Malocclusions and perceptions of attractiveness, intelligence, and personality, and behavioral intentions

  • Jase A. Olsen
    Private practice, Southern Pines, NC
    Search for articles by this author
  • Marita Rohr Inglehart
    Reprint requests to: Marita Rohr Inglehart, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078.
    Associate professor, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Mich; adjunct associate professor, Department of Psychology, College of Literature, Science and Arts, University of Michigan, Ann Arbor, Mich
    Search for articles by this author


      In this study, we explored how others perceive persons with normal occlusion or different malocclusions (open bite, deepbite, underbite, overjet, crowding, and spacing). The objectives were to investigate (1) how occlusion affects others’ perceptions of attractiveness, intelligence, and personality, and their desire to interact in personal and professional settings, and (2) whether these assessments are affected by the target person’s sex or the respondent’s characteristics.


      Survey data were collected from 889 patients or accompanying adults (46% male, 54% female; age range, 18-90 years) who evaluated target photos that had been manipulated to display either a normal occlusion or 1 of 6 malocclusions.


      The ratings of attractiveness, intelligence, conscientiousness, agreeableness, and extraversion differed significantly depending on the occlusion status depicted. Persons with normal occlusion were rated as most attractive, intelligent, agreeable, and extraverted, whereas persons with an underbite were rated as least attractive, intelligent, and extraverted. Female targets were rated more positively than male targets. Younger respondents and more educated respondents were more critical in their evaluations than were older and less educated respondents.


      Occlusion status affects a person’s perceptions comprehensively. Subjects with normal occlusion were rated the most positively.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Orthodontics and Dentofacial Orthopedics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Proffit W.R.
        • Fields Jr., H.W.
        • Moray L.J.
        Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey.
        Int J Adult Orthod Orthognath Surg. 1998; 13: 97-106
        • Dye B.A.
        • Tan S.
        • Smith V.
        • Lewis B.G.
        • Barker L.K.
        • Thornton-Evans G.
        • et al.
        Trends in oral health status: United States, 1988-1994 and 1999-2004.
        Vital Health Stat 11. 2007; (National Center for Health Statistics)
        • Urtane I.
        • Pugaca J.
        • Liepa A.
        • Rogovska I.
        The severity of malocclusion and need for orthodontic treatment in correspondence with the age.
        Stomatologija. 2006; 8: 35-38
        • Buttke T.M.
        • Proffit W.R.
        Referring adult patients for orthodontic treatment.
        J Am Dent Assoc. 1999; 130: 73-79
        • Proffitt W.R.
        Special considerations in comprehensive treatment of adults.
        in: Proffit W.R. Fields Jr, H.W. Contemporary orthodontics. 3rd ed. Mosby, St Louis1993: 644-673
        • Tung A.W.
        • Kiyak H.A.
        Psychological influences on the timing of orthodontic treatment.
        Am J Orthod Dentofacial Orthop. 1998; 113: 29-39
        • Holmes A.
        The prevalence of orthodontic treatment need.
        Br J Orthod. 1992; 19: 177-182
        • Helm S.
        • Kreiborg S.
        • Solow B.
        Psychosocial implications of malocclusion: a 15-year follow-up study in 30-year-old Danes.
        Am J Orthod. 1985; 87: 110-118
        • Kanazawa S.
        • Kovar J.L.
        Why beautiful people are more intelligent.
        Intelligence. 2004; 32: 227-243
        • Eagly A.H.
        • Ashmore R.D.
        • Makhijani M.G.
        • Longo L.C.
        What is beautiful is good, but… : a meta-analytic review of research on the physical attractiveness stereotype.
        Psychol Bull. 1991; 110: 109-128
        • Landy D.
        • Sigall H.
        Beauty is talent: task evaluation as a function of the performer’s physical attractiveness.
        J Pers Soc Psychol. 1974; 29: 299-304
        • Shaw W.C.
        The influence of children’s dentofacial appearance on their social attractiveness as judged by peers and lay adults.
        Am J Orthod. 1981; 79: 399-415
        • Shaw W.C.
        • Rees G.
        • Dawe M.
        • Charles C.R.
        The influence of dentofacial appearance on the social attractiveness of young adults.
        Am J Orthod. 1985; 87: 21-26
        • Kenealy P.
        • Frude N.
        • Shaw W.
        An evaluation of the psychological and social effects of malocclusion. Some implications for dental policy making.
        Soc Sci Med. 1989; 28: 583-591
        • Jung M.H.
        Evaluation of the effects of malocclusion and orthodontic treatment on self-esteem in an adolescent population.
        Am J Orthod Dentofacial Orthop. 2010; 138: 160-166
        • Shaw W.C.
        • Richmond S.
        • Kenealy P.M.
        • Kingdon A.
        • Worthington H.
        A 20-year cohort study of health gain from orthodontic treatment: psychological outcome.
        Am J Orthod Dentofacial Orthop. 2007; 132: 146-157
        • Albino J.E.
        • Alley T.R.
        • Tedesco L.A.
        • Tobiasen J.A.
        • Kiyak H.A.
        • Lawrence S.D.
        Esthetic issues in behavioral dentistry.
        J Behav Med. 1990; 12: 148-153
        • Broder H.L.
        • Strauss R.P.
        • Smith F.B.
        Effects of visible and invisible orofacial defects on self-perception and adjustment across developmental eras and gender.
        Cleft Palate Craniofac J. 1994; 31: 429-436
        • De Paula D.F.
        • Santos N.C.M.
        • Da Silva E.T.
        • De Fatima Nunes M.
        • Leles C.R.
        Psychosocial impact of dental esthetics on quality of life in adolescents—association with malocclusion, self-image, and oral health-related issues.
        Angle Orthod. 2009; 79: 1188-1193
        • Kapp K.
        Self-concept of cleft lip and/or cleft palate children.
        Cleft Palate J. 1979; 16: 171-176
        • Klages U.
        • Bruckner A.
        • Guld Y.
        • Zentner A.
        Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults.
        Am J Orthod Dentofacial Orthop. 2005; 128: 442-449
        • Mandall N.A.
        • McCord J.F.
        • Blinkhorn A.S.
        • Worthington H.V.
        • O’Brien K.D.
        Perceived aesthetic impact of malocclusion and oral self-perceptions in 14- to 15-year-old Asian and Caucasian children in greater Manchester.
        Eur J Orthod. 1999; 21: 175-183
        • Kerosuo H.
        • Hausen H.
        • Laine T.
        • Shaw W.C.
        The influence of incisal malocclusion on the social attractiveness of young adults in Finland.
        Eur J Orthod. 1995; 17: 505-512
        • Digman J.M.
        Personality structure: emergence of the five-factor model.
        Annu Rev Psychol. 1990; 41: 417-440
        • Goldberg L.R.
        An alternative “description of personality”: the big-five factor structure.
        J Pers Soc Psychol. 1990; 59: 1216-1229
        • Goldberg L.R.
        The development of markers for the big-five factor structure.
        Psychol Assess. 1992; 4: 26-42
        • Goldberg L.R.
        The structure of phenotypic personality traits.
        Am Psychol. 1993; 48: 26-34
        • McCrae R.R.
        • Costa Jr., P.T.
        Personality trait structure as a human universal.
        Am Psychol. 1997; 52: 509-516
        • Flanary C.
        The psychology of appearance and the psychological impact of surgical alteration of the face.
        in: Bell W.H. Dyson J. Modern practice in orthognathic and reconstructive surgery. volume I. W. B. Saunders, Phildelphia1992: 3-21
        • Tedesco L.A.
        • Albino J.E.
        • Cunat J.J.
        • Slakter M.J.
        • Waltz K.W.
        A dental-facial attractiveness scale—part II. Consistency of perception.
        Am J Orthod. 1983; 83: 44-46
        • Flores-Mir C.
        • Silva E.
        • Barriga M.I.
        • Lagravere M.O.
        • Major P.W.
        Lay person’s perception of smile aesthetics in dental and facial views.
        J Orthod. 2004; 31: 204-209
      1. Inglehart M, Boone A. Stereotyping healthcare providers: the significance of gender, race/ethnicity, and profession. Proceedings of the American Psychological Society; 1993 June 25-28; Chicago, Ill.

        • SPSS Inc
        SPSS 17.0 student version for Windows (SA).
        Prentice Hall, Upper Saddle River, NJ2009
        • Campbell D.T.
        Experimental and quasi-experimental designs for research.
        Rand McNally and Company, Chicago1966
        • Ajzen I.
        • Fishbein M.
        The prediction of behavioral intentions in a choice situation.
        J Exp Soc Psych. 1969; 5: 400-416
        • Ajzen I.
        • Fishbein M.
        Attitudinal and normative variables as predictors of specific behaviors.
        J Pers Soc Psych. 1973; 27: 41-57