“I’d like a broader smile”… but that’s the least of what she needs!

“I hate my narrow smile with the teeth tipped inward” are the exact words of a 48 year old woman who recently came to our office for the first time. I hear this all the time in our practice. The cause of the problem is sadly very predictable and preventable! The esthetic concern which brought her in the door is very common, but vastly less important than the functional issues she had no idea were related to the esthetic issue.

What is my point? She had traditional orthodontics with removal of four bicuspid teeth and subsequent retraction of her front teeth when she was an adolescent. The esthetic result was not to her liking when she finished the treatment, and more than 30 years later she wants to do something about it.

The functional issues include a migraine at least three days a week, snoring, a poor sleeping pattern which finds her awaking gasping for air, a sour taste in her mouth (diagnosed with GERD), and significant weight gain over the past two years. All of the preceding are STRONG SIGNS OF POSSIBLE OBSTRUCTIVE SLEEP APNEA due to a reduced airway. I palpated the muscles of her face and neck and found many of them were sore probably as a result of grinding her teeth at night. I took her BP and she was not pleased when it turned out to be 157/107! Sad stories like this have become routine in our practice.

So what is my point? The very treatment which caused her smile to be narrow in the first place also likely reduced her tongue space/airway to the point that she stops breathing at night and suffers from Obstructive Sleep Apnea (OSA). We sent her for a sleep test. Her sky high BP is likely a result of her actually suffering from OSA for years. Not all patients who undergo retractive orthodontics will have this occur, but there is no way to predict when this will or will not happen with retraction.

What can we do? If she has mild or moderate OSA, re-opening her previous orthodontic extraction spaces may do the trick and give her enough tongue space to eliminate the problem. We make no guarantees, but we’ve seen it work in other cases. If that doesn’t work then surgery to advance the jaws to open the airway may be necessary after we have re-opened the spaces.

We can definitely replace the extracted teeth by re-opening the spaces and having implants placed. This will dramatically broaden her smile and resolve her esthetic concern. One way or another we can likely resolve the OSA problem if we have surgery as a possible option. We’ve seen dramatic drops in BP readings and have seen patients get off their BP meds after years of taking them. Imagine having the broad smile you wanted and also hopefully be done with the OSA which makes you never feel well rested! There are no guarantees, but doing nothing is guaranteed to be a bad choice. Untreated OSA carries with it a 20% reduction in life expectancy. So this woman’s desire for a better smile may mean she will get rid of her OSA and actually live a longer life.