Award winning cosmetic dental surgeon Dr Ian Hallam, tells resident health writer Laura Lewis what makes a beautiful beam
What ‘ages’ a smile?
There are several factors in combination that cause a smile to age. Firstly the front teeth become worn down, causing them to look shorter and squarer. Secondly they become discoloured and there can be some gum recession, with exposed, yellower dentine at the gum margin.Thirdly, the lips become thinner and less hydrated with age and the volume and definition is lost as the lips invert. The surrounding skin is also likely to show more lines and wrinkles.
What does the perfect smile look like?
For a perfect smile, the teeth should work in harmony with the shape of the face. They should be a light shade with no discolouration, the centre line should correspond to the centre line of the face (although faces sometimes can be asymmetrical) and the level of the front teeth should be horizontal. There should also be the correct amount of tooth display with the lips relaxed (usually about 3-4mm although it can be more with a high lip line). The gum around each tooth needs to be the correct level in relation to each other and the lips should have sufficient shape and volume and be in harmony with the face, with the skin around the mouth looking smooth and hydrated.
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Problem fixers
Thin lips
The latest generation of fillers include a specific product for lips which is softer and allows for natural lip movements without breaking down. The product chosen will either give volume or just refresh, depending on what is required. The shape can be restored, the border defined and the surface texture improved. Generally, clients can be understandably nervous about having lips treated because they don’t want a ’trout pout’. However if lips are enhanced with the correct filler, they will look more shapely but very natural.
Lip lines
Fine lines around the mouth are particularly noticeable on the upper lip and are the result of constant contraction of the orbicularis oris muscle, which is responsible for the ‘puckering’ of the lips. They are known as ‘smokers lines’ because smokers are puckering frequently to hold the cigarette, and the skin condition deteriorates more in smokers. They are treated by either injecting a very ‘flowable’ filler to smooth the skin and stimulate collagen and elastin production or by injecting the client’s own plasma, rich in growth factors, or micro-needling (Derma-roller), both of which stimulate collagen production in a completely natural way.
Missing tooth
Missing teeth can lead to the lip or cheek collapsing into the space. Removable dentures used to be the solution but now you can have a bridge or an implant. An implant is a titanium screw that becomes integrated into the bone and acts as an artificial root onto which a crown is placed. It is incredibly strong to chew on, looks natural, can be cleaned easily and avoids the tooth reduction of the adjacent teeth required for a bridge.
Receding gums
Incorrect tooth brushing can cause gums to recede and sensitivity can appear. If the gums are healthy and the exposed dentine not unsightly, it doesn’t need treating. However, if it is more severe it can make the tooth look too long. It can be improved with soft tissue surgery or a tissue graft from the palate.
Gummy smile
A gummy smile is often the result of a high lip line causing too much gum to be displayed. This can look unattractive and self-conscious people tend not to smile as much. It can be corrected by surgery to reposition the level of the attached gum or, as an alternative to surgery, by injecting a small quantity of ‘Botox’ into the levator muscles that lift the lip so that on smiling, the lip isn’t raised as high.
Tooth wear and tear
Teeth can wear down or cusps break as a result of changes to the way they bite together. Treatment can sometimes require a complete rehabilitation of the occlusion so that the teeth bite together correctly and allow for natural chewing movements without any interference of cusps on posterior teeth. Broken teeth can be treated by bonding some composite filling material if it is a small fracture. A larger fracture may require a veneer or crown. The latest porcelain veneers are ultra-thin and require minimal preparation to the tooth and modern ceramic crowns are thin but very strong. Many smile makeovers require veneers or crowns which enable the teeth to be straightened and the correct length and proportions to be re-established.
Discolouration
Surface staining can be removed by a hygienist but this will not change the shade of the teeth, which can only be achieved by tooth whitening. This can be done either as an in-surgery procedure using a concentrated whitening gel, or at home, or a combination of both. An improvement of 6-8 shades can be achieved.
