More Than a Pretty Smile

By staff April 1, 2007

The good news first: You don’t have to be born with a perfect smile to have one—not anymore. Like most things these days, you can buy it. You, too, can flash a celebrity smile after only a few hours in the dentist’s chair, thanks to what’s informally called "cosmetic dentistry."

The not-so-good news?

If your mouth is hiding underlying dental disorders, such as the onset of gum disease or a bite gone bad, you may have just wasted a lot of money on those gleaming new chompers. Worse, you may be headed for serious dental problems down the road.

Face it: If you’ve made it to your mid-40s, you’ve put your teeth through a lot of punishment. As we age, our dental dilemmas shift from cavity control to gum disease, receding gum lines, misaligned bites, chipped and broken teeth, damaged bridge and crown work, and fractured fillings.

Dr. Howard Chasolen, D.M.D, a prosthodontist with the Chasolen Centre of Sarasota, says that more than half of his 40-something patients show problems that have been brewing for years. They just didn’t know it.

Chasolen says that untreated periodontal problems top the list of unpleasant dental surprises. Gum disease is a slowly progressing condition that, if left untreated, will result in tooth loss. (Studies show that gum disease, not tooth decay, is most likely to rob baby boomers of their teeth.) Chasolen, who shares his practice with his wife, Dr. Ginger Chasolen, D.D.S., says that people aren’t always aware of the complicated dental issues that arise with aging. That ignorance can be costly when they spend thousands of dollars on cosmetic issues, only to find out that underlying problems still need to be fixed.

How can that happen?

For one thing, "cosmetic dentistry" doesn’t exist as a specialty, according to the American Dental Association. ADA-recognized specialties include endodontics, oral and maxillofacial radiology and surgery, orthodontics, pediatric dentistry, periodontics and prosthodontics. A prosthodontist, for instance, has three years more schooling after graduating from dental school and is skilled in the replacement of missing teeth and the restoration of natural teeth.

"No uniform guidelines exist regarding cosmetic dentistry," says Chasolen. What the general public doesn't know, he adds, is that many of the dentistry procedures considered "cosmetic" (including replacing crowns and bridges with dental implants) aren’t taught at most dental schools. That means, Chasolen says, that a dentist can take a weekend course and be "qualified" to make significant changes to your mouth.

If your mouth’s in good shape, that may not be a problem. But it’s a big problem if your mouth contains complications that only a dental specialist should address.

"Patients need to be proactive," says Chasolen. "They need to recognize that getting the pretty teeth they want may involve more steps than just slapping on veneers." He encourages his patients to think in big-picture terms.

"It’s like a building a house," he says. "You can build this fabulous house only to learn later that it was built on a sinkhole. We’ve seen too many patients come to us with advanced periodontal problems after they’ve already undergone extensive cosmetic procedures. If there’s not enough bone to hold the tooth due to gum disease, then all of the new work was for nothing."

Dr. Corey G. Warrenbrand, D.M.D., a Sarasota-based dentist, agrees with the "first things first" principle. But he remains optimistic that barriers between various medical specialties are starting to come down. Dental generalists and specialists are starting to talk to each other; they’re even talking to medical practitioners outside the field of dentistry. (Only a decade ago, that was rare.) It’s more than just talk, he says. Health practitioners of all stripes are starting to cooperate with each other.

"The medical and dental communities are working together more to address dental issues in a systemic way," says Warrenbrand.

He gives two examples: Periodontists and cardiologists are joining forces to explore the causes and effects of gum disease. Physicians and dentists are also working together to combat disorders of the temporomandibular joint—commonly known as TMJ. "We know that TMJ is often the culprit behind chronic back, neck and shoulder pain, which can sometimes be remedied by fixing the patient’s bite. Many of my TMJ patients came to me after years of seeing chiropractors and neurologists," Warrenbrand says.

And that is good news.

Although Warrenbrand also sees patients looking for a quick fix, he always takes time to explain the benefits of undergoing a comprehensive exam first. The exam screens for health, comfort, function, and appearance. "After completing a full-mouth charting, we create a blueprint that determines the appropriate course of action for this particular patient," he says. "What’s key is the long-term picture. Immediate gratification is one thing—but how many times does someone want to do a smile makeover? The intelligent person wants to get it right the first time."

So, from a patient’s perspective, the first step to that perfect smile is getting a comprehensive evaluation from a qualified dentist or prosthodontist. After they’ve determined the state of your teeth, you can chart a course to achieve your goal.

What are your options? Twenty-first-century dentistry offers plenty of techniques to spiff up broken, discolored and decayed teeth. Simple problems have simple solutions: Tooth-whitening is the simplest procedure of all—so simple it’s become routine, done either at home or in the dentist’s chair. To mask basic cosmetic problems, many dentists recommend veneers, which are thin, porcelain covers that are placed over the fronts of teeth. Bonding, or applying tooth-colored materials to broken or chipped teeth, is less expensive—but also less permanent. A procedure called "enamel shaping" can modify a tooth’s shape. Even filling cavities has changed for the better, since they can be filled with a tooth-colored filling instead of all that silver and gold. And crooked teeth can be straightened with nearly invisible braces now. Nobody has to look like "Jaws" anymore.

But problems and solutions aren’t always so simple, especially when the patient is missing teeth. Technological advancements in implant dentistry and bone grafting have opened up a wealth of solutions for patients who are missing teeth, says Chasolen. Dental implants substitute as a root for the missing tooth, and act as an anchor for a replacement crown or bridge.

Chasolen knows what he’s talking about. As a credited member of the American Academy of Implant Dentistry, he’s worked with hundreds of implant patients, from those who needed only one tooth replaced to those who needed full-mouth restoration.

"Patients with severe dental problems are candidates for full-mouth restoration," says Chasolen. "This usually involves a combination of procedures, including bone grafting for patients without enough bone to support the implant. Orthodontics may also be employed to help properly position the jaw."

The upside of implants is that their five-year success rate is more than 75 percent. For many people, the downside is their high cost: An implant plus crown can cost up to $4,000 per tooth.

Implant technology is also used to fit dentures more naturally in the mouth. Warrenbrand has seen his share of happy patients after undergoing this particular procedure. "This procedure, along with so many of these aesthetic fixes," he says, "is changing people’s lives for the better. Imagine the frustration of someone whose dentures are loose in their mouths. The implant procedure opens up a new world to them. Their frustration ends and their self-esteem returns."

It’s basic psychology. Our mouths are the first point of contact we have when interacting face to face with others. A cheerful, healthy smile is often the first thing people notice about someone—from potential lovers to potential employers.

But there’s a more subtle connection: Dental problems have a ripple effect on the muscles associated with the teeth and jaws. When those problems are solved, the muscles relax. You not only have a great smile, you feel like smiling again. Your whole face looks different.

"Dental restoration can be life-changing," says Warrenbrand. "First impressions are everything—and fear of making a bad impression because of problem teeth keeps many people isolated. An unattractive smile can be viewed as a disability. Solving those problems gives many people a new lease on life—new marriages, new jobs, new everything. I’ve seen it firsthand."

Chasolen agrees. "It’s said that a smile is the light in the window of our face," he says. "Nothing brings a smile to my face faster than helping put a healthy, happy smile on someone else’s."





Employed adults lose more than 164 million hours of work each year due to oral health problems or dental visits.

In 2005, Americans made about 500 million visits to dentists, and an estimated $84 billion was spent on dental services.

32 percent of Americans cite bad breath as the least attractive trait of their co-workers.

Topping an American poll for greatest-looking teeth were Hollywood actors Brad Pitt and Julia Roberts.

75 percent of the U.S. population has some form of periodontal gum disease.

50 percent of Americans do not receive regular oral health care.

Terms to Know

Tooth whitening (bleaching) brightens teeth that are discolored or stained. Bleaching may be done completely in the dental office or the dentist may dispense a system for you to use at home.


Bonding can improve the appearance of teeth that are chipped, broken, cracked, stained, or have spaces between them. With bonding, tooth-colored materials are applied, or bonded, to the tooth surface.


Enamel shaping involves modifying teeth to improve their appearance by removing or contouring enamel. The process, which often is combined with bonding, usually is quick and comfortable and the results can be seen immediately.


Veneers are thin custom-made shells designed to cover the front side of teeth. Made of tooth-colored materials, veneers are used to treat spaces between teeth as well as teeth that are chipped or worn, permanently stained, poorly shaped or slightly crooked.


Braces are not just for kids. Orthodontics may be needed if teeth are crooked, crowded or do not meet properly. If your dentist thinks you should see a specialist for treatment, he or she will refer you to an orthodontist.

SOURCE: The American Dental Association,

Body Talk


Michelle Manna on the advantages of Thai massage.

Ask any spa director what the hottest new bodywork technique is and he or she will answer without hesitation: Thai massage. From chic urban day spas to sports clinics, Thai massage has become an essential offering in the healing-arts industry.

This rhythmical and meditative massage technique originated in India thousands of years ago, says Michelle Manna, L.M.T., N.M.T., a Sarasota-based Thai massage instructor and practitioner. "It’s based on Ayurvedic medicine, Buddhist spiritual practice and yoga. Like acupuncture, acupressure and shiatsu, it centers on the belief that the body responds to pressure points along central energy lines."

Thai massage is more than just massage, says Manna, who teaches the technique at Sarasota School of Massage Therapy. It blends gentle acupressure and deep, assisted stretches to open, exercise and tone all systems of the body. Therapists use their feet, elbows, knees and thumbs to free the tension inside joints and knotted muscles. This energetic procedure is sometimes referred to as "passive yoga" because it takes recipients through normally strenuous yoga poses, "encouraging proper alignment and deep relaxation," Manna easy.

But Thai massage isn’t just beneficial to the client. Because it’s performed on a floor mat, the practitioner has greater ease of movement and leverage and can accomplish more bodywork with less effort. Indeed, says Manna, "Many practitioners see Thai massage as a form of dance in which both therapist and recipient participate. Since the client usually wears loose clothing during the procedure, he or she can stretch, push and move with ease into the various postures."

Who should consider it? "Pretty much anyone who seeks more flexibility and range of movement," says Manna. "There’s no pain in Thai massage. But there are all sorts of gains."



For more information about Thai massage, call Michelle Manna at (941) 952-1908.


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