Comparison of subjective orofacial esthetic perception and objective malocclusion severity: a cross-sectional study

This cross-sectional study aimed to compare subjective orofacial esthetic perception assessed using the Orofacial Esthetic Scale (OES) with objective malocclusion severity assessed using the Dental Aesthetic Index (DAI), and to identify demographic and occlusal factors associated with OES scores. A total of 263 participants (163 females and 100 males) were included. OES summary scores were calculated from seven items (range, 0–70), with higher scores indicating greater esthetic satisfaction. DAI scores were categorized according to established malocclusion severity thresholds. Associations with demographic characteristics were examined using appropriate non-parametric and categorical tests, the relationship between continuous DAI and OES scores was assessed using Spearman correlation, and factors associated with OES scores were evaluated using univariable and multivariable linear regression with HC3 robust standard errors. DAI category distribution was significantly associated with education level ( p = 0.010), but not with gender ( p = 0.235) or age group ( p = 0.080). Female participants had lower OES scores than males in the unadjusted comparison (median 44.0 vs 47.0; p = 0.034), whereas OES scores did not differ significantly across education levels ( p = 0.436). DAI and OES scores showed a moderate inverse correlation (Spearman’s ρ = − 0.407, p < 0.001). In the adjusted model, largest anterior maxillary irregularity (β = − 1.690, p < 0.001), maxillary overjet (β = − 1.337, p = 0.005), and mandibular overjet (β = − 3.182, p = 0.002) remained independently associated with lower OES scores, whereas gender, age, and education level were not independently associated with subjective esthetic satisfaction. These findings indicate that greater objective malocclusion severity is associated with poorer self-perceived orofacial esthetics and support incorporating patient-reported esthetic assessments alongside normative clinical indices in orthodontic evaluation and treatment planning.