One of the most common concerns I have from older individuals in my practice is about how their smiles have changed with time. Teeth that were once straight are now crowded or overlapping in the front. The color of their teeth seems to have gone from white to yellow, with cracks or lines darkly stained on the fronts. Teeth may also show more of their roots as gums have receded, leaving spaces or “dark triangles” between the teeth where food gets trapped. Others complain of teeth being worn down on the edges or notched out at the gum line, often accompanied by sensitivity to cold or brushing. While these same issues affect many younger people as well, the longer you have your teeth, the more common these changes become.
The shifting of teeth to the front is something that is currently happening to all of us; most of us just don’t notice it yet. Teeth are surrounded by a thin ligament, which allows the teeth to flex slightly when you put pressure on them by chewing or biting. When this happens, the teeth respond by moving a little bit towards where they are being pushed. Braces work similarly by putting constant pressure on teeth. The movement from chewing is imperceptible. Over time, however, the cumulative effect is to crowd teeth to the front of the mouth and often cause overlap or rotation. This is a phenomenon called “mesial drift”. Depending on the severity of the crowding and any concurrent issues with the teeth, a dentist may suggest treatment with reshaping and bonding (tooth colored resin fillings), invisible tray aligners (Invisalign), traditional braces, or crown and bridgework. Our most esthetically minded patients are opting for all porcelain “Empress” restorations on their front teeth. Most people call this treatment “veneers”. This corrects not only the misalignment issues, but also any color, shape, size, and spacing issues as well. Porcelain veneers give amazing results, likely creating a more beautiful smile than the patients have ever had, even in their youth.
The color of teeth change for a couple of reasons. The most obvious reason is stain, and this usually does account for some of the change, but it is confined to the outside of the teeth only. Color changes deep within the tooth are usually due to changes in the makeup of the tooth itself. There are nerves and blood vessels within each tooth, and every time something irritates one of the nerves, like eating something cold, the nerve protects itself by laying down a thin layer of insulation around itself and receding a little bit. Ultimately, the blood supply and nutrients no longer effectively get to the outer parts of the tooth and the tooth gets darker and brittle. A similar thing happens when the nerve is removed from the tooth by root canal treatments. As you age, this darkening becomes more apparent. Teeth that are yellowed often bleach easily, either by use of take home, tray bleaching, or one hour, in office Zoom laser whitening. If problems are more severe, bonding or veneering may be the best options.
Areas where gums and bone have receded, making teeth look “long” by exposing the roots of the teeth, are usually a result of some form of periodontal or gum disease. About 80% of Americans have some form of gum disease, whether it is merely inflammation or “gingivitis”, or the loss of bone, called “periodontitis”. Over time, so much bone can be lost that the teeth may become mobile, abscess, or be lost. The spaces between the teeth not only affect appearance, but also can cause food to be caught, aggravating the underlying problem. Periodontitis is also linked to heart attacks, strokes, lung infections, diabetes, and other whole body diseases. This disease requires immediate treatment and constant maintenance. Gums may often be grafted by a specialist to fill in recession, or restorations may be necessary to fill the spaces between teeth.
Many people have worn or fractured teeth. This is a result of wear and tear, but may be aggravated by clenching or grinding, bite discrepancies, or jaw joint problems. I have seen some people get to the point where their teeth are almost worn off to their gums or have notches in their teeth so deep as to cause the tooth to snap off or cause nerve damage. Wear can often be stopped if noticed early by use of a “night guard” or splint that is worn over the teeth during sleep, when most people grit and grind. Damage that is done may require restoring the bite back to it’s originally height through crowning teeth. The original bite can be defined by use of a “TENS” unit, an electric stimulation device that relaxes muscles to find the natural point of rest of the jaw.
Both periodontal disease and wear issues can cause sensitivity. A new medication is available, called “SootheRX”, that actually lays down new tooth structure to block microscopic pores in teeth and permanently stop many sensitivity issues. If you have sensitivity, DO NOT use whitening toothpastes. They don’t bleach teeth, they just scour stain off with strong abrasives that can also aggravate sensitive spots.
Great teeth make you look and feel years younger. At any stage in your life, you and your dentist can work together to create a dazzling smile.
Dr. Greg Grobmyer