After 33 Years, Melissa Gets the Smile of her Dreams.
For as long as I can remember, I’ve had dental problems. I grew up in southern Alberta, Canada—where my dad was self-employed—as the fourth of six children. With so many kids at home, my siblings and I rarely had the opportunity to visit a dentist. Fortunately our neighbor was a dentist, and from time to time my parents would pay cash and my siblings and I would visit the dentist for cleanings and fillings. During those visits, the dentist had to do as much work as possible during one appointment for my siblings and me.
As my permanent teeth came in, I noticed that two of them grew in just behind two baby teeth. At the time, my older brothers and sister were wearing braces, so my parents couldn’t afford braces for me as well.
The problems with my teeth weren’t just cosmetic. I had headaches and my jaw popped and clicked. I actually had a delayed click—when I opened my mouth wide, my jaw seemed okay, but then it would click. My jaw locked up a couple of times, too. It was painful and annoying.
I played a lot of sports when I was young, so my jaw problems might have been due to repeated elbows to the face during basketball games, or from volleyballs hitting my face. Regardless of the reason, my jaw had trauma. In addition, I had small lateral incisors. My mouth was therefore very crowded in the anterior.
To help with these issues, the dentist in Canada extracted the two maxillary bicuspids on both sides of my mouth. The assumption was that my front teeth grew in behind the baby teeth because there wasn’t enough room. The dentist also made a retainer for me to wear that pushed my front teeth forward.
The Root of the Problem
Because of my early experiences, I dreaded visiting the dentist. Unfortunately, that fear is not terribly unusual—many kids dread dental appointments. What is unusual, however, is how those early experiences shaped my life. When I was in high school, I decided that I wanted to help make other kids’ dental experiences better than mine. So immediately after high school I worked toward becoming a dental assistant.
Unlike in the United States (where dental assistant requirements vary from state to state), in Canada, dental assistants must be nationally certified. So I started working at an oral surgeon’s office and afterwards went to dental assisting school.
Once I had some dental assisting skills, I started working on my own teeth to try and correct some of the issues that had bothered me since childhood. I asked a dentist to help and he did some bondings on my laterals. Later on, I bleached my teeth and redid my bondings, but nothing gave me the results I wanted.
Because the bondings were made at different times, my teeth were varying colors—I had four or five different colors in my mouth. I was frustrated with the different colored bondings and the build-ups (which I was unable to bleach). I was also unhappy with the uneven spacing in my anterior teeth. Someday I hoped for a uniform, beautiful smile.
Early Efforts
With my dental assistant income, I was able to pay for braces when I was 25 years old. I hoped that getting braces would address the issues of crowding and anterior spacing, and also the crossbite issues. So while I was in braces, I asked the dentist to open my bite slightly to help with my TMJ issues.
After correcting the spacing issues, I did additional work on my teeth, trying to create a smile that I liked. I made some E4D crowns to correct my peg laterals. One crown was a blue-grey crown because you don’t really do E4D in the anterior. I also remade my lateral crowns after I had braces, but I was still unsatisfied with my smile.
Making A Move
By this time, I was working for a dental office in Las Vegas, NV, as a lead assistant. My responsibilities included patient care, supplies, ordering, problem solving, and more.
After getting married, I moved with my husband to Utah. Because I had worked in the dental industry for years, I was familiar with Arrowhead Dental Lab (conveniently located in Utah), so before the move, I reached out to them for potential employment opportunities. Fortunately, I got a job with Arrowhead, where I work today.
My current role is as a Doctor Relations/Technical Support Representative at Arrowhead Dental Lab. After working at Arrowhead, I learned that volunteers are sometimes needed for the continuing education (CE) courses that the Dr. Dick Barnes Group offers to dentists. Frequently, the CE class offerings include a full arch or full mouth reconstruction.
Arrowhead usually has a long list of patients wanting to volunteer for these courses, but I decided to put my name on the list and hope for the best. I thought, ‘Someday, when I have saved enough money, I will get my teeth completely redone.’ And it has been the best thing that I’ve ever done!
My “someday” finally happened in June of 2015. I was prepped for a full arch reconstruction and cemented in September—one week before my thirty-third birthday!
The Procedure
Dr. Jim Downs from Denver, CO, did my work during a CE course. Dr. Downs is experienced in full arch and full mouth reconstructions and he knew how to restore my mouth and give me the smile of my dreams. I had confidence that he would be aggressive enough to fix my crossbite, and also compassionate enough to leave me with some of my tooth structure.
Instead of a full mouth reconstruction, I had a full arch reconstruction. Dr. Downs opened my bite—probably half a millimeter—just on the upper arch. He didn’t really need to open it for the Shimbashi (the distance between CEJ to CEJ on tooth numbers 8 to 25) to be perfect. He was able to correct those things on the upper arch and with braces. I opted for the strength of gold crowns in the back on my molars because of my bite.
Prior to the procedure, I was completely calm. I wasn’t worried about the full arch procedure because I had witnessed it many times as a dental assistant. I also wasn’t worried about having a group of people (the seminar participants) look in my mouth. In fact, despite having about 20 people peering at me and having suctions in my mouth and water in my nose, I fell asleep! The whole process lasted about 2 hours and 45 minutes.
Dr. Downs prepped me fast! Still, I was surprised how natural the temporaries looked and how even my smile became. No one could tell that my teeth were peg laterals. That’s a big accomplishment!
Having peg laterals makes the two front teeth protrude a bit. I felt like I had “Bugs Bunny” teeth because the side teeth were so much smaller! So I was surprised at how even, straight, and perfectly aligned my teeth looked after the temporaries.
I had a White Wax-Up done in preparation for the temporaries. This is a 3D mold of my teeth that the dentist can adjust and sculpt to determine the proper amount of gum tissue. The White Wax-Up comes with a matrix, a transfer bite, and a clear plastic reduction guide to show which gum tissue needs to be reduced or sculpted.
I requested a few changes to my White Wax-Up for my teeth. I wanted to make my canines a little bit more predominant so they would look more natural. I also asked to change the arch form so that tooth numbers 7 through 10 would be more aligned. Once the changes were made, I was thrilled how the temporaries looked!
In the past, with all the composite fillings and the crowns that I had put on my front teeth, my gum tissue was always puffy. During the reconstruction, Dr. Downs made the gum tissue look perfect with the use of a CO2 laser. It was painless! I didn’t feel anything and it wasn’t sore afterwards, either. It was just amazing!
The clear reduction guide removed the guesswork so that Dr. Downs could use a wax pencil and make adjustments exactly where he needed to make the zenith symmetrical. Once the gum tissue healed, it changed slightly, so he had to adjust a small spot.
In September 2015, Dr. Downs seated my crowns and adjusted the bite—again at Arrowhead Dental Lab. After Dr. Downs left Utah, he flew back to Colorado. The next day, I noticed that the bicuspid on my upper right was uncomfortable and Dr. Downs wasn’t scheduled to return to Utah for a couple of weeks.
The tooth didn’t actually hurt—it was just irritating. I could chew on the other side of my mouth without any problem, but it was sensitive on the right side.
To remedy the problem, Dr. Downs took a T-Scan® during a later course and made an adjustment. After I had that spot adjusted, it was heaven! Now I can chew food on either side of my mouth without any issues.
When doing a full arch reconstruction, doctors should always confirm that everything is symmetrical a week later, because there’s still time to make adjustments and drop margins if needed.
The First Reveal
After getting my temporaries, I visited my family in Montana. All my siblings and I met at my parents’ cabin. Everyone was looking at me and asking what was different. Only my mom knew I was wearing temporaries. After seeing them, my mom decided that she wanted to have her teeth done, too! She was so impressed with how natural my teeth looked and how beautiful my smile was. She told me that I was glowing!
I didn’t experience any problems while wearing the temporaries—no reactions to heat or cold, and none of the temporaries came off. My overall feeling during the restoration process was one of relief. The entire experience was great—from the timeline of getting things done, to having support through the process and adding my input for the outcome that I wanted. Dr. Downs understood what I wanted and made me feel valued and heard.
At the time of printing, it has been about a year since I’ve had my teeth seated and I haven’t had any issues with them. I don’t have headaches, my jaw hasn’t locked, and if I clench my teeth, I’m not aware of it. I probably will make myself a nocturnal orthotic, just to be safe, but everything feels great!
What I’ve Learned
After working in the industry for many years, I was thoroughly prepared to undergo a full arch restoration. Still, I learned many things that may help others going through the process.
For Patients:
1. Don’t worry! My first suggestion is to relax and not worry. Although it may seem like a daunting procedure, it’s not as difficult as you may imagine.
2. Do more than the Social Six. I strongly suggest doing more than just the front six teeth (also called the “Social Six”). I wanted a big, “Julia Roberts” smile. To accomplish that goal, we had to work on more than just my front six teeth. If patients have pictures of the smile they want, it can be helpful to show the doctor. But then patients should listen to the doctor if he or she recommends doing additional teeth to accomplish that goal.
3. The temporary crowns feel different. The temporaries look great and give patients a great idea of what their new smile will look like, but they don’t have the smoothest feel. When patients get their permanent crowns, they’re smooth.
4. Continue good hygiene. After getting my temporary crowns, I got a Waterpik® and regularly rinsed my mouth out. Patients should be prepared to keep up good oral hygiene habits, which includes brushing and using a Waterpik®.
5. Use clear mouthwash. Make sure to use mouthwash that isn’t colored. Use clear or white mouthwash instead because colored mouthwash can stain the temporaries.
For Doctors:
1. Use a White Wax-Up. Some people don’t know what they want until they see it. A White Wax-Up can help indecisive patients by showing them what’s possible.
2. Set realistic expectations for your patients. Make sure you understand which smile the patient really wants. If a patient wants to look like the actress Julia Roberts and they only have four teeth, be honest with the patient and tell him or her that you’ll get as close as you can to the desired smile, within realistic limitations.
3. Prepare your patients for the entire procedure. Make sure that patients understand that a full mouth or full arch restoration requires several appointments. It’s not an overnight transformation—it is a process. Clearly explain that the patient is going to have his or her teeth for a long time, so you want to make sure they’re absolutely perfect. It will require multiple appointments.
4. Understand a patient’s likes and dislikes. Try to learn what your patient likes and doesn’t like about his or her teeth. Clear communication between doctor and patient is key.
5. Fill out the medical prescription completely. When doctors fully complete the prescriptions (the size of teeth they want, etc.), it helps the lab technicians. Completed prescriptions clearly articulate the patient’s desires and expectations and can expedite the process in the lab.
Looking Back
In retrospect, the only thing I would have done differently is to have done it sooner! Looking back at my wedding pictures, I didn’t smile as big or as pretty as I should have because I was self-conscious about my teeth.
Before I had my smile done, my sister even told me that I wasn’t allowed to be in her wedding because I didn’t know how to smile properly. It was just because I wasn’t confident in my smile. Who wants to smile when they don’t like their teeth?
What’s more, the changes to my smile were not overly dramatic. I wanted more of a subtle look so that it was still me, but a better me. My restoration shows that it is definitely possible to make subtle changes and improvements to a patient’s smile without making a huge change.
Some patients want a bright white, television-news-anchor kind of a smile, but it’s nice to know that there are many other options—not everyone has to go to that extreme.
The biggest difference my new smile has made in my life is in my self-confidence! I believe that when you look good, you feel good and you’re happy! And because I looked good, I started to feel better, which made me happier in general. It was a boost to my self-esteem and to my confidence.
With that newfound confidence, my life is turning around! I’ve lost 40 pounds since having my teeth done. I got a Fitbit®, started watching my steps, and I’m enjoying life to the fullest. I feel more attractive, rejuvenated, and ready to tackle any obstacles in life.
In my professional role, I feel like I can represent Arrowhead well when I visit with doctors because my smile is everything I hoped it would be. Because of my firsthand experience, I can better understand, help, and guide the process for doctors and patients.
I spent many years living in pain and feeling embarrassed because of my smile. I knew that someday I would get my teeth done, and I am so glad that day finally came! The results surpassed all my expectations.
