Abstract
Background/Objectives: Smile esthetics are a crucial aspect of facial attractiveness, playing a central role in social interactions. Dental students' perception of smiling esthetics may evolve as they progress through their education and clinical exposure. This study aimed to investigate the influence of educational level on dental students' perception of altered smile esthetics. Methods: A cross-sectional study was conducted among 410 undergraduate dental students across five academic years at the National and Kapodistrian University of Athens. Participants evaluated 22 digitally altered smile images, including single and combined esthetic discrepancies, using a visual analog scale (VAS). Perceived attractiveness scores were analyzed in relation to academic year, gender, and specific types of smile alterations. Results: The perception of smile attractiveness varied significantly across academic years for certain esthetic discrepancies, including central incisor length mismatch, midline diastema, and open gingival embrasures (p < 0.05). Clinical-year students (years 4-5) demonstrated a more critical assessment compared to preclinical students. Female students exhibited greater sensitivity to specific discrepancies, including fluorosis and reduced tooth lightness. The combination of a midline diastema, a gummy smile, and reduced lightness received the lowest attractiveness scores across all groups. Conclusions: The perception of altered smile esthetics among undergraduate dental students evolves throughout their education, although this progression does not follow a linear trajectory. Dental education appears to influence the perception of specific smile esthetic discrepancies, reflecting a selective influence on features. Clinical training appears to be a critical parameter of dental education, influencing the perception of smiling esthetics.