Straight Teeth Talk: Little investigating goes long way with dental disease

July 6, 2010 at 2:06 a.m.

This patient was concerned about the space between her front teeth.

This patient was concerned about the space between her front teeth.

By Mac Lee, DDS

Diagnosing dental disease and problems is like investigating a crime scene. If something doesn't look right, it usually isn't.

For the sake of our investigation, let's call the patient in these images Amanda. She was concerned about the space between her front teeth. Amanda felt the gap was getting wider and that things simply didn't "feel right."

In order to confirm my suspicions, we took X-rays, and I examined each tooth closely. Just like any investigation, there were several possibilities, so, let's consider the different ways to solve this mystery.

One possibility is that there is nothing to solve, that the space is normal. The gap between David Letterman's and Condoleezza Rice's teeth is called a diastama. These naturally occurring spaces occur in the early teenage years and last a lifetime.

Obviously, these two superstars have enough time and money to close the space between their teeth with modern dental technology if they desired. The fact that they don't simply means they must like the space and it represents their individuality, giving them their "chi."

The big clue here is that Amanda's space is getting bigger where Rice's and Letterman's space is remaining the same. Healthy teeth do not get gaps between them over time. If you examine these pictures or "crime scenes" closely, you will notice the two front teeth look pushed out and are angled backward, instead of straight down. They are even beginning to overlap the smaller lateral teeth to the sides.

In the second picture, where Amanda opens her mouth, you can see the jagged lower teeth. She has chipped and worn down the biting surfaces at least a couple of millimeters.

Can you see the worn down areas on all of the front teeth? As you examine this scene, note that everything that looks crooked, worn, broken, chipped or moved are clues as to what is wrong.

Teeth are like fence posts. If a post is braced well and it is in solid ground, it will withhold a lot of outside forces such as heavy winds, big gates and even angry bulls. But if the posts are not in the ground very far or are in soggy ground, they are going to move away from external pressures.

As we continue the investigation and review Amanda's X-rays, I see this is exactly what is happening to her teeth.

Overtime, she has been losing bone due to gum disease. Her lower teeth and bite are putting too much pressure on the upper teeth, and they are moving to literally get out of the way.

Unfortunately, Amanda's bone loss is so severe, there is no hope for her upper teeth. Her next step is for us to take some very accurate impressions of her upper and lower teeth and to record the way she bites. From this, a qualified dental lab will make an upper healing denture that will fix her existing lower teeth. This will keep Amanda from ever having to go without teeth.

Telling patients disappointing news is hard, however, it is important to be up front and honest, even when the diagnosis is difficult to report and hear.

The good news is that Amanda is getting healthy and working on eliminating the disease in her mouth.

If you are worried or feel that something just isn't "right," do not hesitate, call your doctor or dentist right away. You deserve to have a happy, healthy smile and body.

Mac Lee is a dentist in practice in Edna. He is the co-founder of Dentists Who Care, a national movement to educate the public on modern dentistry. If you have dental questions you can call him at 361-782-7191or visit him at



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