Making harmony between teeth and face. Smile design, lips and the rest of the face

When we look at a face, we're drawn to two features, eyes and mouth. Desmond Morris (he who wrote The Naked Ape) demonstrated this brilliantly in his 1982 book, Manwatching. He used a photograph of a face and then traced the path that the gaze took over it. There was a great concentration on eyes and mouth, but not a great deal else. So these two features have a disproportionate impact on the look of our faces.

Whether we like it or not, Society does make instant judgements about us based on our facial features. Sadly, this means that those of us who are unfortunate, and don't conform to Society's perceived norms, have to work harder to be accepted.

In dentistry we have the ability to change some of those parameters. We can change lives dramatically. We can change them for the better, but we can also make them worse.

So what makes someone beautiful?

Interesting question! Over the millenia a great deal of time and effort has gone into this. There does appear to be a mathematical element to it discussed ever since ancient Greek times. It's all tied up with something called the Golden Ratio. I was going to ramble at length about the Golden Ratio, but came across this webpage that explains it brilliantly. So I'm not going to reinvent the wheel.

Aesthetically, we're tuned to like objects whose shapes tune into the Golden Ratio, not just faces. look at this shell. The spiral that makes it up just happens to fit the Golden Ratio perfectly

 

 

 

 

 

 

 

 

 

 

 

 If we take examples of people who Society perceive to be "easy on the eye",

George Clooney is a good example. And guess what? He fits this mathematical grid very nicely.

 
 

As a simplifed rule, we discuss faces in thirds. Upper, middle and lower thirds. Lower third being up to the level at which the teeth bite. Middle third being from the teeth to eyes. Upper being the area from eyes upward. As a general rule these thirds should be equal. If one is disproportionately greater than the others, it looks "wrong". The portions we can often influence in dentistry are the middle and lower thirds. Note the term 'often' - to some extent we have the faces we have. They can be moulded to different shapes when young, but when older the options are somewhat limited. When the term moulded is used, we're describing the use of orthodontics to rearrange teeth and sometimes the jaws themselves, often around puberty.

We have two parts to a face - the bones and the soft tissue. When we're young, the soft tissue is taut. As we get older it "goes south". So, as a general rule younger people will show more upper teeth than lower. And older people will show increasing amounts of lower teeth as the soft tissues of the face lose some of their tension. A common trap is to provide crowns or dentures for older people showing just too much upper teeth. It's an attempt to look younger, but often fails.

Remember the Spice Girls Wannabe video in St Pancras Station? Remember the woman in the black dress and pearls? No? Watch it here. Scroll to 3:00 and have a good look. It's all wrong. Too much tooth showing in a vain attempt to make her look younger. What it actually does is to distort this concept of the thirds and flies against our ingrained knowledge that older people show less upper teeth. Yes, we can fiddle with this a little, but overstep the mark and the smile becomes bizarre. So we must restrain ourselves.

Likewise, we all lose bulk in our lips with time. Some lose bulk worse than others - usually smokers. IF YOU DON'T WANT TO LOSE YOUR UPPER LIP - DON'T SMOKE. Smoking destroys your ability to repair collagen and gives you those horrible vertical lines that appear in upper lips. The trend is to inject fillers to attempt to replace this bulk. Of all the lips I have ever seen bulked out with filler, I have only ever seen one that I would say was a success. It goes wrong in two ways. Too much filler is placed and it's placed in such a way that rolls the lip edge (the vermilion border) upwards and outwards, bringing the skin that should be inside the mouth out onto the lip where it is visible.

 

Here's an example. Personally, I don't see what was wrong with the lips as they were! I will go so far as to say they looked good. They've been "augmented" in the photo on the right. So, if we remove the lipstick (usual trick to improve the end result photo), both lips have been rolled outwards, bringing the skin from inside the lip out until it is outside the mouth. You may like the result. Personally, I don't. I also think much of the effect could probably have been achieved with a good lesson in how to apply makeup. And what are the long term consequences?

I researched the operator who'd done the above job. They advertise themselves as specialists, but have no Specialist Registration - so they're not specialists - end of story.

So, am I completely anti lip augmentation? No. But if it's going to be done, it needs to be done by someone with a true understanding of how a face works. You only get one face. Give it to a Specialist Plastic Surgeon, not somebody who's bought a few tubes of stuff, done a weekend course and fancies themselves as an aesthetic specialist.

So what about the teeth?

 

Here's our practice skull, Napoleon (Bonaparte). Look at the arrangement of the teeth. If you follow a line where the teeth bite together, there's a gentle curve from from to back. There's also a curve from side to side. These two curves are critical to the way that the teeth function in the bite (the occlusion) - here's a link to our page about occlusion. These two curves are also important in aesthetics in that they define the shape of our smile from the front.

We're aiming for a number of features - 

Symmetry - to some extent, symmetry is everything. It's not uncommon for the midline to be shifted to one or other side, sometimes but a missing tooth. Recreating this symmetry will often dramatically improve a smile

Size - too large or too small and everything looks wrong. We refer back to the magic proportions. Selecting the correct size of tooth (incorporating the bite) is an artform.

Shape - as a general rule, men have squarer teeth and women have rounder, more tapered teeth. That's a vastly oversimplistic statement, but as a rule of thumb it does work. Flattening the tips of teeth will tend to make them more masculine and rounding the corners will tend to make them more feminine. Another general rule is to mimic the shape of the face. Square faces suit squarer teeth, and longer, narrower faces suit longer, narrower teeth

Arrangement - should teeth be perfectly straight? Personally, it's not our thing. We do like to see a bit of character in teeth. Teeth should also be placed in a "trough" that defined how far "in" or "out" they are. But why are your front teeth where they are? The lip pushes from the front and the tongue from behind. Wherever the forces are equal, they'll naturally come to rest. BUT, if we push them either back or forth from this "neutral zone", they'll be unstable and want to drift. That's why some braces eventually fail, because the teeth are in a position that doesn't balance with the muscles of the face. To some extent, we have the faces we have. Also, pushing the teeth out of this trough can easily cause a lisp - listen to David Bowie before and after he had his teeth "done".

Aesthetics of the tooth substance

A wall of teeth that are all identical colours looks ridiculous. Yet, sadly many patients have this inflicted on them in the name of aesthetics. Tricks of the eye can make all the difference - making the two central incisors brightest and gradually tapering backwards in shade to a slightly darker shade makes things look natural - good but natural.

The porcelain itself is also critical - take a look at these teeth


The one on YOUR left is a natural tooth and the one on the right is a crown being tried in. You're seeing them much larger than usual, which is an advantage. Now REALLY look at the left one. It has a hairline crack in the enamel and it has a dimple in the front surface, which reflects light differently. BUT the actual tooth isn't a solid colour. If you look at the edge furthest from the centre of the picture, it's quite translucent. It almost looks blue. Parts of the tip are the same. But mixed in with the tip are areas that are orange. The porcelain crown was being sent back to the laboratory for alteration. If you think about it, it's quite solid in appearance, lacking translucency. It's a crown that many would have fitted, but with some of the porcelain replaced with blue porcelain (seriously) it will mimic the other tooth so much better.

Dentistry is very much a blend of science with art!

Copyright Hesslewood Lodge Dental Practice

 Updated 16 Nov 2015