Attractiveness and determinants of maxillary midline diastemas in a West African smile

Introduction: This cross-sectional study examines whether the assumption that diastemas of 1 mm or greater are un-attractive is true in a Black West-African population, and identifies the determinants of attractiveness. Methods: A structured questionnaire was self-administered to adult participants, who rated digitally altered full-face colour photographs of a male and female model with diastema widths of 0–6 mm on a 5-point Likert scale. Quantitative data was analysed using SAS® (version 9.4) and SPSS® (version 26). Qualitative data was analysed with thematic analysis. Results: 375 participants completed the questionnaire (51% female, 48% male, 1% preferred not to disclose) with a modal age of 25–34. 65% of participants found maxillary midline diastema esthetic and/or desirable, with 63% of those with diastemas choosing to have no treatment, and the desire to have treatment decreasing with increasing age (p = 0.012). No smile was perceived to be unattractive, however female smiles were rated more favourably (p < 0.001) and increasing diastema width correlated with a decreasing attractiveness especially for diastemas wider than 3 mm in females and 2 mm in males. Diastema width, the gender of the model, and whether or not the participant had a diastema themselves was shown to impact perceptions of attractiveness in a multi-variable analysis. Conclusion: There is limited evidence to support the position that MMDs over 1 mm are not attractive in this population. Diastemas of ≤3 mm in females and ≤2 mm in males are considered attractive. In addition gender, diastema width, and an individual’s own diastema (or absence thereof) impact perceived attractiveness.