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Many patients present the dentist with diverse complaints about a loss of facial height and profile.

Typically 'I can't see my teeth anymore when I smile and I am embarrassed to have my photograph taken', 'I have difficulty chewing my food' or 'I don't like the gaps that have formed between my teeth' to mention but a few. Or they may have acute toothache from an overstressed tooth because of progressive changes in the patients bite over a period of time.

However there is often a common link between all of these signs and symptoms and this article will guide you through a treatment protocol.

The patient is typically in the 45 years plus age group. They may have been habitually unconsciously grinding their teeth for a long time, especially at night or when they are stressed.

Clinical examination usually reveals extensive wear on the tooth surfaces often coupled with a loss of several of the back teeth and thus a forward drift of the lower jaw in order to get contact in chewing or function. The patient may sometimes have pain or discomfort in the hinge joints (Temporomandibular joints) just in front of their ears.

Examining the patient's facial height usually reveals that the tip of their chin is far too close to the tip of their nose when they close their teeth together. This can give the patient a premature ageing effect. The teeth are often very small showing extensive wear.

To treat these cases successfully the dentist must consider the whole mouth. In the first instance a detailed and comprehensive examination is required. Taking full mouth X-rays and photographs as well as mounted study models or plaster cast.

Following this a diagnostic splint may be made for the patient to wear for a few weeks. This opens the bite up to nearer what it once was and should be worn as often as possible. It is made of clear acrylic and seats neatly over the top or bottom teeth. When the patient is found to be comfortable wearing the splint at the restored vertical height the dentist may then get the dental laboratory to duplicate the study casts and produce a diagnostic wax up of what the finished dentition would look like with all the teeth restored at the new vertical height.

Up until now none of the teeth in the patient's mouth have had any active treatment from the dentist. Ultimately the detail from the wax up would have to be replicated in the patient's mouth either by building up the natural teeth by crowning and or filling the gaps with bridges/dental implants or partial dentures.

Before any treatment is commenced the patient should receive a detailed written cost treatment plan from the dentist which they both understand and are happy with.

If any of the for mentioned facial problems concern you then don't be conscious of your smile or not showing your teeth '.. Consult your dentist and explain your concerns. Your dentist should be able to help you or if not refer you to another practitioner who can.

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