White, perfectly aligned teeth have become an American staple. Because of this, many believe that the “Hollywood smile” is the healthiest, most ideal smile. Many dentists brand themselves as “cosmetic dentists” to address this demand. The American Academy of Cosmetic Dentistry says that aesthetic dentistry must complement the overall general and oral health of the patient. Cosmetic dentistry refers to any dental work that improves the appearance of teeth, gums and occlusion, despite functionality. However, the importance of functionality in smile design must not be overlooked.
A functional smile and occlusion allow for proper mastication, speech and deglutition. It can be argued that a functional smile is more important than an aesthetic smile, yet patients may be more motivated by the latter.
It is important to discern the difference between normal occlusion and ideal occlusion. The concept of normal occlusion focuses on the absence of disease and an adaptive physiologic range. A normal occlusion isn’t necessarily aesthetic; it emphasizes functionality.
An ideal occlusion meets anatomic, physiological and aesthetic standards. Americans value a beautiful smile not only for its physical and functional aspects, but also for psychological and social reasons. A nice smile is a boost to one’s self-esteem and confidence. A 2007 survey conducted by Kelton Research found that two-fifths of Americans would rule out a second date with someone who has misaligned teeth, and that those with straight teeth are 38 percent more likely to be perceived as smart.
What constitutes a beautiful smile? Perceptions of dental beauty vary across cultures. While Americans value straight, white teeth, other cultures have different standards of smile attractiveness. Japanese women seek out cosmetic dentists to modify their teeth to make them appear crooked. This is referred to as yaeba, meaning “double-tooth.” Fang-shaped veneers are placed on the maxillary canines and positioned more apically, creating a youthful appearance. The British hold similar standards, placing value on natural, misaligned teeth.
These standards have evolved from past traditions. At the end of the 19th century, Ohaguro was popular in Japan. Ohaguro is the practice of blackening one’s teeth and was regarded as a sign of beauty in ancient Japanese culture. Ancient cultures in sub-Saharan Africa practiced tooth mutilation. These mutilations included sharpening, filing and pointing the teeth. Ancient Egyptians had a cosmetic flare to their dental aesthetics. They used gold to make dental crowns and bridges, and brushed their teeth with a mixture of pumice stone and vinegar to remove stains. The Ancient Romans brushed their teeth with their own urine, an unusual start to the practice of teeth whitening.
During Medieval Times, barbers practiced dentistry, and the use of bone and ivory was rediscovered to make dentures. It wasn’t until the 1700s that prosthetic and cosmetic dentistry dramatically began to improve. In the 1800s, the use of porcelain teeth became popular and dentists used molds with plaster to ensure better denture fit. The 1900s introduced the use of plastics and acrylics for dental materials. The 20th century marked the era in which cosmetic dentistry officially began.
Today, dentists are focused on delivering functional, aesthetic and natural-looking smiles to our patients. A balance between beauty and function dictates the current standard of care and will pave the way for the future of cosmetic dentistry.
~Kristen Forlano, Stony Brook ’20