Defense Date


Document Type


Degree Name

Master of Science in Dentistry



First Advisor

Elizabeth Bortell, DDS

Second Advisor

Caroline Carrico, PhD

Third Advisor

Bhavna Shroff, DDS, MDentSc, MPA


Purpose: The mixed dentition is a period of unique dental changes for developing children and their parents. The purpose of this study is to determine threshold levels of concern regarding diastema spacing and angulation of maxillary incisors during the “Ugly Duckling Stage” in pediatric patients and their parents.

Methods: This study is modeled as a cross sectional-survey among pediatric patients and parents. The surveys contain photographs of a sex-neutral, mixed-dentition smile with variations of midline spacing and incisal angulation which randomly differ in quantifiable values. Participants were asked to rate each photograph on a visual analog scale.

Results: The interaction between respondent type and image was not statistically significant. Children aged 8-12 years old showed less concern with appearance of diastema and angulation variations within the anterior maxillary dentition relative to the adult parent population. Parents who have experienced a child through the mixed dentition (oldest child that was 12 years or older) showed significantly more concern with appearance of diastema and midline discrepancies in the mixed dentition. Overall, images of maxillary central incisors in the mixed dentition with 30 or 40 degree rotation were rated significantly lower than the baseline image and the images with 5 degrees of rotation, 10 degrees of rotation, and 1mm diastema.

Conclusions: Dental professionals can use this information to better understand the concerns of their patient population and for purposes of anticipatory guidance and treatment planning.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission