A few years ago the television show Extreme Makeovers highlighted the dramatic changes that can occur with plastic surgery, makeup and hair treatments. Can you imagine how silly the show would be if patients would appear with their new bodies, but still have their dilapidated smiles? Discolored and crooked teeth would be the focus of attention, not a hidden liability. Dentistry plays a very significant role in your appearance and can even take years off your appearance without any plastic surgery.

You may already have an idea of what would make your smile look its best. You may simply want whiter teeth. You may wish your teeth looked the way they did in your high school graduation photo. Misaligned teeth may have bothered you for years, but you have said nothing about it to your dentist or spouse. Dark gaps may be present between your teeth or dark triangles along the gumline where you have recession. You may have too much gum tissue showing in your smile. All of these situations are treatable with dentistry’s latest technologies such as tooth whitening (bleaching) and porcelain laminate veneers or caps.

Whether you have an idea of what you would like or not, your dentist may be able to demonstrate to you what would give you your ultimate smile. Techniques such as photo imaging (computerized previews of your future smile) or in-the-mouth mockups will give you a good idea of what to expect from dental treatments. If you are curious, simply ask your dentist to show you what can be done before you have any treatment. Most dentists are eager to have you participate in your treatment selection.

An area that is most neglected in smile makeovers is the correction for loss of facial height that occurs as we age. Loss of facial height can occur in patients who have had excellent dental care. In fact, the condition is prominent in patients who have had many crowns, in patients who clench their teeth and in patients who have had TMJ (jaw joint) problems.

You can tell if you have lost facial height with the following tests:

1. Check an old photo and then look at yourself in a mirror. Is your nose closer to your chin? If so, you have lost height in the lower half of your face, contributing to an older appearance than is necessary. Not all patients lose this facial height, so they naturally remain younger looking as they age.
2. Again, look at the photo. Is your lip line thinner now? This is a telltale sign of loss of facial height and muscle tone.
3. Do you show wear on the edges of your upper or lower front teeth? This results in a more aged appearance?
4. Have you worn through the enamel on some or all of your back teeth? Your dentist may have had to place crowns on some of these teeth due to breakage and wear.
5. Place two identical small objects, such as a piece of carrot, about one-quarter inch thick, one on each side of your mouth between your back teeth. Close softly to hold these objects in place. With a very relaxed mouth and facial muscles, look at yourself in the mirror. Does this recapture any of your lost facial height? Do your lips appear fuller, but unstrained? If so, dentistry can make you look and feel younger, sometimes as much as five or ten years younger.

It is important to be evaluated for loss of facial height before undertaking any extensive dentistry. Dentistry that is built into an existing worn bite might require early replacement. If your bite needs to be built up, this is the time to do it.

Most dentists feel comfortable providing some level of cosmetic dentistry, such as caps and crowns. There are many levels of service available from simple monochromatic “ Hollywood“ Smiles to complex works of art that accurately replicate the appearance of perfect teeth.

A small percentage of dentists are comfortable and competent in providing reconstructive dentistry. Reconstructive dentistry refers to rebuilding the bite, including correcting for loss of facial height, with caps, onlays or veneers. The problem for the patient occurs when cosmetic dentistry is provided, but both cosmetic and reconstructive dentistry are indicated. If you answered “yes” to any of the tests above, you should be aware of the potential consequences of not having your bite reconstructed at the same time that your veneers or caps are placed.

Dentists are often confronted with the dilemma as to when to reconstruct a bite that is being destroyed. Delaying treatment allows continued destruction and creates technical problems that may prevent a total recapture of lost facial height. It also may necessitate treatment of additional teeth, elective root canal treatments and bone surgery. A perceptive dentist can recognize the telltale signs that accompany bite destruction and loss of facial height. It is preferable to initiate treatment before major destruction has occurred.

Following is a list of signs of deterioration. You may need help from your dentist or hygienist to see some of these signs:

Early stage signs – the patient reports grinding or clenching of teeth, the edges of front teeth look flat across prior to age 40, portions of teeth (cusps) break off, first molars show small dimples on the cusp tips (points of the teeth), sleeping partners may mention grinding of teeth at night.

Mid-stage signs – all enamel is worn off the edge of the upper or lower front teeth, the cuspids (canines or eye teeth) are flat along the biting edge, one or more back teeth have wear through all the enamel, beginning signs of loss of facial height or lip fullness, appearance of bony bumps (tori) along the inside of the lower teeth or the outside of the upper back teeth.

Late state signs – front teeth look wider than they are tall due to wear, loss of one or more back teeth without replacement, clearly evident loss of lip fullness, clearly improved appearance when bite is opened one-quarter inch or more (see test above).

Treating at an early stage is preferred because this provides added years of enjoyment of a beautiful and healthy smile. In some cases, an occlusal bite guard is constructed for nighttime wear to reduce damage during the early stage.

Treating by the middle stage allows re-creation of the bite to the most ideal position possible. Patients are usually younger and tolerate procedures very well.

While the most dramatic results can be achieved by treating patients who have arrived at the late stage, this is not the ideal. Late stage patients sometimes present as “emergency reconstructions” with multiple broken teeth and lost crowns. Teeth are weaker and there may be greater damage to supporting structures, such as the jawbone and joints. This will result in greater maintenance requirements for the reconstructed teeth.

If you are a candidate for aesthetic and reconstructive dentistry, your dentist will develop a sequential plan to accomplish the desired objectives. All patients are not alike. While some patients may require or desire to have every tooth rebuilt, other patients may only need upper teeth or lower teeth rebuilt, or a combination of some lower and some upper teeth rebuilt.

For samples of cosmetic dentistry, dental makeovers and aesthetic reconstruction cases, visit the author’s website at www.studiodentistry.com.

PRO-TIP Your satisfaction with the appearance of new cosmetic dentistry is largely dependent on your own expectations. This may be different from what your dentist believes will look great on you. Communication is the key, so don't be afraid to ask for a mock-up or photo imaging so you can envision the results before your treatment begins.

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