Think about the Mona Lisa. As the most famous painting in the world – currently worth an estimated $800 million dollars – it has triggered centuries of analysis. Perhaps the most common question that typical viewers ask is “Why does she have that cryptic smile?” Maybe she had a secret. Maybe that was the easiest pose that she could hold while Leonardo worked. Maybe the master knew how unique and arresting the effect would be. But there is another possibility: she did not have a dentist.
For millennia, the vast majority of smiles were with lips together. This was true in paintings and early photographs. None of the classic portraits showed teeth. But a little over a century ago, this began changing. Within decades, toothy smiles became the norm. Photogenic smiles are now essential for political candidates, media stars, models, and potential mates. What happened?
Dentistry. As our profession became adept at saving, restoring, and straightening teeth, our patients became comfortable expressing happiness with a partial laugh. Showing teeth became a valuable proxy for overall hygiene and health. What was true for horses became true for people: before you choose a mate, check their teeth. Our profession facilitated this evaluation. No longer would an open laugh automatically convey an image of rotted teeth and a blast of horse breath.
The most genuine smiles – Duchenne smiles – require contraction of the zygomaticus major and orbicularis oculi muscles. The result is creation of crinkles at the eyes. This type of smile is most readily achieved with an open mouth. It is distinct from a forced smile, which generally lacks activation of the orbicularis oculi muscles and resulting crinkles and involves a closed mouth. The two different types of smiles have different unconscious effects on the sender and receiver. Duchenne smiles evoke greater trust and happiness. But they only come freely when our teeth are healthy and attractive.
A recent study of how we evaluate facial esthetics found that our smiles dominate all other facial features, including eyes, cheekbones, nose, and chin features (Patusco, V. et al, JADA 149:680, 2018). The eyes may be windows to the soul, but as Marilyn Monroe knew, “A smile is the best makeup any girl can wear.” This is of course true for boys too. It is impossible to be attractive without attractive teeth and soft tissue.
We are fortunate to be in the smile business, and humanity is better off having us. Focusing on dental esthetics leads to a happier planet, and can motivate patients to be more attentive to their oral health. The treatment planning approach formulated by Spear Education, which prioritizes esthetics (followed by function, structure, and biology), has it exactly right. Our approaches to patients should always place their smiles at the forefront of their treatment plans.
One of the commonest causes of death in the Civil War and through human history was dental infections. Over the last century the dental profession has banished dental infections from our list of lethal afflictions, and we have allowed ourselves to smile and laugh without being self-conscious. Before dentistry, life was grim, and we were grim. No longer. Thanks to us.