Sound Bites: Smile has changed later in life | Health

Q: I would like to get your opinion on correcting over jetting, perhaps as topic for your column. 

I am 74 years old and have always received compliments on my “great smile.” I have mild TMJ and wear a nightguard.

I was looking at some group photographs and wondered why my smile looked like I was grimacing and/or frowning. I started noticing that my inherited diastema (space between teeth) was larger and the front teeth were jutting out.

I discussed nonsurgical alignment with my dentist, which he discouraged. He recommended an orthodontist for a second opinion, who agreed with my dentist.

I enjoy reading and learning from your insight into different dental health issues.

Thank you for keeping us informed.

A: Thanks so much for your question and kind words regarding the my columns.

My initial thoughts are that your teeth must be moving in order for you to make the comment that the diastema is getting larger and that your front teeth are jutting out.

I wonder if your night guard was made for the bottom or top teeth. I also wonder if a dentist made it or was it store bought. I’m sure you understand that I can only address this is general terms, since I have not seen you in person or reviewed your X-rays.

I would assume that you have some degree of periodontal disease that has lead to bone loss in at least the front teeth. This is the most common reason for front teeth to move in the later years of life.

If you were a patient of mine, I would go back and look at X-rays to see if I am correct, or you may already know that you have bone loss.

Another thought is that we also see this happen in tongue-thrusters. I doubt this is the case for you since we see this primarily in children and teens.

You may be wondering what can be done. Unfortunately, the answer is very little, if what you mean by nonsurgical is that you do not want any changes made to your teeth.

With that being said, I have closed or minimized spaces between teeth with cosmetic bonding. This is a relatively low-cost way to address this, though it is likely to continue to happen over time.

The other thing that can be done is selective removal of teeth and the placement of a splinted bridge. This can also be done without removing teeth in some cases. Whether this is actually possible in your case would depend on a thorough examination and review of current X-rays.

I hope that I have been of some help to you regarding your situation.

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