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Smile dysmorphia: A growing concern

Feb. 20, 2023
Patients wanting a perfect smile isn't new, but social media has brought it to a different level. Here's what to look for and how you can help educate patients on why that ideal can come at a cost.

Social media has become a part of just about every young person’s day-to-day life. It’s a place where they connect, learn, and grow. However, it can also bring about constant comparisons to others. From our skin, to our hair, to our teeth, the media tells us we need fewer wrinkles, fuller hair, and whiter smiles. The high pressure from society to portray perfection has increased the demand for cosmetic dentistry.1 As dental professionals, we need to explore the correlation between social media and smile dysmorphia (SD).

Imagine for a moment that you’re treating a young patient with a healthy periodontium. This patient has generalized health, no active decay, and healthy occlusion. As you prepare for the doctor to do an exam, the patient says, “I’m interested in shaving down my canines because they’re too pointy” or “I really want veneers so I can have a perfect smile.” As preventive specialists, we should use this as an opportunity to educate the patient about the importance of maintaining healthy tooth structure. We should also consider the possibility of SD.

What is smile dysmorphia?

People suffering from SD have a healthy periodontium but feel deeply insecure about specific aspects of their teeth. They may have unrealistic outcome expectations and seek out invasive procedures to correct a perceived flaw. Some of the requested aesthetic dental procedures include shaving down healthy tooth structure, unnecessary veneers, gingival contouring, and extreme whitening. Frequently the treatment never reaches the patient’s complete satisfaction and continues causing irreversible damage to a healthy periodontium.

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Social media has the power of influencing trends without revealing long-term effects. Popular media has increased the demand for esthetic dental procedures.2 The substantial growth in social media has created high pressure on adolescents to get that perfect smile.3 With more than half the world using social media, it leaves dental professionals with the responsibility of being able to identify and understand SD.4

Teeth and body dysmorphic disorder

Teeth are one of the common body parts associated with body dysmorphic disorder (BDD).5 Many patients suffering from BDD are not diagnosed or do not disclose their condition with health-care providers.6 The first step to gathering critical information about our patients' health is through a thorough medical history review. Medical history reviews provide us with the opportunity to gain insight about the complete health of our patients, including mental health, which is often overlooked but a critical component to building the correlation between oral-systemic health.

Medical history reviews should include questions about how the patient feels about their smile and what their goals are. The answers can be used as a tool to provide our patients with quality care.

With a surge of adolescents being diagnosed with BDD7, we should use the entire appointment time to educate about a healthy periodontium versus a so-called perfect smile. We know the challenges our patients face when enamel becomes compromised. That’s why staying up-to-date with social media trends can help us be prepared to provide evidence-based advice. Over the years we’ve seen at-home dental trends such as tooth gems, teeth whitening with Magic Erasers, and filing down teeth with a nail file—all of which can damage healthy tooth structure. Do you discuss these topics with your patients?

Learn the signs of BDD

Although dental professionals can’t diagnose BDD, we can become familiar with potential signs. Patients with BDD may know in-depth details about procedures, which can be a good thing; however, some patients may know so much that they have a perceived idea of what the outcome will be. The problem with this is that sometimes the expected outcomes are unachievable and can leave the patient frustrated and angry with the results. Consent is important with any procedure, and you want to be sure your patients fully understand the risks and benefits of their treatment before moving forward.

Another sign is when the perceived flaw is so minor that it can’t be detected. We must be realistic when taking on certain cases, and when a patient requests something that is not within our abilities—or is unidentifiable—we should clearly discuss this with the patient.8

Further research into smile dysmorphia is needed to better understand the causes, symptoms, and treatment. Until then, dental hygienists can continue to build medical-dental integration by exploring the connection between mental health and oral health by creating interprofessional collaboration and building connections with physicians, behavioral specialists, and allied health professionals.


1. Doughty J, Lala R, Marshman Z. The dental public health implications of cosmetic dentistry: a scoping review of the literature. Comm Dent Health. 33;(3):218–224. doi:10.1922/CDH_3881Doughty07

2. Theobald AH, Wong BKJ, Quick AN, Thomson, WM. The impact of the popular media on cosmetic dentistry. The New Zealand Dental Journal. 102;(30):58–63.

3. Khalid A, Quiñonez C. Straight, white teeth as a social prerogative. Sociology of Health & Illness, 37;(5):782–796. doi:10.1111/1467-9566.12238

4. Kepios. Global social media statistics. https://datareportal.com/social-media-users Digital Insights

5. Jafferany M, Osuagwu FC. Evaluation of the body parts that preoccupy adolescents with body dysmorphic disorder. The Primary Care Companion for CNS Disorders. 10;19(5):17m02154. doi:10.4088/PCC.17m02154

6. Bjornsson AS, Didie ER, Phillips KA. Body dysmorphic disorder. Dialogues in Clinical Neuroscience. 12;(2):221–232. doi:10.31887/DCNS.2010.12.2/abjornsson

7. Himanshu, Kaur A, Kaur A, Singla G. Rising dysmorphia among adolescents : A cause for concern. Journal of Family Medicine and Primary Care, 2020;9(2):567–570, doi:10.4103/jfmpc.jfmpc_738_19

8. Dental protection (articles section). Accessed Feb. 8, 2023. https://www.dentalprotection.org/australia/publications-resources/dentolegal-articles/articles/body-dysmorphic-disorder-spotting-the-warning-signs