An 'Unfortunate' Toxic Smile

Dr. Steven Andreaus artist, photographer, master of cosmetic and aesthetic dentistry'relishes the challenges offered by every patient who comes to his Glenwood Avenue practice, in Raleigh.



His passion, talent, and enthusiasm have propelled him into the forefront among the nation's cosmetic dentists, into the elite rank of some 300 dentists who have earned accreditation by the American Academy of Cosmetic Dentistry. In fact, Dr. Andreaus in recent years has served as an examiner of the work of other dentists who are seeking the same coveted designation.



'There's no such thing as a boring case in this practice,' he emphasizes. 'Patients are different. Teeth are different. Their aspirations are different. The challenge in each instance is to understand what is wanted, understand what is possible, and strive together with the patient for the best possible outcome.'



In dentistry as in other health practices, toxicity is an important issue. 'We can talk about the toxicity of dental materials, and the good progress we've made in this area,' says Dr. Andreaus. 'But what is most powerful and prevalent among the general public is to observe the toxicity of an unfortunate smile.



'By the term 'unfortunate smile,' I mean those instances where teeth are crowded or there is decay. People who move through their childhood and adolescent years with unattractive teeth learn to hide their smiles.



'In many instances, these are people who stop taking care of their smile and their teeth. There's a much higher prevalence of cavities and periodontal disease. The psychological toxicity of an unattractive smile often, over time, manifests in a physical toxic reaction: inflammation, infection, and other health problems. There is a growing body of solid research which links poor oral health, especially periodontal disease, with heart disease and stroke, and it is also a serious complicating factor with diabetes, respiratory illnesses, and osteoporosis.'

Anthony Evans

Anthony Evans of Cary ended a five-year stretch in the U.S. Army (including a year in Iraq) determined to treat himself to a new, brighter, more attractive smile. He is representative of the diversity Dr. Andreaus sees in his practice on a daily basis.

'He sought me out,' says Dr. Andreaus, 'because he wanted to explore the potential of Invisalign' to produce a more attractive smile, and his regular general dentist did not offer this option.

'We spent 16 months working together, and watching the magic of Invisalign produce exactly the smile Anthony was looking for.'

Dr. Andreaus recently achieved Premier Provider status with Invisalign. He first became involved with invisible aligner technology'a form of orthodontic treatment'as an invaluable tool in protecting a patient's natural teeth even as it works, over time, to give them a wonderful smile. The designation of Premier Provider (his new Invisalign logo is reproduced on this page), the company says, is for 'a select group of doctors who have achieved the highest level of Invisalign expertise.'

'Invisalign works well for 80 percent of the people who could benefit from orthodontic work,' notes Dr. Andreaus. 'In using orthodontic braces, it's possible to move a tooth as much as a quarter of a millimeter every two weeks. Invisalign isprogrammed by computer to make exact incremental movements of a quarter of a millimeter every two weeks.

'For some patients, as a result of this new product, we don't need to restore a tooth'as was the case with Anthony (see before-after photos). Invisalign allows me to take care of their wishes in an aesthetic fashion even as we're also straightening their teeth orthodontically. The beauty of the procedure, in addition to the fact that it is precise and quick, is that it really is virtually invisible to see.'

In the 16 months he was wearing Invisalign aligners, Anthony reports, 'only my mother and my sister knew they were in my mouth'and only because I told them! And during this time, I also used the Invisalign trays to whiten my teeth to where they are today'exactly where I wanted them to be.'

Invisalign received FDA approval in 1998. 'Because it does not rely on the use of metal or ceramic brackets and wires, Invisalign significantly reduces the poor aesthetic and other limitations associated with braces,' says Dr. Andreaus. 'Invisalign utilizes advances in 3-D imaging technology to create a series of customized plastic aligners. Patients simply wear each aligner for a few weeks, removing it only to eat, brush, and floss. After as few as 8 or as many as 48+ nearly invisible aligners, the procedure is done. And the results are consistently wonderful. Patients typically finish the process in six to 18 months.'

While he worked with Dr. Andreaus, Anthony also had a gingivoplasty procedure. 'I had a kind of gummy smile,' he says.  'So Dr. Andreaus simply reshaped my gum tissue to enhance tooth appearance. Before the procedure, I had about 9mm of tooth exposed. Now I have about 12mm of tooth exposed'more tooth, less gum. It looks terrific.'

A New Patient

A new patient we'll call Barbara also represents diversity and challenge for Dr. Andreaus. 'This young woman has hated her smile since she was a child, and even extensive orthodontic work did not produce a pleasing result.

'She came to see me with a folder filled with reproductions of the exact smile she wants to achieve, to the smallest detail. She is likely to be a challenge'and in fact, she is exactly the kind of case I love to do. We can, in fact, give her a whole new smile. She wants longer teeth than she has now, and so we expect to also do a gumlift'a gingivoplasty. She asked, 'Why can't we just make the teeth longer?' But there's a risk that longer teeth could affect her speech. So, with a gingivoplasty, she will get longer teeth and less pink'a win-win outcome.'
 

PHOTOS:

1. Dr. Steven Andreaus

1. The smile of Anthony Evans, before and after Invisalign treatment (coming from Dr. A)

1. The new logo designates Dr. Andreaus as a Premier Provider for Invisalign, one of the few general dentists in the area to earn this recognition.

CALL-OUT:

'There's no such thing as a boring case in this practice,' he emphasizes. 'Patients are different. Teeth are different. Aspirations are different.'
 

For Dr. Steven Andreaus, the path to dental health and beauty 'incorporates creative use of technology, attention to detail, appreciation for balance and beauty, and'perhaps above all else'a sense of partnership and a shared vision with each patient to achieve mutually conceived goals.'

His devotion to these ideals has been recognized in many ways, perhaps most notably when he earned accreditation from the American Academy of Cosmetic Dentistry (see box).

Health & Healing: What are among the technical advances that have had a major impact on your practice?

Dr. Andreaus: I completed dental school at UNC-Chapel Hill 20 years ago. Technically, we've advanced light years since then. For example, I was the first general practitioner in the country to introduce radiography, with estimates that it reduces radiation exposure for patients by as much as 90 percent. That's a major contribution to good health. When you walk into our office today, it's become a digital environment in many different ways, designed to make the dental experience quicker, safer, and more effective. This gives us more time for the patient.

The introduction of Vizilite a few years ago is another major advance in recent years. ViziLite is a quick, painless and important exam for the early detection of cancer. It detects cancer cells not visible to the unaided eye at an early stage when treatment can be highly successful.

The rate of cure for oral cancer is high if it is detected in an early stage. Unfortunately, it is often detected in a later state, and as a result, 24 Americans'one every hour--die of oral cancer every single day. Annual exams for oral cancer are critically important.

H & H: You are recognized nationally for your skill and talent in cosmetic and aesthetic dentistry. What is new and important in that field?

Dr. Andreaus: As I have said before, the introduction of Invisalign' is a major advance'for patients and for practitioners. I'm using Invisalign with as many as a third of my cosmetic patients, because it allows me to move teeth creatively and relatively quickly, with nearly invisible aligners, while often whitening their teeth at the same time. It's proving to be a good choice for perhaps eight out of ten patients whose teeth need realignment. We can determine very quickly if a patient is a good candidate for Invisalign.

Using Invisalign

Permits me to save tooth structure, and it allows me in many instances to correct gum heights, as well. Simply put, it's an excellent way to straighten teeth without braces. Rather than metal braces, we use a series of clear, removable, plastic aligners that over time gently and steadily move teeth into alignment. Typically, a patient wears each set of aligners for about two weeks, removing them only to eat, drink, brush, and floss. As we replace the aligners with the next in the series, the teeth will continue to move into the desired position. Designing the series of aligners is a custom-fit, computer-assisted process.

I'm nearing my 200th case with Invisalign, and am perhaps the only general dentist in the area who has been designated as a Premier Provider of Invisalign by the company, based on training, education, and outcomes.

H&H: Periodontal disease continues to be a major health issue. Is technology helping in this area?

Dr. Andreaus: We're having excellent results with local antibiotic therapies. Systemic antibiotics have very limited use in treating typical periodontal disease. Our goal is to deliver the antibiotic directly to the periodontal pocket, which allows the concentration of the antibiotic to be as much as 100 times greater than when taking it orally.

The newest product of this type is Arestin, a local antibiotic therapy that consists of small spheres of minocycline, a derivative of tetracycline. It is very effective in killing the bacteria that cause periodontal disease, and it's simple and easy to use. The spheres, which look like a fine power, are placed into the perio pocket, without the need for anesthesia. They are bioadhesive, and stick to the pocket wall where they slowly dissolve and release minocycline over a 14 to 28 day period, and thus do not require removal.

We use Arestin after the root surface of the area is cleaned very thoroughly. We are actually seeing pocket depths of six-plus millimeters reduced to a normal two or three millimeters'all without surgery. In the past, we went straight to surgery. These local antibiotic therapies represent a major breakthrough in the treatment of periodontal disease.

Periodontal disease is, as we know, an important health issue, with direct correlations to heart disease, diabetes, and other health conditions. When a patient has a constant low-grade infection in their mouth, it potentially affects the entire body.

If a patient has multiple periodontal pockets'perhaps they've been away from treatment for some years'they may well be great candidates for placing one of these anti-microbial, antibiotic products in a dozen or more areas. It certainly can be effective in multiple locations simultaneously.

BOX

Earning Accreditation

Of the many thousands of U.S. dentists who do cosmetic work, fewer than 300 have achieved accreditation by the American Academy of Cosmetic Dentistry. Dr. Steven Andreaus is one of that elite group.

In achieving accreditation, notes Dr. Andreaus, "there is more than beauty on trial. The judges review before-and-after radiographs of each case, the materials used, and challenge every choice made by the dentist. It's much like sitting for a master's or doctorate thesis. A key concern is the health of the gums'they must be free of bleeding, redness, and discoloration'and they must look natural and healthy."

Having long since been recognized as a master in cosmetic and aesthetic dentistry, Dr. Andreaus has gone on to serve as a mentor and examiner of the work of other cosmetic dentists as they seek AACD accreditation.

PHOTOS:

1. An artist and photographer, Dr. Andreaus has since its inception incorporated Gallery A into his practice. Currently on display are works by Eric McRay. His jazz paintings'here admired by Dr.Andreaus'are also on display at the U.S. Embassy in Denmark.

2. (before-after photos) Even difficult stains respond well to whitening and other cosmetic approaches, notes Dr. Andreaus.

CALL-OUT:

Periodontal disease is, as we know, an important health issue, with direct correlations to heart disease, diabetes, and other health conditions. When a patient has a constant low-grade infection in their mouth, it potentially affects the entire body.

Dr. Steven Andreaus'artist, photographer, master of cosmetic and aesthetic dentistry'relishes the challenges offered by every patient who comes to his Glenwood Avenue practice, in Raleigh.



His passion, talent, and enthusiasm have propelled him into the forefront among the nation's cosmetic dentists, into the elite rank of some 300 dentists who have earned accreditation by the American Academy of Cosmetic Dentistry. In fact, Dr. Andreaus in recent years has served as an examiner of the work of other dentists who are seeking the same coveted designation.



'There's no such thing as a boring case in this practice,' he emphasizes. 'Patients are different. Teeth are different. Their aspirations are different. The challenge in each instance is to understand what is wanted, understand what is possible, and strive together with the patient for the best possible outcome.'



In dentistry as in other health practices, toxicity is an important issue. 'We can talk about the toxicity of dental materials, and the good progress we've made in this area,' says Dr. Andreaus. 'But what is most powerful and prevalent among the general public is to observe the toxicity of an unfortunate smile.



'By the term 'unfortunate smile,' I mean those instances where teeth are crowded or there is decay. People who move through their childhood and adolescent years with unattractive teeth learn to hide their smiles.



'In many instances, these are people who stop taking care of their smile and their teeth. There's a much higher prevalence of cavities and periodontal disease. The psychological toxicity of an unattractive smile often, over time, manifests in a physical toxic reaction: inflammation, infection, and other health problems. There is a growing body of solid research which links poor oral health, especially periodontal disease, with heart disease and stroke, and it is also a serious complicating factor with diabetes, respiratory illnesses, and osteoporosis.'

Anthony Evans

Anthony Evans of Cary ended a five-year stretch in the U.S. Army (including a year in Iraq) determined to treat himself to a new, brighter, more attractive smile. He is representative of the diversity Dr. Andreaus sees in his practice on a daily basis.

'He sought me out,' says Dr. Andreaus, 'because he wanted to explore the potential of Invisalign' to produce a more attractive smile, and his regular general dentist did not offer this option.

'We spent 16 months working together, and watching the magic of Invisalign produce exactly the smile Anthony was looking for.'

Dr. Andreaus recently achieved Premier Provider status with Invisalign. He first became involved with invisible aligner technology'a form of orthodontic treatment'as an invaluable tool in protecting a patient's natural teeth even as it works, over time, to give them a wonderful smile. The designation of Premier Provider (his new Invisalign logo is reproduced on this page), the company says, is for 'a select group of doctors who have achieved the highest level of Invisalign expertise.'

'Invisalign works well for 80 percent of the people who could benefit from orthodontic work,' notes Dr. Andreaus. 'In using orthodontic braces, it's possible to move a tooth as much as a quarter of a millimeter every two weeks. Invisalign isprogrammed by computer to make exact incremental movements of a quarter of a millimeter every two weeks.

'For some patients, as a result of this new product, we don't need to restore a tooth'as was the case with Anthony (see before-after photos). Invisalign allows me to take care of their wishes in an aesthetic fashion even as we're also straightening their teeth orthodontically. The beauty of the procedure, in addition to the fact that it is precise and quick, is that it really is virtually invisible to see.'

In the 16 months he was wearing Invisalign aligners, Anthony reports, 'only my mother and my sister knew they were in my mouth'and only because I told them! And during this time, I also used the Invisalign trays to whiten my teeth to where they are today'exactly where I wanted them to be.'

Invisalign received FDA approval in 1998. 'Because it does not rely on the use of metal or ceramic brackets and wires, Invisalign significantly reduces the poor aesthetic and other limitations associated with braces,' says Dr. Andreaus. 'Invisalign utilizes advances in 3-D imaging technology to create a series of customized plastic aligners. Patients simply wear each aligner for a few weeks, removing it only to eat, brush, and floss. After as few as 8 or as many as 48+ nearly invisible aligners, the procedure is done. And the results are consistently wonderful. Patients typically finish the process in six to 18 months.'

While he worked with Dr. Andreaus, Anthony also had a gingivoplasty procedure. 'I had a kind of gummy smile,' he says.  'So Dr. Andreaus simply reshaped my gum tissue to enhance tooth appearance. Before the procedure, I had about 9mm of tooth exposed. Now I have about 12mm of tooth exposed'more tooth, less gum. It looks terrific.'

A New Patient

A new patient we'll call Barbara also represents diversity and challenge for Dr. Andreaus. 'This young woman has hated her smile since she was a child, and even extensive orthodontic work did not produce a pleasing result.

'She came to see me with a folder filled with reproductions of the exact smile she wants to achieve, to the smallest detail. She is likely to be a challenge'and in fact, she is exactly the kind of case I love to do. We can, in fact, give her a whole new smile. She wants longer teeth than she has now, and so we expect to also do a gumlift'a gingivoplasty. She asked, 'Why can't we just make the teeth longer?' But there's a risk that longer teeth could affect her speech. So, with a gingivoplasty, she will get longer teeth and less pink'a win-win outcome.'
 

PHOTOS:

1. Dr. Steven Andreaus

1. The smile of Anthony Evans, before and after Invisalign treatment (coming from Dr. A)

1. The new logo designates Dr. Andreaus as a Premier Provider for Invisalign, one of the few general dentists in the area to earn this recognition.

CALL-OUT:

'There's no such thing as a boring case in this practice,' he emphasizes. 'Patients are different. Teeth are different. Aspirations are different.'