FULL mouth rehabilitation involves the restoration of most of the teeth, if not all the teeth, in both the upper and lower jaws. If the situation allows and the treatment plan so indicates, the restoration can also involve only one jaw, either the upper or the lower jaw. Because the extensive restoration of the teeth often positively impacts on the facial appearance of patients by restoring facial heights and giving the patients fuller lips, full mouth rehabilitation is also referred to as "non-surgical facelift" or "smile makeover".

Photo: The Star/ANN

The procedures, if properly indicated and performed, do indeed make patients look younger and rejuvenated, besides restoring chewing function and enhancing smile aesthetics. However, not everybody is a candidate for this procedure. If not properly indicated, the results can be catastrophic, to say the least.

Below are the most common reasons for carrying out full mouth rehabilitation.

Bruxism

Extensive wear or attrition affecting almost all the teeth in the mouth due to bruxism, which is nocturnal parafuntion grinding of teeth. This wearing down of teeth can be so severe that the teeth can be shortened significantly, sometimes even causing the exposure of the pulp (tooth nerve), which may make root canal therapy necessary.

The facial height or length of face is partly determined and maintained by the presence of upper and lower teeth. Shortening of the teeth due to wear and tear causes the lower jaw to come closer to the upper jaw, thereby causing a shortening of the lower third of the face.

Photo: The Star/ANN

This can actually give rise to an aged appearance. The attrition of the upper front teeth also results in an absence of tooth display when the lips are slightly parted, as in speech or during smiling. This gives an impression or illusion that the patient is without his or her front teeth.

In fact, it is often this aesthetic concern that motivates the patient to seek consultation and treatment. In this situation, full mouth rehabilitation not only addresses the issue of restoring lost tooth structure and function, but also improves the facial profile and smile aesthetics of the patient.

Medical problems

Severe wear of teeth can also be caused by medical problems such as bulimia nervosa and gastroesophageal reflux disease. Both medical conditions result in chemical erosion of the teeth, particularly the palatal surfaces of the upper teeth, due to the reflux of gastric acid. The tooth wear is made worse if the patient also suffers from bruxism.

The effects of this type of tooth wear on facial profile and smile aesthetics are similar to those caused by bruxism. In order to protect the tooth structure from further destruction by gastric acid reflux, the ideal restoration involved in full mouth rehabilitation for this type of tooth wear will be full coverage ceramic crowns.

Ceramic veneers, which cover only the facial surfaces of the teeth, are not suitable as the palatal surfaces will continue to be attacked by acid erosion. The patient must also be treated medically by the appropriate medical specialists.

Loss of teeth

Early loss of posterior teeth or molars that are not replaced often results in collapse of the bite. The occlusal loading or biting force which concentrates on the remaining front teeth often results in excessive wear or even affects mobility of these teeth.

In such cases, the patient will require full mouth rehabilitation to restore the missing posterior teeth with either bridges or implants and the front teeth will need to be restored to normal function with either crowns or veneers.

Painful mouth

Painful conditions of the temporomandibular joint (TMJ), jaw muscles, and even headaches can result from poor occlusion (bite) due to excessive tooth wear.

Just smile

Full mouth rehabilitation is sometimes carried out electively to improve the aesthetic appearance of the smile. In such cases, the procedure is usually referred to as a smile makeover, usually to address:

1. Dark tetracycline-stained teeth that are resistant to tooth bleaching or whitening.

2. Slight spacing or gaps between teeth due to hypodontia (congenital absence of several teeth) or early loss of some teeth, resulting in shifting or movement of the adjacent teeth.

3. Mild crowding or mal-position of the teeth

4. An uneven smile line due to a slanting or canted occlusal plane (horizontal plane of teeth arrangement when patients are viewed face on).