Social Media (SM) is a computer-based innovation that enables the people to share information, thoughts and ideas through virtual communities and platforms.  SM use is a grossly growing sensation of the 21st century where individuals receive news content and entertain themselves.1 Young people widely use SM for entertainment, building identity, improving social links and maintaining interpersonal connections .2 Studies suggested that a means can be provided via SM to overcome distance barriers, make it easier to make new connections and reconnect with old ones  thus  expanding and strengthening  offline networks and

interactions.3,4 The most well-known SM platforms are Facebook, YouTube, Twitter, P interest, LinkedIn, and Instagram, among a variety of others. Prior studies suggest that one’s own opinion of ones looks is a major feature that contributes a lot to self-esteem of young adults, more so in females.5 As the youth counts  on social media images as essential  means of self-presentation6, it heightens the significance of esthetics and form to the one self even more.7 This phenomenon applies to dental appearance as well as stated in a study by Fardouly et al8 where participants showed increased concern with dental and facial esthetics after they were exposed  to the ideal facial images on social media. Similarly, the findings of Meier and Gray9 conclude that a lack of satisfaction with facial and body image was more related to viewing pictures on SM rather than the entire period spent browsing social media websites. Literature  review on the use of SM against self-image concluded that because most of the studies do not discuss the activities consumers engage in, there are mixed outcomes, with some studies reporting a positive relation between SM usage and self-image, some showing negative relationship and others finding no relationship at all.10

Sufficient evidence exists regarding effect of social media on general wellbeing. However, very few studies evaluated the influence of social media on self-perception of an individual’s dental appearance with the results being inconclusive. Also, most of these studies are targeted at a younger population (adolescents) missing out on the effect this may have on older population. Thus, the need arises to determine the influence of social media on perceived dental appearance. Investigating which can help to identify the positive and negative aspects of social media and how it can be used for maximum benefit.

Objectives:

• To evaluate the impact of social media on perceived dental appearance.
• To determine the relationship between times spent on social media and its impact on perceived dental appearance.

Study design: Cross sectional study

Ethical consideration: The study was conducted after taking approval from the ethical committee of Gandhara University ( ) Data was collected in accordance with the guidelines and regulations of ethical committee. Objectives of the study were described and informed consent was taken from the participants.

Study setting: Online survey

Sampling technique: Convenient sampling

Data Collection tool:  A questionnaire was designed in English on Google form that included 13 close-ended questions. Amongst them four questions were about socio-demographic variables, four questions were about use of social media and five questions were regarding the perception of their dental appearance in which participants had to score their perceptions using 5-point Likert scale. Two professors did face validity from department of “Community dentistry” and one professor from department of “Prosthodontics”.

Participants were asked to rank each statement on a scale from 1 to 5. Each number was labelled according to the question to make it easier for the participant to understand.  A composite score for each participant was obtained by adding scores of all 5 questions about perception.

Data Collection Procedure: The surveying tool was circulated through social media platform (watsapp).

Data Analysis:

Data was analyzed using SPSS, version 21. Frequency (percentages)were calculated for demographical variables as well as for questions regarding use of social media and perceived dental appearance. Association between times spent on social media and perceived dental appearance was analyzed using Pearson Chi square test. 

Operational definitions:

Impact of social media: The positive or negative effect on an individual’s behavior, feelings and emotions because of social media. Scores were given to the following variables: Confidence, depression, participation in social gatherings, being ignored socially and being bullied because of dental appearance. The total score for each individual was added. The impact of social medial regarding dental appearance was categorized as

Total score 5-8 = strongly negative

Total score 9-12= Negative

Total score 13-17= Neutral

Total score 18-21= Positive

Total score 22-25= Strongly Positive

Demographic details:

Among 343 participants, 130 (38%) were males and 213 (62%) were females. In these respondents, 211 (61.5%) were single, 127(37%) were married, 3 (0.9%) were divorced and 2 (0.6%) were separated. Mean age of participants was 27.28 (SD +7.82) the qualification of 174 participants (50.1 %) was undergraduate, 148 were postgraduate (43.1%), 17 students (5 %) had higher secondary qualification, 3 participants (0.9%) had studied until matric and 1 (0.3%) had under matric qualification.

Use of social media:

Social media was reported to be extremely important for 24 participants (7%), very important for 76 participants (22.2 %) moderately important for 121(35.3%), slightly important for 88(25.7%) and not important for 34 (9.9%) of participants. The participants using social media for 1-2 hours were 121 (35.2 %), 154 (44.8%) participants use it for 3-4 hours, 68(19.8%) use it for more than 5 hours.  Instagram was the most important social media platform for 101(29.4 %) participants, 101 (29.4 %) used Facebook, 91 (26.5%) used YouTube, 28 (8.2%) used Twitter and 22 (6.4%) used Snapchat.

Among the participants, 92 never posted their pictures (26.8%), 188 (54.8%) posted their pictures occasionally (once in 5 years), 25 (7.3%) posted yearly, 2 (0.6%) posted monthly, 31 (9 %) posted weekly, 5 (1.5 %) posted daily on social media. The respondents using any software/app or filter to beautify their smile before uploading on social media is 26(7.6 %) always beautifying their pictures, 122(35.6 %) who do it occasionally and 195 (56.9 %) who never modify their pictures before posting them on social media.

Perception about Dental appearance:

Participants were asked to answer all questions with respect to effect of social media on their perception.

Table 1:   Perception about Dental appearance

Composite score for each participant was calculated and was labelled Strongly Negative, Negative, Neutral, Positive and Strongly Positive according to the final score. Frequency and percentages were calculated for all the categories of impact of social media.

Table 2: Impact of social media on perceived dental appearance.

Survey participants were asked to report a daily average time spent, in hours, on social media.  This was recorded to evaluate second objective of the study that was to find association between time spent on social media and its impact on perceived dental appearance.

Table 2: Association between times spent on social media and its impact on perceived dental appearance. 

                     Impact of Social Media vs. Daily Social Media Usage

                     Impact of Social Media vs. Marital Status

In our study majority of the respondents were female having a male to female ratio of 1:1.6. It could be accounted to more use of social media by females since the questionnaire was generated of google forms and circulated via whatsapp.11, 12The mean age of the 343 respondents in our study was 27.28 years with SD 7.82. In the present study majority of the respondents were undergraduate students followed by post graduate students with least responses from candidates with education below matric.

The time spent on social media among the respondents of our study was predominantly 2 hours or less accounting for 57.4% of the respondents in contrast to previous studies conducted in Saudi Arabia and France which showed results of 15% and 17% respectively.13 Jiotsa et al14 reported 79% used social media up to 5 hours per day compared to 20.7% in our study which is significantly less. It can be attributed to the fact that most of our respondents belonged to an older age group and most were either dental students or postgraduates.

The most commonly used social media site in our study was instagram unlike the studies conducted in Saudi Arabia where instagram was an uncommonly used social media site among general population as well as dentists.15,13 This difference can be due to the difference in popular trends in both localities.

In our study majority of the respondents reported either never posting their pictures or posting pictures only occasionally (81.6%). A similar study conducted in France over social media use and body dissatisfaction reported 34% never posted pictures.14 In both studies 1% respondents posted pictures daily. The difference in statistics can be accounted to religious and cultural restrictions in our locality.

The results of our study showed 57.1% never used apps or filters to beautify the image prior to uploading and only 7.5% did it invariably. However, a survey conducted in London showed 90% of young females always used filters for modifying their images including whitening their teeth.16 The difference in results is because the mentioned study was conducted predominantly among teens and females where as our study was conducted among a vast age range.

In our study we could not establish a relationship between time spent on social media and an impact on perception of dental appearance. Greater number of respondents had a positive impact on perception of dental appearance. Another study carried out in adolescents revealed that greater use of social media to see pictures posted by other people decreased their self-esteem from age of 10-12 and 12-14 years.17 The study argued that comparing oneself with pictures posted by others, based on ideal self-portrayals, leads to decreased self-esteem from childhood to early adulthood.7,18,19 The decrease in confidence based on appearance was predicted in girls only which could be because the use of photograph based social media websites is more among females compared to males,20 females have a greater tendency to use social media for comparing themselves to others in contrast to males21, and social comparison has a greater negative influence on females’ than on gents’ body image22.

A study carried out in Singapore on adolescent females revealed surfing through pictures was adversely associated with body esteem while posting photos had a positive association. Similarly, photo editing was negatively related to self-esteem.23 A previous study proposed that beauty standards shared in ones close circles can be causes of stress on young girls’ leading to constant body awareness thus promoting discontent in one’s own appearance.24 The previous studies have been carried out in adolescents, predominantly females and with primary education only in contrast to our study which may be why the results do no align. In another study carried out on social media use and body image disorders, an association was found between the frequency of comparing an “individual’s own physical appearance to that of people followed on social media” and “body dissatisfaction” and “drive for thinness”. However, education level was a confounder in this relationship.25 Similarly, our study was also conducted mostly on undergraduate and postgraduate students, making our study population more educated. Hence our results also do not show an adverse association between social media use and perceived dental appearance The difference in results can also be because our study emphasizes only on dental appearance while the previous studies carried out are based on entire body image.

A study conducted on effect of social media on the perception and demand of Aesthetic Dentistry showed that dental appearance is equally important in both older and younger adults, and the reason behind this esthetic revolution could be  social media.15 A study by Carlsson G et al revealed that the majority of participants in two different elderly age groups agreed that beautiful and perfect teeth are very significant.25 This also corresponds with study  conducted by Hassel A et al. in Germany on elderly participants which showed that  the dental appearance  is important to overall appearance.19 Although these studies do not show an impact on the respondents’ self-esteem, it does show that social media is affecting the demand for esthetic dental appearance.

In a study conducted on use of social media among older adults, it was revealed that it had a positive correlation allowing them to overcome stress, loneliness and give a feeling of self-efficacy hence greater self-esteem.14 Aging provides individuals with maturity of thoughts and greater focus on more practical concerns. Our study was performed on an adult population, this may be the reason why our studies show a positive correlation.

This study had been conducted through a questionnaire circulated on Whats App, so, there is a probability, that study sample consisted of participants from middle or higher socioeconomic status, which is not the true representative of entire population. This can be considered a limitation of the study. On the other hand, normally the assumption is made that the people from lower socioeconomic class have to strive for their daily living, and they have limited means to access social media so there is a chance that social media had a minimum impact on their perception of dental appearance.

Keeping in mind the impact of social media which came out to be positive, social media can be used for awareness of general population regarding significance of oral hygiene, oral health related information to promote self-care of dental health and reduce burden of dental diseases.

This study concluded that majority of the participants reported to have a positive impact of social media on their dental appearance. No correlation was found between time spent on social media and its impact on perceived dental appearance. 

  Declarations:

1. Competing interests: There is no conflict of interest associated with the study.
2. Ethics approval and consent to participate: Ethical approval was obtained from ethical committee of Gandhara University. Objectives of the study were described and informed consent was taken from the participants. Data was collected in accordance with the guidelines and regulations of ethical committee.
3. Consent for publication: Not applicable.
4. Funding: Self-funded
5. Acknowledgements

We are deeply grateful to all those who guided and helped us in this research project and made it a success.

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