Marvin Fier, DDS, FASDA, ABAD, executive vice president, American Society for Dental Aesthetics, and dentist in private practice, Pomona, New York. SmileRockland.com
Teeth show your age just as much as drooping muscles or sagging skin. Even if you get regular dental care and keep your teeth white, you might want to consider other dental enhancements. Age-related changes can dim your smile and even change your facial structure, making you look far older than your age.
Common problems—and the best solutions…
Decades of chewing (or tooth-grinding or clenching) can wear down the upper and lower teeth. As the teeth get shorter, the distance between the chin and nose also shortens. Result: A shorter face that makes you look older.
Solution: Veneers or crowns that restore natural tooth shapes and dimensions. Veneers are ultrathin pieces of porcelain that, when attached to the surface of existing teeth, become extremely strong (see photos). A crown goes over the entire tooth. Crowns are a better choice if your teeth are structurally weak because of fillings, root canals, etc. Sometimes increasing the length of only the upper teeth can create a dramatic improvement.
Crowns and veneers can last at least 10 to 15 years and sometimes longer.
Cost: Between $800 and $2,500 per tooth, depending on the part of the country where you live. Veneers and crowns are roughly the same price. Insurance rarely, if ever, covers any service performed strictly for esthetic reasons. However, if a tooth is structurally compromised, a crown may be covered as a necessary service.
People often don’t realize that the shape of the face partly is determined by the teeth. This is particularly true in the cheek areas because the muscles are supported by the side teeth. If you have one or more missing teeth, your cheeks can cave inward and create an older, drawn appearance.
Even one missing tooth can cause a “sunken” appearance if you have a small, narrow face. It will be less apparent if you have a large, broad face.
Solution: A dental implant is ideal as long as the underlying bone is healthy. A dentist will surgically implant a titanium cylinder in the jawbone. After the bone heals, a connector, called an abutment, is attached to the implant. Then a new tooth (a crown) is attached to the abutment.
Dental implants typically last just as long as your regular teeth, and in many cases, even longer. Warning: Smokers are about two-and-a-half times more likely to have failed implants than nonsmokers.
Cost: Approximately $3,000 to $5,000 per tooth.
Another option: A stationary bridge—often called a permanent, or fixed, bridge (as opposed to a removable one)—that replaces one or more teeth and is connected to the adjacent teeth with supporting crowns. It can cost almost as much as an implant but is more likely to be covered by insurance.
Patients with temporomandibular disorder (TMD) will sometimes experience changes in the jaw joint that cause the chin and lower jaw to move to an abnormal position. This can distort the normal appearance of the face.
Solution: Some patients can correct a TMD problem by wearing a splint—sometimes known as a night guard or a bite guard—when they sleep. This is called occlusal splint therapy. Splints, made from a type of durable plastic, usually slip over all or some of the teeth. They cause changes in the joint that can reposition the lower jaw and both relieve pain and restore a more normal appearance.
Splints are relatively inexpensive, but they can take years to work—and they don’t work for every patient. If occlusal splint therapy fails, you might need surgery of the temporomandibular joint to correct the problem.
Important: Don’t bother with over-the-counter boil-and-bite splints. They are not effective for a receding jaw. You need a splint that is customized by a dentist to fit your specific teeth and jaw shape.
Cost: Between $400 and $1,000 for occlusal splint therapy, plus the expense of imaging tests, such as an MRI or a CT scan.
If you’re middle-aged or older, you probably have one or more silver amalgam fillings. These don’t last forever. The edges can open up and allow bacteria to get under the fillings. Also, the metal fillings in teeth can darken and appear as gray shadows that are visible through the tooth enamel, imparting an old and unattractive appearance.
Solution: Remove old fillings and replace them with nonmetal, tooth-colored fillings.
Cost: Approximately $150 to $350 per tooth, depending on the size of the original filling and how much work is required for the new one.
Even if you don’t break or “pop” a porcelain crown, it won’t maintain its original appearance forever. Example: The gums often recede with age. This can produce a thin gray or black line between the crown and the gum.
Solution: Replace the crown. A lower-cost option is to use tooth-colored filling material to fill the gap. It isn’t as durable or as attractive as a new crown, but it’s a good choice for patients with limited funds.
Cost: Filling the gap is about $100.
You’ve probably heard the expression, “He/she is long in the tooth.” Changes in the shape and health of the gums can make the teeth appear longer. Or they can make the gums disproportionately prominent. Either of these changes can compromise your appearance and make you look older.
Solution: A “gum lift,” known technically as a gingivectomy or gingivoplasty. The dentist will use a laser and/or scalpel to give your gums a more even appearance that’s in harmony with your face.
Cost: $1,000 to $2,000.
Even if your partial or complete dentures fit perfectly when they were new, they tend to become loose or misaligned as your mouth changes. It’s normal for the gums and underlying bone to change over time.
Poorly fitting dentures can sometimes give you jowls and wrinkled skin as your muscles work overtime to keep the dentures in place.
Solution: Ask your dentist to check the fit of your dentures. Most people find that it is worth replacing them every five to 10 years.
Cost: Insurance plans typically cap the expense at about $800 to $900 per upper and lower denture. If you don’t have insurance, the cost per denture could range from $1,800 to $5,000 depending on where you live and the design and quality of the denture.