There is something rather special about a big bright smile. There is a certain warmth that we feel when greeted by someone who is smiling broadly. What is it about a full smile that makes it so attractive? Is there such a thing as a perfect smile? Marc Sher touches on some of the fundamentals of aesthetics in dentistry.
When the human eye sees things in proportion, we immediately find this attractive. This concept is known as the golden proportion or golden ratio, and is mentioned countless times in literature pertaining to cosmetic surgery and dental aesthetics. The golden proportion is an ancient concept, dating back to the times of the ancient Greeks. It has helped us understand why the relationship of adjacent shapes/objects makes it appeal to the human eye. The golden ratio is 1:0.618 or Pi, and is consistent in nature. The ratio between the front eight teeth, when looking directly at the central incisors, is one of these natural concepts that follows the golden proportion.
When the eight front teeth (smile line) of the top jaw follow the golden proportion, they will immediately look attractive; this is what we aim to achieve in dental aesthetics. It will always be a dentist and dental specialist’s greatest challenge when trying to recreate a smile.
The concept of the golden ratio is also seen in the relationship between the lips and teeth, the smile and teeth, and even the eyes and teeth. For any dentist to achieve that perfect smile for their patient, they must understand the golden ratio.
Just to clarify, the perfect smile does not exist in isolation and cannot be copied from person to person. To have a perfect smile is to have the right smile for you. Yes, we follow the principles that can help create that perfect ratio which may lead to a more attractive smile, but to try and achieve ‘perfection’ is only in the eye of the beholder.
Many dentists who specialise in aesthetic dentistry will understand the concept of a smile design. This is a process that we use to analyse a specific patient’s smile that helps guide the dental team in achieving their desired result; it involves using digital photography and videography to evaluate a patient’s smile line, lip line and central line, amongst other important features. We can use this information to digitally design a smile. It allows us (the dentist/specialist) to communicate the needs to the dental laboratory, in order, to create the ceramic/porcelain crowns or veneers which are to be bonded onto the front six to eight teeth (sometimes more) in the smile line. We then communicate this back to the patient. The use of a specialised dental laboratory is essential in this process as the dental technician is the one creating the ceramic/porcelain teeth.
The process of crowning/veneering teeth can be incredibly invasive as the tooth is usually irreversibly cut down to allow the ceramic prosthesis to fit. I, personally, do not advocate the cutting of healthy teeth to change their appearance. Once a tooth is cut/drilled on, there is no turning back. In cases where all other non-invasive options have been investigated and a tooth is already compromised, filled, broken, or missing, only then should the use of ceramics/porcelains be used.
I usually urge a patient to follow a less invasive route if they’re looking at changing their smile line. Orthodontics is my preferred method of moving teeth into their ideal proportion/relationship as orthodontists are incredibly skilled in creating the correct relationship between teeth. I always encourage my patients seeking an ‘aesthetic makeover’ to investigate the orthodontic process. This specific process does involve a sacrifice of sorts; wearing braces or retainers to move the teeth can be uncomfortable, cumbersome and obviously less attractive. However, it is important to understand that it is only a short-term sacrifice in the grand scheme of things, and the benefit is that you do not land up cutting healthy tooth structure.
“We shall never know all the good that a simple smile can do” – Mother Teresa
Tooth whitening
Tooth whitening plays a massive roll in the realm of aesthetic dentistry. I am often bombarded with requests to make my patients teeth whiter. What is important to understand, is the concept of tooth colour and staining. A natural tooth can have a variety of different levels of whites, yellows, blues and, even, greys. Therefore, we classify tooth colour in shades. This can be seen quite easily if you look at your canines; the neck of a canine has more of a yellow shade then the adjacent incisor.
Tooth whitening or bleaching changes the intrinsic (natural) shade of a tooth by penetrating the enamel layer and ‘bleaching’ the layer below, the dentine. The process involves the use of a peroxide-based bleaching agent, and a heated exchange reaction takes place. Tooth sensitivity is a very common side effect. However, it is not long-lasting.
Staining of teeth involves the extrinsic surface of the tooth. This is the after-effect caused by many of the wonderful things we love to eat and drink, such as coffee, tea, red wine, fruits, some vegetables and more. Smoking is also a major factor in extrinsic tooth staining. Fortunately, extrinsic stains can be quite easily removed by an oral hygienist or a dentist with specialised cleaning instruments. I always recommend a professional cleaning before any bleaching procedure is commenced.
All the concepts I have mentioned play a pivotal role in aesthetic dentistry. In today’s times, we can easily become obsessed with our appearance and be incredibly self-conscious of our smile. We may feel pressured to achieve perfection in our smile, and that obsession can alter the very essence of why we smile in first place. The act of smiling is far more important than the way it looks!
It is vital to protect what nature has given you by following a strict protocol of maintenance and prevention. You must also never compromise your dental health and function to achieve an aesthetic outcome. It is however comforting to know that with the help of modern technology in dentistry and with the skilled hands of a dentist, specialist and dental technician, we’re able to create beautiful bespoke smiles if needed.
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