What It Really Takes to Get a Better Smile

Beyond Pretty: What It Really Takes to Get a Better Smile

By Dr. Dean Carlston

1. 'I Want a Better Smile' — What That Really Means

When a patient sits down and tells me, 'I want a better smile,' I hear more than just a request for white teeth. What I really hear is, 'I want to feel confident when I speak, when I laugh, when I look in the mirror.' And I take that seriously. But I also know something most patients don’t: the foundation of a beautiful smile is structure. You can’t just decorate the outside without first checking what’s going on underneath.

2. Step One: We Start with the Bite (Occlusion)

The first thing I examine is your bite—your occlusion. Are your upper and lower teeth meeting properly? Are your muscles working harmoniously when you chew, speak, and swallow? A poor bite can lead to jaw pain, tooth wear, headaches, and even the failure of cosmetic treatments. Before we discuss veneers or bonding, we need to ensure your bite isn’t causing silent damage.

3. Orthodontics: Do We Need to Move Teeth Before Beautifying Them?

In some cases, your arch may be too narrow, or your teeth may be crowded, rotated, or tilted. In those situations, we might recommend orthodontic treatment first. Moving the teeth into the correct position creates a stable foundation for any future cosmetic work. I don’t want to build a beautiful smile on an unstable platform. That would be like painting over a cracked wall.

4. The TMJ and Muscle Connection

We also need to examine your temporomandibular joint (TMJ) and the muscles that assist your jaw in movement. If these muscles are strained or the joint is misaligned, you might be grinding your teeth or clenching without knowing it. If we skip this step, any cosmetic work could be compromised. A healthy, balanced bite ensures that your new smile not only looks good but lasts.

5. Gum Health and Bone Support

Gums are the frame of your smile. If your gums are inflamed, receding, or overgrown, they can distort the look of your teeth. We check for periodontal disease and make sure the bone supporting your teeth is healthy.  Think of this as ensuring your house has a solid foundation before installing designer windows.

6. Shade, Shape, and Symmetry — Now We Talk Aesthetics

Once everything under the hood is functioning correctly—bite, muscles, bone, and gums—we can talk about aesthetics. That includes:
- The shade (color) of your teeth
- The shape of individual teeth
- The symmetry between left and right
We’ll use photographs, models, and digital simulations to show you what’s possible. However, the key is that we’re now designing your smile on a healthy foundation.

7. Options for Cosmetic Treatment

Depending on your goals and what we find, we might recommend:
- Teeth Whitening: for brightening natural enamel
- Composite Bonding: to close gaps or reshape teeth
- Porcelain Veneers: for a full smile transformation
- Enamel Recontouring: subtle reshaping for smoother lines
Each of these has pros and cons, and I’ll walk you through what works best for your specific case. No shortcuts, no guesswork.

8. Long-Term Success: How We Make It Last

A great smile isn’t just about today—it’s about 10 years from now. That’s why we:
- Test your bite with articulating paper or digital scans
- Check for parafunctional habits (like nighttime grinding)
- Offer nightguards or splints if needed
- Schedule follow-ups to monitor both aesthetics and function
The goal is always the same: to make your smile not only beautiful but healthy and long-lasting.

9. My final thoughts

I love helping people look and feel their best.  But I’ll never do cosmetic work that compromises your health.  We’ll always begin with a full-mouth evaluation.  From there, we’ll discuss your goals honestly, explore your needs, and create a plan that respects your anatomy, comfort, and future.

A better smile starts with a better foundation—and I’m here to build both with you.