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They do not play as visitors in the field of aesthetic medicine, and in addition to dealing with that set of structures, organs and tissues that relate to each other and allow the physiological functions of chewing, swallowing, speaking, smiling and other facial expressions, dentists are behind an increasingly important discipline: orofacial harmonization, a specialty where the functional and the aesthetic are under the same magnifying glass, and which seeks to improve the appearance of the entire face through techniques and products such as botulinum toxin, the use of polydioxanone threads, hyaluronic acid, platelet-rich plasma and other biostimulators.
“We dentists treat one system, which is the stomatognathic system. Within our area of expertise, the need began to arise to complement our treatments within the different specialties of dentistry, and over the years new procedures were added to this new branch that was being born and that today we call Orofacial Harmonization (AOF),” explains dentist Garbiela Scarimbolo, a teacher at FOUBA and a member of the EIMEC training team. The objective is to harmonize the patient’s face for cosmetic and therapeutic purposes, because orofacial harmonization in dentistry always seeks to balance the proportions of the patient’s face, mainly based on function”.
“I don’t like my smile”
The face, Scarimbolo insists, is in direct relationship with the stomatognathic system. That is why, when a person smiles, a series of muscles intervene that are responsible for enabling such an act. “These muscles are inserted in different areas of the skull as well as on the surface of the skin, and when the patient raises the upper lip excessively when smiling, we are dealing with a patient with a gummy smile, where more than 3 mm of maxillary gingiva can be observed.
EIMEC model patient intervention.
This gummy smile not only creates an imbalance in the appearance of the face. It also, and this is something that most people refer to when they come to the office, dents self-esteem and confidence. “I don’t like my smile,” is often heard almost as a loop in the office chair. “It is a condition that must be correctly diagnosed in order to achieve satisfactory results if you want to use AOF procedures, such as the use of botulinum toxin, to relax those muscles that act in the smile,” says the expert, adding: “If the diagnosis reveals that this gummy smile is related to an excessively short lip, we will no longer obtain the same results using botulinum toxin. In that case, other procedures should be used”.
However, botulinum toxin is also widely used to relax the chewing muscles when the patient suffers from bruxism. In this case, Scarimbolo suggests, it is essential to diagnose the masticatory function prior to the application of the toxin. “That is why we always say that the diagnosis in AOF starts from the inside out,” the dentist emphasizes.
Enhancing tonicity and accompanying processes
With the irrevocable passage of time, says Scarimbolo, we begin to age. We perceive the first changes in the skin at around the age of 30,” she says. Within these multiple alterations that begin to occur, the perioral area, or around the mouth, is also affected.” What happens? The lips lose tone and the upper lip flattens. Convexities in shapes and contours also dissipate, and those vertical lines better known in the urban dictionary as barcodes appear. “They go down from the commissures and form a crease that many wish to correct (marionette lines), and the commissures themselves also go down,” the dentist points out. This process will accompany the other changes that occur over the years, since in adulthood, when speaking and smiling, the lower teeth show more than the upper teeth”.
This happens, the specialist explains, because the upper lip “falls” and covers more of the upper jaw teeth. “All this that happens in the soft tissues is also accompanied by changes inside the mouth. The possible absence of teeth or disharmonies in occlusion can cause deficiencies in what we call ‘vertical dimension,’ which could be simply described as the height of the lower third of the face, which is determined by multiple factors that must be diagnosed prior to any aesthetic treatment of the face,” Scarimbolo says. Otherwise, he argues, such a decrease in vertical dimension can bring serious alterations to masticatory function and the jaw joint (TMJ).
Previous check-up of the patient to diagnose the situation and proceed to the appropriate treatment.
In defense of interdisciplinary work
One of the AOF’s missions, Scarimbolo reinforces, is to preserve the patient’s esthetic balance based on a good diagnosis. “This diagnosis includes the patient’s state of health, both in the oral cavity and systemically. And in this line we give equal importance to emotionality as well as to the expectations of each patient with respect to possible changes in the appearance of his or her image,” says the specialist, and concludes: “I am an advocate of interdisciplinary work. I was trained in interdisciplinary work, and I believe that each one of us alone, individually, cannot get very far. One always grows hand in hand with others, as a team. I am fortunate to learn from many physicians and colleagues, to exchange concepts, to adjust criteria that, in the end, benefit patients and us as professionals. Just as I defend the AOF within dentistry, I am also an admirer and defender of the work and development of aesthetic medicine. We are moving forward together from all specialties, treating patients who, like everyone else, come with their concerns, dreams, fears and the need to look and feel good,” she concludes.
