Abstract
This cross-sectional study aimed to assess children’s aesthetic and social perceptions of anterior open bite (AOB). The sample comprised 272 evaluators, divided into three age groups: 4–6, 7–9, and 10–12 years old. Artificial intelligence was used to generate the children’s facial images, and Adobe Photoshop was used to modify their smiles, obtaining paired images of AOB and normal overbite. Participants completed a questionnaire that included images of children in their age range. An illustrated 5-point Likert scale was used to assess aesthetic rating. Social and aesthetic perceptions were evaluated using objective questions. Independent t-tests and chi-square were applied for data analysis. The aesthetic rating differed significantly, with smiles showing normal overbite judged as statistically significantly more attractive across all age groups. Among the objective responses, only the questions related to aesthetic perception differed between the occlusion statuses depicted. The social judgments were similar between them. An anterior open bite showed a negative impact on the aesthetic perception of children aged 4 to 12 years. The findings suggest that during counseling about the importance of discontinuing deleterious habits, professionals may present smiling photographs of children with and without AOB to reinforce the aesthetic benefits of stopping those habits.
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Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
References
Al-Bitar, Z. B. et al. Relationship between discrimination, personality traits, and dentofacial features among schoolchildren in Jordan. Am. J. Orthod. Dentofac. Orthop. 167, 648–659 (2025).
Henson, S. T. et al. Influence of dental esthetics on social perceptions of adolescents judged by peers. Am. J. Orthod. Dentofac. Orthop. 140, 389–395 (2011).
Nabarrette, M., Brunheroto, J., Dos Santos, P. R. & de Vedovello, C. M. M. Esthetic impact of malocclusions in the anterior segment on children in the mixed dentition. Am. J. Orthod. Dentofac. Orthop. 159, 53–58 (2021).
Pithon, M. M. et al. Influence of malocclusion on social perceptions of adolescents at public and private schools. Eur. Arch. Paediatr. Dent. 15, 37–43 (2014).
Pithon, M. M. et al. Oral health-related quality of life of children before, during, and after anterior open bite correction: A single-blinded randomized controlled trial. Am. J. Orthod. Dentofac. Orthop. 156, 303–311 (2019).
Shaw, W. C. The influence of children’s dentofacial appearance on their social attractiveness as judged by peers and lay adults. Am. J. Orthod. 79, 399–415 (1981).
Carneiro, D. P. A., Venezian, G. C., Valdrighi, H. C., de Castro Meneghim, M. & Vedovello, S. A. S. Esthetic impact of maxillary midline diastema and mandibular crowding in children in the mixed dentition. Am. J. Orthod. Dentofac. Orthop. 161, 390–395 (2022).
Kragt, L., Tiemeier, H., Wolvius, E. B. & Ongkosuwito, E. M. Measuring oral health-related quality of life in orthodontic patients with a short version of the Child Oral Health Impact Profile (COHIP). J. Public. Health Dent. 76, 105–112 (2016).
Kragt, L., Wolvius, E. B., Jaddoe, V. W. V., Tiemeier, H. & Ongkosuwito, E. M. Influence of self-esteem on perceived orthodontic treatment need and oral health-related quality of life in children: the Generation R Study. Eur. J. Orthod. 40, 254–261 (2018).
Maia, P. R. M. et al. Relationship between dentofacial features and bullying in school children. Pediatr. Dent. 46, 99–107 (2024).
Rossini, G. et al. Children’s perceptions of smile esthetics and their influence on social judgment. Angle Orthod. 86, 1050–1055 (2016).
Seehra, J., Fleming, P. S., Newton, T. & DiBiase, A. T. Bullying in orthodontic patients and its relationship to malocclusion,self-esteem and oral health-related quality of life. J. Orthod. 38, 247–256 (2011). quiz 294.
Dion, K. K. Young children’s stereotyping of facial attractiveness. Dev. Psychol. 9, 183–188 (1973).
Prado, L. H. et al. Adolescents’ perception of malocclusion, their motivations, and expectations concerning the orthodontic treatment. Is it all about attractiveness? A qualitative study. Am. J. Orthod. Dentofac. Orthop. 161, e345–e352 (2022).
de Sousa, R. V. et al. Prevalence and associated factors for the development of anterior open bite and posterior crossbite in the primary dentition. Braz Dent. J. 25, 336–342 (2014).
Gois, E. G. et al. Incidence of malocclusion between primary and mixed dentitions among Brazilian children. A 5-year longitudinal study. Angle Orthod. 82, 495–500 (2012).
Gomes, M. C. et al. Association between psychological factors, socio-demographic conditions, oral habits and anterior open bite in five-year-old children. Acta Odontol. Scand. 76, 553–558 (2018).
Assaf, D. D. C. et al. Association between malocclusion, tongue position and speech distortion in mixed-dentition schoolchildren: an epidemiological study. J. Appl. Oral Sci. 29, e20201005 (2021).
Martins-Junior, P. A., Marques, L. S. & Ramos-Jorge, M. L. Malocclusion: social, functional and emotional influence on children. J. Clin. Pediatr. Dent. 37, 103–108 (2012).
Olsen, J. A. & Inglehart, M. R. Malocclusions and perceptions of attractiveness, intelligence, and personality, and behavioral intentions. Am. J. Orthod. Dentofac. Orthop. 140, 669–679 (2011).
Verdecchia, F., Bee, M., Lombardo, L., Sgarbanti, C. & Gracco, A. Influence of anterior tooth alignment on peer perception in 8- to 10-year-old children. Eur. J. Orthod. 33, 155–160 (2011).
Massetti, T. et al. A didactic approach to presenting verbal and visual information to children participating in research protocols: the comic book informed assent. Clinics 73, e207 (2018).
Buchanan, H. & Niven, N. Validation of a Facial Image Scale to assess child dental anxiety. Int. J. Paediatr. Dent. 12, 47–52 (2002).
Howard, K. E. & Freeman, R. Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale. Int. J. Paediatr. Dent. 17, 281–288 (2007).
Mellor, D. & Moore, K. A. The use of Likert scales with children. J. Pediatr. Psychol. 39, 369–379 (2014).
Ouwehand, K., Kroef, A., Wong, J. & Paas, F. Measuring Cognitive Load: Are There More Valid Alternatives to Likert Rating Scales? Front. Educ. 6, Article702616 (2021).
Vingilis-Jaremko, L., Maurer, D. & Gao, X. The influence of averageness on judgments of facial attractiveness: no own-age or own-sex advantage among children attending single-sex schools. J. Exp. Child. Psychol. 120, 1–16 (2014).
Hamdan, A. M., Singh, V. & Rock, W. Perceptions of dental aesthetics of Class III and anterior open bite malocclusions: a comparison between 10- to 11-year-old schoolchildren and orthodontists. Angle Orthod. 82, 202–208 (2012).
Ma, F. & Xu, F. Children’s and adults’ judgments of facial trustworthiness: the relationship to facial attractiveness. Percept. Mot. Skills. 121, 179–198 (2015).
Pazzaglia, F. et al. Multiple dimensions of self-esteem and their relationship with health in adolescence. Int. J. Environ. Res. Public Health 17. (2020).
Chen, H., Lin, L., Chen, J. & Huang, F. Prevalence of malocclusion traits in primary dentition, 2010–2024: a systematic review. Healthcare (Basel) 12. (2024).
Matoula, S. & Pancherz, H. Skeletofacial morphology of attractive and nonattractive faces. Angle Orthod. 76, 204–210 (2006).
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E.F.: Methodology, Validation, Investigation, Project administration. K.M.S.F: Formal Analysis, Data Curation, Writing—Review & Editing, Visualization. P.C.: Investigation, Writing—Review & Editing. F.P.V.: Writing—Review & Editing. J.A.G.: Writing—Review & Editing. C.R.M.P.: Conceptualization, Methodology, Investigation, Writing—Original Draft, Supervision, Project administration.
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Faria, Ê., Freitas, K.M.S., Cotrin, P. et al. Peer aesthetic and social perceptions of anterior open bite in children. Sci Rep (2026). https://doi.org/10.1038/s41598-026-43275-4
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DOI: https://doi.org/10.1038/s41598-026-43275-4
