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ABSTRACT BACKGROUND The importance of physical appearance in social and professional situations has been well studied. It has been suggested that improving dental appearance may increase
employment prospects. This scoping review aims to map the current literature regarding the impact of dental appearance on employability. METHODS A scoping review was carried out in
accordance with guidance from the Joanna Briggs Institute. Inclusion and exclusion criteria were developed iteratively, databases were searched and decisions on inclusion made in duplicate.
Data were charted in Excel and synthesised using a visual map, study summary table and narrative description. RESULTS We identified 16 relevant articles: ten experimental simulation studies,
two qualitative studies, one cross-sectional survey, one pre-/post-dental treatment survey, one retrospective cohort study and one narrative systematic review. Experimental simulations
support the notion that visible dental conditions can negatively impact appraisals of employment-related personal characteristics. Negative impacts on job-seeking self-efficacy and
willingness to apply for jobs have also been documented. CONCLUSIONS The applicability of this evidence base to the UK health system context is uncertain and demonstration of real-life
impact on employment is lacking. Further research is needed before programmes to improve dental appearance could be justified on the basis of improving employment outcomes. KEY POINTS * Maps
the existing literature on the link between dental appearance and employability. * Identifies where there are gaps in the literature and makes recommendations for further research. *
Questions the NHS definition of 'clinically necessary' dental treatment. You have full access to this article via your institution. Download PDF SIMILAR CONTENT BEING VIEWED BY
OTHERS SUPPORTING DENTISTS' HEALTH AND WELLBEING - WORKFORCE ASSETS UNDER STRESS: A QUALITATIVE STUDY IN ENGLAND Article 20 July 2021 GLOBAL PERSPECTIVE ON CHILD AND ADOLESCENT ORAL
HEALTH: A SYSTEMATIC REVIEW AND META-ANALYSIS OF ORAL IMPACTS ON DAILY PERFORMANCE Article 27 February 2024 WIMPOLE TIMINGS STUDY Article 08 July 2024 BACKGROUND Healthy teeth are not only a
vital component in maintaining good health, but they also make a significant contribution to physical appearance. There is abundant literature demonstrating that ratings of personal
characteristics such as competence, intelligence and trustworthiness are influenced by facial attractiveness.1,2,3 Such judgements have been shown to take place in as little as 100
milliseconds, below the threshold of conscious awareness.2 Furthermore, attractiveness has been shown to influence judgements regarding suitability for employment, particularly for
consumer-facing roles.4,5,6 Smiling has been shown to increase positive ratings of characteristics including agreeableness, trustworthiness and intelligence, and the negative impact of not
smiling may be greater for women than men.7,8,9 Oral health in developed countries has drastically improved over the last 50 years.10,11 Alongside these improvements, patient expectations
and social norms around what is an acceptable dental appearance have also changed.12 In the past, missing, discoloured or misaligned teeth were as acceptable as they were common.12 In more
recent times, television makeover programmes, social media and advertising have all been credited with changing attitudes towards what is an acceptable dental appearance.13,14,15 What may
have once been termed the 'Hollywood smile' has become increasingly transatlantic; cosmetic dentistry was the most desired non-surgical cosmetic treatment among UK adults in
2018.16 Straight, white teeth are a prominent outward-facing display of social and economic capital; a signifier of class, self-control and success.15 Poor dental appearance may negatively
impact employment opportunities through a variety of mechanisms. Fifteen percent of adults in England, Wales and Northern Ireland report difficulty smiling or laughing without embarrassment
because of their teeth.17 Nearly 18% of US adults have reported that the appearance of their mouth and teeth affected their ability to interview for a job, increasing to 29% for those in
low-income households.18 Reduced ability to speak and smile confidently, combined with expectations of negative appraisals, could hinder performance at interviews.19 Furthermore,
interviewers may make less favourable judgements of ability based solely on appearance, because of conscious or subconscious biases. Social differences in oral health are more likely to be
explained by attributing blame to poor 'lifestyle choices' than for other conditions such as diabetes or cancer.20 This is despite abundant evidence that the greatest contributors
to inequalities in health and oral health are environmental, rather than behavioural.21 Stable employment is beneficial for the individual and society; long-term unemployment increases the
risk of depression, cardiovascular disease events and all-cause mortality.22 At present, 'return to work' support programmes in the UK23 do not include supported access to dental
care, but this is something that has been examined in other countries.24 This scoping review aims to map the current literature regarding the impact of dental appearance on employability and
identify areas for future research. METHODS Scoping reviews are used to map the existing literature on a particular topic, to identify the number and types of studies available. They are
particularly useful where the body of literature is complex and varied, or where a systematic review with precisely defined _a priori_ inclusion criteria could result in an overly narrow
pool of evidence. This scoping review has been carried out in accordance with the guidance produced by the Joanna Briggs Institute25 and is reported following the PRISMA extension for
scoping reviews (PRISMA-ScR)26 (see online supplementary information). The research questions of interest were: * 1. Does poor dental appearance negatively impact employability in adults? *
2. Can dental treatment improve employment outcomes? We developed a protocol in advance, which is available on request from the corresponding author. The searches were undertaken iteratively
in September 2019. Firstly, a broad search was undertaken using Google and Google Scholar, to identify grey literature and scope out the potential numbers of studies and the types of
journals they were found in. The search terms used were: (dental appearance/oral health/dental treatment and employment). Secondly, a database search using PsychINFO, Social Policy and
Practice, Embase and Medline via Ovid was carried out using the following search terms: (worklessness OR job OR employment OR employability OR unemployed) AND (dental treatment OR oral
health OR dental appearance OR dental attractiveness OR smile). Informed by the terms found in some of the identified studies, a further search was carried out, replacing the
employment-related terms with: (social perceptions OR social judgements). Studies were limited to human, English language and from 1980. The authors did not have the capacity to translate
other languages and we felt that, before 1980, social norms around appearance may not be relevant for today. We placed no restriction on study type. The reference lists of the retrieved
full-text articles were scanned for further relevant studies. Titles and abstracts were screened and assessed in relation to the following inclusion and exclusion criteria: * Participants
aged over 16 * Studies investigating the relationship between dental appearance, dental treatment or oral health and employment * Studies investigating the relationship between dental
appearance and judgements of employment suitability * Studies investigating the relationship between dental appearance and judgements about personal characteristics related to employment
(for example, intelligence) * Studies concerning purely aesthetic judgements, extraoral craniofacial conditions and orthodontic appliances were excluded. Studies identified as potentially
relevant for inclusion were obtained in full text and reviewed by DM and RK to inform the final decision. Data charting/extraction was carried out in Microsoft Excel, under the following
headings: study reference, study type, aim, country, participants, sample size, intervention or exposure, comparator group, outcomes used, key findings, authors' conclusions and
reviewers' conclusions. The data charting was completed by DM and cross-checked for accuracy by RK. Due to the heterogeneous nature of the included studies and in common with most
exploratory scoping reviews, we did not undertake a formal critical appraisal of each individual study.25 RESULTS A PRISMA flowchart illustrating the iterative search process is provided in
Figure 1. After completion of data charting, we synthesised the results by creating a study summary table (Table 1) and a visual map of how the studies related to each research question
(Fig. 2). Studies represented with a green circle provided supportive evidence in response to the research question. Studies represented by a red circle provided evidence of a negative or
equivocal response to the research question. The number within the circle relates to the number of studies. The study summary table (Table 1) and the visual map (Fig. 2) informed the
narrative synthesis which is presented below in response to each research question. DOES POOR DENTAL APPEARANCE NEGATIVELY IMPACT EMPLOYABILITY IN ADULTS? Three studies specifically
investigated the impact of dental aesthetic conditions on employment or suitability for employment.27,28,29 One cross-sectional study investigated the association between an
individual's number and severity of aesthetic dental conditions (measured using a 'Dental Problem Index') and current employment status.29 The authors found that a one-point
increase in the Dental Problem Index was associated with 7.70% (CI: 5.15-10.19%) lower odds of being employed, after taking account of age, gender, marital status, years of education,
poverty level and health status.29 Two experimental studies modified photographs to illustrate dental aesthetic conditions and asked participants to make judgements about the subjects'
employment prospects.27,28 Pithon _et al._ found that perceptions of intelligence and hiring potential were negatively impacted by malocclusion, while those of honesty and work efficiency
were not.27 In a similar study where photographs were also accompanied by a CV, no significant impacts were observed on the likelihood of shortlisting for interview or expected performance
in earning commission.28 Two qualitative interview studies identified themes related to the impact of poor dental appearance on employment prospects.30,31 Douds _et al._31 interviewed 30 US
adult male parolees about their experiences of prison dental care. Kerr30 interviewed six recent patients of a dental outreach organisation about the impact of the dental care they had
received. Participants felt that their poor dental appearance was assumed to be related to past or current drug use,30,31 likelihood of re-offending31 and expectations of needing time off
from work to attend dental appointments.31 The social disadvantage incurred by not smiling was raised as a barrier to employment in both studies.30,31 A particularly impactful quote is
reproduced below: 'They kept telling us in a job training class that we need to look like the job we want. "Dress for success." Ha! You can put me in an Armani suit, and I
still won't have any teeth.'31 The majority of the studies that we identified in relation to this research question assessed the impact of aesthetic dental conditions on
perceptions of work-related character traits.32,33,34,35,36,37,38,39 While these studies did not specifically set out to explore the relationship between dental appearance and employability,
they were included because they contribute towards the theoretical and conceptual basis for such a relationship. All of these studies found that images which had been modified to illustrate
visible dental conditions received less favourable judgements compared to unmodified dentition. A large variety of conditions were tested: caries,32,33,34,37,38 stained dentine,33 pulpal
necrosis,32,33 tooth shade,35,37 malocclusion36 and fluorosis.38,39 The types of characteristics that were perceived more negatively included intelligence,32,33,34,35,36,37,38,39
education,33,34 trustworthiness,35 laziness,34 reliability,38,39 sociability32,37,38,39 and friendliness.32,35 CAN DENTAL TREATMENT IMPROVE EMPLOYMENT OUTCOMES? All of the studies of
relevance to this research question were conducted in Canada.30,40,41,42 A systematic review included seven heterogeneous studies and concluded that there was little evidence to suggest that
dental care could improve employment outcomes and the available studies were of poor quality, with the majority lacking a comparator group.40 A large retrospective cohort study using
administrative data42 investigated if recipients of an employment-assistance programme who utilised the offer of free basic dental care were more likely to leave the programme than those who
did not. The authors found that employment outcomes were not significantly different 12 months after receiving dental care.42 A small pilot study found that the 'job-seeking
self-efficacy' of the 31 participants increased one month after receipt of public dental care, which consisted mainly of urgent treatment and/or dentures.41 This self-reported increase
in willingness to apply for jobs was also raised in one of the qualitative interview studies.30 The participants felt that the dental treatment they had received had improved their job
prospects by increasing their self-confidence and willingness to make applications and attend interviews: 'Prior to having the dental work done, I would not have had any vested interest
in sending out resumes or making appointments for job interviews. Now, I send out my resume. I don't have a problem going to meet with anybody'.30 DISCUSSION This study aimed to
map the existing literature regarding the impact of dental appearance on employability and to identify gaps in the evidence base. The search revealed a diverse array of study types, although
relatively few that directly addressed both dental appearance and employment_._27,28,29,30,31 All but one28 of those studies provide some evidence to support the notion that dental
aesthetic conditions may negatively impact employment outcomes or employment prospects.27,28,29,30,31 Similarly, the studies which measured the impact of dental appearance on perceptions of
work-related personal characteristics all reported negative impacts.32,33,34,35,36,37,38,39 This finding aligns with existing research on facial attractiveness, which has demonstrated that
the stereotype that 'what is beautiful is good'3 holds for a range of characteristics, particularly social competence and intelligence.43,44 However, despite the number of studies
which suggest that poor dental appearance can negatively impact employment-related outcomes,27,28,29,30,31,32,33,34,35,36,37,38,39 only one41 of the three studies which specifically
investigated the impact of dental treatment on employment-related outcomes reported any evidence of benefits.40,41,42 Furthermore, the benefits of dental treatment that were reported related
to intermediate steps of increased confidence and ability to apply for jobs, rather than actually becoming employed.30,31,41 A strength of this review was the scoping review methodology,
which allowed for a broad consideration of the evidence base around this topic. If we had limited the review strictly to the highest levels of evidence suitable for this research question,
we would have found very little to learn from. The qualitative interview studies in particular provided rich insight into how poor dental appearance may hinder job-seeking, but unfortunately
we did not identify any that were carried out in the UK context.30,31 The systematic search strategy and large range of databases searched were also strengths, although the majority of
studies were identified through the Medline database. Limitations are that studies were restricted to English language because of a lack of translation facilities and the review protocol was
not registered, as we were unaware of a suitable repository at the time. We have since learned that the Centre for Open Science hosts a publicly available repository which we would utilise
in future.45 In accordance with guidance on scoping reviews, we did not undertake any formal assessment on the quality of the included studies. However, the majority were experimental
simulation studies using modified photographs.27,28,32,33,34,35,36,37,38,39 How well these reflect judgements made in real-life social situations is unknown. It has been shown that viewing
distance and being asked to look specifically at teeth can affect judgements of dental aesthetic conditions.39,46 Many such photograph-based studies have also demonstrated that the social
judgements made are affected by characteristics of the judge themselves, such as age, sex, ethnicity,27,47,48 actual and self-perceived attractiveness,49,50 and intelligence.50 Many of the
included studies did not adequately control for these variations in the perceivers themselves, because they used different groups to judge different sets of images. Epidemiological
observational29 and intervention40,41,42 studies provide a more robust level of evidence than experimental simulations and the findings of these were mixed. Furthermore, applicability to the
UK context is uncertain, as all of the studies were conducted in countries where dental care is funded either by the individual or through private insurance.29,40,41,42 In the UK, the
partial funding of dentistry through the NHS means that for adults receiving certain employment, disability or low-income-related benefits, dental care is provided free of charge.51 For
those not receiving benefits, dental care is subsidised. Despite these provisions, cost is cited as a barrier by 20% of adults from routine and manual occupations,52 and people experiencing
homelessness report multiple barriers to accessing NHS dental care.53 Two studies35,37 reported positive benefits of a lighter tooth shade on perceptions of character traits related to
employability (intellectual ability,35,37 academic performance, trustworthiness, friendliness,35 and social competence).37 The scope of NHS dentistry is broadly defined as any treatment that
is 'clinically necessary' to achieve and maintain good oral health, as opposed to purely cosmetic treatments such as tooth whitening.54 Despite this, it is accepted that the
majority of NHS orthodontic care delivers aesthetic, rather than functional, improvements.55 This is justified by evidence that social wellbeing is improved by correction of
malocclusion.55,56 This more holistic view of health aligns with the World Health Organisation definition, agreed in 1948, which frames health as 'complete physical, mental and social
wellbeing and not merely the absence of disease or infirmity'. The complex relationships between social judgements, psychological wellbeing, social inequalities and the role of publicly
funded dental care are an interesting area for debate. Perhaps NHS provision of tooth whitening or other cosmetic treatments could be justified if a patient's dental appearance was
found to negatively affect their social, or even economic, wellbeing? Further investigations of the interactions between social and economic disadvantage, visibly poor oral health, and
subconscious bias and discrimination in a UK context are warranted. Qualitative studies would be informative, including those seeking the views of potential employers on the impact of poor
dental appearance at interview. Public health interventions are often advocated for in terms of the potential for cost savings and 'return on investment'. While we did find
evidence suggestive of a negative impact of poor dental appearance on employment prospects,27,28,29,30,31,32,33,34,35,36,37,38,39 we did not find any to suggest that including dental care
within 'return to work' programmes could improve employment outcomes or result in economic gains. The most compelling evidence to support a role for dental care in reducing the
social and economic impact of unemployment would be a randomised controlled trial of an integrated pathway into NHS dental care as part of a package of 'return to work' support,
with employment status as the outcome. However, it is important to remember that facilitated access to dental care for marginalised groups can also be justified in light of the legal duty of
NHS Commissioners to 'have regard to the need to reduce inequalities between patients with respect to their ability to access health services, and [...] the outcomes achieved for
them'.57 CONCLUSIONS There is a relatively abundant and diverse array of research to support the conceptualisation that poor dental appearance may have negative impacts on employment.
The applicability of this evidence base to the UK health system context and demonstration of real-life impact on employment are more tenuous. Similarly, we did not identify any evidence to
suggest that improving dental appearance could improve rates of employment. Further research is needed before programmes to improve dental appearance could be justified on the basis of
improving employment outcomes. However, this does not mean that this type of support could not be justified already in terms of reducing health and social inequalities and capacity to
benefit from publicly funded healthcare. REFERENCES * Talamas S N, Mavor K I, Perrett D I. Blinded by beauty: Attractiveness bias and accurate perceptions of academic performance. _PLoS One_
2016; DOI: 10.1371/journal.pone.0148284. * Willis J, Todorov A, Willis J, Todorov A. Making Up Your Mind After a 100Ms Exposure to a Face. _Psychol. Sci_ 2019; 17: 592-598. * Dion K,
Berscheid E, Walster E. What is beautiful is good. _J_ _Pers Soc Psychol_ 1972; 24: 285-290. * Johnson S, Podratz K, Dipboye R, Gibbons E. Physical attractiveness biases in ratings of
employment suitability: Tracking down the 'beauty is Beastly' effect. _J_ _Soc Psychol_ 2010; 150: 301-318. * Watkins L, Johnston L. Screening Job Applicants: The Impact of
Physical Attractiveness and Application Quality. _Int J_ _Sel Assess_ 2002; 8: 76-84. * Baert S, Decuypere L. Better sexy than flexy? A lab experiment assessing the impact of perceived
attractiveness and personality traits on hiring decisions. _Appl Econ Lett_ 2014; 21: 597-601. * Tatarunaite E, Playle R, Hood K, Shaw W, Richmond S. Facial attractiveness: A longitudinal
study. _Am J_ Orthod Dentofac_ Orthop_ 2005; 127: 676-682. * Schmidt K, Levenstein R, Ambadar Z. Intensity of smiling and attractiveness as facial signals of trustworthiness in women.
_Percept Mot Skills_ 2012; 114: 964-978. * Mehu M, Little A C, Dunbar R I M. Sex differences in the effect of smiling on social judgements: An evolutionary approach. _J Soc Evol Cult
Psychol_ 2008; 2: 103-121. * Murray J J, Vernazza C R, Holmes R D. Forty years of national surveys: An overview of children's dental health from 1973-2013. _Br Dent J _2015; 219:
281-285. * Steele J G, Treasure E T, O'Sullivan I, Morris J, Murray J J. Adult Dental Health Survey 2009: transformations in British oral health 1968-2009. _Br Dent J_ 2012; 213:
523-527. * Cronin M, Meaney S, Jepson N J A, Allen P F. A qualitative study of trends in patient preferences for the management of the partially dentate state. _Gerodontology_ 2009; 26:
137-142. * Wong B, Quick A N, Thomson W M. The impact of the popular media on cosmetic dentistry. _N_ _Z_ _Dent J_ 2006; 102: 58-63. * Binalrimal S. The Effect of Social Media on the
Perception and Demand of Aesthetic Dentistry. _IOSR_ J _Dent Med Sci_ 2019; 18: 69-73. * Khalid A, Quiñonez C. Straight, white teeth as a social prerogative. _Sociol Health Illn_ 2015; 37:
782-796. * RealSelf. U.K. Aesthetics Interest Survey. 2018. Available at https://drive.google.com/file/d/1xh0x0ar-PW_fSGcJDr3vUBBi58FGnVSm/view (accessed May 2020). * Health and Social Care
Information Centre. 7: Outcome and impact - a report from the Adult Dental Health Survey 2009. 2011. Available at
https://files.digital.nhs.uk/publicationimport/pub01xxx/pub01086/adul-dent-heal-surv-summ-them-the7-2009-rep9.pdf (accessed August 2020). * Health Policy Institute. Oral Health and
Well-Being in the United States. 2015. Available at https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/OralHealthWell-Being-StateFacts/US-Oral-Health-Well-Being.pdf (accessed
August 2020). * Sheiham A, Cushing A, Maizels J. The social impacts of dental disease. _In_ Salde G (ed) _Measuring oral health and quality of life_. pp 47-56. North Carolina: University of
North Carolina, 1997. Available at https://www.adelaide.edu.au/arcpoh/downloads/publications/reports/miscellaneous/measuring-oral-health-and-quality-of-life.pdf (accessed August 2020). *
Moeller J, Singhal S, Al-Dajani M, Gomaa N, Quiñonez C. Assessing the relationship between dental appearance and the potential for discrimination in Ontario, Canada. _SSM Popul Health_ 2015;
1: 782-796. * Sanders A E, Spencer A J, Slade G D. Evaluating the role of dental behaviour in oral health inequalities. _Community Dent Oral Epidemiol _2006;34: 71-79. * Siegrist J, Rosskam
E, Leka S. Work and worklessness: Final report of the Task group on employment and working conditions, including occupation, unemployment and migrant workers: Review of social determinants
of health and the health divide in the WHO European Region. 2016. Available at https://www.euro.who.int/__data/assets/pdf_file/0004/334354/EWC-task-report.pdf?ua=1 (accessed August 2020). *
UK Government. Work and Health Programme. 2019. Available online at https://www.gov.uk/work-health-programme (accessed November 2019). * Hyde S, Satariano W A, Weintraub J A. Welfare dental
intervention improves employment and quality of life. _J_ Dent_ Res_ 2006; 85: 79-84. * Peters M D J, Godfrey C M, Khalil H, McInerney P, Parker D, Soares C B_._ Guidance for conducting
systematic scoping reviews. _Int J Evid Based Healthc_ 2015; 13: 141-146. * Tricco A C, Lillie E, Zarin W _et al._ PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and
explanation. _Ann Intern Med_ 2018; 169: 467-473. * Pithon M M, Nascimento C C, Barbosa G C G, Coqueiro R D S. Do dental esthetics have any influence on finding a job? _Am J Orthod Dentofac
Orthop_ 2014; 146: 423-429. * McErlain M, Newton J T, Jeremiah H G. Does dental appearance affect employment prospects: a prospective cross-sectional study. _J Orthod_ 2018; 45: 71-78. *
Halasa-Rappel Y A, Tschampl C A, Foley M, Dellapenna M, Shepard D S. Broken smiles: The impact of untreated dental caries and missing anterior teeth on employment. _J Public Health Dent_
2019; 79: 231-237. * Kerr L. More than Just Pulling Teeth: The Impact of Dental Care on Patients' Lived Experiences. _J Can Dent Assoc_ 2018; 84: i4. * Douds A S, Ahlin E M, Kavanaugh P
R, Olaghere A. Decayed Prospects: A Qualitative Study of Prison Dental Care and its Impact on Former Prisoners. _Crim Justice Rev_ 2016; 41: 21-40. * Newton J T, Prabhu N, Robinson P G. The
impact of dental appearance on the appraisal of personal characteristics. _Int J Prosthodont_ 2003; 16: 429-434. * Feng X, Newton J, Robinson P. The impact of dental appearance on
perceptions of personal characteristics among Chinese people in the United Kingdom. _Int J Prosthodont_ 2001; 51: 429-434. * Eli I, Bar-Tal Y, Kostovetzki I. At first glance: Social meanings
of dental appearance. _J_ Public He_alth Dent_ 2001; 61: 150-154. * Montero J, Gómez-Polo C, Santos J A, Portillo M, Lorenzo M C, Albaladejo A_._ Contributions of dental colour to the
physical attractiveness stereotype. _J Oral Rehabil_ 2014; 41: 768-782. * Shaw W C, Rees G, Dawe M, Charles C R. The Influence of dentofacial appearance on the social attractiveness of young
adults. _Am J Orthod Dentofac Orthop_ 1985; 87: 21-26. * Kershaw S, Newton J T, Williams D M. The influence of tooth colour on the perceptions of personal characteristics among female
dental patients: Comparisons of unmodified, decayed and 'whitened' teeth. _Br Dent J_ 2008; DOI: 10.1038/bdj.2008.134. * Williams D M, Chestnutt I G, Bennett P D, Hood K, Lowe R,
Heard P_._ Attitudes to fluorosis and dental caries by a response latency method. _Community Dent Oral Epidemiol_ 2006; 34: 153-159. * Williams D M, Chestnutt I G, Bennett P D, Hood K, Lowe
R. Characteristics attributed to individuals with dental fluorosis. _Community Dent Health_ 2006; 23: 209-216. * Singhal S, Correa R, Quiñonez C. The impact of dental treatment on employment
outcomes: A systematic review. _Health Policy _2013; 109: 88-96. * Singhal S, Mamdani M, Mitchell A, Tenenbaum H, Quiñonez C. An exploratory pilot study to assess self-perceived changes
among social assistance recipients regarding employment prospects after receiving dental treatment. _BMC Oral Health_ 2015; 15: 2-7. * Singhal S, Mamdani M, Mitchell A, Tenenbaum H, Lebovic
G, Quiñonez C_._ Dental treatment and employment outcomes among social assistance recipients in Ontario, Canada. _Health Policy _2016;120: 1202-1208. * Eagly A H, Ashmore R D, Makhijani M G,
Longo L C. What Is Beautiful Is Good, But.: A Meta-Analytic Review of Research on the Physical Attractiveness Stereotype. _Psychol Bull_ 1991; 110: 109-128. * Feingold A. Good-Looking
People Are Not What We Think. _Psychol Bull_ 1992; 111: 304-341. * Centre for Open Science. OSF. Available online at https://www.cos.io/ (accessed May 2020). * Edwards M, Macpherson L M D,
Simmons D R, Gilmour W H, Stephen K W. An assessment of teenagers' perceptions of dental fluorosis using digital simulation and web-based testing. _Community Dent Oral Epidemiol_ 2005;
33: 298-306. * Pithon M M, Bastos G W, Miranda N S _et al._ Esthetic perception of black spaces between maxillary central incisors by different age groups. _Am J Orthod Dentofac Orthop_
2013; 143: 371-375. * Henson S T, Lindauer S J, W Gardner G, Shroff B, Tufekci E, Best A M_._ Influence of dental esthetics on social perceptions of adolescents judged by peers. _Am J Orthod
Dentofac Orthop_ 2011; 140: 389-395. * Tennis G H, Dabbs J M. Judging physical attractiveness: Effects of judges' own attractiveness. _Person Soc Psychol Bull_ 1975; 1: 513-516. * Sim
S Y L, Saperia J, Brown J A, Bernieri F J. Judging attractiveness: Biases due to raters' own attractiveness and intelligence. _Cogent Psychol_ 2015; DOI: 10.1080/23311908.2014.996316. *
NHS. Understanding NHS Dental Charges. 2020. Available at https://www.nhs.uk/using-the-nhs/nhs-services/dentists/understanding-nhs-dental-charges/ (accessed March 2020). * Hill K B,
Chadwick B L, Freeman R, O'Sullivan I, Murray J J. Adult Dental Health Survey 2009: Relationships between dental attendance patterns, oral health behaviour and the current barriers to
dental care. _Br Dent J_ 2013; 214: 25-32. * Paisi M, Kay E, Plessas A _et al._ Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review.
_Community Dent Oral Epidemiol_ 2019; 47: 103-111. * NHS. Understanding NHS dental charges. 2020. Available at:
https://www.nhs.uk/using-the-nhs/nhs-services/dentists/understanding-nhs-dental-charges/ (accessed September 2020 * Benson P E, Javidi H, Dibiase A T. What is the value of orthodontic
treatment? _Br Dent J_ 2015; 218: 185-190. * Feu D, Miguel J A M, Celeste R K, Oliveira B H. Effect of orthodontic treatment on oral health-related quality of life. _Angle Orthod_ 2013; 83:
892-898. * The National Archives. Health and Social Care Act 2012. Part 1 - 4. The Secretary of State's duty as to reducing inequalities. 2012. Available online at
https://www.legislation.gov.uk/ukpga/2012/7/contents/enacted (accessed August 2020). Download references ACKNOWLEDGEMENTS The authors gratefully acknowledge the input of Mrs Sandra White in
identifying the research topic. This study was funded by Public Health England. The views expressed are those of the authors and not necessarily those of Public Health England or the
National Health Service. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * University of Manchester, Division of Dentistry, Dental Health Unit, Williams House, Lloyd Street North, Manchester,
M15 6SE, UK Deborah Moore & Ross Keat Authors * Deborah Moore View author publications You can also search for this author inPubMed Google Scholar * Ross Keat View author publications
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PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Moore, D., Keat, R. Does dental appearance impact on employability in adults? A scoping review of quantitative and
qualitative evidence. _Br Dent J_ (2020). https://doi.org/10.1038/s41415-020-2025-5 Download citation * Received: 12 March 2020 * Accepted: 14 May 2020 * Published: 20 October 2020 * DOI:
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