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Appearance Anxiety

Nov. 1, 2006
I’m too fat. I’m too skinny. I'd be happier if I had straighter teeth, no freckles...
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I’m too fat. I’m too skinny. I’d be happier if I had straighter teeth, no freckles, a smaller nose, less wrinkles, bigger boobs, longer legs, smaller butt, whiter teeth.

Any of the statements to the right sound familiar? Chances are good you have either said them or heard someone say them. In our society of media images and popular culture ideals of skinny girls and bulked-up boys, self-esteem and body image are forever linked.

This article is influenced by the challenge of balancing the dental office expectations of educating patients on smile enhancements while respecting their self-esteem and body image. I hope to begin a dialogue about trends in beauty, how we can responsibly market cosmetic services, and their effect on our patients. A more narrow focus is the self-esteem of female patients between ages six and 17. As we explore this relationship and continue as a profession to break out of traditional practice settings, we will be further connected to the populous. When we become more cognizant of the pressure young patients perceive in the realm of beauty and how they view themselves, we may be able to positively affect their well being, lives and healthy smiles.

Self-esteem: Do you have resilience?

According to the Nemours Foundation, self-esteem is how much people value themselves, the pride they feel in themselves, and how worthwhile they feel. Feeling good about yourself can affect how you act. Body image is how a person feels about his or her physical appearance. A person who believes in him or herself and has a healthy self-image is more in control of his/her behavior. In fact, refers to this as resilience. Skill resilience is defined as “People who believe in themselves are better able to recognize mistakes, learn from them, and bounce back from disappointment.”

When teens develop their individual styles, yet still have the desire to “fit in,” television has an enormous influence. The “extreme” phenomenon that captured American viewers is still having a strong affect. Admittedly, our fascination with transforming the ugly duckling into a beautiful swan showed positive returns for many dental offices. After people witnessed the extreme smile changes on television, many decided to make appointments and ask questions about smile enhancing to learn how their smiles could be changed. Whether or not you agree with the media attention on beauty transformation or the public’s fascination with the results, it has changed the attention to dental services and the number of services dentists provide.

What is the best way to approach patients with the newest advances and technologies? Do we wait for them to ask or do we take a proactive role and plant seeds? And by planting seeds, at what age do we begin to make such smile distinctions?

According to the American Academy of Facial and Plastic Survey 2005 member survey, Trends in Facial Plastic Surgery, the latest trends seen in member offices in 2004 is an increase in teen procedures by 37 percent, and an increase in the amount of plastic surgery given as a gift, up 49 percent.

This scene is similar in dental marketing plans across the nation. What market segment are we targeting when it comes to cosmetic procedures? I have seen promotional pieces with such titles as “The Straight Scoop for Graduating” or “A Brighter Smile for the Prom.”

Some of these tactics seem like appropriate marketing avenues, yet in our desire for an increase in cosmetic procedures, is it possible that we have negatively led young adults to believe that they must look a certain way or have a perfect, white smile to fit in? Have we begun to sidestep oral disease, caries and periodontal issues, which are our obligation to assess and treat? Have we trained ourselves to spot the tiniest flaws, but forgotten the role this may play in developing people’s self worth?

A global look at beauty

“Beyond Stereotypes: Rebuilding the Foundation of Beauty Beliefs,” was a two-phase study conducted by StrategyOne. The research was commissioned by Dove®, a Unilever beauty brand, in their corporate commitment to challenge the current beliefs and media portrayals of beauty. The first component of the study was a review of the current data that deals with the socialization of beauty and its impact on self-esteem and engagement.

The second phase was a quantitative study among 3,300 girls and women in 10 countries. This 2004 study is the foundation for Dove’s recently launched advertising campaign, “Campaign for Real Beauty.” It features real women, not Hollywood models, in the advertising and outreach programs like the Dove Self-Esteem Fund (see related article).

Hygienists’ impact

Besides media, lots of factors play roles in affecting teen self-worth, such as family life, puberty, peers, celebrities, etc. While girlfriends and mothers of girls are the earliest and most powerful influencers, the impact of that influence is decidedly different. The study showed that a mother’s influence, which takes into account cultural and generational differences, showed a girl how to have higher appearance satisfaction and self-esteem. Yet girlfriends influence the correspondence between low appearance satisfaction and self-esteem. Finally, male hygienists should consider how they impact teen patients. The study found that male non-paternal influences powerfully influence girls’ feelings about their beauty and body image.

A disease free-smile or the condition of a smile’s esthetics will affect a patient’s self-worth, and dental professionals can uncover these issues while building self-esteem. Many teens will not share concerns about their smile, especially if they have expressed them before and have not been validated, or if it is a continued source of peer or family ridicule.

Here are some tips that will assist young patients in developing a confident self-image. First, create an atmosphere without sarcasm. Even the most unintentional banter can fail miserably. Creating an environment that is safe and nonjudgmental will allow teens to express concerns they may have with their teeth, gums or breath.

Second, as esthetic practitioners and positive influencers, use positive communication strategies. For instance, “Johnny, as part of your dental hygiene service, I will perform a smile assessment. As you know, we are in the healthy smile business, so it is my privilege to make sure that everyone who visits me is happy and confident about their gums and teeth. I perform these evaluations on all my patients.” It may take a few hygiene sessions to build trust and rapport. When the teen does share, encourage this behavior and validate the concerns. “Johnny, I appreciate you sharing with me that you are unhappy with the color of your teeth. If something could be done to minimize the yellow, would you be interested in it?”

Additional self-esteem building strategies include:

  • Positive feedback during self-care education. Make the teen feel good about his or herself.
  • Emphasize that all smiles are different, and that their smile is unique.
  • Provide nutritional counseling.
  • Encourage involvement in the decision making process.
  • Being in the smile business makes us a powerful influence in our patients’ self-esteem, especially when some of our services and marketing targets are 15 to 17 year olds whose self-esteem and body image is very vulnerable. As a trusted oral health professional and adult influencer, dental hygienists can support teen patients’ self image and provide positive feedback about smiles and oral health. We can be committed to helping our patients repair and reclaim confident self-esteem and body image. We can do this specifically in the area of smile image, so that our patients will be well supported in developing complete engagement in all aspects of life. RDHThe Dove/Unilever studies referred to in this article resulted in a white paper that was released last February. Some compelling statements from “Beyond Stereotypes: Rebuilding the Foundation of Beauty Beliefs” include:• Living with beauty ideals The objective was to determine if the “desire for perfection” portrayed in today’s beauty ideals creates appearance anxiety.
  • Women 15 to 64, and specifically girls 15 to 17, feel pressure and lack self-beauty when they are compared to such perfect images.
  • As a result of this focus on physical attributes, 9 out of 10 women globally want to change some aspect of themselves. Ranking the highest is body weight and shape.
  • • The relationship between beauty ideals, appearance satisfaction and self-esteem The data showed that globally there is a correlation between a woman’s satisfaction with her exterior (overall physical appearance, facial appearance and body weight and shape) and her sense of self-worth.
  • Girls 15 to 17 are significantly more likely to report low self-esteem.
  • Girls, who often have a more fragile sense of self, are more likely to report feeling stupid or ugly when they feel poorly about their appearance.
  • • Influence of beauty ideals on how women live their lives This section dealt with appearance satisfaction and self-esteem, and if it affects how women live their lives, both emotionally and physically.
  • Two thirds of women 15 to 64 around the world avoid basic activities of life because they feel badly about how they look. Activities include meeting friends, exercising, voicing an opinion, going to school, going on a job interview, going to work, dating, and seeking medical help.
  • Activity avoidance is higher in girls 15 to 17 who have low self-esteem.
  • One fourth of the girls reported that “at some point I would consider getting plastic or cosmetic surgery to enhance my looks.”
  • • Revealing the early influences of beauty socialization 97 percent of the girls in the study ages 15 to 17 believe that changing some aspect about themselves would make them feel better. They are mainly focused on being thinner, taller, or more athletic.• Thinking about when it started One in 10 girls remembers being concerned about her overall physical appearance, facial appearance, and body weight between ages 6 and11.• The study noted a correlation between how early these girls became aware of their appearance and the lower their satisfaction and self-esteem is today as women.• Solutions for moving forward • Participants believe that it is very important for women to be supportive of other women’s beauty.• The most important lesson globally is that young girls should learn how to “eat healthy rather than diet.”• Girls should be taught differently about beauty beliefs and ideals.These are just some of the overviews from the study, and as oral health professionals we can use this information to craft our communication and education approaches to our patients, especially to girls ages 15 to 17.The smile design areas that may be incorporated and evaluated during a teen visit include:
  • Discoloration of teeth. Brown, white, yellow, and orange staging caused by developmental distrubances.
  • Trauma or medication-induced enamel hyperplasic, fluorosis, and genetic pigment distributions.
  • Congenitally missing anterior teeth.
  • Diastema
  • Fused teeth.
  • Malformed teeth, such as a peg lateral.
  • Crowding/space maintenance.
  • Gingival hyperplasia.
  • Kristine A. Hodsdon, RDH, BS, is the director for RDH eVillage, an online newsletter from PennWell Corporation. She is a hygiene marketing consultant and speaker who frequently contributes to industry publications. She has presented more than 200 lectures, both nationally and internationally, on topics such as dental hygiene marketing, the future of dental hygiene, and communication skills. Kristine is scheduling for her newest program entitled How to Address Patients “E”ase: Education, Entertainment and Emotions. She can be reached at KristineHRDH@Pennwell.