Dr. Louis Malcmacher opines on the latest skills needed to fully serve patients and expand professional goals.
Q: What has been the biggest change in aesthetic dentistry in the last 10 years?
A: By far, the biggest change is the realization by dental professionals that aesthetic dentistry involves more than just the teeth. For years, aesthetic dentistry educators would teach dental professionals to tell their patients, “If I only put white veneers on the 4 to 6 front teeth, you will have some great looking teeth, but you will not have a great looking smile. If we place veneers on the 12 upper teeth, then you will have a great looking smile.” Of course, we now know that is not true at all. You could put veneers on all 32 teeth, and you will still only have great looking teeth and not necessarily a great looking smile. Any patient that gives you that big white smile and has scraggly, thin lips and deep paragraph folds around his or her mouth that do not allow the patient to show all those teeth will have compromised dental aesthetics. Dentistry has finally come to realize its rightful place by understanding that clinicians should be educated in dental and facial aesthetics, something that we have talked about for years and only now can truly accomplish.
Q: What’s the relationship between dental and facial aesthetics?
A: Facial aesthetics is an integral part of dental aesthetics, and dental aesthetics is an integral part of facial aesthetics. You cannot have one without the other. A beautiful smile involves total facial aesthetics. This gives dentists a unique advantage over any other healthcare professional who delivers Botox and dermal fillers because dentists are the only ones who can also make the teeth look great.
Q: You’ve coined the term “outside in dentistry.” What do you mean by that?
A: Outside in dentistry means that clinicians are trained to look at patients’ faces before even having them open their mouths. In the American Academy of Facial Esthetics (AAFE), we call it “reading faces.” There is a lot you can learn from reading (observing and studying) someone’s face before you look at his or her teeth. This applies to both temporomandibular joint (TMJ)/orofacial pain and, especially for the purposes of this brief discussion, dental/facial aesthetics. Some of the things we look at include the amount of fat or collagen the patient has lost in his or her face, the depth of the nasolabial folds, the flatness of the cheeks, and the thinness of the lips. All this mid-face and lower-face volume loss directly relates to the lip lines and smile lines, and, after a little bit of experience, the clinician can predict how much the teeth are going to show (or hide) based on the facial volume. Mid-face volume provides the lip support needed to show beautiful teeth when the patient goes into a full smile. Once this is evaluated and diagnosed properly, the clinician can then also look at the patient’s dentition and come up with a treatment plan that will provide the best possible aesthetic outcome. Today, Botox and dermal fillers are essential tools for every dental aesthetic case, as shown by the 10,000-plus dental members of the AAFE.
Q: Are there any new tools available for dental and facial aesthetics?
A: Yes! There is an exciting addition to what dental professionals can now provide patients. As a quick review, Botox is used for unsightly wrinkles, folds, and TMJ/orofacial pain caused by muscle movement. Dermal fillers are hyaluronic acid gels used to replace lost facial volume. One major void that Botox and dermal fillers do not address is lifting and tightening sagging skin, which can give us much better dental aesthetics. We now have nonsurgical solid filler PDO threadlifts available that can smooth, tighten, and lift sagging skin to create defined lip lines, smile lines, and jaw lines—all of which directly affect dental aesthetics.
Q: How important are the lips to dental aesthetics?
A: For too long, those involved in teaching dental aesthetics have given only superficial “lip service” (pun intended) to the role of the lips in dental aesthetics. Ideally, the shape of the upper lip should match the contour of the upper teeth incisal edges for the best aesthetics. Now you can plan your anterior dental aesthetic cases as you see fit, and then you can use dermal fillers to enhance the lips to match the teeth. I have seen beautiful and aesthetic dental cases where, after placement of the restorations, the clinician adjusted the incisal edges to match the upper lip contour. What a mistake! Why would you irreversibly remove bone and tooth structure to match the soft tissue when you could have easily adjusted the lip by using a dermal filler? Every dentist should be trained in Botox and dermal fillers so that he or she can match the lips and the face to the final aesthetic case upon insertion. This gives the dentist total control over the case and will provide the patient with optimal dental aesthetics.
Q: What do dentists need to do to competently add aesthetic treatments for their patients, such as Botox, dermal fillers, and PDO threadlifts?
A: This year is the AAFE’s 10th anniversary! Throughout the years, the AAFE has trained more than 15,000 dental professionals in the use of Botox, dermal fillers, and PDO threadlifts. This has changed dentistry forever. Dentists now use Botox, dermal fillers, and PDO threads for dental and facial aesthetics, restorative cases, orthodontics, TMJ, orofacial pain, and even in periodontal cases that involve the treatment of black triangles. Getting trained in Botox, dermal fillers, and PDO threadlifts is an example of skills-based training. Once learned, the clinician will have these skills to better serve his or her patients for an entire career.
Dr. Malcmacher is a practicing general dentist in Cleveland, Ohio, and is president of the American Academy of Facial Esthetics. He can be reached at (800) 952-0521 or via email at drlouis@facialesthetics.org.
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