Los Angeles Smile Makeover for Gummy Smile

A recent survey by the American Academy of Periodontology found that 1 in 4 people felt that their smiles' were too gummy. Dr. Farnoosh, a Los Angeles and Beverly Hills smile makeover specialist, offers an innovative solution

Beverly Hills, California - A smile is one of the first facial characteristics a person notices. For those with imperfect or abnormal smiles, it can be an agonizing ordeal and is avoided at all costs. However, now there are new Los Angeles smile makeover procedures in place to give everyone their perfect smile. Dr. Farnoosh has brought new hope for those people concerned about their "gummy smile."

The results of a recent consumer survey conducted by the American Academy of Periodontology (AAP) revealed that almost one out of four individuals that participated in the study felt that their smile revealed too much of their gums or that their teeth appeared longer than they should. These startling results show that nearly 1/4 of the population may not be confident about the appearance of their smile. To hide their "gummy smile," many people who suffer from this condition have compensated by perfecting the art of smiling with closed lips. Dr. Alex Farnoosh, a Beverly Hills periodontist offers an innovative solution.

For people who feel their smile is gummy or shows too much of their teeth, a revolutionary procedure has been developed by a Beverly Hills cosmetic dentist to alleviate this problem. This condition, called a gummy smile, occurs when the lip sits unnaturally high on the gum line, creating a smile exhibiting excess gums. This is often due to either the upper lip being too short or a hypermobile lip.

The rather harsh, traditional treatments of the past for this condition have included cutting and repositioning part of the upper jaw or crown lengthening. Removing part of the upper jaw is not only expensive, but also very painful and risky. Many dentists claim that crown lengthening, which involves cutting back, and re-sculpting the gum line, will correct any gummy smile. Unfortunately, crown lengthening alone either via traditional surgical blade or via laser is often insufficient. While crown lengthening may be effective in diminishing some gummy smiles, it can often create teeth that appear too long producing a "horse-like" appearance.

As an alternative, one of the most effective and least invasive methods that exist to improve a gummy smile is lip lowering. This procedure developed by Dr. Farnoosh, lowers the lip line that covers the gum thereby minimizing the gummy smile and producing a more attractive appearance (view before and after photos). In addition, this procedure can be used in conjunction with crown lengthening, to reshape the gumline around short teeth by removing excess gum. In some cases, the placement of veneers or crowns may also be needed. By combining these techniques in the right manner Dr. Farnoosh brings a "perfect smile" within the reach of his patients.

"The AAP survey shows that there is a large percentage of the population who could benefit from these procedures and may not be aware that they exist," said Dr. Farnoosh. "In the past, the treatment for a "gummy smile" was painful, risky and expensive. My method is safer, less invasive, less costly and the results we have seen over the past 10 years are just outstanding."

About Dr Farnoosh

Dr. Farnoosh is a graduate of the University of Iowa, where he earned his M.S. degree and specialty certificate in Periodontology in 1974 and a Ph.D. in Pathology in 1978. He has taught at the University of Southern California (USC) since 1981, where he has held the title of Director of Doctoral and Post Doctoral courses. He also served as admissions chairman for the School of Dentistry. He was promoted to Tenured Associate Professor in 1988 and subsequently to Clinical Professor in the Department of Periodontology.

Request a consultation with Dr. Farnoosh or call his office at 310-657-0503 to find out more about his procedures and flexible financing options or visit Top3dentists for more information.

Various Types of Dentures

Overdentures
An overdenture is a precision device that is secured by dental attachments. Types of overdentures include bar joint dentures and telescopic dentures. Over dentures are basically any non-permanent tooth replacement appliance that is worn over your existing teeth or their remnants, replacing missing teeth with false teeth. With the advent of modern dentistry, making teeth removal safer and far less painful, over dentures are sometimes a cost effective alternative to implants, and certainly a better choice than full dentures, if they can be avoided.

Today, teeth that seem beyond hope are usually extracted before the insertion of an over denture, although there may be times when those teeth can be salvaged for the patient's best interest. Currently, the most commonly seen over denture involves teeth that have had root canal procedures. If the roots of these teeth are still healthy, the crown may be cut off at the gum line and a removable device fitted over the remaining stumps. Often, your dentist will place a filling material or cast metal copings over the stumps first to help protect them from decay.

The great benefit to this is that the roots of these teeth help preserve the bone that supports them. This bone, that is vital to supporting the denture, would otherwise quickly resorb. Also, the root itself serves as a vertical foundation for the denture, providing for more stability than would otherwise be possible.

The addition of a soft denture material such as CuSil on the denture surface that directly covers the stiff root stumps permits the overdenture to sit more snugly into the soft tissue on the roof of the mouth. This allows for more suction to build up and will usually improve the retention of an overdenture.

Implant Retained Dentures
A full set of implants can be cost prohibitive for many people, however, a minimum of two implants can retain a lower denture, which may not have been tolerated by that patient otherwise. Generally speaking, more than two implants are required for upper implant retained dentures.

Even though the dentures that fit over implants are significantly higher priced than standard dentures, they present the benefit of allowing upper dentures to be created in the shape of an arch instead of having to cover the entire palate. This is of special importance to people who have severe gagging reflexes, and probably could not wear full dentures because of that.

Implant retained dentures are also of particular value to patients who cannot wear lower dentures. As a toothless patient ages, and the bone continues to resorb, lower ridges often fade away entirely. This leaves no vertical bone underneath the gums to steady a lower denture. The placement of just two implants in the front of the lower jaw can make it possible to retain a lower denture, which would otherwise not be possible for the patient to endure.

Mini Implant Retained Dentures
Mini implants, first introduced in the late 1990's, have come to be the gold standard for holding lower dentures. An attractive feature is that they can usually be inserted into the lower jaw without having to cut an incision into the gums. Anesthesia is generally injected immediately into the position for each individual implant only. The original lower denture may then be retrofitted for immediate placement over the new implants. Also, patients who have been advised that they may not have enough bone left to consider standard implants are often candidates for minis, since they are only the size of a basic toothpick.

Another nice feature is that this can all be achieved in under an hour. It is virtually pain free, and usually creates very little postoperative discomfort. In conclusion, this procedure is far less costly than standard implants for retaining lower dentures.

Duplicate Dentures
When a full denture is first created, it is often an affordable option to order a duplicate set made at the same time. Duplicate dentures are made by flowing liquid agar around the finished denture and allowing it to harden. Agar is a thick, gelatin-like material made from seaweed, which is liquid when hot, but cools to form a supple, rubbery substance. The original denture is then removed from the agar mold, leaving a hole in the agar where the denture used to be. Liquid plastic is then used to fill in the mold; white plastic in the tooth indents and pink to form the foundation and flanges. The two halves of the agar mold are then placed back together and the liquid plastic is allowed to solidify.

Duplicate dentures are not particularly high quality since the plastic used to create them is somewhat porous and less resilient to wear, and they may not appear as natural as the original set, however they do provide a great alternative to going without if the primary denture is lost or must be sent out for repair, et.

The duplicate denture is generally given tot he patient with no follow up fittings or treatments for sore spots, etc, since they are made inexpensively and are meant to be used only in emergencies.

Types of Dentures

In this article we will discuss three of the four basic types of full dentures. These are the standard dentures, the immediate dentures, and the Cu-Sil dentures. In future articles we will go into detail regarding implants, and the implant retained denture, another alternative.

The Standard Denture

Usually, the back of a standard denture ends just behind the hard bone in the roof of the mouth. This is because they require as much surface area as possible to maximize their retention and stability. In the case of patients who struggle with gagging, however, the dentist will trim the denture forward, making its base resemble more of an arch shape. This does help the gagging reflex, however, some stability is relinquished.

Standard dentures are usually made for patients who are already missing all of their teeth. The top denture depends on suction to hold it in place, and the solidity of the underlying tissues for its strength. It generally takes at least four appointments to create a set of standard dentures.

The first appointment consists of an oral examination, usually x-rays, and a set of impressions of the upper and lower edentulous (toothless) ridges (gums). These impressions are poured, using plaster, to form accurate models of the shape of the edentulous ridges. Other considerations are determined such as the coloring, size and shape of the teeth that will be used for the new dentures.

Sometimes the dentist will suggest surgical alteration of the ridges to remove excess flabby tissue which will interfere with the stability of the new denture, and sometimes to alter the shape of the underlying bone, creating a better fit. In most cases, this surgery will not be necessary, however, it may make a much more satisfactory final fit. Modifications like these are generally time and money well spent, if your dentist recommends them.

The second appointment will generally consist of determining how long to make the new teeth, deciding the plane of the tooth setup. A guideline is, when you smile, the teeth should be parallel to a line between the pupils of your eyes, and the correct relationship of the upper and lower teeth so that when you bite together, the upper and lower teeth line up correctly. This is done using a loose fitting denture base and a rim of wax to determine the position of the teeth.

Both upper and lower wax rims are carefully adjusted to fit properly in the patient's mouth so he can speak correctly without the wax rims clicking together, and so that the upper and lower rims fit together squarely. Preferably, the wax rim should be visible a little below the patient's lip when the lip is at rest. When the patient smiles, the position of the lip is marked in the wax to help the lab decide which set of teeth are suitable for this patient. Once these relationships are accurate, the rims are sent to the lab where they are used to fabricate the wax try in.

The third appointment is for the wax try in. The laboratory has returned the loosely fitting tray from the second appointment with the true final plastic teeth lined up along the outer edge of the wax rim. The wax try in appears just like a real denture, other than the foundation sits loosely on the gums, and the teeth are implanted in wax instead of what will be plastic.

This gives your dentist a chance to see how the denture looks and works before the final setup. During this step things can still be readily adjusted, by sending the denture back to the lab, where a skilled technician can re-melt the wax and set the teeth to a different specification.

Your dentist will undoubtedly refit your denture as many times as necessary until the teeth look and function as they should. When everything is ideal, the denture will be sent back to the lab to be processed and finished. The old loose fitting foundation and all the wax will be discarded, and replaced by a snug fitting plastic denture base.

The fourth appointment is usually the insertion date when the patient walks out of their dentist's office with new dentures. The plastic does tend to contract during processing, so some adjustment is typically required before they will maintain the suction that you might associate with a new denture.

Immediate Dentures

Immediate dentures, also often referred to as temporary dentures, are in fact made prior to the natural teeth being extracted. The patient goes into their dentist's office with natural teeth, and walks out the same day with dentures. Their teeth are extracted, and a prefabricated denture is inserted immediately over the unhealed gums. The patient is still numb from the extractions, and really won't feel any discomfort until later at home. Usually, most patients do not mention too much pain after their teeth are extracted and the immediate denture is inserted. The denture acts like a pressurized band aid, helping to reduce pain.

The manufacture of an immediate denture necessitates only one or two preliminary appointments before the insertion date, depending on how many natural teeth the patient has left to extract, ect. They generally work out relatively well. When the patient leaves, he certainly looks much better than when he came into the office. The bone that maintained the original teeth is still intact, and the gum tissue is secure. For at least the first week, the immediate denture will remain secure and fairly well retained.

For the most part of cases, immediate dentures simply become permanent dentures, however there are large amount of issues related with immediate dentures that may cause the patient to desire new dentures made after their gums have fully healed, in about a year. These issues account for the alternative name, temporary dentures.

If the patient has more than one or two remaining front top teeth, it is frequently unfeasible to do a wax try in. The denture teeth are placed in about the same position as the natural teeth before extraction. Even though the denture teeth will be straight, their position may not be perfect because there is no way to preview them as the dentist normally would with a standard denture. For this reason, not everyone will be happy with the finished look of their immediate denture, and may desire a new one at the end of about a year.

After all of the natural teeth have been extracted and the immediate denture is placed, there will be a rather quick loss of the bone that used to hold the natural teeth in place. By the end of about three weeks, enough bone has been lost that there is a great deal of space between some parts of the denture and the healing gums. This leads to ever-increasing slackness and sore spots which must be removed recurrently. In some offices, the dentist will include a free temporary "soft" reline at about one month after the extraction and insertion date. This is an uncomplicated way to tighten the denture against the gums, and since the material is a bit rubbery, and frequently medicated, it makes the denture much more comfortable until enough healing has taken place to do a permanent "hard" reline, usually at an additional charge.

At the end of 4 to 6 months, the immediate denture must be relined with the same acrylic that the denture base was made from originally. The hard reline is a separate procedure and the cost is normally not included in the original price of the immediate denture. Consequently, the immediate denture ends up costing a little more than the standard denture when the price of the reline is taken into account. The hard reline defines the official transition of the immediate denture into a standard denture.

Cu-Sil Dentures

There are a significant amount of problems connected with full dentures, and not everyone can effectively bear them. In many cases, false teeth are not particularly useful due to maintenance or steadiness problems. On this basis, even a single healthy tooth left in place can steady an otherwise unstable full denture.

Just of late it has become feasible to develop a denture leaving an outlet here and there to allow any remaining teeth to thrust through without destroying the suction which usually holds the denture in place. The Cu-Sil denture has these outlets for any remaining natural teeth. These outlets are encircled by a gasket of stable silicone rubber which hugs the natural teeth and allows the rest of the denture to rest against the gums giving the advantage of suction in addition to the wonderful stability presented by the immobility of the natural teeth.

CuSil dentures help stabilize loose teeth and may even prolong their lives. It is also simple to replace lost natural teeth with the CuSil denture, and the denture can be relined like any other standard denture. The versatile CuSil denture can finally, should the need arise, be altered into a regular full denture if the patient one day loses all the natural teeth.

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The Difficult Truth About Dentures

Most dentists who have been in practice any length of time have probably made quite a few complete sets of dentures. These occur often in cases when patients go in with old sets that need to be replaced. There are also cases in which the patients go in to see a dentist with their teeth in such bad condition that there is literally no other affordable option. However, sometimes young people may go into a dentist's office with numerous teeth that have what they believe are non-repairable cavities, or they may not like the appearance of their teeth because they are crooked. They assume that dentures will be a simple way to correct all their problems.

Many of these people have avoided going to the dentist because they are afraid of what the dentist will think, or afraid of what will happen to them once they get there. Let me try, in this article, to clear up a few important points.

Your Fear of the Dentist

Any fear you have of going to the dentist, and the pain you may experience while being worked on is completely out of proportion to the actual discomfort you will feel while you are there.

Modern dentistry is designed to care for you in such a way that you will feel very little pain at all during your visits. In fact, your dentist can even give the very anxious patient medicine to take just before their appointment time, to help them relax, so that even their fears are lessoned.

Full Dentures Should be Your Last Resort

You cannot even imagine how disappointed you may be with full dentures. You do not naturally lose your teeth when you get old. With a little care, anyone can keep their teeth all their life! Having full dentures is not at all like having real teeth. People with them can barely chew their food. Most people can put just an average of 15% of the pressure on their false teeth as they normally used to chew their food with, before they lose the suction that keeps the top denture in their mouth. The lower ones have no suction at all and they just sit there by virtue of their own weight, and the ability of the tongue to help them stay in place. Many people find lower dentures so cumbersome that even if the top ones are reasonably successful, they do not wear the lowers except when they go out in public.

Nearly the instant the natural teeth are removed, the face begins to age rapidly. When your new dentures are inserted for the first time, your facial appearance remains the same, for the time being, however within a very short amount of time, the bone that held your original natural teeth begins the process of resorption, literally disappearing, which begins the process of collapsing your facial structure.

Wearing dentures rapidly accelerates the aging progression of your face because the distance between your nose and your chin begins to diminish as soon as the natural teeth are removed. The bone that used to hold your top natural teeth begins to draw back up toward your nose, and the bone that held the lower natural teeth "goes south", allowing both the top and bottom false teeth to ride with them in the same directions. Within just the first few months, your face has aged several years. As a result, the denture teeth ultimately begin to disappear under your lips while the lips themselves begin to flatten out. This process continues for the rest of your life, as you will always appear much older than you actually are. The rapid aging usually has a profound effect on the emotional well-being of the patient, and can unfortunately affect their ability to gain employment and be socially active.

Dentures Must be Refitted Every Two Years

Approximately every two years you must go back to your dentist to have your dentures relined. What this means is that new plastic must be added to the inside of your existing denture in order to fill in the spaces between the denture and your gums left have been left vacant by the receding bone. Relines do not actually restore vertical dimension, but they do help keep the denture fitting tight and stable. If you fail to reline the denture regularly the consequences will not be good. As the bone continues to recede and more and more space becomes vacant inside the denture, most people will begin wearing some type of stiff denture adhesive to maintain the denture stability in their mouths. They tend not to notice that the teeth move around more and more while they are chewing their food. When a denture retains suction, but begins to move around over the bony ridge that supports it, dentists say that the denture has good retention, however it lacks stability. When the hard denture base is in close approximation to the bone that supports it, the denture has maximum stability, but as the distance increases, no matter what type of substance you put under it, the teeth become less and less secure and are much more easily dislodged when chewing food.

People just try to live with this worsening condition and they plan to get new dentures, someday, when the difficulty becomes so serious that they can not eat properly at all. However, if they have waited over two years to refit their denture, something very unfortunate begins to happen to the tissue that supports the denture. Nature begins to actually create more gums between the bone and the denture to take up the slack. At first this sounds good, but the gum tissue that nature builds after the real teeth are gone is soft and flabby. You can compare it to a layer of play dough. Of course, play dough will adhere to a wall, and it has some retention values, however it won't support any weight and it certainly has no stability. That is just like the loose new gum tissue that forms under an ill fitting denture, it will not support a new stable denture.

If your dentist attempts to fit a new denture over a growth of this flabby tissue, it will have the same stability problems that the old one did unless you first go to an oral surgeon to have the tissue removed before your denture is made.

If you get to the point when you are needing to use more than just a touch of denture adhesive to retain your denture, then you are due for a reline. Do not try to fit something under your denture to make up for the gap as a makeshift "denture liner". Using anything other than actual denture adhesive is a bad idea because the denture breath gets pretty sour very quickly.

The Gag Reflex

If you have a strong gag reflex, and avoid going to the dentist because of this, be assured that your dentures will cause you to gag too. Perhaps the saddest group of patients that dentists must try to treat are those who hate their dentists because they tend to gag when anyone, especially the dentists, put something in their mouths. These patients have the idea firmly in their minds that they will just wait until their teeth get so bad that a dentist will just have to put them to sleep, remove all their teeth and they will wake up with dentures and live happily ever after.

Certainly, you can wait that long to see a dentist. And, although it is very costly, you can have all of your teeth extracted at once, while under general anesthesia and have an immediate denture placed. However, I am not too certain about the "happily ever after" part. Gaggers tend to go without their dentures quite a bit, because the very presence of the denture in their mouths makes them feel like throwing up all the time. They begin to avoid accepting invitations to eat out, and will wear their dentures only when it is absolutely necessary. The only real hope these patients have is if they can someday afford full mouth implants.

Are There Affordable Alternatives to having all the Teeth Removed?

The missing teeth and teeth that are beyond repair can be replaced without extracting the remaining good teeth. They can be replaced using removable partial dentures. Partial dentures are much more comfortable and secure than full dentures. They do not have to cover the entire roof of your mouth for stability because they are kept secure by the remaining natural teeth. Even the existence of a few natural teeth remaining on either side of the dental arch can make it feasible to wear a partial denture as an alternative to full dentures. The presence of any number of real teeth can greatly reduce, although not completely eliminate, the hastened aging process related to having full dentures.

Having said all of this, there certainly always will be some patients who truly do need to have all their teeth removed. For them, we will be posting an article describing the different types of dentures, and the steps involved in making them.

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