Great-looking teeth, or a great-looking smile?

by Louis Malcmacher, DDS, MAGD

I have taught dental esthetics for over 30 years. For years, we taught this concept – Mrs. Jones comes in for a consultation because she wants to make her teeth look more esthetically pleasing. She thinks that to solve the problem all she needs is two veneers on her upper central incisor teeth. Of course, like everyone else on the planet, she wants these two front teeth bright white, while the rest of her teeth are a shade C4.

Many dentists will want to try to treat this case, and from my personal experience, I can tell you this is a total loser case. This is because if you give her what she wants, she will have two teeth that are shining like beacons out of her mouth, she will look like Bugs Bunny, and she will blame you, her dentist, for making her look this way. In the past, we've taught dentists to explain this to patients -- "You know, Mrs. Jones, if you put porcelain veneers on only two teeth, you'll have good-looking teeth but you won't have a great-looking smile. In order to achieve a great-looking smile, you'll need eight to 10 veneers."

At this point, it doesn't matter if you put veneers on 28 teeth; you still have given the person only great-looking teeth, not a great-looking smile. Let me ask you a question. Do your patients have lips, chins, cheeks, and soft tissue in the perioral area that surrounds their mouths? My patients certainly do. They do not walk in with just teeth. They come in with teeth that have to match their face and a face that has to match their teeth.

Here is another concept that dentists have been wrong about -- patients want white teeth. When they see someone with very white teeth, most people think that they look fake or look like dentures. That is not always true -- if the patients' surrounding face and lips match the youthfulness of the teeth, then white teeth can look much more natural. If you put beautiful white teeth in patients with thin, deficient lips, and deep folds and wrinkles in their face, then of course the entire situation will look fake. Even if you treat every tooth in the mouth, you have still only given the patient great-looking teeth, not a great-looking smile. If you do a dental esthetic makeover case in addition to restoring the anterior dentition to a whiter shade, and you revolumize the lips and surrounding perioral tissue to establish esthetic lip and smile lines, now you have truly given the patient a great-looking smile. The overall appearance will look more natural because the teeth and entire face will have a more youthful appearance.

Whenever I attend a dental esthetic lecture and see "before-and-after" retracted views of esthetic dentistry, it means nothing until I see the patient full-face views. When I see 10 to 20 white veneers on a patient who has lost volume in the midface region, and who cannot even smile and bring their lip up because of that lost volume to show the veneers, I know this is an esthetic failure. How many times have you sat in a dental esthetic lecture and seen the retracted "before-and-after" views of a case that seemed beautiful, but when you saw the full-face views you were less than impressed? My patients don't walk around with retractors in their mouths and I highly doubt yours do. When a dental esthetic case is only successful in a retracted view, that dental esthetic case is a failure unless it fits the rest of the face.

Do you treat only teeth for dental esthetics? If so, you're giving your patients only great-looking teeth, not a great-looking smile. Today, you as a dentist can treat all the surrounding soft tissues, including the lips, nasolabial folds, and oral and maxillofacial areas, with Botox and dermal filler procedures, and finally truly deliver a great-looking smile to your patients.

Louis Malcmacher, DDS, MAGD, is a practicing general dentist, lecturer, author, and dental consultant. An evaluator emeritus for CLINICIANS REPORT, he is the president of the American Academy of Facial Esthetics. Contact him at (800) 952-0521 or [email protected]. Sign up for a free monthly newsletter at www.commonsensedentistry.com.