ETHNIC VARIATION IN THE MOST COMMON SHADE OF ANTERIOR TEETH AMONG MALAYSIAN STUDENTS: A CROSS-SECTIONAL STUDY

Aim: Determination of the most common shade of anterior teeth in Malaysian students of different ethnicities. Materials and Methods: A total of 120 subjects, 40 each from different ethnicities (Malay, Chinese, and Indian) aged 18-22 years were evaluated for tooth shade using the VITA Classical shade guide. The subject was asked to sit in an up-right position with teeth at the clinician’s eye level and the subject was instructed to remove makeup or tinted eyewear which may affect the result. The procedure was done in natural daylight. The shade tabs were positioned adjacent to the maxillary central incisor and the middle 1/3rd of the facial surface was assessed by experts to determine the correct tooth shade. The data was statistically analysed. Results: The differences in tooth shade were seen among the subjects of different ethnicities. The Malay ethnicity has B1 (37%) as the most common tooth shade whereas Chinese has C1 (27%) and Indian C1 (40%). Conclusions: Under the limitation of the study, it was found that there is a relationship between tooth color and ethnic background. Malay students tend to have brighter teeth as compared to Chinese and Indian students.

Resultados: Se observaron diferencias en el color de los dientes entre los sujetos de diferentes etnias.La etnia malaya tiene el B1 (37%) como el color de dientes más común, mientras que los chinos tienen el C1 (27%) y los indios C1 (40%).The shade selection using these digital devices provides better results than conventional visual methods.Therefore, care should be taken while using the visual method of shade determination, and experienced experts should be involved in the study. 5Hence, the conventional visual shade matching method continues to be preferred, despite its susceptibility to inaccuracies, because it is not reliant on specialized devices and remains a cost-effective option. 6ghts and colors are not the only factors that can affect a shade selection.There are a few key optical properties of teeth that need to be kept in mind before selecting a color for restoration. 7There are many factors that are

Participant selection
The research was carried out on Malaysian Subjects with discolored upper anterior due to intrinsic, extrinsic staining were excluded.
Oral prophylaxis was done, and teeth were polished using polishing paste and rubber cups prior to shade selection.

Color blindness test
The experts were selected based on their extensive experience in restorative dentistry and shade matching.

Statistical analysis
Collected data were organized and analysed using dedicated software (IBM SPSS V 17.0).Descriptive data were presented in tabular form.
The chi-square test was employed to assess correlations among qualitative data, with statistical significance set at a p-value <0.05.

RESULTS
A total of 120 participants, 40 each from different ethnicities (Malay, Chinese, and Indian) aged 18-22 years were evaluated for tooth shade using the VITA Classical shade guide.The most common shading for Malay par-ticipants is B1, which is 37.5% within the Malay group.The most common shading for Chinese participants is C1, which is 27.5% of the Chinese participants.For India, the most common shading is C1, which is 40% within the Indian participants (Table 1).

None of the Chinese participants have shade
A1 and shade B3.The only group that has shade B4 is the Chinese participants (Figure 2 and Figure 3).There is a significant association between ethnic groups and shade guides (p= 0.002).

DISCUSSION
5][16] The important factor affecting aesthetics is tooth shade or color.The determination of tooth color is quite complex, as it involves both subjective and objective components. 17ere is limited data available on the relationship between tooth shade and ethnic background, hence the present study was In our study, the results were in agreement with the study done by Jahangiri et al. 19 This study shows that there is a significant The color-matching accuracy is assumed to improve and be reliable as clinical experience increases.
Individuals aged over 30 were intentionally excluded from the study.This is because there

Conclusión:
Bajo las limitaciones del estudio, se encontró que existe una relación entre el color de los dientes y el origen étnico.Los estudiantes malayos tienden a tener dientes más brillantes en comparación con los estudiantes chinos e indios.Palabras Clave: Diente; Incisivo; Color; Colorimetría; Etnicidad; Malasia ORIGINAL ARTICLE INTRODUCTION Shade selection in dentistry is an important step in achieving aesthetically pleasing and harmonious restorations.The ability to accurately match the color of dental restorations with natural teeth is a technical skill and an art, as it requires an in-depth understanding of color perception, lighting conditions, and the complex interplay between shades and tooth structure.The choice of the most appropriate shade significantly impacts the overall appe-arance and patient satisfaction.Various me-thods are used for shade selection such as shade guides or digital devices such as intraoral spectrophotometers and scanners. 1,2 required to be kept in mind for shade selection in a patient.Numerous studies in the past have sought to investigate the relationship between tooth shade and skin color.This study aims to understand shade selection by investigating the common shades of anterior teeth in Malaysian students of different ethnicities.
students of diverse ethnic backgrounds, including Malay, Chinese, and Indian, following approval from the Institutional Ethical Committee of Manipal University, India (IEC 171/2017).The targeted sample size is 120 (40 from each ethnicity).The study was conducted by using the VITA Classical shade guide to determine the shade of maxillary anterior teeth under controlled conditions of bright daylight to ensure consistent lighting across all observations.Bright daylight was chosen to replicate the most encountered lighting situation in natural settings, as it can influence the perception of tooth shade.

Gupta R &
Saluja I. Ethnic Variation in the Most Common Shade of Anterior Teeth among Malaysian Students: A Cross-sectional Study.J Oral Res.2023; 12(1): 217-225.https://doi.org/10.17126/joralres.2023.019Three independent female experts, each possessing over five years of clinical experience, underwent a color blindness assessment con-ducted by an ophthalmologist.This step was taken to ensure the accuracy of shade matching, as discrepancies in color vision can impact the process. 8-10Color deficiency screening took place in a controlled, consistently lit room using the Ishihara color blind test, where clinicians had to identify numbers within coloured circles with a provided answer key.Conditions like room lighting were maintained constant, and participants with normal vision correctly identified all numbers in the test. 8,9Grouping A total of 120 participants, 40 each from different ethnicities (Malay, Chinese, and Indian) aged 18-22 years were evaluated for tooth shade using the VITA Classical shade guide (Figure 1).Each of the three experts independently evaluated the tooth shade of all 120 students in the study.To ensure consistency, the experts used a standardized shade guide for assessment.Following the evaluation, each expert reported the final tooth shade using the Vita Classical shade guide.The Vita shade guide was selected due to its widespread use and established standardization in dental practice.Shade selection The shade of teeth on subjects is determined as follows: Subjects sat upright at the operator's eye level, holding the VITA Classical shade guide at arm's length.Shade assessment focused on the middle one-third of the facial surface of the maxillary central incisor due to color variation reasons.Shade tabs were placed at a 45-degree angle to the light source to replicate clinical all three observers following this angle.The tooth and tabs were kept moist during the process.The following precautions were taken such as makeup/ tinted eyeglasses being removed.Operatory walls were kept neutral.Shade comparisons were made quickly to avoid eye fatigue and tooth shade was evaluated under natural daylight in a time frame of 5-10 seconds. 12,13
conducted to determine the most common shade in ante-rior teeth in Malaysian students of different ethnicities and to evaluate its association with ethnic background.The human eye is very accurate in determining variations in the texture or color of various surfaces.The human eye possesses a remarkable ability to perceive visual details, it is essential to consider various factors that 221 Gupta R & Saluja I. Ethnic Variation in the Most Common Shade of Anterior Teeth among Malaysian Students: A Cross-sectional Study.J Oral Res.2023; 12(1): 217-225.https://doi.org/10.17126/joralres.2023.019influence the accuracy of color perception.Factors such as lighting conditions, individual variations in perception, and inherent limitations in human vision can impact the perceived accuracy of color matching.Furthermore, quantifying the level of accuracy can be challenging without a comparative framework to other objective methods of color assessment.Thus, while the human eye is capable of nuanced color perception, the context in which it operates must be carefully considered to understand its limitations and strengths.Visual shade determination is widely used by dentists across the globe.Various devices such as handheld spectrophotometers, colorimeters, and optical color scanners are used for shade detection in dentistry.Visual tooth shade se-lection by shade guide is a more widely used method and much more cost-effective. 6The tooth shade guide was arranged based on value components into 4 categories as per the previous study. 18In the present study, the most prevalent shade among Malay was B1 (highest value) and the least was B4 (low value), followed by C3, C4, D1, D2, and D4.The most prevalent shade among Chinese was C1(high value) and the least was A1(highest value), followed by B3, C4, D1, D3, and D4.The most prevalent shade among Indians was C1(high value) and the least was A4 (low value), followed by B4, C4, D1, D3, and D4.
relationship between ethnic background and tooth shade.However, there is no literature available regarding the comparison of tooth color in different populations.The middle one-third of the tooth was used to assess tooth shade because the incisal part if often translucent while the cervical onethird is affected by light scattered from the gingiva.20In our current study, clinicians who exhibited normal visual acuity and were confirmed to have no color vision deficiency through the Ishihara pseudoisochromatic plate test were recruited.Recognizing the potential for retinal cell fatigue when focusing on an object for extended periods, clinicians were encouraged to alleviate eye strain by taking intermittent breaks and looking at a neutral gray background that was provided for this purpose.This approach aimed to maintain the visual acuity and accuracy of the clinicians throughout the process. 10-13Female clinicians were chosen for shade mat-ching, primarily due to the potential advantage of tetrachromacy in women.This genetic trait, stemming from differences in cone pigment genes on the X chromosome, could enhance their ability in the shade-matching process.21Another factor that can influence the accuracy of visual shade matching is the clinical experience of the dental personnel.22

1,2
The process of shade selec-

Table 1 .
Data Collection.Ethnic Variation in the Most Common Shade of Anterior Teeth among Malaysian Students: A Cross-sectional Study.