Dr. Nammy Patel explains the S in AGES: Sculpt. She discusses biological smile design, no-prep veneers, biocompatible materials, bite and airway considerations, and regenerative tools such as PRP and PRF for healthy, natural-looking aesthetics.
John Maher: Hi, I’m John Maher and I’m here today with Dr. Nammy Patel, founder of Green Dentistry in San Francisco, California, helping patients recognize the vital connection between dental health and whole body health, and author of their bestselling books, Age With Style: Guide to a Youthful Smile and Healthy Living and Total Wellness: Understanding the Link Between Your Teeth and Your Health. Today, we’re talking about the AGES Protocol and specifically the S of AGES, which stands for Sculpt. We’re talking about aesthetics without compromise. Welcome, Dr. Nammy.
Dr. Nammy Patel: Hi, John. I’m so delighted to be here.
What Patients Really Want From Veneers
John: Dr. Nammy, when patients ask you for things like veneers, what are they usually really asking for and what does that conversation sound like before you agree to work with them?
Nammy: One of the things patients are really looking for when they’re looking for veneers, and especially with a holistic dentist is really, or biological dentist, is they really want materials in their mouth that are not going to lead to toxicity. And wanting materials that are going to be long-lasting and look beautiful and making sure it’s in alignment with their health. That’s the one thing that they’re looking for, and they specifically seek us out because they want to know that the materials, the liners, everything that’s being utilized is being done in a way that’s non-toxic or least toxic that’s available on the market. And that’s really important is to make sure if you’re going to do a smile design or if you’re going to do something to change your smile and do some work, we want to make sure the materials that go inside your body are going to be healthy.
Biological Smile Design vs. Cosmetic Dentistry
John: So you mentioned smile design. You talk about something called a biological smile design, as opposed to sort of standard cosmetic dentistry. What do you mean by a biological smile design and what does that look like maybe on a single tooth or even across the whole mouth?
Nammy: So a biological smile design is very different from a traditional smile design because most of the traditional smile designs are just looking to make you look good. Now, what I’m looking to do is make you look good, make sure you’ve got materials in your mouth that don’t cause headaches, don’t cause fatigue and low energy levels or chronic illnesses. That’s what I’m looking at. And so we want you to have beauty, but we also want you to have health. Why should they not be in hand in hand? They should be, you should look good, feel good, and live long. And that’s what we focus our energy on. We do this by using materials or a biocompatible. Biocompatible materials mean that they do not elicit a toxic response. So when they go inside your mouth, your body isn’t sitting there trying to fight them. It’s actually materials that are inert.
They’re actually biocompatible, meaning your body actually likes having these materials in your body, and it’s not going to cause your immune system to become hyperactive or overloaded. And also materials that actually resist bacteria. And that’s what we really look for is materials that also help you decrease the bacterial burden inside the mouth. For example, some patients do, they have crowns of metals underneath it. Those metal actually attract bacteria and cause an oxide reaction over time because that’s an inflammatory reaction. We don’t do any of those in our practice. We do biocompatible restorations. Zirconia, we do porcelain with lithium disilicate. These are all materials that actually help biocompatibility and also make sure your immune system is happy.
No-Prep Veneers and Smile Design Trade-Offs
John: I hear a lot about no prep veneers. What are they and who’s a good candidate for those? And are there trade-offs that we’re not hearing about in the marketing?
Nammy: The no-prep veneers are wonderful. They are a great way to be able to give a cosmetic lift to the mouth. And when it’s done properly, that’s always the key is when it’s done properly, it works really, really, really well. And patients who are good candidates for this are patients who want to have a lift in their smile. They want to preserve their natural teeth and make sure that they have something that’s going to last. So that’s actually my first go-to is always a no prep veneer. It’s not the first thing. I don’t want to drill down teeth. The first thing I want to look at is how can I preserve natural tooth structure and make it work and make it look good? That’s going to be my first reaction.
Now, my second reaction is if we need to do something, then we want to do a full mouth work up, really look at the full mouth comprehensively and make sure that we’re using biocompatible materials, making sure that the bite is in the proper shape, making sure the airway is in the proper shape, making sure the gums are in the proper shape so that everything, the shape, the size, the color, everything is natural and aesthetic and optimized with your health because that’s the key.
Why Biocompatible Dental Materials Matter
John: You just mentioned biocompatibility and biocompatible materials. What are they? Why is that important? And what are some of the materials that are maybe used in traditional cosmetic dentistry that you’re trying to avoid?
Nammy: One of the biggest things I’m trying to avoid is materials that have bisphenol in dentistry. Bisphenol is a cancer causing agent, and it can be very problematic because it leaches into your body over a period of time. So my preferences and materials when it comes to smile design are going to be porcelain. And the type of porcelain also is really key, looking at zirconia, looking at lithium disilicate. And these materials in particular are really great because they have a wonderful fit. We’re able to design it so there’s not a lot of liners or there’s not a lot of materials that are like cement. It’s mostly the material with very little, very thin, thin amount of cement in there that keep the natural teeth that really make sure your immune system is happy and not having to have an allergic reaction to the smile because that’s what we want.
We want you to have a beautiful smile, but to have a beautiful smile and have your body have an allergic reaction to it, it’s not good. That’s not what we want. So we want health and we want biocompatibility.
Beauty Follows Function in Smile Design
John: You said that beauty follows function. How does the airway and your bite and tissue health really shape the smile design?
Nammy: The smile design is really important because it’s done in a way that has to be in harmony. Just like our face is not just bone, it’s bone muscle ligament. When we do a smile design, we have to look at the shape of your lips, the shape of your gums, the shape of your teeth, the way you speak, the way your jaw joint works, the positioning of your tongue to make sure that everything is going to be in harmony. It is a highly detailed work that needs to be analyzed and done properly. And one thing you must avoid is working with people who will slap veneers on you like this. If they’re not doing the data, they’re not doing the analysis, you should run. You should only work with someone who ask you detailed question, is analyzing you and looking at you as a whole person.
The gums, the teeth, the lips, the muscles, the tongue, your speech, looking at how everything moves is how everything is dynamic and anything that they put in should be biocompatible, means materials that are not going to induce an allergic reaction, but also it’s going to function properly with the rest of your body so you don’t have a lisp, or you can say “the” very clearly, you can say San Francisco very clearly. You want to be able to have form and function and beauty.
PRP and PRF for Regenerative Aesthetics
John: You use treatments called PRP and PRF sometimes in cosmetic dentistry, but those are treatments that we sometimes more often hear about in terms of skin aesthetics. How do you use those in dentistry?
Nammy: PRP and PRF are great materials. We use them for a number of reasons. Sometimes if you have a long tooth and we need to make it shorter to make sure that we get the gum tissue to be aligned, we’ll use PRP and PRF. We can also use it in areas of deep pockets if we want the body to heal well. We can use that. We can actually use it on the face as well for cosmetic reasons. If we tighten up the skin with laser fractional lasers, and then we can use that to be able to make sure that the skin is healing really well and it allows it to bring back youth and elasticity and collagen, which is what we’re looking for. So PRP and PRF are wonderful materials for healing and regeneration of gum tissue, of skin tissue, and also a great way to make sure that we are helping your teeth look beautiful naturally.
A Patient Story: Smile Design and Function
John: So can you talk about a patient who thought that they had a chronic fatigue problem and it really turned out to be a mouth problem? What was the turning point for them?
Nammy: Sure. So I’ll talk about my patient, Susie. And so Susie came to me and she is actually 56 years old. Wonderful. She has a smile design that she had done. It’s been about 10, 15 years or so. She had the original crowns done. When she came to me, she’s like, “I’m in my 50s. I want to look a little different. These are a little too white, a little too short, a little too bulky for the way my facial structure looks now, and I kind of feel like I have a lisp.” And so I said, “Okay, let’s take a look around.” And we did. Her gums were healthy, her airway was in good shape, but the way her teeth looked, I made her look like she was 75 and she was only 56 because they were so yellow and big and bulky. So we did a smile design on her and we did it in a way that she was very, very happy because we used biocompatible materials.
We actually custom made a temporary so she can really try on the shape, the size and the color of her teeth and she can walk around with it, practice speaking with it so that we knew that it was going to be perfect for her. So we made sure that we used bicompatible materials. We made sure that she was able to have something that reflected her personality and her age. And we did something that was going to really last her 20, 50 years because we wanted this to be the last of her smile design. We didn’t want her to have to get a smile design done every 10 years. We wanted to do this in a way that would really benefit her for her entire life. Then we added some tongue training exercises so that she can exercise her tongue and also her facial muscles. When she exercised all her facial muscles, it created a lot of tone, which really helped her feel good, tighten up a lot.
It’s like facial yoga, and she really left feeling amazing. And now it’s been about seven years since she’s had her smile design. She’s very happy, loves the way she feels, and she actually lives in Australia. So we get a postcard every Christmas with her smile saying she’s so happy and that she still loves her smile.
Takeaways on Biological Smile Design
John: That’s great. What would you like people to take away from this conversation in terms of sculpting and biological smile design?
Nammy: So biological smile design is wonderful. That is the only way to go is what I would like for you to take home because we want to make sure the materials that are being used are biocompatible and they’re going to look good, but we also want you to feel good and make sure that you don’t get an allergic reaction to the materials that are in your mouth. We also want things that look beautiful and last forever and somebody who does and tests everything from the way you speak, from the way your gums look, to the length of your teeth, to your functional airway, and really looking at you as a whole person.
John: All right, well, that’s really great information, Dr. Nammy. Thanks again for speaking with me today.
Nammy: Oh, my pleasure.
John: And for more information about Green Dentistry, visit the website at sfgreendentist.com or call 415-433-0119.
