Tooth Loss, Aging and Facial Collapse

Effect On Esthetics

Facial changes naturally occur in relation to the aging process. When the teeth are lost this process is grossly accelerated with more rapid facial aging. The loss of teeth can add 10 or more years to a persons face. A decrease in face height occurs as a result of the collapse of bone height when teeth are lost. This results in several facial changes. The decrease in the angle next to the lips and deepening of vertical lines on the lips create a harsher appearance. As the vertical bone loss progressively and rapidly increases, the bite relationship deteriorates. As a result, the chin rotates forward and gives a poorer facial appearance. These conditions result in a decrease in the angle at the corner of the lips, and the patient appears unhappy when the mouth is at rest.

Short facial types have higher bite forces, greater bone loss and more facial changes with tooth loss, compared to others. A thinning of the upper lip results from the poor lip support provided by the denture. And, there is a loss of tonicity of the muscles. Women often use one of two techniques to hide this cosmetically undesirable appearance: either no lipstick and minimum make-up, so that little attention is brought to this area of the face or lipstick is drawn over the border of the lips to give the appearance of fuller lips.
The upper lip naturally becomes longer with age as a result of gravity and loss of muscle tone. The loss of muscle tone is accelerated in a patient with no teeth hence the lengthening of the lip occurs at a younger age. Men often grow a moustache to minimize this effect. This has a tendency to “age” the smile, because the younger the patient the more the teeth show in relation to the upper lip at rest or when smiling. A deepening of the groove next to the nose and an increase in the depth of other vertical lines are made worse by the bone loss in the upper front jaw. This usually is accompanied by an increase in the angle under the nose. This can make the nose appear larger. The attachments of the muscles to the jaw also are affected by bone loss. The tissue sags along the lower jaw with bone loss, producing “jowls” or a “witch’s chin.” This effect is additive because of the loss of muscle tone along with the loss of teeth.

Patients are unaware that these bone, gum and facial changes are due to the loss of teeth. Instead, they blame these problems on aging, weight loss, or the dentist for making a poor denture.

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