Influence of Educational Level on the Perception of Altered Smile Esthetics Among Dental Students: A Cross-Sectional Study

Background/Objectives: Smile aesthetics are a crucial aspect of facial attractiveness, playing a central role in social interactions. Dental students' perception of smiling aesthetics 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 aesthetics. 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 aesthetic discrepancies, using a visual analogue 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 aesthetic 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 midline diastema, gummy smile, and reduced lightness received the lowest attractiveness scores across all groups. Conclusions: The perception of altered smile esthetics evolves throughout dental education, particularly after the initiation of clinical training. However, this development is discrepancy-specific and does not follow a linear pattern. Educational programs should emphasize the critical evaluation of aesthetic features to better prepare students for clinical decision-making in aesthetic dentistry.