Worn Teeth: problems of a Modern Society

I see more patients that suffer from worn teeth than ever before. This seems to be a phenomenon of our modern style of living. The advent of processed foods, sugar and chemicals in our diets could be a factor along with the high stress lifestyles we have all grown accustomed to (or have we?). Combine this with people living longer and keeping their teeth longer the dental profession faces new challenges in predictably treating these cases.  Cosmetic and reconstructive dentistry has become more desirable and affordable, and now patients more than ever people want to have their teeth restored back to a more youthful appearance.

Most often people begin to notice that their teeth appear shorter or they don’t see their teeth as much when they smile. But treating worn teeth can be more complex than just “making the teeth longer”. When evaluating these types of cases the first thing we need to do is determine what caused wear and appearance. The most common causes I see today are: 1) abrasion due to grinding and 2) erosion due to diet or gastric reflux.

          Many people grind or clench their teeth, usually at night when they are sleeping but daytime clenching and grinding is becoming more common. Bruxism is the term for this condition.   Stress, sleeping habits, misaligned teeth all could be contributory factors for bruxism. The goal for successful treatment is to attempt to reduce the grinding and restore the teeth to ideal esthetic forms. Because it may be impossible to completely eliminate grinding we need create a biting environment (occlusion) that works for that patient. Also protection of the restored teeth after treatment needs to be considered.

          Erosion can cause similar wearing of the teeth to grinding but how you get there is completely different. Erosion is a chemical process whereby the tooth structure is weakened by acids then worn away by normal things like chewing and brushing. Erosion appears to be a modern problem. Primitive teeth studied prior to the introduction of   sugar and soft drinks into our diets didn’t seem to suffer the effects of erosion. Soda and citrus fruits are very acidic and if consumed frequently can cause serious erosion of teeth. Teeth eroded in this way have a very specific appearance but once identified the diet can be changed and the problem corrected. After the teeth are restored there is then little risk moving forward.

          Acid reflux, GERD and bulimia cause acids from the stomach to attack the biting surface of back teeth and the back of front teeth. The damage to the teeth is a combination of the acid demineralizing or weakening the enamel and then chewing and brushing removes the softened tooth structure. This type of erosion has a unique appearance and its own treatment considerations, but as previously described once the problem is corrected the teeth can be restored back to their original form and function.

Nesconset, NY's Nesconset Dental Associates Redesigns and Reshapes Patient Smiles with Veneers

Nesconset, NY's Nesconset Dental Associates Redesigns and Reshapes Patient Smiles with Veneers

"Case of the Month" for February and March

The Smile Makeover- A True Story

You don’t need a beautiful smile to be a beautiful person. But then again, like a beautiful home where the façade and entry make the first impression a smile can be the welcome to the observer’s eye.

Much more than just aesthetics, a smile translates the unspoken language of emotion. A smile communicates happiness, confidence, warmth, trust and more. The smile is an invitation to friendship. A smile can be silent hello or agreement.

So when a patient comes to me and tells me they don’t smile because they don’t like the appearance of their teeth, I know they are missing out on a part of life. Social interactions become skewed. The grumpy old lady down the block is really someone’s sweet grandma but she never smiles because she is embarrassed by her teeth. That girl at the party is stuck up and unapproachable because she barely talks to anyone, but inside she is dying to laugh, chat and smile but she has an ugly front tooth and talks with her hand over her mouth. I’ve heard all the stories. I am fortunate to have the ability to play a part in a smile makeover.

Case Study: This patient (figure 1) presented with discolored and crowded teeth. After a records and a comprehensive exam were completed a treatment decision was reached. Orthodontic treatment would be done followed by porcelain veneers on the upper six front teeth.

Fig.1

The orthodontic treatment consisted of brackets on all teeth and was completed in 18 months. At that point impressions were taken to create a diagnostic wax up. The diagnostic wax up allows us to design how the smile will be on a stone model. After which the teeth are prepared and temporaries are made from the wax up. The patient then wore the temporaries for one and returned to make custom changes to shape, size and color as per the patients liking. Was the temps were exactly the way we wanted them, photos and models were sent to the lab for fabrication of the permanent porcelain veneers.

                                                Fig. 2

The patient was very happy with the outcome (figure 2), and now smiles even more than she did before.  One day we hope to treat the lower and back teeth as well for an even bigger wow factor.

Salvatore Lotardo DDS

Responsible Esthetics

                Cosmetic dentistry has been around a long time but has changed dramatically over the years. In the forties, Hollywood starlets would get their teeth capped so that they were “ready for their close-ups Mr. DeMille”. Because techniques and materials were limited back then, much of the tooth structure had to be sacrificed to obtain an acceptable result. Dentistry has progressed through the years and great improvements were made for patient comfort and higher quality care.

But it wasn’t until the early eighties when predicable bonding to teeth was achieved that the modern era of cosmetic dentistry really began. There is a lot of confusion over the term “bonding”. I often hear people say “I had my teeth bonded”, but that could really mean many things. Bonding really refers to the method by which dentist adhere materials to tooth structure. Most commonly, the esthetic materials we bond are composite and porcelain.

                With composite and porcelain; crowns, fillings and veneers can be bonded to the teeth for natural looking tooth colored restorations.  Porcelain veneers are thin shells of porcelain which are bonded over the teeth became very popular because patients were able to receive “smile makeovers” in a few visits, producing dramatic changes in shape and color. This power to transform a person’s smile had its consequences. In my opinion, we became too aggressive and not open to consider other more conservative options.        

                The present era of responsible esthetics aims to achieve excellent cosmetic results while minimizing the removal of healthy tooth structure. Direct composites material can be used to mimic tooth structure so well, many times any preparation of the tooth can be avoided. Porcelain veneers can be made so thin now that no preparation or addition only restorations are possible. The use of adjunctive services such as orthodontics and implant also enable the dentist to provide less invasive and irreversible treatment in the pursuit of beautiful and healthy smiles.

“With great power, comes great responsibility.” --- Spiderman

               

Canine Substitutions

                   Some people are congenitally missing their upper lateral incisors. Meaning that, genetically those teeth never develop and when the baby teeth fall out they are left with two missing teeth. The lateral incisors are the small teeth next to the front central incisors.

                Once this condition is identified a plan needs to be formulated to assure an optimum outcome. There are two ways to handle this, the first is canine substitution. In canine substitution we use orthodontics to move the upper canines into the lateral positions. There are some compromises aesthetically and functionally with this approach.

 Aesthetically canines are much wider and more triangular shaped than laterals. So if moved as is the smile looks unusual unless the canines are altered. If treatment is coordinated properly with the restoring dentist and the orthodontist, the canines can be narrowed and reshaped with composite bonding and the position of the tooth moved to mimic a lateral.

The bite or occlusion can be compromised as well since you are left with fewer teeth in the upper arch compared to the lower arch. Most of the time, the occlusion can be compensated for as part of the orthodontic treatment and an acceptable bite can be established.

The other approach is to maintain or regain the space that would normally be present with the lateral incisors. In this case, orthodontics is needed to move or hold the canines in their normal positions, and then later restore the missing teeth with implants or bridgework.

There are numerous factors that guide us into selecting the proper treatment plan, and unfortunately there will be compromises in either case. But if detected early and planned properly both treatment options can finish with beautiful results.

Diastema: The Space Between Your Teeth

Diastema is the term for any space between two teeth.  The midline diastema (space between the two upper central incisors) is by far the most common. Some celebrities have embraced their diastemas and have become part of their persona. For example…

Many people have a diastema and in most cases it may give some character, but for some they feel it detracts from their smile. With the advent of new materials and techniques patients have very conservative options available to eliminate these spaces.

In order to determine the best treatment we need to establish the etiology or cause for the diastema. The most common cause is the shape of the teeth. If the central incisors are rectangular shaped rather than ovoid this will lead to formation of a space. This is also the most easily corrected. Simply adding composite bonding to the side of the teeth will establish proper contours and close the space, and this is done without any harm to the teeth

Another common reason for spaces is a tooth size discrepancy. Simply put this is when the teeth are too small for the size of the jaw. For these cases bonding can be done to make the teeth wider, but if the shape of the teeth is good then orthodontic treatment (braces) may be the treatment of choice. There are now many esthetic options for orthodontic treatment (Invisalign, Ceramic Brackets, Short Term Orthodontics), and in some cases treatment can be completed in a few months.

Any spaces between teeth that were not previously there or are getting worse can be a sign of a problem. Gum disease weakens the support for the teeth and they become mobile and eventually spread out from biting forces causing spacing. Gum disease needs to be treated early to prevent systemic illness and tooth loss.

If you love your space and want to remain in the gap tooth club with Madonna, David Letterman, Arnold Schwarzenegger, Anna Paquin and Woody Harrelson, it worked for them. But if you are looking for a change or think your smile will look better and give you more confidence without the space; see your dentist for a consultation.

                                                              Composite Veneers by Salvatore Lotardo DDS