Your smile is one of the first and most crucial parts of your appearance that people notice immediately. Everyone likes to have a white, well-aligned, and appealing smile. It is a significant boost to your self-confidence. Not everyone is born with a perfect set of teeth. More than half of the total American population suffers from cosmetic dental problems.
Some of the common cosmetic concerns include chipped tooth, crooked smile, gummy smile, missing teeth, tooth discoloration, receding gums, congenital abnormalities in the tooth, and developmental dental problems. It is essential to know about the different dental conditions so that you can discuss it with your dentist.
Cosmetic dentistry specializes in detecting the flaws in your mouth and correcting it in the most natural way possible. Let’s read the article to understand the different types of cosmetic dental problems that can occur in children and adults.
What is the purpose of cosmetic dental treatments?
Cosmetic dentistry mainly deals with the restoration and repair of the teeth and gums. A wide range of dental procedures is used to correct the smile of the patient. Often the cosmetic dental problems can be addressed through a single process like veneers.
Otherwise, a combination of two or more dental procedures may be required as per the smile expectations of the patient. Such multiple combinations of cosmetic dental procedures are known as a smile makeover. (1)
Treatment for cosmetic makeover often depends on the type of dental condition, oral health status, and realistic expectations of the patient. It is always essential to know about your current dental defects and conditions so you can take care of your smile for a long time.
What are the dental conditions treated by cosmetic dentistry?
The most common cosmetic dental concerns develop due to poor oral hygiene and the type of food habits. Over time these two factors cause tooth decay and discoloration, which reduces the appeal of your smile. Some rare cosmetic concerns may develop due to congenital disabilities and developmental abnormalities. Let’s take a closer look at the different types of cosmetic dental problems –
Tooth related dental conditions
A chipped or cracked tooth
While similar factors may cause both the states, there is a slight difference between chipping and cracking of the tooth.
- Chipping – chipped tooth is one wherein a small part of enamel cuts off the tooth surface. Usually, the patient does not feel any pain unless the chip is large enough to expose the underlying pulp tissue. Exposure of dentin or pulp can cause severe tooth sensitivity.
A chip on the pointed chewing surface of back teeth is referred to as a broken cusp. Although it may not be painful, dental restoration of the cusp with the help of a crown, or onlay is necessary to restore the tooth structure and prevent the risk of tooth decay.
- Cracked tooth – cracked tooth may occur in any form. It may involve only enamel, or fracture the tooth down to its root. Usually, the patient feels pain only on biting or chewing. Tooth sensitivity may be experienced in severe cases. Evaluation of cracked tooth is essential to restore the tooth at an early stage. (2)
Possible causes of the chipped or cracked tooth often include the following –
- Tooth decay and a cavity can weaken the tooth structure and predispose to chipping of the tooth. Extensive tooth decay can also cause cuspal damage.
- One of the most common causes of tooth chipping is biting on hard objects such as ice or hard candy.
- A traumatic blow to the face or injury to the tooth can cause severe tooth cracking and may also fracture the tooth root.
- A habit of teeth grinding, also known as bruxism, can cause chipping of the teeth and gradually it involves the underlying layers of the tooth, causing extreme tooth sensitivity.
Tooth staining, or discoloration, is one of the prime cosmetic dental problems faced by people. It can occur as a result of surface stains or changes in the tooth structure. Typically, tooth discoloration can be categorized into three types –
- Intrinsic stains – intrinsic tooth stains reflects the discoloration that is present beneath the surface of the tooth. Usually, intrinsic tooth stains are caused by excessive fluoride intake, medications like tetracycline or doxycycline.
Intrinsic stains are challenging to remove from the tooth surface. Although tooth whitening may improve the esthetics in some cases. Every form of intrinsic tooth staining may require masking of the stains with a dental crown or veneers. (3)
- Extrinsic stains – extrinsic stains are often superficial discoloration of the tooth enamel. Most of the times, it is caused by pigmented residue from food and beverages like tea, coffee, and berries. Poor oral hygiene that causes excessive plaque formation forms a yellowish sticky layer on the tooth surface. Other causes of extrinsic tooth staining include oral habits like smoking or chewing tobacco.
Proper oral health care regime and regular tooth cleaning are essential to keep the teeth clean and free from unnecessary staining. Moreover, professional tooth cleaning and polishing can contribute significantly to maintaining your pearly white teeth.
Whitening toothpaste is also an excellent option to tackle the extrinsic stains and improve the color of your smile.
- Age-related stains – as the age progresses, the teeth become prone to both extrinsic and intrinsic tooth staining. Progressive thinning of the enamel layer often exposes the underlying yellowish layer of dentin. Additionally, a chronic habit of drinking tea, coffee, or chewing tobacco further degrades the color of the teeth and causes tooth discoloration.
Missing teeth have a severe influence on the appearance of a smile. Most commonly, tooth loss affects the mouth in the following ways –
- Effect on the bone and gums – loss of teeth often disturbs the relation between a tooth and the bone. Usually, the gums and bone firmly adhere to the tooth structure and supports it in the socket. Tooth loss no longer stimulates the gums and bone, which leads to shrinkage of the bone. Additionally, the gum pulls back and become weak.
Another consequence of missing teeth is a proximal shifting of the adjacent teeth. Such situations increase the space between all the teeth in the arch. Moreover, it changes the alignment of the teeth in the arch.
- Effect on the appearance of the smile – Often, loss of teeth reduces the height of the jaw bone and makes a face look older and wrinkly. The cheeks gradually become saggy and hollow. Moreover, the lips do not get enough support from the cheeks and jaw.
Other effects that missing teeth can have on the mouth includes improper chewing of food and speech problems.
Fluorosis is a dental condition which is often caused by overexposure of the teeth to fluoride during the first eight years of life. It appears as faint white lines or streaks on the surface of the teeth. An interesting fact about fluorosis is that it can only affect the teeth during the developmental stages. (4)
Fluorosis usually doesn’t change the health of the teeth. It gives a mottled appearance to the tooth enamel, which is not pleasing to look at. Typically there are five main categories of fluorosis –
- Questionable fluorosis – this is the earliest stage of fluorosis wherein the enamel shows slight changes that may range from a few white flecks to occasional white spots.
- Very mild fluorosis – this stage is characterized by the presence of small opaque paper white areas on the tooth surface. These areas can be scattered over less than 25% of the tooth surface.
- Mild fluorosis – mild stages are characterized by white extensive opaque areas on the surface that cover less than 50% of the tooth area.
- Moderate fluorosis – the affected area in this stage covers more than 0% of the tooth surface and gives a slightly mottled appearance of the enamel.
- Severe fluorosis – this is the advanced stage of fluorosis wherein the enamel surface is greatly affected. The teeth also show pitting of the enamel, which may be discrete.
Tooth attrition is a type of dental wear which is usually caused by permanent tooth to tooth contact like grinding of teeth. It typically starts at the incisal or occlusal surface and leads to more advanced and extensive stages which can expose the underlying dentin and pulp tissue.
Attrition of teeth is also considered as a natural aging process. However, this physiological process is limited to the enamel layer of the tooth. As the tooth surface reduces in height, it affects the shape and form of the teeth and changes the way you smile. Typical signs and symptoms of tooth attrition include –
- Loss of tooth anatomy that may be characterized by rounding or flattening of the chewing surface.
- Increased tooth sensitivity or pain, which is secondary to enamel loss.
- The yellowish appearance of the tooth surface
- Change in occlusion
- Tooth mobility and compromised periodontal support
Attrition caused by constant tooth grinding can further affect the functioning of the temporomandibular joint and muscles. Therefore, it is essential to get a dental check-up to detect the cause and treat the condition.
Misaligned teeth or in simple terms crooked smile is one of the common complaints of people that visit the dental office. Most often, crooked teeth are inherited traits. However, several factors may affect the alignment of teeth in the arch –
- Early loss of primary teeth
- Failure to maintain the space for permanent tooth eruption
- Gum disease
- A proximal shift of adjacent teeth into the space created by tooth loss
- Oral habits like tongue-thrusting and thumb sucking
- Prolonged bottle-feeding or use of a pacifier
- Presence of extensive cyst or tumors that may deviate the tooth out of the arch
Primarily misaligned teeth take a toll on the self-confidence of a person as it affects the appearance of a person’s smile. Misaligned teeth often interfere with chewing and speaking. Moreover, crooked teeth are difficult to clean; therefore, they increase the risk of tooth decay, cavity formation, and gum disease.
Malocclusion often puts a great deal of load on the jaws and muscles, which can cause unnecessary tooth mobility. Misalignment of teeth can be broadly divided into the following types –
- Overbite – in this condition, the upper jaw vertically overlaps more than 50% of the height of lower teeth. (5)
- Underbite – this dental condition is characterized by an extension of lower teeth in an outward direction as compared to the upper teeth. Typically it creates a bull-dog appearance wherein the lower teeth overlap the upper teeth.
- Crowding – crowding of teeth refers to lack of space in the arch to accommodate all the teeth. Such conditions cause rotation and displacement of the teeth. It usually occurs due to a disharmony between the tooth and jaw size.
- Spacing – teeth spacing is usually characterized by prominent interdental spaces and lack of contact between the adjacent teeth. Spacing between the upper incisors is typically referred to as midline diastema. It is one of the most common types of cosmetic dental problem.
- Rotation – rotation of teeth usually occurs when there is no space in the arch to accommodate all the teeth. In simple terms crowding of teeth causes the movement of the tooth around its long axis. Such teeth require orthodontic treatment to come back to their original alignment.
Abnormally shaped teeth
As the name suggests, unusually shaped teeth develop with irregular tooth structure. Such teeth develop as a result of many different conditions like –
- Ectodermal dysplasia – abnormal development of skin, hair, sweat glands, nails, and teeth.
- Cleidocranial dysplasia – a congenital disability that mostly affects the bones and teeth.
- Ehler-danlos syndrome – a group of disorders that affect the connective tissue supporting the skin, blood vessels, bones, and teeth. (6)
- Cerebral palsy – a permanent movement disorder that causes gradual weakening of muscles and bones.
Teeth formed due to the conditions as mentioned above can be broadly characterized as follows –
- Hutchinson teeth – in this condition, the teeth are smaller and widely spaced as compared to healthy teeth alignment. Often Hutchinson’s teeth have prominent notches on the bitting surface.
- Peg laterals – as the name describes, the lateral incisors develop in a peg shape. It is small, pointed, and often resembles a cone.
- Mulberry molars – these are characterized by multiple rounded rudimentary enamel cusps that develop on the permanent molar teeth. Mulberry molars are characteristic of congenital syphilis and only affect the molars.
- Conical teeth – such teeth are long and pointed which gives them a conical shape. These teeth taper incisally.
Conditions that involve the gums
Excessive gingival display under the upper lips is a common cosmetic dental problem that lowers down the self-confidence of a person. A gummy smile is caused by the abnormal eruption of the teeth or due to hyperfunction of the upper lip.
Other causes of gummy smile include excessive vertical growth of the upper jaw, over-eruption of upper front teeth or the combination of the two. Usually, this condition is treated with orthodontic treatment or gum contouring to enhance the appearance of the smile. (7)
Multiple reasons cause gingival hyperplasia or gum overgrowth around the teeth. One f the prime reason for the development of such condition is poor oral hygiene. Medications like immunosuppressants, calcium channel blockers, and antiseizure drugs often cause inflammation and overgrowth of the gums.
Typically, gum overgrowth can lead to misalignment of the teeth. Moreover, the patient may experience pain and tenderness around the affected area, bad breath, and plaque buildup. Treatment of gum hypertrophy includes gingivectomy wherein the overgrowth is removed surgically or with the help of gingival laser.
Receding gums is a dental condition in which the gums pull back from the tooth surface, exposing the tooth root. Usually, gum recession is caused by [rogressive gingival infection or periodontal breakdown. It leads to the formation of pocket between the teeth and gum line. Moreover, gingival pockets form an entry portal for oral bacteria to cause deeper infections. (8)
Other causes of gum recession may include malocclusion, traumatic injury, trauma from the orthodontic appliance, and oral piercings. Treatment depends on the extent of recession and is commonly treated by graft surgery.
Developmental dental defects
Cleft lip and palate
Cleft lip and palate are congenital malformations that are characterized as openings or splits in the upper lip, the roof of the mouth or a combination of both. This condition often affects the healthy development and growth of facial and oral tissues. (9)
Often cleft lip and palate occur as isolated congenital disabilities. However, they can be associated with some inherited genetic syndromes. Typical signs of cleft lip or palate include –
- A split in the upper lip and roof of the mouth which may be present on one side or both sides of the face.
- A split that may appear as a notch on the upper lip
- A notch on the upper lip that may extend to the gums and palate
- A separation that only involves the roof of the mouth without affecting the upper lip
It is essential to get immediate help from a dentist and plan treatment for proper growth and development of the face and mouth. Surgical approach to close the gap between the lips and palate are taken at a young age.
If left untreated, cleft lip and palate may interfere with feeding, swallowing, speaking, and often cause an ear infection.
Amelogenesis imperfecta is a developmental anomaly that usually affects the tooth development. The teeth in this condition are unusually small, discolored, pitted, and grooved. Moreover, the teeth are brittle, which increases the risk of rapid wear and breakage. (10)
The common cause behind the formation of this disorder is a genetic mutation of enamel forming genes. It results in altered proteins that form the enamel layer and leads to the development of abnormally soft, yellow, and fragile teeth.
Furthermore, the teeth may become incredibly susceptible to tooth decay, hypersensitivity, and gum disease. Typically, amelogenesis imperfecta is categorized into four types –
- Hypoplastic – it affects the enamel matrix formation, which leads to an abnormal thickness of enamel. Usually, the enamel is thin, hard, and translucent with pits and grooves.
- Hypomaturation – in this stage, the enamel has standard thickness but with a pitted appearance. The hardness of enamel is lesser than average, which makes it prone to rapid wear.
- Hypocalcified – as the name suggests, malfunction of enamel calcification makes the layer brittle and gives it a flaky or chalky appearance. The teeth are often prone to staining and wear.
- Hypomature, hypoplastic enamel with taurodontism – this condition is a combination of the first two types along with taurodontism. Taurodontism is a condition wherein the body of the toot hand pulp chamber enlarges vertically at the expense of the tooth root.
Dentin dysplasia is a genetic disorder which affects the dentin production of the tooth. Typically, this condition is characterized by healthy enamel development but with underlying atypical dentin and abnormal pulp morphology. Dentin dysplasia is characterized into two types –
- Radicular type – this condition affects the development of the tooth root. Both the primary and permanent teeth can be affected by radicular dentin dysplasia. Often the primary teeth may give a bluish brown or amber-colored appearance. However, permanent teeth may look normal. (11)
- Coronal type – coronal dentin dysplasia cause discoloration of the primary teeth. Typical features include translucent opalescence in the teeth. Moreover, the pulp enlarges abnormally entending into the root canals of the tooth.
Overview of cosmetic dental problems
Our smile is an essential asset that often determines the personality of a person. Most people like the way they smile. However, a part of them always wishes to have straighter and whiter teeth. Several factors can affect the appearance of your smile. Some of them are specific to tooth color and structure, while others may be related to the overgrowth or recession of gums.
Other forms of cosmetic dental problems may include cleft lip and palate, developmental disorders like amelogenesis imperfecta, dentin dysplasia, and congenital abnormalities. Whatever the reason may be, knowing such conditions can make you aware of the long term effects of the disease. Moreover, you can talk to your dentist and get cosmetic dental treatments to refine your beautiful smile.