Even with good dental hygiene and care, your teeth may show signs of wear as you age. Fortunately, we now have ways to treat these symptoms of aging and restore a youthful look and function to your teeth and jaws.

How Do Teeth Wear?

All the tissues in your body are constantly in a process of breaking down (catabolism) and rebuilding (anabolism). During childhood the anabolic processes exceed the catabolic processes. But after you have reached physical maturity the balance changes and the breakdown process begins to draw ahead of the building up. The result: signs of wear.

In your teeth, the outer layer, the enamel, is a hard, mineralized substance that is resistant to wear. Under the enamel is a layer called dentin, which is a living tissue something like bone. As teeth age, the dentin layer thickens, causing teeth to lose some of their whiteness. Most wear to your teeth comes from the pressure of the upper and lower teeth's biting surfaces against each other. How much wear occurs depends on your bite or occlusion (how the teeth are aligned, and how they meet) and the ways in which you use your teeth.

Constant interactions between the biting surfaces of your teeth result in removal of small amounts of enamel. Your body naturally compensates for this wearing away of material. As teeth wear, they erupt from your jaws by tiny amounts, moving slightly up or down to stay in the proper occlusal relation with the teeth on the other jaw. They also slowly move toward the front of your mouth.

If the wear becomes excessive, your body can no longer compensate for it. At this point you may find that your bite relationships are not working correctly, and the lower third of your face loses height. This creates or accentuates an older appearance.

Some people clench or grind their teeth, applying greater than normal — and damaging — forces to their teeth. This problem, often a reaction to stress, is called bruxism. It can cause a number of problems from jaw pain to loose teeth or excessive wear or tooth fractures. If you suffer from excessive wear due to bruxism, a professionally made mouthguard may prevent further damage.

Modern Dentistry Can Restore a Youthful Look

Modern dentistry can successfully restore the normal shape, appearance and function of worn teeth by installing porcelain crowns or veneers. These not only replace the tooth structure lost through wear, but they also restore the bite relationship. Crowns on excessively worn teeth can dramatically improve tooth color and facial appearance, resulting in a more harmonious, younger look.

Contact us today to schedule an appointment to discuss your questions about dental wear and aging. You can also learn more by reading the Dear Doctor magazine article “How and Why Teeth Wear.”

Designing a better smile sometimes requires a change in the size, shape, or color of your teeth. Porcelain laminate veneers (thin layers of dental ceramic material) enhance your appearance by replacing the natural enamel on the outside of your teeth. A veneer is physically bonded to the surface of a tooth, in essence, becoming part of it.

Traditionally, a small amount of the natural tooth enamel is drilled away to allow room for the veneer. But today, in some circumstances, it is possible to use an approach where enamel reduction or preparation is not necessary because the veneers can be bonded directly onto the tooth's natural surface. These are called “Prepless” or “No-prep” veneers, and are used to create aesthetically pleasing and natural looking restorations. An advantage of the prepless procedure is that the process is reversible so that you can give your new smile a “test drive.”

You may be a good subject for Prepless veneers if:

• Your smile is narrow because the teeth in the sides of your smile are positioned inward and do not show from a frontal view.
• There is spacing between your teeth, and the teeth appear too small.
• You have a fairly common genetic condition in which one or both of the teeth directly next to the two upper front teeth are very small and peg-shaped.
• There is an imbalance between the size of your lips and teeth (large lips and small teeth), which are not in proportion to show off your best smile.

Prepless veneers are probably not for you if:

• Your teeth are not aligned properly in your bite.
• Your teeth are very crowded, resulting in poor facial profile.
• Your teeth are already relatively large or positioned forward.

In these cases you may need to have some form of orthodontic treatment to move your teeth into better position. Sometimes veneers can be used to create an illusion of proper tooth alignment, but some amount of tooth reduction may be required.

We can assess whether prepless veneers are right for you. There is no substitute for an expert dentist's talent and expertise with the various cosmetic techniques available today. These skills combined with a thorough diagnostic evaluation, and a clear understanding of your goals, are the keys to providing you with a successful and beautiful smile.

Contact us today to schedule an appointment or to discuss your questions about cosmetic dentistry. You can also learn more about prepless veneers by reading the Dear Doctor magazine article “Porcelain Veneers Without the Drill.”

When you begin a smile makeover in our office, you are embarking on an exciting partnership with my laboratory technician and me. You should be full of excitement and anticipation — if you have been dissatisfied with your current smile, and you have great expectations for the results of this project. You will really like what you see in your mirror.

Being completely satisfied with your new look depends upon successful communication — between you and me and also between my dental lab technician and me. As you might expect, your perceptions of how your teeth appear are different from a dentist's perceptions. My education leads me to think of factors that untrained individuals probably won't consider, such as crown (tooth) length, midlines (how the teeth line up with other facial features) and the distance from gum to lip.

It is helpful to be able to describe what you like and don't like about your current smile, and what changes you would like to see. Using visual aids is a good idea. Bring photos and magazine illustrations to show what you have in mind. (Remember that we cannot make you look exactly like a celebrity or anyone else. The pictures are guidelines.)

Things to think about:

• The color, size, shape, alignment and spacing of your teeth.
• How much of your teeth and gum tissues show when your lips are relaxed and when you smile.
• Tooth color: bright “Hollywood” white or more natural looking off-white.

Your makeover is more likely to meet your expectations if you get an advanced view of the results. Computer imaging is one way to do this. Another is for us to make a mock-up of the proposed dental work in tooth-colored wax on models of your mouth.

Finally, a “Provisional Restoration” can be used as a test to make sure that what I envision is also what you, the patient, want to see. A provisional restoration, made from temporary materials, gives you a chance to test out the changes and make sure they work for you — that they not only look good, but they are also functional in terms of biting, chewing, speech, and gum health.

If the provisional restoration works, it is used as a blueprint to make durable and long lasting porcelains in the same design. We will take impressions of the provisional restoration and communicate the relevant information to a dental laboratory technician, who will make the final porcelain tooth replicas for your new smile.

Competent communication and a provisional restoration will put you on track to meet your expectations and obtain the most aesthetic and functional result in your Smile Makeover.

Contact us today to schedule an appointment to discuss your questions about Smile Makeovers. You can also learn more by reading the Dear Doctor magazine article “Great Expectations — Perceptions in Smile Design.”