Healthy Smile: My Bottom Teeth Are So Short

by Jeffrey Gross, DDS, FAGD of The Healthy Smile

Yes, his teeth were relatively short. The lower front teeth showed years of wear, and finally, treatment was on the horizon. My patient told me that he had been dealing with other health issues for the past five to six years. “My teeth were neglected,” he proceeded to tell me. He came to me to seek my approval and find someone who would not be judgmental about his delay in treatment. My hygienist and I both said that in our office, there is no judgment. I wanted to help if he would allow me the opportunity.

Before we talk about treatment, let’s discuss why he had so much wear on his front teeth. There can be many factors that contribute to short front teeth. In the next few moments, we will touch on a few of them. Cosmetically this patient had nice upper teeth. Those teeth have looked the same for many years due to crowns across all of his upper teeth. Although the treatment of the upper teeth happened many years ago, they still looked good. Permanent crowns change very little, if at all over time. That’s the good news. The bad news is due to their long life span, the material that comprises a cap is very hard. In fact, tooth-colored caps are typically harder than tooth enamel. We know that tooth enamel is the hardest substance in the body. It is even harder than bones.

The chewing mechanism is essentially a grinding process when the lower teeth move in all the planes of space and rub or grind against the upper teeth. When upper and lower teeth are the same material, the constant rubbing causes similar wear on the top and bottom teeth. If some of the teeth are made of a hard material, then the wear of the teeth will be uneven. The softer material will wear away quicker than the harder material. In our patient, the natural teeth, although very hard, are not as hard as the crowns on the top teeth. The end result is a wearing away of the lower teeth until they are almost gone.

The other reason lower teeth can become very short is the lack of back chewing teeth. When we lose our back teeth and do not replace them, the job of chewing and specifically grinding our food shifts to the front teeth. I have written extensively on how bad that is for the front teeth. In our situation today, the bad results in destroying the front teeth and loss of a smile. The way to prevent smile destruction involves replacing back teeth as quickly as possible after removal.

Coming back to our patient, his back teeth were present. The loss of tooth structure and ultimate shortening of his front teeth were due to his upper crowns. The lower teeth were worn uniformly and required a uniform fix. I suggested to him that we rebuild his bite and his teeth to the place that they once were. My approach involved creating provisional crowns to test the new look and bite. When I use that technique, the patient and I get a preview of the final appearance of the proposed new teeth. Changes in shape, color, and size are easily accomplished with provisional crowns. Once everything looks and feels perfect, I use a digital scanner to convey the information back to the lab. Armed with that knowledge, the lab makes the permanent crowns to those exact specifications. There are no surprises for the patient or me. The provisional crowns allow us to get as close to perfection as possible.

As I write this article, our first real snow of the season is upon us. January is really here for those of us in Northeast Ohio. Now is a great time to reflect and think about all the items on our bucket list. For many of you, that means getting your teeth into the best shape possible. Please call 440-892-1810 and set up an appointment to eliminate disease or improve cosmetics in our mouths. I look forward to seeing you.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 • www.jeffreygrossdds.com