One of the most important aspects of a denture is the smile. People typically get dentures because they want to have their smile improved, but one of the biggest concerns that my patients have is they want the right teeth for their mouth. Everyone seems to have a story about someone who has teeth that are way too small or way too big for their face. I can understand this fear about getting the wrong tooth because very few people want others realizing they have dentures. People want their teeth to look either natural so they blend with their face or they want them to look beautiful with the hopes that they might get a Hollywood smile. In this blog, I want to discuss the process of making the smile from first picking out the tooth shape and size to deciding what color to choose and finally to checking the position of the smile.
Picking the tooth shape and size
Picking out the tooth shape and size is usually the easiest part of the process , but in certain situations it can be the most difficult part of making a denture. It is easy when I have a front tooth to match either by making a copy of their current denture or simply measuring their current natural front tooth when we are removing all the teeth and placing a denture the same day. Usually in both of these cases, the front tooth is worn down and sharp from use. If my patient is younger or wants teeth that look younger, I will choose a slightly longer tooth that is rounded. If my patient is older and wants teeth that fits their age, I will still typically choose a slightly longer tooth but I will keep the sharper look to keep a bit of wear on the tooth. Now if a person comes to me with no reference tooth, I generally have to work by two different guide lines. The first is that the shape of the front tooth typically has the same shape as the person’s face upside down. Seems like a weird correlation, but it typically fits. The second way is to look at how the top and bottom arches of the gums look. Round arches get round teeth, square arches get square teeth, and tapered arches get tapered teeth. The size of the tooth typically depends on how many teeth I can fit on the front part of the arch. By using these metrics, I am usually able to choose the appropriate tooth that would fit the patient’s face. However, occasionally the arches do not actually match what the patient wants. I find that this happens when the patient has lost their denture and usually the old denture has much smaller teeth than the patient probably had when they had natural teeth. All the same, I will do as many try ins as needed to get to the correct smile because that is my policy.
Picking the right tooth color
The second part is choosing the color of the teeth or what dentists call the shade. Now most people just assume that teeth are white, but teeth are usually white with some level of red and yellow in them. Now for dentists, the most common shade system uses sixteen different natural colors of teeth with one color of tooth that is pure white. I typically shrink these sixteen different options down to three common ones and two uncommon ones. The three most common shades that are used are what I call natural (A2), natural white (A1), or Hollywood white (B1) and the two uncommon ones are what I call natural dark (A3) and sparkling white (010). The terms in the parenthesis are the actual dental names for each shade and I included them in case you want to search for what the colors actually look like. I don’t often show the colors because I find that showing a single tooth of a color doesn’t really describe it well. The shade chosen typically matches what a person wants their smile to look like at first glance. Natural is for when someone wants their smile to blend well with their face as it typically matches skin tones the best. Natural white is the whitest a person can get by using whitening gel on a regular basis, and it has a hint of yellow in it to help mimic the inside part of the tooth that shows through the enamel. Hollywood white always looks good, but it shows off. I liken it to a white Porsche that drives down the interstate: it is beautiful but very noticeable. Natural dark is generally chosen by my patients who smoke and want their teeth to look natural. While I don’t do many natural dark smiles, I can understand a person’s desire to make sure that their teeth don’t look too white. The final one is sparkling white which looks opaque white. Sparkling white is like someone shining a flashlight in your eyes. I use this for my patients who desire the whitest tooth possible as you cannot get whiter than that. If someone is on the fence of which tooth to get, I will usually recommend a shade lighter as I have never had a patient tell me that their teeth are too white.
Making the denture look just right
The final part of making a denture look beautiful is putting together the entire smile. The teeth must be placed properly so that everything comes together right. The first most important part is to find the midline which can be tricky for some people as they might have up to four different reference points to use to match their midline. The different reference points are the center of the top gums, the middle of the bottom teeth, the middle of the nose, and the middle of the eyes. If these four midlines are not the same, I will typically chose the middle of the nose and use that to set the teeth. The second part is making sure the angles are right from both the side view as well as from the front view. For the front view, we want to make sure that we line up the teeth so that they are parallel with the eyes also known as the intrapupillary line. For the side view, we want to line up the teeth to be parallel from the top part of the eye to the most forward part of the top of ear lobe also known as the ala tragus line. The next part is to determine how much teeth are shown. We want to set the front teeth so that the lips can comfortably cover them without them straining too much and also so that the “F” sounds are acceptable. By using these different reference points, we can design a smile that fits a person’s face correctly.
Smiles are important because they are the second most noticeable feature on a body after a haircut. However, people can usually forgive a bad haircut, but they will remember a bad smile. I and my team at NOLA Dentures and General Dentistry work hard to get my patient’s back to the smile that they want. If you feel that your smile needs to be fixed, please call us at 504-392-5104, and we will help you out.