Automated measurement of infant and mother Duchenne facial expressions in the Face-to-Face/Still-Face

Although still-face effects are well-studied, little is known about the degree to which the Face-to-Face/Still-Face (FFSF) is associated with the production of intense affective displays. Duchenne smiling expresses more intense positive affect than non-Duchenne smiling, while Duchenne cry-faces express more intense negative affect than non-Duchenne cry-faces. Forty 4-month-old infants and their mothers completed the FFSF, and key affect-indexing facial Action Units (AUs) were coded by expert Facial Action Coding System coders for the first 30 s of each FFSF episode. Computer vision software, automated facial affect recognition (AFAR), identified AUs for the entire 2-min episodes. Expert coding and AFAR produced similar infant and mother Duchenne and non-Duchenne FFSF effects, highlighting the convergent validity of automated measurement. Substantive AFAR analyses indicated that both infant Duchenne and non-Duchenne smiling declined from the FF to the SF, but only Duchenne smiling increased from the SF to the RE. In similar fashion, the magnitude of mother Duchenne smiling changes over the FFSF were 2-4 times greater than non-Duchenne smiling changes. Duchenne expressions appear to be a sensitive index of intense infant and mother affective valence that are accessible to automated measurement and may be a target for future FFSF research.

The perception of smile attractiveness to altered vertical position of maxillary anteriors by various groups

There is a gap in research about the differences in smile attractiveness. The problem the study addresses is how the vertical canine and incisor position affect smile attractiveness. The aim of this study was to assess the perception of the smile attractiveness between Saudi laypersons, orthodontists, non-orthodontist, and various dental students levels, and to determine how the canine and incisor vertical positions affect the attractiveness of smile. The study is a cross-sectional survey and was conducted at King Abdulaziz University, Jeddah, Saudi Arabia. Six groups of subjects participated in the study: Orthodontic residents (n = 31), prosthodontic, restorative, periodontics specialties residents specialties residents (n = 30), interns (n = 31), fifth year students (n = 41), 6th year students (n = 39), and laypeople (n = 39). Participants were asked to rate the attractiveness of a smile of a female subject photographed using a Minolta DiMage 7i digital camera. The image had been manipulated to produce 2 sets of images; 1 to modify the incisors and 1 to change the canines. The subjects were asked to choose the most and least attractive picture. For the best incisor positions, only the laypeople and prosthodontics liked the original picture, the rest liked +0.5 mm which accentuate the smile curve and make it follow the lower lip line. For the worst incisor position, all groups did not prefer the minus 1.5 reversed smile. For the best canine vertical position, all groups preferred the original position where canine was at the level of the incisal plane. For the worst canine position, they all disliked the minus 1.5 reversed smile. Results confirmed past findings that orthodontists are in general more critical about smile attractiveness than laypersons, but just like other dental specialists. The findings can be used in the esthetic dentistry field, but further research on the study population based on other dental design parameters remain necessary.

"I'm smiling back at you": Exploring the impact of mask wearing on communication in healthcare

BACKGROUND

Surgical and respirator masks are worn to reduce the risk of droplet and airborne transmission of viral respiratory disease. As a result of the novel coronavirus (COVID-19) pandemic, mask wearing has been designated mandatory for healthcare professionals working in UK hospitals for the foreseeable future. It is thus timely to consider the long-term implications of mask wearing on communication within healthcare settings, from both a patient and a clinician perspective.

AIMS

The primary objective is to identify research evidence that corresponds to the mask-wearing experiences of healthcare professionals working on the ground. By drawing together a summary of the literature illustrating the potential challenges associated with mask wearing, it is possible to make an application to various clinical cohorts and to formulate a set of preliminary, evidence-based support strategies. The paper additionally explores the role for the Speech and Language Therapist (SLT) in supporting communication in the context of mask wearing.

METHODS & PROCEDURES

Through a scoping review of the relevant literature, this paper reflects holistically on the prospective challenges associated with mask wearing across a variety of healthcare settings and patient populations. The subsequent conclusions have been used to inform the proposed clinical guidelines for safe and effective practice.

OUTCOMES & RESULTS

There is a current research gap with regards to mask wearing in non-medical and non-clinical healthcare workers, and the impact this may have on both a professional and a personal basis. In the absence of preliminary data, the development of associated communication support strategies is hindered. This paper draws upon a variety of clinically conceivable issues faced by healthcare professionals, outlines important practical and ethical considerations, and proposes evidence-based solutions to some of the challenges identified. Future research is required to gather evidence with regards to actual clinical experiences of mask wearing to substantiate hypotheses.

CONCLUSIONS & IMPLICATIONS

Although undoubtedly essential in protecting the health of staff and patients, there are numerous logistical, physiological, psychological, social and economic complications associated with the wearing of masks. The ability of healthcare staff to successfully communicate with patients and with colleagues is jeopardized, which may adversely affect the efficiency, effectiveness, equitability and, most notably, safety of therapeutic intervention. The SLT has a distinct role in facilitating communication in order to safeguard the provision, accessibility and efficacy of services. What this paper adds What is already known on the subject Existing research explores the impact of mask wearing on medical doctors, surgeons and dentists, and upon the corresponding patient cohorts. Little is known about how mask wearing may affect Allied Health Professionals and their ability to deliver therapeutic interventions safely and effectively. With mandatory face covering potentially a long-term requirement for UK healthcare staff, it is both timely and relevant to consider the consequences of mask wearing on communication across acute and community settings. What this paper adds to existing knowledge This paper identifies a range of prospective key issues associated with mask wearing across a variety of clinical and non-clinical populations, with application specifically to vulnerable patient cohorts. Through evidence synthesis, this paper provides a summary of fundamental issues supported by relevant literature, and draws upon these in order to propose a preliminary set of evidence-based clinical guidelines setting out potential solutions to the challenges faced. This review additionally assists in quantifying the role of the SLT within these extraordinary circumstances, with the aim of prompting unified practice, building upon professional guidance and increasing skill recognition. What are the potential or actual clinical implications of this work? In addition to their role in facilitating the development of individualised communication strategies for patients, SLTs should actively seek to provide widely accessible multidisciplinary education opportunities focusing on supporting communication; with specific reference to mask wearing and the associated communicative challenges. At a commissioning and managerial level, leaders within healthcare should acknowledge mask wearing as just one of the complexities associated with frontline working in the context of the COVID-19 pandemic, and aim to support their workforce by delivering resources and protocols which maximize and promote staff safety, efficiency, resilience and well-being in concurrence with positive patient outcomes.

Observers perceive the Duchenne marker as signaling only intensity for sad expressions, not genuine emotion

The Duchenne marker-crow's feet wrinkles at the corner of the eyes-has a reputation for signaling genuine positive emotion in smiles. Here, we test whether this facial action might be better conceptualized as a marker of emotional intensity, rather than genuineness per se, and examine its perceptual outcomes beyond smiling, in sad expressions. For smiles, we found ratings of emotional intensity (how happy a face is) were unable to fully account for the effect of Duchenne status (present vs. absent) on ratings of emotion genuineness. The Duchenne marker made a unique direct contribution to the perceived genuineness of smiles, supporting its reputation for signaling genuine emotion in smiling. In contrast, across 4 experiments, we found Duchenne sad expressions were not rated as any more genuine or sincere than non-Duchenne ones. The Duchenne marker did however make sad expressions look sadder and more negative, just like it made smiles look happier and more positive. Together, these findings argue the Duchenne marker has an important role in sad as well as smiling expressions, but is interpreted differently in sad expressions (contributions to intensity only) compared with smiles (emotion genuineness independently of intensity). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Association of Facial Paralysis With Perceptions of Personality and Physical Traits

IMPORTANCE

Facial paralysis has a significant effect on affect display, with the most notable deficit being patients' the inability to smile in the same way as those without paralysis. These impairments may result in undesirable judgements of personal qualities, thus leading to a significant social penalty in those who have the condition.

OBJECTIVE

To quantify the association of facial paralysis with the way smiling patients are perceived by others with respect to personality traits, attractiveness, and femininity or masculinity and to evaluate the potential association of facial palsy-related patient-reported outcome measures with how patients are perceived by others.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cross-sectional study used 20 images of smiling patients with facial paralysis evaluated between January 1, 2014, and December 31, 2016. Using photograph editing software, the photographs were edited to create a simulated nonparalysis smiling facial appearance. A total of 40 photographs were split into 4 groups of 10 photographs, each with 5 altered and 5 unaltered photographs. The surveys were designed such that altered and unaltered photographs of the same patient were not placed in the same survey to avoid recall bias. Anonymous raters used a 7-point Likert scale to rate their perception of each patient's personality traits (ie, aggressiveness, likeability, and trustworthiness), attractiveness, and femininity or masculinity based on photographs in their assigned survey. Raters were blinded to study intent. Scores from the Facial Clinimetric Evaluation questionnaire were included to assess self-perception. Data were analyzed from November 11, 2019, to February 20, 2020.

MAIN OUTCOMES AND MEASURES

Ratings of personality traits, attractiveness, and femininity or masculinity. Social function domain scores and overall scores were analyzed from the Facial Clinimetric Evaluation questionnaire.

RESULTS

This study included photographs of 20 patients with facial paralysis (mean [range] age, 54 [28-69] years; 15 [75%] women). A total of 122 respondents completed the survey (71 [61%] women). Most respondents were between the ages of 25 and 34 years (79 participants [65%]). Overall, smiling photos of patients with facial paralysis were perceived as significantly less likeable (difference, -0.29; 95% CI, -0.43 to -0.14), trustworthy (difference, -0.25; 95% CI, -0.39 to -0.11), attractive (difference, -0.47; 95% CI, -0.62 to -0.32), and feminine or masculine (difference, -0.21; 95% CI, -0.38 to -0.03) compared with their simulated preparalysis photographs. When analyzed by sex, smiling women with facial paralysis experienced lower ratings for likeability (difference, -0.34; 95% CI, -0.53 to -0.16), trustworthiness (difference, -0.24; 95% CI, -0.43 to -0.06), attractiveness (difference, -0.74; 95% CI, -0.94 to -0.55), and femininity (difference, -0.35; 95% CI, -0.58 to -0.13). However, smiling men with facial paralysis only received significantly lower ratings for likeability (difference, -0.24; 95% CI, -0.47 to -0.01) and trustworthiness (difference, -0.30; 95% CI, -0.53 to -0.07). As patients' self-reported social function and total Facial Clinimetric Evaluation scores increased, there was an increase in perceived trustworthiness (rs[480] = 0.11; P = .02) and attractiveness (rs[478] = 0.10; P = .04) scores by raters.

CONCLUSIONS AND RELEVANCE

In this study, photographs of patients with facial paralysis received lower ratings for several personality and physical traits compared with digitally edited images with no facial paralysis. These findings suggest a social penalty associated with facial paralysis.

Dentofacial mini- and microesthetics as perceived by dental students: A cross-sectional multi-site study

Background

How dental education influences students’ dental and dentofacial esthetic perception has been studied for some time, given the importance of esthetics in dentistry. However, no study before has studied this question in a large sample of students from all grades of dental school. This study sought to fill that gap. The aim was to assess if students’ dentofacial esthetic autoperception and heteroperception are associated with their actual stage of studies (grade) and if autoperception has any effect on heteroperception.

Methods

Between October 2018 and August 2019, a questionnaire was distributed to 919 dental students of all 5 grades of dental school at all four dental schools in Hungary. The questionnaire consisted of the following parts (see also the supplementary material): 1. Demographic data (3 items), Self-Esthetics I (11 multiple- choice items regarding the respondents’ perception of their own dentofacial esthetics), Self-Esthetics II (6 Likert-type items regarding the respondents’ perception of their own dentofacial esthetics), and Image rating (10 items, 5 images each, of which the respondents have to choose the one they find the most attractive). Both the self-esthetics and the photo rating items were aimed at the assessment of mini- and microesthetic features.

Results

The response rate was 93.7% (861 students). The self-perception of the respondents was highly favorable, regardless of grade or gender. Grade and heteroperception were significantly associated regarding maxillary midline shift (p < 0.01) and the relative visibility of the arches behind the lips (p < 0.01). Detailed analysis showed a characteristic pattern of preference changes across grades for both esthetic aspects. The third year of studies appeared to be a dividing line in both cases, after which a real preference order was established. Association between autoperception and heteroperception could not be verified for statistical reasons.

Conclusion

Our findings corroborate the results of most previous studies regarding the effect of dental education on the dentofacial esthetic perception of students. We have shown that the effect can be demonstrated on the grade level, which we attribute to the specific curricular contents. We found no gender effect, which, in the light of the literature, suggests that the gender effect in dentofacial esthetic perception is highly culture dependent. The results allow no conclusion regarding the relation between autoperception and heteroperception.

Human perception and biosignal-based identification of posed and spontaneous smiles

Facial expressions are behavioural cues that represent an affective state. Because of this, they are an unobtrusive alternative to affective self-report. The perceptual identification of facial expressions can be performed automatically with technological assistance. Once the facial expressions have been identified, the interpretation is usually left to a field expert. However, facial expressions do not always represent the felt affect; they can also be a communication tool. Therefore, facial expression measurements are prone to the same biases as self-report. Hence, the automatic measurement of human affect should also make inferences on the nature of the facial expressions instead of describing facial movements only. We present two experiments designed to assess whether such automated inferential judgment could be advantageous. In particular, we investigated the differences between posed and spontaneous smiles. The aim of the first experiment was to elicit both types of expressions. In contrast to other studies, the temporal dynamics of the elicited posed expression were not constrained by the eliciting instruction. Electromyography (EMG) was used to automatically discriminate between them. Spontaneous smiles were found to differ from posed smiles in magnitude, onset time, and onset and offset speed independently of the producer's ethnicity. Agreement between the expression type and EMG-based automatic detection reached 94% accuracy. Finally, measurements of the agreement between human video coders showed that although agreement on perceptual labels is fairly good, the agreement worsens with inferential labels. A second experiment confirmed that a layperson's accuracy as regards distinguishing posed from spontaneous smiles is poor. Therefore, the automatic identification of inferential labels would be beneficial in terms of affective assessments and further research on this topic.

The subjective value of a smile alters social behaviour

Face-to-face social behaviour is difficult to explain, leading some researchers to call it the “dark matter” of psychology/neuroscience [1]. We apply an idea from neuroeconomics to this problem, suggesting that how people subjectively value facial expressions should predict usage differences during unconstrained interaction. Specifically, we ask whether the subjective value of smiles is malleable as a consequence of immediate social experience and how this relates to smiling during face-to-face interactions. We measured the value of a smile in monetary terms and found that increases in people’s social neediness caused devaluation of polite smiles but no changes in how they valued genuine smiles. This result predicts that participants induced to feel high levels of social need should be less responsive to their social partners’ polite smiles in a subsequent unconstrained social interaction. As expected, high social-need participants returned fewer polite smiles when interacting with a partner, leading to poor interaction outcomes. Genuine smile reciprocity remained unchanged. Findings show that social states influence real-world interactions by changing social-cue valuation, highlighting a potential mechanism for understanding the moment-to-moment control of social behaviour and how behaviour changes based on people’s subjective evaluations of the social environment.

Interventions of computerized psychotherapies for depression in Primary Care in Spain

Currently, depression is a global health problem recognized by the WHO. The prevalence of this pathology in Primary Care is estimated at 19.5% worldwide, and 20.2% in Spain. In addition, the current intervention policies and protocols involve significant costs, both personal and economic, for people suffering from this disorder, as well as for society in general. On the other hand, the relapse rates after pharmacological interventions that are currently applied and the lack of effective specialized attention in mental health services reflect the need to develop new therapeutic strategies that are more accessible and profitable. Therefore, one of the proposals that are being investigated in different parts of the world is the design and evaluation of therapeutic protocols applied through Information and Communication Technologies, especially through the Internet and computer programs. The objective of this work was to present the current situation in Spain regarding the use of these interventions for the treatment of depression in Primary Care. The main conclusion is that although there is scientific evidence on the effectiveness of these programs, there are still important barriers that hinder their application in the public system, and also the need to develop implementation studies that facilitate the transition from research to clinical practice.

Perceiving happiness in an intergroup context: The role of race and attention to the eyes in differentiating between true and false smiles

The present research comprises six experiments that investigated racial biases in the perception of positive emotional expressions. In an initial study, we demonstrated that White participants distinguished more in their happiness ratings of Duchenne ("true") and non-Duchenne ("false") smiles on White compared with Black faces (Experiment 1). In a subsequent study we replicated this effect using a different set of stimuli and non-Black participants (Experiment 2). As predicted, this bias was not demonstrated by Black participants, who did not significantly differ in happiness ratings between smile types on White and Black faces (Experiment 3). Furthermore, in addition to happiness ratings, we demonstrated that non-Black participants were also more accurate when categorizing true versus false expressions on White compared with Black faces (Experiment 4). The final two studies provided evidence for the mediating role of attention to the eyes in intergroup emotion identification. In particular, eye tracking data indicated that White participants spent more time attending to the eyes of White than Black faces and that attention to the eyes predicted biases in happiness ratings between true and false smiles on White and Black faces (Experiment 5). Furthermore, an experimental manipulation focusing participants on the eyes of targets eliminated the effects of target race or perceptions of happiness (Experiment 6). Together, the findings provide novel evidence for racial biases in the identification of positive emotions and highlight the critical role of visual attention in this process. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Esthetic perception of smiles with different gingival conditions

This study aimed to compare the perceptions of smile esthetics among general practitioners, periodontists, and laypeople. Photographs of smiles were taken and digitally modified to create different gingival conditions: gingival asymmetry, unilateral gingival recession, and bilateral gingival recession. These photographs were evaluated by 150 volunteers (19-70 years old) using a 100.0-mm visual analog scale. The volunteers consisted of 50 laypeople with no knowledge of dentistry, 50 general dentists, and 50 periodontists. Analysis of variance and Student t test were performed when data presented a normal distribution. If the hypothesis of normality was rejected, the Newman-Keuls test was applied to the data. Results showed that laypeople noticed gingival asymmetry only when it reached 2.0 mm, while periodontists and general dentists noticed it at 1.0 mm. Periodontists and general dentists considered smiles with unilateral recession of ≥1.0 mm to be less attractive, while the smallest modification that was deemed unesthetic by the laypeople was 2.0 mm. In the evaluation of bilateral gingival recession, general dentists and periodontists found smiles with a 1.0-mm modification less attractive, while the changes were not noticed by laypeople until the modification reached 1.5 mm. It can be concluded that laypeople perceived changes in smile esthetics differently than did dental professionals, which suggests that laypeople may be less concerned about the esthetic effects of minor gingival alterations than are dental professionals. Therefore, it is important for the dentist to understand the individual patient's perception of what constitutes an esthetic smile before recommending a dental treatment plan.

Face Value and Cheap Talk: How Smiles Can Increase or Decrease the Credibility of Our Words

How do our facial expressions affect the credibility of our words? We test whether smiles, either uninhibited or inhibited, affect the credibility of a written statement. Participants viewed a confederate partner displaying a neutral expression, non-Duchenne smile, Duchenne smile, or controlled smile, paired with a written statement. Participants then made a behavioral decision based on how credible they perceived the confederate's statement to be. Compared to a neutral expression, Experiment 1 found that participants were more likely to believe the confederate's statement when it was paired with a deliberate Duchenne smile and less likely to believe the confederate's statement when it was paired with a deliberate controlled smile. Experiment 2 replicated these findings with spontaneously emitted expressions. These findings provide evidence that uninhibited facial expressions can increase the credibility accompanying statements, while inhibited ones can decrease credibility.

Relationship between perception of smile esthetics and orthodontic treatment in Spanish patients

One of the main objectives of orthodontic treatment is to achieve an esthetic smile. This study set out to analyze differences in the perception of smile esthetics among patients before and after receiving orthodontic treatment. 250 Spanish patients analyzed a single photograph in which, by means of computer software, midline diastema, black triangle, gingival margin of the left central incisor, and gingival ("gummy") smile were altered. Each patient analyzed these images before and after undergoing orthodontic treatment. Patients scored the photographs on a scale from 1 to 10. Statistical analyses of each group's level of perception were carried out, identifying significant differences in evaluations before and after treatment, and in relation to subjects' gender and age. Patients presented significant differences in the esthetic perception of midline diastema and gummy smile anomalies after they had completed orthodontic treatment. Gender influenced the perception of smile esthetics, whereby women were significantly more critical of midline diastema, black triangle and gingival margin of the upper central incisor than men. The age variable also showed significant differences in the perception of midline diastema and black triangle anomalies. The perception of smile esthetics of some dental anomalies changes as a result of orthodontic treatment. Gender influences the perception of some of the dental anomalies studied.

Recognizing Face Identity from Natural and Morphed Smiles

It is easier to identify a degraded familiar face when it is shown moving (smiling, talking; nonrigid motion), than when it is displayed as a static image (Knight & Johnston, 1997; Lander, Christie, & Bruce, 1999). Here we explore the theoretical underpinnings of the moving face recognition advantage. In Experiment 1 we show that the identification of personally familiar faces when shown naturally smiling is significantly better than when the person is shown artificially smiling (morphed motion), as a single static neutral image or as a single static smiling image. In Experiment 2 we demonstrate that speeding up the motion significantly impairs the recognition of identity from natural smiles, but has little effect on morphed smiles. We conclude that the recognition advantage for face motion does not reflect a general benefit for motion, but suggests that, for familiar faces, information about their characteristic motion is stored in memory.

Dynamic properties of successful smiles

Facial expression of emotion is a foundational aspect of social interaction and nonverbal communication. In this study, we use a computer-animated 3D facial tool to investigate how dynamic properties of a smile are perceived. We created smile animations where we systematically manipulated the smile’s angle, extent, dental show, and dynamic symmetry. Then we asked a diverse sample of 802 participants to rate the smiles in terms of their effectiveness, genuineness, pleasantness, and perceived emotional intent. We define a “successful smile” as one that is rated effective, genuine, and pleasant in the colloquial sense of these words. We found that a successful smile can be expressed via a variety of different spatiotemporal trajectories, involving an intricate balance of mouth angle, smile extent, and dental show combined with dynamic symmetry. These findings have broad applications in a variety of areas, such as facial reanimation surgery, rehabilitation, computer graphics, and psychology.

The use of the Duchenne marker and symmetry of the expression in the judgment of smiles in schizophrenia

Research has recurrently shown that individuals with schizophrenia have impairments in emotional facial recognition and this deficit has been associated with aberrant visual scanning of the face. Because human beings have the ability to control the expression of emotion, the communication process becomes more complex. The goal of the current study was to conduct a systematic examination of the response pattern and perceptual-attentional processing in distinguishing smiles with the presence and absence of the Duchenne marker and symmetry and asymmetry of the activation in individuals with schizophrenia. Sixteen individuals diagnosed with schizophrenia and 16 control individuals were asked to judge whether the smiles were really happy or not. Individuals with schizophrenia produced fewer expected responses than controls in judging the symmetric non-Duchenne smile as not really happy. In addition, like their healthy counterparts, individuals with schizophrenia showed difficulty with the judgement of asymmetric Duchenne smiles. In addition to not being as sensitive to the cues, individuals with schizophrenia show differences in their viewing patterns. While the current study does not provide clear links between these viewing patterns and judgment responses, future research should explore other explanations, such as explicit knowledge, for the differences in results.

A large-scale analysis of sex differences in facial expressions

There exists a stereotype that women are more expressive than men; however, research has almost exclusively focused on a single facial behavior, smiling. A large-scale study examines whether women are consistently more expressive than men or whether the effects are dependent on the emotion expressed. Studies of gender differences in expressivity have been somewhat restricted to data collected in lab settings or which required labor-intensive manual coding. In the present study, we analyze gender differences in facial behaviors as over 2,000 viewers watch a set of video advertisements in their home environments. The facial responses were recorded using participants’ own webcams. Using a new automated facial coding technology we coded facial activity. We find that women are not universally more expressive across all facial actions. Nor are they more expressive in all positive valence actions and less expressive in all negative valence actions. It appears that generally women express actions more frequently than men, and in particular express more positive valence actions. However, expressiveness is not greater in women for all negative valence actions and is dependent on the discrete emotional state.

Let the Avatar Brighten Your Smile: Effects of Enhancing Facial Expressions in Virtual Environments

Previous studies demonstrated the positive effects of smiling on interpersonal outcomes. The present research examined if enhancing one's smile in a virtual environment could lead to a more positive communication experience. In the current study, participants' facial expressions were tracked and mapped on a digital avatar during a real-time dyadic conversation. The avatar's smile was rendered such that it was either a slightly enhanced version or a veridical version of the participant's actual smile. Linguistic analyses using the Linguistic Inquiry Word Count (LIWC) revealed that participants who communicated with each other via avatars that exhibited enhanced smiles used more positive words to describe their interaction experience compared to those who communicated via avatars that displayed smiling behavior reflecting the participants' actual smiles. In addition, self-report measures showed that participants in the 'enhanced smile' condition felt more positive affect after the conversation and experienced stronger social presence compared to the 'normal smile' condition. These results are particularly striking when considering the fact that most participants (>90%) were unable to detect the smiling manipulation. This is the first study to demonstrate the positive effects of transforming unacquainted individuals' actual smiling behavior during a real-time avatar-networked conversation.

Facial Feedback and Social Input: Effects on Laughter and Enjoyment in Children with Autism Spectrum Disorders

Both social input and facial feedback appear to be processed differently by individuals with autism spectrum disorder (ASD). We tested the effects of both of these types of input on laughter in children with ASD. Sensitivity to facial feedback was tested in 43 children with ASD, aged 8-14 years, and 43 typically developing children matched for mental age (6-14), in order to examine whether children with ASD use bodily feedback as an implicit source of information. Specifically, children were asked to view cartoons as they normally would (control condition), and while holding a pencil in their mouth forcing their smiling muscles into activation (feedback condition) while rating their enjoyment of the cartoons. The authors also explored the effects of social input in children with ASD by investigating whether the presence of a caregiver or friend (companion condition), or the presence of a laugh track superimposed upon the cartoon (laugh track condition) increased the children's self-rated enjoyment of cartoons or the amount of positive affect they displayed. Results showed that the group with ASD was less affected by all three experimental conditions, but also that group differences seemed to have been driven by one specific symptom of ASD: restricted range of affect. The strong relationship between restricted affect and insensitivity to facial feedback found in this study sheds light on the implications of restricted affect for social development in ASD.

Familiarity Breeds Attraction: Effects of Exposure on the Attractiveness of Typical and Distinctive Faces

Several studies have shown that facial attractiveness is positively correlated with both familiarity and typicality. Here we manipulated the familiarity of typical and distinctive faces to measure the effect on attractiveness. In our first experiment, we collected ratings of attractiveness, distinctiveness, and familiarity using three different groups of participants. Our stimuli included 84 images of female faces, presented in a full-face view. We replicated the finding that attractiveness ratings negatively correlate with distinctiveness ratings. In addition, we showed that attractiveness ratings were positively correlated with familiarity ratings. In our second experiment, we demonstrated that increasing exposure to faces increases their attractiveness, although there was no differential effect of exposure on typical and distinctive faces. Our results suggest that episodic familiarity affects attractiveness ratings independently of general or structural familiarity. The implications of our findings for the ‘face-space’ model are discussed.

Physiotherapy Rehabilitation of the Smile after Long-Term Facial Nerve Palsy using Video Self-Modeling and Implementation Intentions

OBJECTIVES: To improve smiling after long-term facial nerve palsy (FNP). Physiotherapy rehabilitation of an adapted (more symmetrical) smile was investigated in FNP subjects 1 year post-onset, using video self-modeling (video replay of only best adapted smiles) and implementation intentions (preplanning adapted smiles for specific situations).

STUDY DESIGN AND SETTING: Prospective, blinded clinical trial. Facial-Nerve-Palsy Clinic.

RESULTS: After video self-modeling: 1) reaction time (RT) to initiation of adapted smiles became 224 ms faster whereas RT for everyday (asymmetrical) smiles became 153 ms slower; 2) adapted smiles were completed 544 ms faster; 3) adapted smiles had higher overall quality, movement control, and symmetry ratings; and 4) Facial Disability Index scores also improved. Implementation intentions after video self-modeling ensured transfer of adapted smile to everyday situations.

CONCLUSION: Following intervention the smile improved, with significant changes in availability, execution speed, and quality.

SIGNIFICANCE: This study supports these rehabilitation techniques to maximize quality of smiling following FNP.

EBM rating: B-2b

The Influence of Facial Feedback on Race Bias

Two studies were conducted to examine whether facial feedback can modulate implicit racial bias as assessed by the Implicit Association Test (IAT). Participants were surreptitiously induced to smile through holding a pencil in their mouth while viewing photographs of unfamiliar Black or White males or performed no somatic configuration while viewing the photographs (Study 1 only). All participants then completed the IAT with no facial manipulation. Results revealed a spreading attitude effect, with significantly less racial bias against Blacks among participants surreptitiously induced to smile during prior viewing of Black faces than among participants surreptitiously induced to smile during prior viewing of White faces.

Confusing acceptance and mere politeness: Depression and sensitivity to Duchenne smiles

BACKGROUND AND OBJECTIVES

Whereas the association between depression and the perception of emotions has been widely studied, only few studies have examined the association between depression and the ability to discriminate genuine (Duchenne) from fake (non-Duchenne) smiles. The present study examined this by comparing currently depressed, previously depressed, and healthy control individuals. Guided by recent theory, the present study also investigated the effect of depression recurrence on smile identification.

METHODS

Participants were 27 healthy controls, 33 with past depression (51% with recurrent depression), and 22 with current depression (77% with recurrent depression). Participants were presented with a series of 20 videos depicting smiling individuals, and were asked to indicate whether each smile was genuine or fake.

RESULTS

Having (or having had) a first episode of depression was associated with more mistakes in categorizing smiles as genuine or fake compared to having recurrent depression or to having no history of depression.

LIMITATIONS

Cross sectional design and a (relatively) small sample size.

CONCLUSIONS

Our results show that an impaired ability to differentiate between markers of affiliation and politeness is specific to first-episode depression, even after the depression has remitted.

The Embodied Attunement of Therapists and a Couple within Dialogical Psychotherapy: An Introduction to the Relational Mind Research Project

In dialogical practice, therapists seek to respond to the utterances of clients by including in their own response what the client said. No research so far exists on how, in dialogs, therapists and clients attune themselves to each other with their entire bodies. The research program The Relational Mind is the first to look at dialog in terms of both the outer and the inner dialogs of participants (clients and therapists), observed in parallel with autonomic nervous system (ANS) measurements. In the ANS, the response occurs immediately, even before conscious thought, making it possible to follow how participants in a multiactor dialog synchronize their reactions and attune themselves to each other. The couple therapy case presented in this article demonstrates how attunement is often not a simple "all at the same time" phenomenon, but rather a complex, dyadic or triadic phenomenon which changes over time. In the case presented, there was strong synchrony between one therapist and one client in terms of their arousal level throughout the therapy session. It was also observed that high stress could occur when someone else was talking about something related to the participant, or if that person mirrored the participant's words. Overall, it seems that in evaluating the rhythmic attunement between therapists and clients it is not enough to look at single variables; instead, integrated information from several channels is needed when one is seeking to make sense of the embodiment.

Mood congruity and episodic memory in young children

Although mood congruity effects on episodic memory have been reported extensively in adults, they have not been reported for children younger than 10 years. The current research investigated mood congruity effects in story recall using an embodied approach to mood induction involving a facial manipulation task with 3- and 4-year-old children. Participants held a chopstick or a popsicle stick in their mouths in a way to either produce or inhibit a smile while they listened to a story featuring happy events for a happy character and sad events for a sad character. Children's mood ratings before and after mood induction indicated that mood became more positive in the smile condition, with no change in the no smile condition. Children in the smile condition, but not in the no smile condition, remembered more about the happy character than the sad character in the story. These results extend mood congruity effects to 3- and 4-year olds, suggesting that at this age representations of emotion interact with basic memory processes. Moreover, the efficacy of reenactment of sensorimotor components of emotion in modifying mood is consistent with embodied representation of emotion during early childhood.

Oral Health Problems and Smile Avoidance Among Preschool Children

PURPOSE

The purpose of this study was to evaluate the influence of oral health problems on the avoidance of smiling among preschool children.

METHODS

A cross-sectional study was conducted with 835 three- to five-year-old children. Caregivers answered the Brazilian version of the Early Childhood Oral Health Impact Scale and a questionnaire on sociodemographic data. The avoided smiling item of the child section was the dependent variable. An oral examination was performed by three dentists who had undergone calibration exercises (Kappa=0.85 to 0.90). Poisson hierarchical regression (PR) was used to determine the significance of associations between the avoidance of smiling and oral health problems (α equals five percent). The multivariate model was constructed with two hierarchical levels: (1) sociodemographic aspects and (2) oral health problems.

RESULTS

Seven percent of the children avoided smiling, which was associated with cavitated lesions and five years of age (PR=5.070; 95 percent confidence interval=1.57 to 16.39).

CONCLUSIONS

Age and cavitated lesions on the maxillary incisors were determinant factors for the avoidance of smiling.

Short alleles, bigger smiles? The effect of 5-HTTLPR on positive emotional expressions

The present research examined the effect of the 5-HTTLPR polymorphism in the serotonin transporter gene on objectively coded positive emotional expressions (i.e., laughing and smiling behavior objectively coded using the Facial Action Coding System). Three studies with independent samples of participants were conducted. Study 1 examined young adults watching still cartoons. Study 2 examined young, middle-aged, and older adults watching a thematically ambiguous yet subtly amusing film clip. Study 3 examined middle-aged and older spouses discussing an area of marital conflict (that typically produces both positive and negative emotion). Aggregating data across studies, results showed that the short allele of 5-HTTLPR predicted heightened positive emotional expressions. Results remained stable when controlling for age, gender, ethnicity, and depressive symptoms. These findings are consistent with the notion that the short allele of 5-HTTLPR functions as an emotion amplifier, which may confer heightened susceptibility to environmental conditions.

Social looking, social referencing and humor perception in 6- and-12-month-old infants

Social referencing refers to infants' use of caregivers as emotional referents in ambiguous situations (Walden, 1993). Studies of social referencing typically require ambulation, thereby over-looking younger, non-ambulatory infants (i.e., ≤8-months) and resulting in a widespread assumption that young infants do not employ this strategy. Using a novel approach that does not require mobility, we found that when parents provided unsolicited affective cues during an ambiguous-absurd (i.e., humorous) event, 6-month-olds employ one component of social referencing, social looking Additionally, 6-month-olds who did not laugh at the event were significantly more likely to look toward parents than their counterparts who found the event funny. Sequential analyses revealed that, following a reference to a smiling parent, 6-month olds were more likely to smile at the parent, but by 12 months were more likely to smile at the event suggesting that older infants are influenced by parental affect in humorous situations. The developmental implications of these findings are discussed, as well as the usefulness of studying humor for understanding important developmental phenomena.

Change in Oral Impacts on Daily Performances (OIDP) with increasing age: testing the evaluative properties of the OIDP frequency inventory using prospective data from Norway and Sweden

BACKGROUND

Oral health-related quality of life, OHRQoL, among elderly is an important concern for the health and welfare policy in Norway and Sweden. The aim of the study was to assess reproducibility, longitudinal validity and responsiveness of the OIDP frequency score. Whether the temporal relationship between tooth loss and OIDP varied by country of residence was also investigated.

METHODS

In 2007 and 2012, all inhabitants born in 1942 in three and two counties of Norway and Sweden were invited to participate in a self-administered questionnaire survey. In Norway the response rates were 58.0% (4211/7248) and 54.5% (3733/6841) in 2007 and 2012. Corresponding figures in Sweden were 73.1% (6078/8313) and 72.2% (5697/7889), respectively.

RESULTS

Reproducibility of the OIDP in terms of intra-class correlation coefficient (ICC) was 0.73 in Norway and 0.77 in Sweden. The mean change scores for OIDP were predominantly negative among those who worsened, zero in those who did not change and positive in participants who improved change scores of the reference variables; self-reported oral health and tooth loss. General Linear Models (GLM) repeated measures revealed significant interactions between OIDP and change scores of the reference variables (p < 0.05). Stratified analysis revealed that the mean OIDP frequency score worsened in participants who became dissatisfied- and improved in participants who became satisfied with oral health. Compared to participants who maintained all teeth, those who lost teeth were more likely to experience improvement and worsening of OIDP across both countries. The two-way interaction between country and tooth loss was not statistically significant.

CONCLUSIONS

Changes in OIDP at the individual level were more pronounced than the percentage distribution of OIDP at each point in time would suggest. The OIDP frequency score showed promising evaluative properties in terms of acceptable longitudinal validity, responsiveness and reproducibility among older people in Norway and Sweden. This suggests that the OIDP instrument is able to detect change in the oral health status that occurred over the 5 year period investigated. Norwegian elderly were more likely to report worsening in OIDP than their Swedish counterparts. Disease prevention should be at focus when formulating the health policy for older people.

[Orthognathic surgery in adults: state of the art]

The objective of orthognathic surgery is the repositioning of the osseous bases of the jaws. Its consequences are both aesthetic and functional. As adults are increasingly concerned with appearance, orthognathic surgery is today, more than ever, a close collaboration between the orthodontist, surgeon and general dentist. The whole team must be capable of coordinating its approach with an aesthetic objective. For the surgeon, a perfect knowledge of complementary techniques (rhinoplasty, bone grafts, plastic surgery of the face, lipostructure or fillers) makes orthognathic surgery a completely separate surgical speciality. The aim of this article is to establish the philosophy underlying this type of treatment and define relevant fundamental aspects. We propose an esthetic "extra-oral" clinical approach not focused on occlusal anomalies but on classification of tooth positional abnormalities in the smile and the therapeutic options that we have for placing teeth in correct positions in the smile.

When a smile becomes a fist: the perception of facial and bodily expressions of emotion in violent offenders

Previous reports have suggested an enhancement of facial expression recognition in women as compared to men. It has also been suggested that men versus women have a greater attentional bias towards angry cues. Research has shown that facial expression recognition impairments and attentional biases towards anger are enhanced in violent criminal male offenders. Bodily expressions of anger form a more direct physical threat as compared to facial expressions. In four experiments, we tested how 29 imprisoned aggressive male offenders perceive body expressions by other males. The performance of all participants in a matching-to-sample task dropped significantly when the distracting image showed an angry posture. Violent offenders misjudged fearful body movements as expressing anger significantly more often than the control group. When violent offenders were asked to categorize facial expressions and ignore the simultaneously presented congruent or incongruent posture, they performed worse than the control group, specifically, when a smile was combined with an aggressive posture. Finally, violent offenders showed a greater congruency effect than controls when viewing postures as part of an emotionally congruent social scene and did not perform above chance when categorizing a happy posture presented in a fight scene. The results suggest that violent offenders have difficulties in processing emotional incongruence when aggressive stimuli are involved and a possible bias towards aggressive body language.

The relation between oral impacts on daily performances and perceived clinical oral conditions in primary school children in the Ugu District, Kwazulu Natal, South Africa

Few studies have related the common oral health related quality of life (OHRQoL) impacts in children to perceived causes.

OBJECTIVE

To assess the prevalence, extent and intensity of oral impacts in relation to perceived clinical conditions in primary school children in South Africa.

METHODS

Cross-sectional study of a random sample of children attending 26 schools. The Child Oral Impacts on Daily Performance (Child-OIDP) index, administered through individual face-to-face interviews, was used.

RESULTS

Sixty four per cent of the sample of 2610 children aged 11-13 years participated. 36.2% reported having one or more oral impacts on daily performances, 61.1% having one affected and 63.1% reporting impacts were of "very little" or "little" intensity. Eating was most commonly affected (22.8%) mainly related to decay (40%), followed by cleaning the teeth (17.2%). Toothache impacted on speaking (32.5%), whereas toothache (35.7%) and tooth decay (28.6%) influenced studying. Position of teeth impacted on smiling (19.2%), social (8.5%) and speaking (7.5%). Bleeding gums" and "tooth colour" affected cleaning teeth and smiling respectively.

CONCLUSIONS

The prevalence of oral impacts on the quality of life in this South African population of schoolchildren was relatively modest, as was the extent and intensity of the impacts, affecting mainly eating, cleaning of teeth and smiling.

Smiles as signals of lower status in football players and fashion models: evidence that smiles are associated with lower dominance and lower prestige

Across four studies, the current paper demonstrates that smiles are associated with lower social status. Moreover, the association between smiles and lower status appears in the psychology of observers and generalizes across two forms of status: prestige and dominance. In the first study, faces of fashion models representing less prestigious apparel brands were found to be more similar to a canonical smile display than the faces of models representing more prestigious apparel brands. In a second study, after being experimentally primed with either high or low prestige fashion narratives, participants in the low prestige condition were more likely to perceive smiles in a series of photographs depicting smiling and non-smiling faces. A third study of football player photographs revealed that the faces of less dominant (smaller) football players were more similar to the canonical smile display than the faces of their physically larger counterparts. Using the same football player photographs, a fourth study found that smiling was a more reliable indicator of perceived status-relevant personality traits than perceptions of the football players' physical sizes inferred from the photographs.

Withholding response in the face of a smile: age-related differences in prefrontal sensitivity to Nogo cues following happy and angry faces

The modulation of control processes by stimulus salience, as well as associated neural activation, changes over development. We investigated age-related differences in the influence of facial emotion on brain activation when an action had to be withheld, focusing on a developmental period characterized by rapid social-emotional and cognitive change. Groups of kindergarten and young school-aged children and a group of young adults performed a modified Go/Nogo task. Response cues were preceded by happy or angry faces. After controlling for task performance, left orbitofrontal regions discriminated trials with happy vs. angry faces in children but not in adults when a response was withheld, and this effect decreased parametrically with age group. Age-related changes in prefrontal responsiveness to facial expression were not observed when an action was required, nor did this region show age-related activation changes with the demand to withhold a response in general. Such results reveal age-related differences in prefrontal activation that are specific to stimulus valence and depend on the action required.

A cross-cultural comparison of the development of the social smile: a longitudinal study of maternal and infant imitation in 6- and 12-week-old infants

Social smiling is universally regarded as being an infant's first facial expression of pleasure. Underlying co-constructivist emotion theories are the assumptions that the emergence of social smiling is bound to experiences of face-to-face interactions with caregivers and the impact of two developmental mechanisms--maternal and infant imitation. We analyzed mother-infant interactions from two different socio-cultural contexts and hypothesized that cross-cultural differences in face-to-face interactions determine the occurrence of both of these mechanisms and of the frequency of social smiling by 12-week-old infants. Twenty mother-infant dyads from a socio-cultural community with many face-to-face interactions (German families, Münster) were compared with 24 mother-infant dyads from a socio-cultural community with few such interactions (rural Nso families, Cameroon) when the infants were aged 6 and 12 weeks. When infants were 6 weeks old, mothers and their infants from both cultural communities smiled at each other for similar (albeit very short) amounts of time and used imitated each other's smiling similarly rarely. In contrast, when infants were 12 weeks old, mothers and their infants from Münster smiled at and imitated each other more often than did Nso mothers and their infants.

Anterior dental alignment and smile: perception and sensations in a sample of 8- to 10-year-old children and their parents

AIM

To describe the perception and sensations that dental alignment and smile determine in a sample of 180 children aged between 8 and 10 years, to assess whether there is a general trend in the classification of smiles, and to understand the influence of background attractiveness and sexual traits on the judgment of smile in the sample of children and 150 parents.

METHODS

We employed visual media showing a smile in four different arrangements (ideal incisal occlusion [N], median diastema [D], incisal crowding [A], and protruding incisors [P), in both a dynamic and static way, with and without background attractiveness.

RESULTS

Trends were found among responses to the four classes of videos and photographs: The boy's smile gained a higher score than the girl's smile. In both the boy and girl presentations, there was an important preference to the following sequence of smiles: N, D, A, and P. Furthermore, the girl photographs showed no relevant difference between A and D.

CONCLUSION

This study showed that there are no different perceptions and sensations due to the variation of dental alignment. There is a general trend in the classification of smiles according to dental alignment. Background attractiveness and sexual traits influenced the judgment of smile.

Fears and concerns of individuals contemplating esthetic restorative dentistry

Questionnaires that focus on the fear of dental treatment typically include a narrow list of previous treatment-related factors. By omitting items concerned with psychologic, emotional, and interpersonal traits that impact treatment, practitioners often fail to gain additional valuable information on related anxiety issues. This study was undertaken to identify previously unrecognized or poorly discussed sources of fear and anxiety in patients seeking esthetic dental treatment. The Esthetic Clinic at Tufts University School of Dental Medicine recruited 62 participants who were asked to score their level of anxieties and concerns based on 24 different items on a 0 to 5 Likert scale. In addition, age, gender, and type of procedure in consideration were the only other variables recorded. The item that elicited the highest level of anxiety was "not feeling happy with my new smile." Thirty-eight respondents (61.3%) said they feel "markedly anxious"or "severely anxious" or answered "avoid completely." Concerns "that the outcome might look false and unnatural" or "that the dentist might not redo it if I am not satisfied with the outcome" both received 37 out of 62 (59.7%) similar responses. These results suggest obstacles to treatment exist not only in areas typically investigated but also in factors rarely discussed during the patient-practitioner encounter. The practitioner needs to consider a broader range of issues when addressing the patient's concerns.

Development of an Orofacial Esthetic Scale in prosthodontic patients

PURPOSE

Despite the interest and need to assess orofacial esthetics in prosthodontic patients, few self-reporting instruments are available to measure this construct, and none describe how prosthodontic patients perceive the appearance of their face, mouth, teeth, and dentures. The development of the Orofacial Esthetic Scale (OES) is reported in this article, in particular its conceptual framework, how questionnaire items were generated, and the scale's measurement model.

MATERIALS AND METHODS

After test conceptualization, the authors solicited esthetic concerns from 17 prosthodontic patients by asking them to evaluate their own photographs. A focus group of 8 dental professionals reduced the initial number of concerns/items and decided on an item response format. Pilot testing in 9 subjects generated the final instrument, the OES. Exploratory factor analysis was performed to investigate OES dimensionality and item analysis to investigate item difficulty and discrimination in 119 subjects.

RESULTS

Prosthodontic patients generated an initial 28 esthetic concerns. These items were reduced to 8 preliminary representative items that were subsequently confirmed during pilot testing. Analysis supported 8 items assessing appearance: face, profile, mouth, tooth alignment, tooth shape, tooth color, gums, and overall impression, measured on an 11-point numeric rating scale (0 = very dissatisfied, 10 = very satisfied). Exploratory factor analysis found only 1 factor and high positive loadings for all items (.73 to .94) on the first factor, supporting the unidimensionality of the OES.

CONCLUSIONS

The OES, developed especially for prosthodontic patients, is a brief questionnaire that assesses orofacial esthetic impacts.

The impact of early-in-life periodontal infection on the smiles of children: a worldwide view

Little attention has been directed toward evidence that an early-in-life oral infection with the potential to reach epidemic proportions is threatening the health of youths throughout world. Health professionals and the public seem unaware that the silent disease process of early-in-life periodontal infection is targeting thousands of children and young adults, their smiles, and, consequently, their emotional and psychologic lives. Yet, the literature is replete with reports that many periodontopathic microorganisms are multiplying at an alarming rate with a serious impact on youths in many cities, towns, and villages throughout the globe. However, clinical measurement of reported periodontal disease has been fraught with problems that have confused and clouded messages to policymakers in government and health professionals in treatment settings. The aim of this article is to help raise the level of awareness so that those who have the power and knowledge can appropriately address the suffering of the youngest members of societies.

Anticipatory smiling: linking early affective communication and social outcome

In anticipatory smiles, infants appear to communicate pre-existing positive affect by smiling at an object and then turning the smile toward an adult. We report two studies in which the precursors, development, and consequences of anticipatory smiling were investigated. Study 1 revealed a positive correlation between infant smiling at 6 months and the level of anticipatory smiling at 8 and 10 months during joint attention episodes, as well as a positive correlation between anticipatory smiling and parent-rated social expressivity scores at 30 months. Study 2 confirmed a developmental increase in the number of infants using anticipatory smiles between 9 and 12 months that had been initially documented in the Study 1 sample [Venezia, M., Messinger, D. S., Thorp, D., & Mundy, P. (2004). The development of anticipatory smiling. Infancy, 6(3), 397-406]. Additionally, anticipatory smiling at 9 months positively predicted parent-rated social competence scores at 30 months. Findings are discussed with regard to the importance of anticipatory smiling in early socioemotional development.

Smile attractiveness. Self-perception and influence on personality

OBJECTIVES

To investigate self-perception of smile attractiveness and to determine the role of smile line and other aspects correlated with smile attractiveness and their influence on personality traits.

SUBJECTS AND METHODS

Participants judged their smile attractiveness with a patient-specific questionnaire. The questionnaire contained a spontaneous smiling photograph of the participant. Objective smile-line height was measured using a digital videographic method for smile analysis. Personality was assessed with the Dutch Personality Index.

RESULTS

Cronbach's alpha for the smile judgment questionnaire was .77. The results showed that size of teeth, visibility of teeth, and upper lip position were critical factors in self-perception of smile attractiveness (social dimension). Color of teeth and gingival display were critical factors in satisfaction with smile appearance (individual dimension). Participants, smiling with teeth entirely displayed and some gingival display (two to four millimeters), perceived their smile line as most esthetic. Smiles with disproportional gingival display were judged negatively and correlated with the personality characteristics of neuroticism and self-esteem. Visibility and position of teeth correlated with dominance.

CONCLUSION

The results of this research underpin the psychosocial importance and the dental significance of an attractive smile.