Australasian Dentist Magazine Sept-Oct 2021

Category 72 Australasian Dentist A geing begins at the ripe-old age of 25! From this point onwards, our genetic chronology means that we produce less collagen every year. This is seen in changes all over the face and body, but particularly in the lower face. As dentists, our patients often present to us wanting to improve their overall appearance, but we can be limited in our treatment options if we don’t look past the teeth themselves. Ageing shows up around the mouth as misaligned teeth, wear, discolouration and fracture lines. But there are a number of changes that occur in the soft tissues as a result of ageing too. The most notable is in the lip tissue itself. In youth, the lip is bound by a mucosal covering. Underneath this is a layer of fat that surrounds the Orbicularis Oris muscle. This is important as it gives voluptuous and structure. In the perioral region, the cutaneous portion of the lip contains hair follicles, sweat glands and most importantly, small oestrogen receptors. Again these give the cutaneous part of the lip structure and volume. So what happens when we age? The underlying skeleton of the face changes in a number of ways. The maxilla starts to narrow and regress posteriorly. This provides less support to the upper lip, as the teeth shift due to the shifting pattern in bone shape. The mandible also undergoes some changes too. The alveolar bone becomes thinner and moves posteriorly, and the lateral aspects of the mandible also loss volume and height. This translates to movement of the teeth and again less support of the lip tissue. The cutaneous part of the lip starts to lose collagen, and this is particularly accelerated in menopausal women. The oestrogen receptions start to see a decline in the essential hormones, and this results in an over[1]exaggerated response in the lips. Barcode lines – also known as smoker’s lines – start to appear with every contraction of the Orbicularis Oris muscle. Part of our response to these changes will be: 1. Check the dental occlusion and make improvements where necessary. 2. Increase the collagen and hyaluronic acid production in the perioral region and lips through stimulation 3. Use of skin boosters to improve skin condition and hydration. 4. Balancing Lip position with neuromodulators. 5. Increase Hyaluronic Acid deposition through the use of fillers. This will provide structure and support to the lip, helping to ‘upright’ the Orbicularis Oris muscle. Dental occlusion Changes in the dental occlusion, or the way teeth bite are constantly occurring through life. We can have a vertical dimension change (where the teeth close over each other more than they used to. Vertical dimension changes can occur as a result of tooth wear, tooth loss and crowding of the teeth. As the vertical dimension of occlusion changes, the distance between the maxilla and the mandible is also changed. Therefore, the position of the upper and How to go beyond the teeth to help your patient By Dr Giulia D’Anna, BDSc, MRACDS, Grad. Dip. Derm. Th Cert IV TAE, Grad. Cert laser Lip anatomy Lip anatomy: Mature Muscles of the face The vermillion border will start to lose volume too, as the fat content over the Orbicularis Oris muscle decreases with time. This results in folding of the muscle and the result is less lip display. This further compounds the appearance of marionette lines, since there is more compression of the lip onto the lower lip, with the reduced supportive tissue. Dr Giulia D’Anna clinical