 2011.\u003c/li\u003e\n \u003cli\u003eMerrifield LL. The profile line as an aid in critically evaluating facial esthetics. \u003cem\u003eAm J Orthod\u003c/em\u003e. 1966;52(11):804-822. doi:10.1016/0002-9416(66)90250-8\u003c/li\u003e\n \u003cli\u003eBurstone CJ. Lip posture and its significance in treatment planning. \u003cem\u003eAm J Orthod\u003c/em\u003e. 1967;53(4):262-284. doi:10.1016/0002-9416(67)90022-x\u003c/li\u003e\n \u003cli\u003eHoldaway RA. A soft-tissue cephalometric analysis and its use in orthodontic treatment planning. Part I. \u003cem\u003eAm J Orthod\u003c/em\u003e. 1983;84(1):1-28. doi:10.1016/0002-9416(83)90144-6\u003c/li\u003e\n \u003cli\u003eKar M, Muluk NB, Bafaqeeh SA, Cingi C. 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Comparison of White and Chinese perception of esthetic Chinese lip position. \u003cem\u003eAngle Orthod\u003c/em\u003e. 2014;84(2):246-253. doi:10.2319/031213-212.1\u003c/li\u003e\n \u003cli\u003eCarneiro EN, Pithon MM, Machado AW, Braga E. Perception of facial profile attractiveness of a brown subject displaying different degrees of lip projection or retrusion, in the city of Salvador/Bahia. \u003cem\u003eDent Press J Orthod\u003c/em\u003e. 2018;23(2):62-67. doi:10.1590/2177-6709.23.2.062-067.oar\u003c/li\u003e\n \u003cli\u003eSarver DM. \u003cem\u003eEsthetic Orthodontics and Orthognathic Surgery\u003c/em\u003e. Mosby; 1998.\u003c/li\u003e\n \u003cli\u003ePerenack J. Treatment Options to Optimize Display of Anterior Dental Esthetics in the Patient With the Aged Lip. \u003cem\u003eJ Oral Maxillofac Surg\u003c/em\u003e. 2005;63(11):1634-1641. doi:10.1016/j.joms.2005.05.160\u003c/li\u003e\n \u003cli\u003eMamandras AH. Linear changes of the maxillary and mandibular lips. \u003cem\u003eAm J Orthod Dentofacial Orthop\u003c/em\u003e. 1988;94(5):405-410. doi:10.1016/0889-5406(88)90129-1\u003c/li\u003e\n \u003cli\u003eNanda RS, Meng H, Kapila S, Goorhuis J. Growth changes in the soft tissue facial profile. \u003cem\u003eAngle Orthod\u003c/em\u003e. 1990;60(3):177-190. doi:10.1043/0003-3219(1990)060\u0026lt;0177:GCITST\u0026gt;2.0.CO;2\u003c/li\u003e\n \u003cli\u003eMaloney B. Cosmetic Surgery of the Lips. \u003cem\u003eFacial Plast Surg\u003c/em\u003e. 1996;12(03):265-278. doi:10.1055/s-0028-1082417\u003c/li\u003e\n \u003cli\u003eAuger TA, Turley PK. The female soft tissue profile as presented in fashion magazines during the 1900s: a photographic analysis. \u003cem\u003eInt J Adult Orthodon Orthognath Surg\u003c/em\u003e. 1999;14(1):7-18.\u003c/li\u003e\n \u003cli\u003eYehezkel S, Turley PK. Changes in the African American female profile as depicted in fashion magazines during the 20th century. \u003cem\u003eAm J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod\u003c/em\u003e. 2004;125(4):407-417. doi:10.1016/j.ajodo.2003.05.007\u003c/li\u003e\n \u003cli\u003eMahmood HT, Ahmed I, Erum G e, Pervez H. Evaluation of lip esthetics by changing the vermillion height as perceived by orthodontists, orthodontic residents and patients.\u0026nbsp;\u003cem\u003eJ Pak Dent Assoc\u003c/em\u003e. 2015;24(3):140-144.\u003c/li\u003e\n \u003cli\u003eValverde-Montalva SH, Flores-Mir C, Rinchuse D, Arriola-Guill\u0026eacute;n LE. Influence of upper lip curvature on smile attractiveness in patients with different degrees of gingival smiles: A cross-sectional study with opinions from oral health providers and laypersons. \u003cem\u003eAm J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod\u003c/em\u003e. 2021;159(4):e321-e329. doi:10.1016/j.ajodo.2020.10.022\u003c/li\u003e\n \u003cli\u003eKrishnan V, Daniel ST, Lazar D, Asok A. Characterization of posed smile by using visual analog scale, smile arc, buccal corridor measures, and modified smile index. \u003cem\u003eAm J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board Orthod\u003c/em\u003e. 2008;133(4):515-523. doi:10.1016/j.ajodo.2006.04.046\u003c/li\u003e\n \u003cli\u003eParekh SM, Fields HW, Beck M, Rosenstiel S. Attractiveness of variations in the smile arc and buccal corridor space as judged by orthodontists and laymen. \u003cem\u003eAngle Orthod\u003c/em\u003e. 2006;76(4):557-563. doi:10.1043/0003-3219(2006)076[0557:AOVITS]2.0.CO;2\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orofacial-orthopedics-fortschritte-der-kieferorthopadie","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie](https://link.springer.com/journal/56)","snPcode":"56","submissionUrl":"https://submission.springernature.com/new-submission/56/3","title":"Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8681202/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8681202/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003eWe aim to investigate the proposed standards of ideal lip proportions and compare those standards to what different people view as most attractive.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA 16-question survey was distributed via Qualtrics to orthodontists, general dentists, and laypersons asking demographics as well as opinion-based questions regarding a series of facial photographs. Photographs were digitally altered using Adobe Photoshop to produce different dimensions of the lips from both profile and frontal views. Participants were asked to rate the perceived attractiveness of the lips shown. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eRegardless of occupation, individuals preferred the appearance of slightly protrusive or thicker lips. Retrusive and thin lip varieties had the lowest median attractiveness scores. Average values for lip projection and thickness were not found to be mutually agreed upon across occupation types (p\u0026lt;0.05) and average lip thickness was not mutually agreed upon between age groups of orthodontists (p=0.004).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eBased on the results of this study, care should be taken not to produce retrusive or thin lips during orthodontic treatment. Acceptance of a slightly thick or protrusive lip profile may be a more esthetic or well-accepted patient outcome.\u003c/p\u003e","manuscriptTitle":"Rethinking Lip Aesthetics: Do Orthodontists, Dentists, and Laypersons Agree on Attractiveness?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-04 13:40:03","doi":"10.21203/rs.3.rs-8681202/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-25T16:28:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-24T07:04:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-24T07:01:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie","date":"2026-01-23T16:13:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orofacial-orthopedics-fortschritte-der-kieferorthopadie","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie](https://link.springer.com/journal/56)","snPcode":"56","submissionUrl":"https://submission.springernature.com/new-submission/56/3","title":"Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"17684c62-6bff-4832-8e93-0722a71e8275","owner":[],"postedDate":"February 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T14:54:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-04 13:40:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8681202","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8681202","identity":"rs-8681202","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}