ORIGINAL ARTICLE Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children Emeria A. Mugonzibwa, DDS, a Anne M. Kuijpers-Jagtman, DDS, PhD, b Martin A. Van ’t Hof, PhD, c and Emil N. Kikwilu, DDS, M Dent d Dar es Salaam, Tanzania, and Nijmegen, The Netherlands The aim of this study was to assess the opinions of Tanzanian children on dental attractiveness and their perceptions of orthodontic treatment need in relation to their own dental attractiveness as measured by the aesthetic component (AC) of the index of orthodontic treatment need (IOTN). In a random sample of 386 school children (48% boys, 52% girls), aged 9 to 18 years, the subjective need was assessed by using a prestructured questionnaire, and attractiveness was scored by using 18 intraoral frontal photographs. Orthodontic treatment need was measured with the IOTN, and 11% of the children definitely needed orthodontic treatment (grades 8-10 of the AC with 4-5 of the dental health component [DHC]). The AC indicated that 11% of the children needed orthodontic treatment, whereas the DHC indicated 22%. Although 38% of the children said they needed treatment, 33% and 31% were unhappy with the arrangement and the appearance of their teeth, respectively. Most children (85%) recognized well-aligned teeth as important for overall facial appearance. Photographs showing severe deviations including crowding were regarded as the most unattractive, with older children tending to dislike them the most (P  .0005). This suggests that, from the children’s point of view, grades 8-10 of the AC and 4-5 of the DHC could be given the first priority when considering an orthodontic treatment policy in Tanzania. (Am J Orthod Dentofacial Orthop 2004;125:426-34) W ell-aligned teeth and a pleasing smile reflect positive status at all social levels, and irreg- ular or protruding teeth reflect negative status. 1,2 In each race and sex, some balance of facial features is viewed by the majority as pleasing to the eye. 3 The perception of beauty not only is an individual preference that could be influenced by training, but also might have cultural and ethnic biases. 4-6 Only a few studies have addressed the perception of malocclusion in the African cultural context. Otuyemi et al 7 showed that the perceptions of dental esthetics of Nigerian students were very similar to those of American groups. The scientific literature in all aspects of craniofacial biology and orthodontics is primarily based on white populations. However, population norms derived from white people might not be valid and accurate for other ethnic groups, and applying them to other populations could lead to clinical decisions that cause undesired and unexpected outcomes. Although dissatisfaction with dental appearance is broadly related to the severity of the occlusal irregu- larities, 1,8,9 there are differences in the recognition and evaluation of the dental features. 10 Some studies have reported that perceptions of malocclusion do not differ among various racial groups and cultural circumstanc- es, 8,11-13 but African people living in Africa can have different malocclusion perceptions compared with other societies. For example, spacing (especially me- dian diastema) is significantly disliked in white cul- tures, 14,15 but it is considered desirable and a sign of beauty in many African cultures. Between 18% and 51% of Tanzanian children have been reported to have some type of dental irregularity in the deciduous and permanent dentitions, 16-18 It is generally understood that the evaluation of malocclu- sion must consider morphological and functional fac- tors, as well as esthetic and psychological ones. 19,20 However, not all potential patients with dental irregu- a Senior lecturer, Department of Preventive and Community Dentistry, Faculty of Dentistry, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. b Professor and chair, Department of Orthodontics and Oral Biology, University Medical Center, Nijmegen, The Netherlands. c Biostatistician, Department of Cariology and Preventive Dentistry, University Medical Center, Nijmegen, The Netherlands. d Head and senior lecturer, Department of Preventive and Community Dentistry, Faculty of Dentistry, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. Reprint requests to: A. M. Kuijpers-Jagtman, DDS, PhD, Department of Orthodontics and Oral Biology, University Medical Center, University of Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands; e-mail, a.kuijpers-jagtman@dent.umcn.nl. Submitted, February 2003; revised and accepted, November 2003. 0889-5406/$30.00 Copyright © 2004 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2003.11.002 426