One of my beloved orthodontic mentors, Dr. John Witzig, used to tell me, “There are two things that parents can give their children to help them succeed in this world. One is an education and the other is a beautiful smile.” A beautiful smile instantly conveys multiple positive messages. However, a beautiful smile does NOT just mean having straight teeth. Teeth are connected to jaw bones that are overlaid with gum tissue. Lips are supported by teeth and a face covers the teeth. All of these structures need to be in a harmonious balance in order to maximize the beauty of a smile. It is imperative that before any teeth are ever moved that there is a clear understanding of the effects that tooth movement will have on the surrounding structures, especially the face. Dr. Witzig used to say, “People see a person’s teeth 60% of the time but they see a person’s face 100% of the time.” Straightening teeth must enhance facial beauty, not detract from it.
I continue to see orthodontic mistakes in my dental practice far too often. Some time ago, a beautiful woman came to see me who was in tears. She explained how she had recently finished orthodontic treatment in another office and was devastated with the results. She explained how her upper lip used to be full and now she can hardly see it. She said her upper arch is narrower than it used to be and she sees dark shadows in the corners of her mouth that were not there before. She confided in me that she thought it might seem crazy, but she felt like her nose was bigger than it was before her teeth were moved. When I asked if she had discussed her concerns with her orthodontist she said she had but he just said she was mistaken. After a brief exam it was obvious that she was definitely not mistaken. This beautiful woman had started treatment with mild to moderate crowding of her teeth, broad dental arches and beautiful full lips. Her face was gorgeous before orthodontic treatment began and now she felt less beautiful after treatment was completed.
Her orthodontist had extracted four bicuspid teeth to create space for the overcrowded arches. He then retracted her upper and lower anterior teeth to fill in the extra space that was created by removing the teeth. Naturally, when the anterior teeth were retracted, her face overlaying her teeth was retracted also. If the lower portion of the face is moved back it will cause the upper lip to look smaller, the chin to look weaker and the nose to look longer.
This beautiful woman could have completed orthodontic treatment in a year or less without extracting any bicuspid teeth and been left with a beautiful full upper lip, a broad beautiful smile with teeth from one corner of her mouth to the other and a chin and nose in the same relationship as God intended. Unfortunately, to fix the damage we had to literally undo the previous orthodontic treatment and replace the four extracted teeth with dental implants. All this extra work and expense could have been easily avoided if the doctor had better understood the relationship of tooth movement to facial harmony.
Whenever a patient comes into our office wanting straighter teeth we will evaluate all aspects of teeth position and facial harmony. We will never move a single tooth until we have considered the effect it will have on a patient’s face. We will also make a thorough evaluation of the TMJ to ensure that this incredibly important and delicate joint is not harmed by moving teeth. In short, we will make a thorough and complete evaluation to ensure that moving teeth will enhance facial beauty and preserve or enhance joint stability.
Because we use multiple treatment modalities to straighten teeth we are not limited to a single tool to fix a problem. In our office we utilize the following treatment options to straighten teeth:
- Conventional braces (brackets and wires)
- Functional jaw orthopedics (fixed and removable appliances)
- Clear aligner therapy (Invisalign, Clear Correct, etc.)
- Veneers
- Lumineers
We strive diligently to accomplish five goals whenever we consider moving teeth:
- Enhance dental health
- Create a beautiful smile
- Maintain or enhance TMJ health
- Maintain or enhance airway health
- Enhance facial beauty