DENTAL CARE

Q: I was Embarrassed To Smile

A: Yesterday, when I finished my patient’s treatment, she volunteered the words you see in the title. We met about a month earlier with a complaint that her front tooth was sticking forward. The tooth in question was not the very front tooth but the one immediately to its left. The front tooth is called the central incisor since its position is about the center of the face. Her problem centered around the one next to the front. We call this tooth the lateral incisor as it is lateral to the front tooth or front incisor.

Her tooth was pushed forward and sticking out of her mouth from a visual perspective. Teeth, when viewed from above, are positioned around a curve or circle. If one or more of the teeth tilts out of the circle, then space becomes visible on both sides of the tooth. Large gaps and a protruding tooth create an unesthetic smile and look. The gap created by the tooth was her only gap and was quite noticeable to the casual observer. She forced her upper lip to hide the tooth and keep it as invisible as possible.

The tooth problem had been going on for some time, and it took her a while to come and see me. She was dealing with some significant health problems. Most notable was a cardiac or heart problem. Changes in diet, stents, and blockages were all part of her life by the time we met. She had started taking a variety of medications, including a blood thinner.

We wrote earlier this year about the connection between gum health and heart disease. My patient’s mouth exhibited this relationship to the extent that her cardiologist strongly recommended seeing me. Even though her teeth were cleaned recently, the debris and tarter on her teeth were unacceptable. Accumulations of plaque are never good, and in the presence of heart and blood vessel issues, the effect is devastating.

I recommended some different home cleaning aids to help with the problem. Adding frequent professional cleanings to that mix is especially important. Most of my patients who have gum problems come for cleanings every three months. Some patients who struggle I see every other month, and some even monthly. There is no absolute number of cleanings that a person should have. Everyone is treated as an individual, and recommendations are made on that individuality.

You are probably wondering what treatment I provided for my patient. I utilized a technique where my lab makes a bridge before our appointment creating the right color and cosmetics. When I see the patient, I remove the badly diseased tooth and proceed to adapt her bridge to the remaining teeth. Due to healing considerations, this immediate bridge is not meant to be in the mouth for more than two months. I use this time to evaluate the cosmetics and tweak whatever is necessary, if anything at all.

She walked out the door, minus her unattractive space, smiling from ear to ear. If you see some tooth movement and spaces developing in your smile, please call me immediately. Nikki will make an appointment for you, and we can explore what is causing that observed phenomenon together. As always, I look forward to meeting you.

Jeffrey Gross, DDS, FAGD, is an Ohio-licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile

34586 Lakeshore Boulevard (¼ mile west of Route 91 on Lakeshore Blvd) Eastlake, Ohio 44095 440-951-7856 Severance Medical Arts, Suite 603 5 Severance Center Cleveland Heights, OH 44118 216-371-2333 www.jeffreygrossdds.com