The psychosocial impact of dental aesthetics and experiencing discrimination at a Peruvian public hospital among outpatients

Abstract

Aim To evaluate the association between outpatient’s perceived psychosocial impact of dental aesthetics and experiencing discrimination at a Peruvian public hospital. Material and methods Cross-sectional study in a Peruvian public hospital, where 207 outpatients (18–30 years old) were surveyed. We asked participants about self-reported experiences of discrimination in the last six months at a Peruvian public hospital using a question from the Peruvian National Household Survey on Living Conditions and Poverty (ENAHO) 2017. We also measured the perceived psychosocial impact of dental aesthetics with the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Additionally, we evaluated age, sex, ethnicity, education, income, and reason for being discriminated against. Association was assessed with Poisson regression using a robust estimator of variance and reporting prevalence ratios with 95% confidence intervals in crude and adjusted models. Results About two out of every five participants having experienced discrimination at a Peruvian public hospital in the last six months. On our adjusted estimates, we found discrimination to be positively associated with two components of the psychosocial impact of dental aesthetics, which were social impact (PR 1.02, 95% CI 1.00–1.04) and the psychological impact (PR 1.07, 95% CI 1.04–1.10). Conversely, dental self-confidence (PR 0.96, 95% CI 0.93–0.98) was negatively associated with discrimination. Conclusions The perceived psychosocial impact of dental aesthetics is associated with experiencing discrimination among outpatients from a Peruvian public hospital. We advocate for structural changes to address discrimination in healthcare spaces by corresponding governmental authorities.

Visagism in Dentistry: Psychosocial approach of smile esthetics: A literature review

“…The aim of this statement is not to standardize patterns or stereotypes about appearance, but to clarify the importance of aesthetics in everyday life and the consequences it can have. Based on this, Carbajal and Klages (3,4) consider it transcendental to reflect that the way a person looks physically has a direct influence on his quality of life, precisely because of the relationship that his appearance has with his self-esteem and the probability of success or failure during social contact. Carbajal (3) also indicates that people considered attractive have better opportunities in society than those who are not, due to stereotypes that relate beauty to kindness, class and ability.…”

“…Also, cultural factors and even media such as social media and television are of utmost importance, as it makes available to patients images and perceptions of the "ideal" esthetic, which constantly changes its parameters. In fact, it is common in the dental office for patients to bring reference images with them (especially of celebrities) to tell the professional what their expectations of treatment are (3,13).…”

“…On these grounds, a study was conducted in a public hospital in Peru, which indicates that the appearance of the smile causes concern in patients on several occasions, as well as could lead to situations of discrimination by the social environment in which they are involved and, in a large percentage, within the health centers they go to, both aspects being increased by the opinion of health professionals and by the ideals imposed in images of "perfect smiles" found in health institutions and/or published in social networks. (3,12) However, it is worth mentioning that a person's self-confidence and security will determine the perception he/she has of discrimination, since a person with low self-esteem may feel discriminated more frequently than one whose self-esteem is higher. (4) It should be clarified that discrimination should not be justified or romanticized under any circumstances, since it is categorized as a violation of Human Rights and a crime according to the Ecuadorian COIP and Constitution (Art.…”

“…(2) Therefore, this doctrine has become paramount to establish the reason why patients seek treatments that improve their esthetics, such as orthodontics or smile designs, and also to plan the procedure that solves that need. The way a person sees him/herself and the image he/she projects to others can determine how successful he/she will be in relating to his/her environment, which can have positive consequences and result in integration, or negative ones, such as discrimination (3,4).…”