Dental jewelry are fashionable accessories such as gemstones or motif foils, which are attached to the labial surfaces (tooth surfaces facing the lip) of the upper incisors at the patient’s request using adhesive technology (special bonding technique). This is a purely cosmetic procedure, but should nevertheless be performed professionally in the dental office to protect teeth and gingiva (gums) from damage. As a dentist, you may be critical of dental jewelry for various reasons (see contraindications). These are countered by the following argument as an advocate: if dental jewelry is consistently offered and used only with good dental hygiene, it acts as an excellent motivator for lasting good dental hygiene. Dental jewelry is offered in many varieties that vary significantly in design and cost, such as:
- Dazzler: gold foils with special coating for permanent sticking.
- Twinkles: thin solid semi-reliefs made of real gold or white gold without or with set crystal, semi-precious or precious stones with patented backside for permanent gluing on
- Skyces (e.g. BrilliAnce): gemstones without metal edging made of high-quality crystal glass (e.g. Swarovski) or diamonds with a diameter of 1.8 mm to 2.6 mm, which have a mirrored back and thus develop a brilliant glitter when exposed to light. They are also permanently bonded to the tooth surface.
- Dental caps: have evolved from dental crowns made of gold, silver or platinum with or without incorporated gemstones, for which patients had their teeth properly prepared (ground) and which were permanently cemented. Meanwhile, these are available as metal caps for occasional insertion, with all the resulting disadvantages for the accuracy of fit of the crown margin and gum irritation.
- Grillz (Grills; Hip Hop Grillz): advancement of dental caps that capture not only individual teeth, but the entire upper and/or lower incisors. They can be custom made in a dental laboratory from gold, silver or platinum with or without gemstones set into them. Alternatively, inexpensive one-size-fits-all grillz are available that are fitted to the teeth with a silicone key.
- Tooth tattoos: colored miniature images that are glued to the surface of the teeth and peel or wear off after a few days due to oral hygiene. They are a suitable method for those who only want to make a short-term fashionable accent on special occasions, or a try for those who do not yet dare to permanent dental jewelry.
Indications (areas of application)
Dental jewelry are fashion accessories and therefore purely cosmetic measures that have nothing to do with dentistry in the true sense. Accordingly, the patient’s wish is the only indication, with the dentist having all the more responsibility to warn of possible complications and contraindications.
Contraindications
From the enumerated possibilities of complications, the following contraindications arise, which prohibit the placement of dental jewelry from the outset:
- Inadequate oral hygiene
- Multiple carious lesions (caries in many places in the dentition).
- Existing chronic gingivitis
- Existing periodontitis
- Allergy to composite or material of the jewelry.
- Wearing removable dental jewelry during sleep
- Wearing dental caps and grillz in the presence of underlying diseases that weaken the immune defenses (immunodeficiency; immune deficiency).
The procedure
1. before applying the dental jewelry in any case is the patient’s education. Any permanently bonded dental jewelry is adhesively attached to the tooth surface in the same way:
- Tooth cleaning with fluoride-free paste and brush or rubber cup.
- Drying: relative or absolute with rubber dam (tension rubber), the latter especially when restoring several teeth.
- Acid etching technique: the site selected for jewelry is chemically roughened by 35% phosphoric acid.
- Adhesive bonding technique: low viscosity (thinner) crystal clear composite material is applied to the roughened tooth surface or the back of the jewelry as an adhesive agent.Composite fillings (plastic fillings) and fissure sealants are connected to the tooth by the same technique.
- Check for excess composite, if necessary fine finishing with ultra-fine polishing diamonds.
- Fluoridation of the tooth surface with varnish or gel to promote its remineralization after etching.
2. removal of dental jewelry:
Permanently fixed dental jewelry lasts about six to 24 months, but there are certainly individual cases with a shelf life of up to ten years. Removal of the jewelry, of which you may well get tired of in this long time, is possible without any problems:
- Removal with a special instrument
- Careful grinding of the composite material with dental preparation instruments without damaging the tooth surface.
- Polishing the tooth surface
- Fluoridation
Possible complications
- Ingestion: it cannot be ruled out that the jewelry may be detached from the tooth surface by shear forces when chewing hard food and subsequently swallowed.
- Aspiration: more serious than swallowing would be inhalation of the detached dental jewelry, which, if it cannot be coughed up, must be removed by bronchoscopy.
- Chipping of dental hard tissue: also conceivable is the accidental biting on the detached tooth jewelry, which in turn can lead to enamel cracks or chipping of enamel on the affected teeth
- Gingivitis: if oral hygiene is inadequate, there is a high risk of increased plaque accumulation around the jewelry. If the jewelry sits close to the gum line, it can lead to gingivitis.
- Marginal caries: because the jewelry is an elevation on the tooth surface, brushing is more difficult in any case compared to the formerly smooth tooth surface, thus there is an increased risk of caries. For the tooth jewelry is therefore a good oral hygiene the basic requirement!
- Periodontitis: frequently worn non-customized tooth caps and Grillz with poor fit represent a strong stimulus for the gingiva (gums), which must inevitably inflame if oral hygiene is not optimal. In the further consequence, it can even come to the inflammatory damage of the periodontium, the so-called periodontitis.
