Smile Aesthetics Satisfaction Scale: development and validation of a new brief five-item measure of satisfaction with smile aesthetics in adults and the elderly

Abstract

To create and validate a brief questionnaire designed for the assessment of satisfaction with smile aesthetics and to test its efficiency as a patient-centred outcome measure of aesthetic interventions in dentistry. A team of three specialists - two from prosthodontics and one psychologist - used a self-evaluation scale consisting of five elements in order to rate self-perceived smile aesthetics. A total of 671 subjects (63% female), 18-86years of age, were included in the investigation. The internal consistency, validity and stability of the questionnaire, along with the responsiveness induced by the tooth-whitening procedure, were evaluated. The relationship between self-perceived satisfaction with the smile aesthetics and the clinical status of the dentition was assessed. The questionnaire had one dimension accounting for 64.3% of variance and showed a high level of reliability (Cronbach α=0.859). It measured a construct similar to concern with tooth appearance and the desire to improve this appearance (r=-0.403 and r= -0.353, respectively; P<0.001). High test-retest reliability was demonstrated (intraclass correlation coefficient=0.985). The questionnaire was able to detect an increase in satisfaction with smile aesthetics as a result of the tooth-whitening procedure (P=0.016). Clinical predictors of greater satisfaction with smile aesthetics were greater tooth display when smiling, decreased chroma and the absence of gingivitis, as well as absence of crowded, fractured and restored teeth in the anterior segment. A new questionnaire, titled the Smile Aesthetics Satisfaction Scale (SASS), showed good psychometric properties and its use can be recommended.