The impact of the popular media on cosmetic dentistry

Tags: New Zealand, cosmetic dentistry, television, popular media, television programmes, aesthetic dental, social norms, television exposure, Journal of Youth and Adolescence, appearance, aesthetic dentistry, American Academy of Cosmetic Dentistry, aesthetic dental procedure, gender Gender, Practice characteristics, THOMSON New Zealand Dental Journal, Journal of Cosmetic Dermatology, random sample, physical appearance, aesthetic expectations, questionnaires, practitioners, attractive individuals, television programme, dental practitioners, television shows, sampling frame, British Journal of Psychiatry, dental procedures, Australian Society of Orthodontists, print media, Journal of Labor Economics, Journal of the American Dental Association, Extreme Makeover, patient expectations, patient demand, print media Women, Henry Schein Regional, Arthur Hall Orthodontics and Healthcare Essentials, Gunz Dental, Journal of Applied Psychology, patient enquiries, Journal of Public Health Dentistry, Journal of Dental Research, Journal of Prosthodontics 13, Australian Society of Orthodontists Newsletter, Female practitioners
Content: SEPTEMBER 2006
New Zealand DENTAL JOURNAL
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articles The impact of the popular media on cosmetic dentistry ANNA H THEOBALD, BENEDICTA KJ WONG, ANDREW N QUICK AND W MURRAY THOMSON New Zealand Dental Journal 102, No. 3: 58­63; September 2006
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ABSTRACT The popular medias influence on social norms with respect to peoples appearance is likely to have played a part in the recent growth of cosmetic dentistry. Aims This study was designed to investigate the manner in which the popular media have affected the perception and delivery of aesthetic dentistry in New Zealand. Methods A nationwide survey was posted to a random sample of 600 general dental practitioners (GDPs) requesting sociodemographic details and information on the types of aesthetic dental procedures provided and the demand for those. Information was also sought on GDPs awareness of television programmes and reality "makeover" television shows (such as "Extreme Makeover") covering issues related to aesthetic dentistry, together with the impact of such programmes (and that of different print media) on their patients perceptions of, and demand for, aesthetic dentistry. Results The response rate was 81.2 percent. A majority of participants perceived an increased demand for tooth whitening (77.8 percent) and veneers (54.8 percent) subsequent to the airing of those television programmes, with 85.2 percent reporting patients mentioning "Extreme Makeover" in relation to aesthetic dentistry. Some 56.8 percent believed that patients had higher aesthetic expectations subsequent to the airing of that programme. An increased demand for tooth whitening was reported by more female than male GDPs, and also by younger practitioners and those who were practising in larger centres. Similar patterns were observed with respect to GDPs recommending tooth whitening for patients. Womens magazines were ranked by GDPs as having the highest impact on patients perceptions of aesthetic dentistry. Conclusion The popular media (especially television) appear to have had an impact on the demand for various aesthetic dental procedures in New Zealand. INTRODUCTION Dentistry has evolved over the past 50 years from being primarily a health service to a hybrid profession (Mandel, 1998; Christensen, 2002a), whereby not only pain and oral disease are treated, but elective aesthetic services are increasingly being provided (Morley, 1999; Priest and Priest, 2004), often at the request of the patient. Social pressure due to changing norms may be the driving force behind this aesthetic revolution, fuelled by the media's portrayal of beauty. Peer-reviewed article. Received November 2005. Revised text accepted April 2006.
In today's society, most people have the desire to look their best, since physical appearance plays an important role in an individuals self-esteem and success. It is human nature to attribute positive personality characteristics to attractive individuals, and such people receive favourable treatment in a variety of situations (Sarwer et al, 2004). There is also evidence that being physically attractive has other benefits. Even children consider attractiveness a more important criterion than intelligence in the selection of friends (Clark and Ayers, 1988), and this attitude often continues into adulthood. There is ample evidence that attractive applicants are more likely to receive job offers than their less attractive peers (Cann et al, 1981; Hamermesh and Biddle, 1994; Biddle and Hamermesh, 1998); this is especially true for women (Marlowe et al, 1996). Attractive individuals also tend to earn more (Hamermesh and Biddle, 1994), and are more likely to gain promotion (Biddle and Hamermesh, 1998). Even in situations where we would like to think that our appearance is of no consequence, research suggests that, whether we like it or not, our appearance really does seem to matter (Sarwer et al, 2004). The quest for an improved appearance has recently become synonymous with cosmetic intervention, involving various health professionals in fields such as plastic surgery and dermatology. For an increasing number of people, an "upgrade" in appearance also involves cosmetic dentistry. An "enhanced smile" not only may make one look younger, but it is also associated with positive attributes such as good hygiene, health and success (Priest and Priest, 2004). Dentistry's image in contemporary fiction and popular culture has undergone a profound change in recent years (Mandel, 1998), having been propelled out of the "age of amputation" and into the "age of augmentation" (GolubEvans, 1994). This has been largely due to the widespread use of dental adhesive technology introduced in the 1950s (Buonocore, 1955). It has been proposed that dentists will continue to experience a growing demand for their services, largely on the strength of patients' desires for better-looking smiles (Christensen, 2002b). This may be (at least in part) attributed to the influence of the media on social norms and expectations. Investigations into the impact of the Mass Media on society have shown that it affects a wide variety of areas, including mental health (Christakis et al, 2004), child development (Signorielli, 1990), attitudes toward eating habits (Thompson and Heinberg, 1999; Becker et al, 2002), sexual attitudes and behaviours (Zuckerman and Zuckerman, 1985; Ward, 2002), violence among children (Felson, 1996), and suicidal tendencies (Gould and Shaffer, 1986). It is therefore not unreasonable to assume that the media may have a similar impact on dentistry. Indeed, in a recent US survey, dentists cited media coverage as the main reason for the increase in demand (by an average of 12.5 percent over the previous five years, with some dentists reporting an increase of almost 40
59 percent for aesthetic dental procedures) (American Academy of Cosmetic Dentistry, 2004). However, media exposure may not always portray dentistry in a positive light: a recent survey conducted by the Australian Society of Orthodontists (ASO) highlighted the negative impact of a current affairs television programme on the publics perception of orthodontic treatment (Australian Society of Orthodontists, 2004). Thus, the medias influence on dentistry can be both Positive and Negative. To date, little is known of the demand for aesthetic dentistry in New Zealand. This study aimed to investigate the manner in which the popular media (such as television and printed media) have affected the perception of, and demand for, aesthetic dentistry in New Zealand. METHOD A nationwide postal survey of 600 New Zealand general dental practitioners was carried out between April and June 2005. The sample was randomly selected from the 2003 New Zealand Dental Register (with permission from the Dental Council of New Zealand). Specialist dentists were excluded from the sampling frame prior to drawing the sample. The study was approved by the University of Otago Ethics Committee. The following information was gathered: socio-demographic details; the types of aesthetic dental procedure practised; the current demand for aesthetic dental procedures among patients in different age groups; the dentists' awareness of current affairs television programmes and reality makeover television shows (that is, programmes in which volunteers undergo a range of cosmetic and surgical enhancements aimed at dramatically improving their appearance) covering issues related to aesthetic dentistry, and the impact such programmes may have had on their patients; and dentists' opinions of which types of printed media appear to have the greatest effect on their patients' awareness of aesthetic dentistry. For reporting purposes, respondents were grouped by gender, number of years in practice (0-14, 15-30 and 30+ years), and site of practice ("major city", "provincial city" and "other centre"). Locations classified as "major cities" included Auckland, Hamilton, Christchurch, Dunedin, Porirua, Upper Hutt, Lower Hutt, Wellington, North Shore, Waitakere, Manukau and Papakura. Locations classified as "provincial cities" included Whangarei, Tauranga, Rotorua, Gisborne, Hastings, Napier, New Plymouth, Wanganui, Palmerston North, Masterton, Nelson, Blenheim, Kaikoura, Timaru and Invercargill. The remaining locations were classified as "other". Participation incentives were offered in the form of seven prize hampers, generously sponsored by several dental supply companies. Prize winners were randomly selected from those who completed and returned the survey. The survey questionnaire was posted with a covering letter explaining the studys purpose, and a freepost envelope was included for returning completed forms. One month later, a second wave of forms was sent to the 290 dentists who had not yet responded. This was accompanied by an amended covering letter. The survey responses were entered into an electronic database, and then analysed using the Statistical Package for the Social Sciences (SPSS; Version 13.0; www.spss.com). Associations between categorical variables were tested for statistical significance using the Chi-square test, with the alpha level set at 0.05. Multiple logistic regression was used to control confounding and derive adjusted odds ratios.
The impact of the media ­ THEOBALD ET AL
RESULTS Description of sample Of the original random sample of 600 general dental practitioners, 47 were outside the sampling frame, either because they were retired or deceased, or because their questionnaires had been returned due to incorrect address details. The 449 questionnaires returned from the remaining 553 general dental practitioners yielded a response rate of 81.2 percent. The socio-demographic characteristics of the participants are summarised in Table I. Respondents were normally distributed relative to their age and number of years since qualifying. Their mean age was 46.5 years (s.d. 11.8), and the mean number of years in practice was 23.2 years (s.d. 11.5). There were more males than females, at 76.6 percent and 23.4 percent respectively. Just under half the sample had been in practice for 15 to 30 years, and almost 60 percent practised in a major city. The proportion of females was greater among those who had been in practice for 30 or fewer years.
Table I. Practice characteristics by gender
Gender (row percentage)
Male
Female
Years in practicea
0 to 14
68 (61.3)
15 to 30
147 (71.7)
31 or more
115 (98.3)
Practice setting Major city Provincial city Other
192 (72.2) 78 (86.7) 74 (79.6)
43 (38.7)b 58 (28.3) 2 ( 1.7) 74 (27.8) 12 (13.3) 19 (20.4)
Total
344 (76.6) 105 (23.4)
a Information not supplied by 16 individuals. b p<0.001
Total (column percentage) 111 (24.7) 205 (45.7) 117 (26.1) 266 (59.2) 90 (20.1) 93 (20.7) 449 (100.0)
Aesthetic dental procedures All participants reported offering at least one type of aesthetic dental procedure. A further breakdown of the aesthetic dental procedures offered according to different practitioner characteristics is presented in Table II. Unless otherwise indicated, only statistically significant differences are described. There was a gender difference for implant restorations, with more males than females offering these. Tooth whitening and veneers were offered by a larger proportion of practitioners who had spent fewer years in practice. With the exception of orthodontics, aesthetic dental procedures were offered by more city-based practitioners than by those in smaller centres. Tooth whitening Most of the participants (97.0 percent) reported that their patients asked for tooth whitening, while 37.9 percent of dentists reported recommending professional tooth whitening to their patients. Participants reported the highest demand for tooth whitening procedures among their 31-40-year-old patients (52.0 percent), followed by those aged 41-50 years (32.4 percent). When asked about their preferred method of
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Table II - Aesthetic dental procedures offered, by practitioner characteristics (brackets contain percentages)
Gender Female Male Years in practice 0 to 14 15 to 30 31 or more
Tooth whitening 94 (89.5) 310 (90.1) 106 (95.5)a 191 (93.2) 97 (82.9)
Veneers 91 (86.7) 288 (83.7)
Type of procedure offered
Aesthetic crowns
Implants
94 (89.5) 316 (91.9)
44 (41.9)a 189 (54.9)
Orthodontics 19 (18.1) 67 (19.5)
97 (87.4)a 185 (90.2) 89 (76.1)
106 (95.5) 191 (93.2) 105 (89.7)
59 (53.2) 114 (55.6) 54 (46.2)
22 (19.8) 43 (21.0) 19 (16.2)
Practice setting Major city Provincial city Other All combined
246 (92.5) 78 (86.7) 80 (86.0) 404 (90.0)
233 (87.6) 73 (81.1) 73 (78.5) 379 (84.4)
247 (92.9) 80 (88.9) 83 (89.2) 410 (91.3)
148 (55.6) 45 (50.0) 40 (43.0) 233 (51.9)
43 (16.2) 23 (25.6) 20 (21.5) 86 (19.2)
aP<0.05
tooth whitening, 66.8 percent of GDPs preferred using takehome trays, 21.1 percent preferred in-surgery whitening, and the remainder had no preference for either method. Females, city-based or younger practitioners were more likely to offer tooth whitening to their patients. Reality makeover television programmes Some 77.8 percent of GDPs perceived an increased demand for tooth whitening subsequent to the airing of reality makeover television programmes such as "Extreme Makeover". The findings relating to those programmes are presented in Table III. Nearly all respondents were aware of "Extreme Makeover" at the time of the survey, although only three-quarters had seen the programme. Respondents reported becoming aware of it through their patients (52.8 percent), friends and family (50.0 percent), or colleagues (23.6 percent; multiple responses were permitted to this item, and therefore the percentages do not add up to 100 percent). Over half believed that their patients may now have higher aesthetic expectations of their dental treatment after viewing such programmes, while more than 85 percent have had patients mention that particular programme with respect to dental aesthetics. Tooth whitening and veneers were the aesthetic dental procedures that were reported to have had a substantially increased demand since the airing of such programmes.
A higher proportion of female GDPs reported having watched "Extreme Makeover" and having perceived a greater demand for tooth whitening, and this was also true of more recent graduates (who also reported having more patient enquiries as a result of the programme). Practitioners in major cities were also more likely to perceive an increased demand for tooth whitening among their patients than those from other centres. Those who had watched "Extreme Makeover" were more likely to perceive higher aesthetic expectations among patients, and an increased demand for tooth whitening, veneers and crowns and bridges. After controlling for age, gender and location of practice using logistic regression, those who had watched "Extreme Makeover" were more likely to perceive a higher demand for veneers (Odds Ratio 2.6; 95 percent confidence interval 1.6, 4.5) or for tooth whitening (OR 2.7; 95 percent CI 1.5, 4.6); gender and practice location were no longer significant predictors, although age was, with older practitioners less likely to perceive a higher demand for either cosmetic procedure. Current affairs television programmes This section of the survey was based on a specific episode ("Straight Talk") of the current affairs programme "60 Minutes". It examined the issues of orthodontic extractions, early treatment and functional appliances. More than one-
Table III - Watching of "Extreme Makeover" and subsequent demand for aesthetic dental procedures, by practitioner characteristics (brackets contain percentages)
Have watched Have had related "Extreme Makeover" patient enquiries
Perceived higher Perceived higher Perceived higher
patient expectations patient demand for patient demand
tooth whitening
for veneers
Gender Female Male Years in practice 0 to 14 15 to 30 31 or more
90 (85.7)a 252 (73.7) 94 (84.7)a 171 (83.4) 66 (57.4)
92 (87.6) 287 (84.4) 100 (90.1)a 181 (88.3) 84 (74.3)
65 (61.9) 186 (55.2) 61 (55.0) 125 (61.3) 58 (52.3)
82 (86.3)a 237 (75.2) 90 (87.4)a 159 (80.7) 60 (61.2)
56 (59.6) 166 (53.4) 62 (60.2)a 119 (60.1) 35 (37.6)
Practice setting Major city Provincial city Other All combined aP<0.05
212 (79.7) 67 (74.4) 63 (69.2) 342 (76.5)
227 (86.3) 78 (86.7) 74 (80.4) 379 (85.2)
153 (58.4) 52 (58.4) 46 (50.5) 251 (56.8)
203 (82.9)a 61 (74.4) 55 (66.3) 319 (77.8)
142 (58.9) 43 (52.4) 37 (45.1) 222 (54.8)
61
The impact of the media ­ THEOBALD ET AL
third of respondents were aware of the programme (Table IV), but fewer than half of these had watched it, while others had become aware of it mainly through colleagues (16.7 percent) or patients (13.1 percent). The data which follow are based on the 184 who were aware of this programme. Just over half (50.6 percent) believed that it was harmful to orthodontics, but most (94.4 percent) believed that it was not harmful to their own practice. Since its airing, 45.8 percent reported having related patient enquiries; 23.3 percent reported an increase in their own awareness of functional appliances; 16.7 percent reported an increased provision of functional appliances; and 10.2 percent reported a decrease in the number of orthodontic extractions. Moreover, 40.4 percent reported greater resistance to orthodontic extractions in their patients, while 44.0 percent believed that the programme was biased. While there were no significant differences by gender, years in practice or practice location, a greater percentage of practitioners who offer orthodontics were aware of (and had seen) the programme, and they also reported having more related patient enquiries (Table IV). Moreover, a greater percentage of practitioners in major cities reported increased awareness of functional appliances after the programme was aired. Practitioners in provincial cities were more likely to have become aware of the programme through their colleagues. Print media Practitioners were asked to rank various components of the print media (from 1 to 5, lowest to highest impact) according to their perceived impact on patients perceptions of aesthetic dentistry. Womens magazines were deemed to have the highest impact (mean = 3.9), followed by gossip magazines (3.5), health/fitness magazines (3.5), and aesthetic dentistry brochures (3.4). Current affairs magazines (2.7) and newspapers (2.7) were rated as having the lowest impact. Nearly all participants (90.1 percent) believed that television has a greater impact than print media on the demand for aesthetic dentistry. No difference in opinion was noted by gender or practice setting, but a significantly lower percentage (83.6 percent) of practitioners with 30+ years in practice shared this opinion than their younger counterparts (where
the proportions by length of time in practice were as follows: 1­14 years, 94.5 percent; 15­30 years, 90.6 percent). DISCUSSION This study has found that the popular media have a measurable impact on dental practice and GDPs perceptions of the publics expectations and attitudes towards aesthetic dentistry. However, before the findings can be discussed and placed in context, it is necessary first to examine the issue of their generalisability. This, in turn, is dependent upon the representativeness of the responding sample. At over 80 percent, the response rate was high by modern standards (Locker, 2000), and the proportion of female respondents (23.4 percent; 95 percent CI 19.5 percent, 27.3 percent) was similar to the 25.5 percent of female dentists in 2003 (Dental Council of New Zealand, 2004). Together, these suggest that the sample was representative of practising dentists in New Zealand, and that the findings may be generalised to that population with confidence. Aesthetic dental procedures All practitioners reported offering at least one aesthetic dental procedure, with only orthodontics offered by a minority of respondents. Implant dentistry was offered by just over half, with more male practitioners than females doing so. This supports the findings of Reid et al (2005), who noted a similar difference. Almost all of the different types of aesthetic dental procedures-- and tooth whitening and veneers in particular--were offered more extensively in large cities than in provincial cities or other locations, perhaps due to city patients being more appearanceconscious, and the practitioners adapting their service mix to meet this expressed demand. The exception was orthodontics, and this is possibly due to orthodontic specialists being largely concentrated in the major cities, thus requiring practitioners in provincial towns and other locations to provide a more extensive range of treatment options, including orthodontics. That more recent graduates were more likely to offer and recommend procedures such as tooth whitening may be due to their older counterparts being less prepared to embrace the new age of aesthetic dentistry (possibly due to their having been trained in an era where the primary focus of treatment was to eradicate disease).
Table IV - Awareness of "Straight Talk" and subsequent related patient enquiries, by different practitioner characteristics (brackets contain percentages)
Gender Female Male Years in practice 0 to 14 15 to 30 31 or more Practice setting Major city Provincial city Other Type of practitioner Does not offer orthodontics Offers orthodontics All combined aP<0.05
Aware of "Straight Talk" 44 (41.9) 140 (40.9) 48 (43.2) 92 (45.1) 38 (32.8) 114 (42.9) 39 (43.8) 31 (33.7) 127 (35.1)a 57 (67.1) 184 (41.2)
Have seen "Straight Talk" Have had related patient enquiries
18 (37.5) 69 (45.7) 23 (44.2) 36 (37.1) 24 (54.5) 54 (43.9) 15 (37.5) 18 (50.0) 55 (38.7)a 32 (56.1) 87 (47.3)
24 (54.5) 58 (42.0) 23 (47.9) 42 (46.2) 14 (37..8) 48 (42.9) 18 (47.4) 16 (50.0) 47 (37.6)a 35 (61.4) 82 (45.8)
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Where patient demand is concerned, the age group with the highest reported demand for tooth whitening procedures was patients aged 31 to 50 years old (the "Baby Boomers"). A US study also reported that this age group had the greatest demand for cosmetic dental procedures (American Academy of Cosmetic Dentistry, 2004). Furthermore, it has been described as comprising the largest target market for aesthetic dental services, being both more concerned with retaining a youthful appearance and able to pay for such care (Priest and Priest, 2004). Television and the perceived demand for aesthetic dentistry Female practitioners and those with fewer years in practice were more likely to have watched reality makeover television programmes such as "Extreme Makeover". Those who had watched such programmes were also more likely to perceive a greater demand, suggesting that the greater awareness among females and younger dentists had been at least partly influenced by television. While there are many positive spin-offs from greater media coverage of aesthetic dentistry through reality makeover television programmes, there are also some negative consequences. Patients' expectations may be unrealistic, as the transformations depicted in these programmes are often portrayed as instant, and treatment appears to be homogenous, regardless of the patient's individual needs. For example, severely maligned teeth are often seen to undergo "instant orthodontics" to enhance smiles without the waiting time of conventional orthodontics (Spear, 2004). Our findings suggest that the demand has significantly increased for tooth whitening and veneers (and it is no accident that these are the two main treatment modalities used in such programmes). Subsequently, dentists may be placed under greater pressure to give in to patients demands when the expressed need for such procedures among patients does not correspond to the clinical indications for treatment. This can place the dental professional in a quandary: is it ethical to provide what the patient demands, irrespective of what is best for them, or ought one to refuse treatment, or refer the patient to someone who will meet their demands (and thereby risk losing ones patient)? Current affairs television programmes Our study indicates that just over half of the practitioners who were aware of the 60 Minutes programme "Straight Talk" believed it to be harmful to orthodontics, and almost as many believed it to be biased. A small number believed that it was harmful to their practice. An Australian survey of orthodontists conducted in September 2004 investigated the effects of the same programme, and reported that three-quarters believed that the programme was harmful to the speciality of orthodontics, while more than one quarter believed that their own practice also suffered (Australian Society of Orthodontists, 2004). These estimates considerably exceed those of our study, but the ASO study surveyed only orthodontists. Moreover, the programme was aired in both countries in August 2003, but more time had elapsed (20 months) before the New Zealand study than before the ASO survey (12 months). Nearly half (40.4 percent) of the surveyed GDPs reported an increased resistance to orthodontic extractions subsequent to the programmes airing, indicating that some members of the public were affected by it. This suggests that the media are powerful in influencing Public perceptions, and emphasizes the need for the profession to take leadership in raising public
awareness of the evidence on controversial dental issues, and in gauging public opinion on such issues. The print media Women's magazines were ranked as having the highest impact on patients' perceptions of aesthetic dentistry, followed by gossip magazines. Since it has been shown that more females request aesthetic dental procedures (American Academy of Cosmetic Dentistry, 2004), this ranking is hardly surprising. While most of our participants believed that television has a greater impact than the print media in this regard, a smaller proportion of practitioners with 30+ years in practice shared this view. This viewpoint may reflect the increasing role of (and differential exposure to) television across age groups. CONCLUSION Female practitioners and those with fewer years in practice had perceived a greater demand for various aesthetic dental procedures, and were also more likely to offer them. City-based practitioners were also more likely than their more rural counterparts to do so. We conclude that the popular media (especially television) appear to have had an impact on the demand for various aesthetic dental procedures in New Zealand, affecting mainly tooth whitening and veneers. ACKNOWLEDGMENTS The authors would like to acknowledge and thank Henry Schein Regional, Shalfoon, Oral-B, Gunz Dental, New Zealand Dental Supplies, Oraltec, BD, Arthur Hall Orthodontics and Healthcare Essentials for sponsoring the prize incentives, and ProudMouth Caring Dentistry for generously funding the postage costs. We would also like to thank Mrs Wilma Neilson for her time and assistance. Finally, all respondents are thanked for taking part. REFERENCES American Academy of Cosmetic Dentistry (2004). North American Survey: The state of cosmetic dentistry. http://www.aacd.com/media/ releases/2004 percent20National percent20Survey.pdf Australian Society of Orthodontists (2004). ASO Member Survey ­ 2004. Australian Society of Orthodontists Newsletter September 2004, 13. Becker AE, Burwell RA, Gilman SE, Herzog DB and Hamburg P (2002). Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. British Journal of Psychiatry 180: 509-514. Biddle JE and Hamermesh DS (1998). Beauty, productivity and discrimination: lawyerslooks and lucre. Journal of Labor Economics 16: 172-201. Buonocore MA (1955). A simple method of increasing the adhesion of acrylic materials to enamel surfaces (abstract). Journal of Dental Research 34: 749. Cann A, Siegfried WD and Pearce L (1981). Forced attention to specific applicant qualifications: impact on physical attractiveness and sex of applicant biases. Personnel Psychology 34: 65-75. Christakis DA, Zimmerman FJ, DiGiuseppe DL and McCarty CA (2004). Early television exposure and subsequent attentional problems in children. Pediatrics 113(4): 708-713 Christensen GJ (2002a). The tooth-whitening revolution. Journal of the American Dental Association 133: 1277-1279.
63 Christensen GJ (2002b). Are prosthodontics a vital part of dentistry? Journal of the American Dental Association 133: 647-648. Clark ML and Ayers M (1988). The role of reciprocity and proximity in junior High School friendships. Journal of Youth and Adolescence 17: 403-11. Dental Council of New Zealand (2005). 2004 Workforce Analysis. Wellington: Dental Council of New Zealand. Felson RB (1996) Mass media effects on violent behaviour. Annual Review of Sociology 22: 103-128. Felton DA (2004). Do no harm (editorial). Journal of Prosthodontics 13 (2): 71-72. Golub-Evans J (1994). Unity and variety: essential ingredients of a smile design. Current Opinions in Cosmetic Dentistry 2: 1-5. Gould MS and Shaffer D (1986). The impact of suicide in television movies. Evidence of imitation. The New England Journal of Medicine 315: 690-694. Hamermesh DS and Biddle JE (1994). Beauty and the labor market. American Economic Review 84: 1174-94. Locker D (2000). Response and non-response bias in oral health surveys. Journal of Public Health Dentistry 60: 72-81. Mandel I (1998). The image of dentistry in contemporary culture. Journal of the American Dental Association 129: 607-613. Marlowe CM, Schneider SL and Nelson SE (1996). Gender and attractiveness biases in hiring decisions: are more experienced managers less biased? Journal of Applied Psychology 81: 11-21. Newton JT, Davenport-Jones L, Idle M, Patel M, Setchell A et al (2001). Patients' perceptions of general dental practitioners: The influence of ethnicity and sex of dentist. Social Behaviour and Personality 29: 601-606. Morley J (1999). The role of cosmetic dentistry in restoring a youthful appearance. Journal of the American Dental Association 130: 1166-1172.
The impact of the media ­ THEOBALD ET AL Priest G and Priest J (2004). Promoting esthetic procedures in the prosthodontic practice. Journal of Prosthodontics 13: 111-117. Reid D, Leichter JW and Thomson WM (2005). Dental implant use in New Zealand in 2004. New Zealand Dental Journal 101: 12-16. Sarwer DB, Magee L and Clark V (2004). Physical appearance and cosmetic medical treatments: physiological and socio-cultural influences. Journal of Cosmetic Dermatology 2: 29-39. Signorielli N (1990). Children, television, and gender roles. Messages and impact. Journal of Adolescent health care 11: 50-58. Spear FM (2004). The esthetic correction of anterior dental malalignment: conventional vs. instant (restorative) orthodontics. Journal of the Californian Dental Association 32: 133-141. Thompson JK and Heinberg LJ (1999). The media's influence on Body Image disturbance and eating disorders: we've reviled them, now can we rehabilitate them? Journal of Social Issues 55: 339-344. Ward LM (2002). Does television exposure affect emerging adults' attitudes and assumptions about sexual relationships? Correlational and experimental confirmation. Journal of Youth and Adolescence 31: 1-15. Zuckerman DM and Zuckerman BS (1985). Televisions impact on children. Pediatrics 75: 233-240. Anna H Theobald, BDS (Otago) Benedicta KJ Wong, BDS (Otago) Andrew N Quick, BSc, MChD (Stell) W. Murray Thomson, BDS, MComDent (Otago), MA (Leeds), PhD (Adel) Department of Oral Sciences School of Dentistry The University of Otago PO Box 647 Dunedin Corresponding author: Murray Thomson E-mail: [email protected]

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