A healthy smile means more than just straight teeth. 

The general public assumes dentists solely observe and treat teeth, however, this couldn’t be further from the truth. In fact, dentistry is a comprehensive subsection of medicine that involves the cardiovascular system, the temporomandibular joint, and the sensory system. Moreover, dentistry affects our facial esthetics, our appearance,  and how we communicate with others. While our general health is important, how we see ourselves, particularly our smiles, can affect our mental health, our confidence, and our self esteem. It is well known that our smile can impact our social and work lives, therefore we should understand all areas of facial esthetics to provide the best quality of care for our patients.

Aside from orthodontists and prosthodontists, most general and pediatric dentists are not fully trained in facial esthetics and what to look for when treating patients. We know that orthodontics can improve someone’s quality of life, but it also:

• Creates a harmonious facial contour.
• Maintains periodontal health.
• Improves dental stability for chewing and speaking.
• Improves facial and dental esthetics.

As dentists, we need to look at the patient as a whole and not just their teeth. Therefore, there are a few important factors to consider when diagnosing, treating, or referring a patient for orthodontic treatment. 

1. Defining and understanding facial esthetics.

In the 19th century, orthodontic treatment emphasized that ideal occlusion is the primary concern and that facial esthetics would naturally follow. Obviously, many years later, we learned that is not necessarily true and that facial esthetics played a major role in patient satisfaction. 

Facial esthetics in dentistry can be defined in three primary ways. 

1. Macro-esthetics: The relationship between the face, lips, gingiva, and teeth.
2. Micro-esthetics: The esthetics of the individual tooth, including the size, shade, and shape.
3. Nano-esthetics: The relationship between teeth and the perception of how light, shade, anatomy, and texture impact the relationship. 

Dentists need to evaluate all three esthetic factors to achieve optimal occlusion and cosmetic design. The smile analysis should begin by first evaluating the patient’s face. Then, the dentist can translate treatment using more minute details and material selection based on micro- and nano-esthetic elements. 

There are many considerations when looking at facial esthetics, although there are some strict guidelines dentists initially look for. One of the first evaluations a dentist looks for is the rule of 42.2, which is applied to the amount of front teeth showing when the lips are at rest, how much gum tissue is revealed, and the relationship between the incisal edge to the lower lip. 

Dentists also need to take into account patient preference, cultural considerations, and realistic expectations for patients. Often, orthodontics alone cannot achieve a patient’s ideal smile and collaboration with a cosmetic dentist is necessary. 

Digital dentistry is an incredible way for dentists to collaborate with their patients and put them in the driver’s seat to satisfy their esthetic needs. They can visualize the beginning and end of their treatment so they can understand each step of the process and communicate better if they have questions.

2. Facial esthetics is dependent upon symmetry.

There is no single component that solely impacts facial esthetics. It is a multi-factorial process that is dependent upon soft tissue, jaw size, gingival esthetics, facial height, and teeth proportion. Most dentists will have some type of baseline to analyze esthetics like lip line or symmetry, but there are so many factors to consider when diagnosing and treating orthodontic cases to improve facial esthetics.

Facial symmetry should be analyzed based on harmonious proportions broken down into thirds. 

• Upper third: From the hairline to the glabella (the area of skin between the eyebrows and above the nose).
• Middle third: From the glabella to the subnasale (above the upper lip before the nose). 
• Lower third: From the subnasale to the mention (the most inferior part of the soft tissue of the chin). 

It is simply not enough to correct a malocclusion. Orthodontics can do wonders, but if there is not enough attention paid to the symmetry of the face, a proper occlusion with poor esthetics may result. Therefore, dentists need to take particular note of the hard tissue and soft tissue to ensure quality orthodontic and esthetic care. 

According to Dr. Ava Kamenshchik, a board-certified orthodontist in private practice, “Proper tooth alignment is fundamental to facial esthetics and smile architecture. Along with orthodontics, your smile arc can be emphasized for optimal incisal display, enhancing symmetry, and proportion.”

3. Orthodontics can dramatically impact facial esthetics.

General and pediatric dentists can benefit their practices and patients by taking an online or in-person orthodontic course. The American Orthodontic Society (AOS) offers continuing education courses for dentists looking to expand their knowledge and be able to treat Class I and II malocclusions to improve patient care. The Basic Straight Wire Course taught by Dr. Brad Williams is a wonderful opportunity for general and pediatric dentists looking to incorporate orthodontics, because the course is designed for dentists who have a foundation, but need didactic and clinical support. 

Orthodontics can dramatically affect patients’ appearances and function. For pediatric patients, expanding dental arches can benefit their dentofacial growth, airway, and self-esteem. It can also help prevent trauma to teeth and soft tissue for patients involved in athletics. For adults, general dentists can correct poor occlusions that result in difficulty eating, speaking, and smiling. By treating malocclusions you are able to make a drastic change in esthetics to give a more youthful appearance and develop a harmonious facial-dental relationship. 

Many patients may initially think there is a simple tooth discrepancy where there is in fact a jaw-tooth issue that requires orthognathic surgery. Orthodontics is one key way to help a patient develop an ideal profile and occlusion, but many times is a multi-specialty approach. 

When a general and pediatric dentist understands how facial esthetics affects orthodontics and vice versa, they can better serve their patient population and have an increased knowledge on the foundation of an ideal occlusion. Patients will appreciate the education because they are constantly looking to improve oral care and facial esthetics.