Posts for: April, 2020
You probably wouldn't be surprised to hear that someone playing hockey, racing motocross or duking it out in an ultimate fighter match had a tooth knocked out. But acting in a movie? That's exactly what happened to Howie Mandel, well-known comedian and host of TV's America's Got Talent and Deal or No Deal. And not just any tooth, but one of his upper front teeth—with the other one heavily damaged in the process.
The accident occurred during the 1987 filming of Walk Like a Man in which Mandel played a young man raised by wolves. In one scene, a co-star was supposed to yank a bone from Howie's mouth. The actor, however, pulled the bone a second too early while Howie still had it clamped between his teeth. Mandel says you can see the tooth fly out of his mouth in the movie.
But trooper that he is, Mandel immediately had two crowns placed to restore the damaged teeth and went back to filming. The restoration was a good one, and all was well with his smile for the next few decades.
Until, that is, he began to notice a peculiar discoloration pattern. Years of coffee drinking had stained his other natural teeth, but not the two prosthetic (“false”) crowns in the middle of his smile. The two crowns, bright as ever, stuck out prominently from the rest of his teeth, giving him a distinctive look: “I looked like Bugs Bunny,” Mandel told Dear Doctor—Dentistry & Oral Health magazine.
His dentist, though, had a solution: dental veneers. These thin wafers of porcelain are bonded to the front of teeth to mask slight imperfections like chipping, gaps or discoloration. Veneers are popular way to get an updated and more attractive smile. Each veneer is custom-shaped and color-matched to the individual tooth so that it blends seamlessly with the rest of the teeth.
One caveat, though: most veneers can look bulky if placed directly on the teeth. To accommodate this, traditional veneers require that some of the enamel be removed from your tooth so that the veneer does not add bulk when it is placed over the front-facing side of your tooth. This permanently alters the tooth and requires it have a restoration from then on.
In many instances, however, a “minimal prep” or “no-prep” veneer may be possible, where, as the names suggest, very little or even none of the tooth's surface needs to be reduced before the veneer is placed. The type of veneer that is recommended for you will depend on the condition of your enamel and the particular flaw you wish to correct.
Many dental patients opt for veneers because they can be used in a variety of cosmetic situations, including upgrades to previous dental work as Howie Mandel experienced. So if slight imperfections are putting a damper on your smile, veneers could be the answer.
If you would like more information about veneers and other cosmetic dental enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Porcelain Veneers” and “Porcelain Dental Crowns.”
A “gummy” smile, in which the upper gums are too prominent, is a common condition. There are several causes for gummy smiles — determining which one is the first step to having your appearance changed.
Although perceptions vary from person to person, most dentists agree a gummy smile shows 4 mm or more of gum tissue, and the amount is out of proportion with the length of the crown (the visible tooth). Teeth normally erupt through the gums during childhood and continue development until early adulthood, shrinking back from the tooth until stabilizing in place.
This typically produces a crown length of about 10 mm, with a “width to length” ratio of about 75-85%. But variations can produce differences in the relationship between teeth and gums and the width to length ratio of the teeth. The teeth may appear shorter and the gums more prominent. Worn teeth, caused by aging or grinding habits, may also appear shorter.
If tooth to gum proportionality is normal, then the cause may be upper lip movement. When we smile, muscles cause our lips to retract 6-8 mm from the lip’s resting position. If the amount of movement is greater (meaning the lip is hypermobile), it may show too much of the gums. The upper jaw can also extend too far forward and cause the gums to appear too prominent.
There are a number of ways to improve gummy smiles, depending on the cause. Periodontal plastic surgery known as crown lengthening removes and reshapes excess gum tissue to reveal more of the tooth. Lip hypermobility can be reduced with Botox injections (to paralyze the muscles) or in some cases with surgery to reposition the muscle attachments. Orthognathic surgery can be used to surgically reposition an overextended upper jaw. Other cosmetic enhancements such as orthodontics, bonding or porcelain restorations can also prove effective.
The first step is to obtain an accurate diagnosis for your gummy smile. From there, we can devise the best treatment approach to bring your smile back into a more attractive proportion.
If you would like more information on minimizing a gummy smile, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gummy Smiles.”
Other than tooth decay, children don't encounter dental disease to the extent adults do. But injuries are another story: More than 5 million teeth are knocked loose each year, and a high percentage involve children. Roughly a third of these and similar children's injuries are sports-related.
April is National Facial Protection Month: Several oral and facial health organizations, including the American Association of Orthodontists, have joined together to raise awareness about the risks of injury to the face and mouth, especially among children. Many of these injuries have long-term consequences with lifetime treatment costs in the thousands of dollars.
But as the name implies, this awareness month is also about protection—what you can do to help your child avoid a costly and devastating dental injury. Top of the list: Have your child wear an athletic mouthguard during all contact sports activities (including practices).
The National Federation of State High School Associations mandates mouthguard wear for football, lacrosse, and ice and field hockey. But those aren't the only sporting activities where a mouthguard should be standard equipment: In fact, basketball has more orofacial injuries each year than any other sport. Generally, mouthguards should be worn for any sports activity that involves potential contact with other players or objects.
There is a variety of mouthguard choices, but most fall into two basic categories, “boil and bite” and custom-made. The former, readily available in retail sports stores, get their name from the procedure employed when first purchased to adjust their fit to an individual player. Out of the package, they should be soaked in hot or boiling water until softened, and then placed in the wearer's mouth to bite down on. After they cool, they'll retain that bite pattern.
Boil and bite guards are relatively inexpensive, but the fit isn't as precise as a mouthguard that is custom-made by a dentist. This can lead to comfort issues—and players are less likely to wear an uncomfortable mouthguard.
Custom mouthguards, on the other hand, have a more accurate fit, allowing them to be thinner and more comfortable. They also provide the highest level of protection against blows to the face and mouth. These are more costly than boil and bite guards, and younger athletes may need a replacement every few years to accommodate jaw growth development. But compared to the physical, emotional and financial cost of a dental injury, custom mouthguards are worth the investment.
A mouth or face injury can happen in an instant and result in damage that can have lingering effects for years. For the best protection, see that your star athlete has and wears a custom mouthguard.