Are healthy teeth and 'perfect' teeth the same thing?

Perfect gnashers are increasingly seen as a must-have by men who want to look their best. But less is more, advise dentists who want patients to focus on healthy teeth and not a day-glow smile

Just as there are trends in fashion, so too are there trends in dental treatments.

Irish men have never been renowned for the whiteness of their pearly whites. There was a time not so long ago when good teeth in this country were often measured by the number of gold crowns you had. Things are changing, but whether that’s always a good thing is open to debate.

The catalyst for change is undoubtedly down to increased visibility. We see more of ourselves and our peers than ever before, and there’s that endless stream of happiness and perfection on social media feeds, television screens, and even in old-school media such as magazines.

While vanity was once the preserve of women, a mix of marketing, a change in the image of sporting icons, and a move away from rugged unkempt manliness to clean-cut machismo have changed how men now view themselves and the expectations around how they present themselves.

“It’s part of a broader cultural shift where men are not as worried about looking after their appearance,” says Dr Mairead Browne, a general dental and aesthetic practitioner based in Cork City. “They are certainly asking more questions. Before, there might have been something that bothered them physically but I’m finding that the likes of pictures on LinkedIn profiles are having an influence. Men are seeing pictures of themselves on social media, and they’re being more critical of what they see.

“Whether it’s a big life event or simply that professional element, there’s an increasing awareness of the importance of a good smile and how it impacts everything else. 

Social media and celebrity influence have a big part to play and men are more aware now that there are other options there for them.

But as Browne adds, “just because some influencers and celebrities have 20 veneers, that’s not necessarily the road to go down or what’s appropriate” for everyone.

“There are alternatives, and these should always be explored before going down the route of veneers and crowns, which are often unnecessary and usually extremely expensive,” says Browne. “The most popular treatment for men would be teeth whitening.

“The first thing you notice about a smile is colour so generally it’s the less invasive option. We try that first and see how we go. It’s simple and the most conservative option. Then you might look at aligning and straightening the teeth, which is interesting and a lot healthier.”

Browne points to data from America, where $1.75bn (€1.55bn) was spent on veneers in 2022, and the market is expected to double by 2031. On this side of the pond, she says, we tend to be a little more realistic when it comes to expectations.

“Men aren’t always looking for perfection but they are looking for an improved look,” she says. “They don’t necessarily want the Simon Cowell or Robbie Williams teeth but want to look better. That leans into a more professional image in the workplace as well. Nice teeth are a symbol of health, success, and confidence.”

Dental tourism

But just as there are trends in fashion, so too are there trends in dental treatments.

“Dentistry as an industry is moving towards being more conservative. We are not rushing to do these veneers and strip away teeth. We have a much more tailored approach, which is more about straightening and aligning and then assessing the outcome and going from there.”

In a world where everyone wants things done yesterday, taking your time and getting things right can be a difficult sell. For Browne, any dental work is about going to a reputable provider who isn’t doing the work unnecessarily.

“There’s this culture now where people want things done and done yesterday, and they have this need for perfection. We have to adapt to that. That’s about going to a reputable provider to get the treatment and to someone who isn’t doing the work unnecessarily.

“We work under Dental Council guidelines, we have ethics and a code of practice. We’re certainly not going to be over-treating people who come to us, which might be the case if you go to other countries.”

Irish dental patients can expect top-tier care. “There are jurisdictions in the world that do not have the same level of training requirement to operate as a dentist in this country,” says Rory Boyd, president of the Irish Dental Association. “So oftentimes, from those countries, we see very subpar work. I can’t say who is going abroad for work because I only ever see people when they’ve travelled and it’s gone wrong. When they return, that’s when they come to me, and in my experience, that’s more common in women [than men].” Turkey is one country that has come under the spotlight in recent years.

In 2023, Boyzone star Keith Duffy explored the phenomenon of dental tourism in his RTÉ documentary Keith’s Teeth: A Dental Odyssey. In it, Duffy balanced cautionary tales from former Irish patients with a visit to one of Istanbul’s more upmarket dental practices, where he witnessed an Irish patient being fitted with a whole new set of teeth.

While Boyd says some dentists in Turkey do good work, others are not so good. “You will often see that there’s over-treatment there, so when it goes wrong, it’s not a small problem, it’s a big problem, and it’s generally 20 teeth instead of one or two. I’m a prosthodontist, so I specialise in drilling teeth for veneers and crowns. 

If you’re ever going to drill teeth and remove healthy tooth structure, there has to be an outright reason why that is going to improve the longevity of that tooth.

Boyd sees a difference in how we are now defining perfect teeth and believes that influencers and reality television stars are getting “their teeth done” to be seen as having had them done.

“In the 1980s and ’90s, we talked about the Hollywood smile, like Julia Roberts, the perfect smile of healthy, natural-looking teeth where you can’t tell whether their dentist has done them, or whether they’ve just been blessed with great teeth.

“We have now seen a move to so-called Turkey teeth, which is where teeth are being modified to appear hyper-natural or too white, and they don’t look natural. Now, more people want to change the shape of their teeth. So edges are chiselled, flat, square, and they’re now looking into more detail in the teeth.”

Boyd says he doesn’t see much of a difference in the treatment that men and women want or need — though he suggests that men are a “little more conservative” in their preferences. Regardless of gender differences, he says the focus should be on healthy teeth.

“We shouldn’t be doing anything in the mouth to impact the oral health of anybody negatively. Drilling the teeth to high heaven, placing crowns on all of the teeth, and drilling the teeth down, removing tooth structure for a purely cosmetic impact when it’s not required is a big problem. So whenever we’re classifying a smile, we should be saying healthy or not healthy. If it is a healthy smile that is misaligned, needs a little bit of tooth whitening, a little bit of Invisalign to straighten the teeth or very minor additions to the teeth, there’s nothing wrong with that.”

Strict regimen

James Patrice: ‘It’s routine, getting into the habit.’ Picture: Brian McEvoy

One man renowned for his great smile is television presenter and social media star James Patrice. He puts his good teeth down to his mother, who not only passed on the good genes but also made sure both he and his sister maintained a strict regimen from an early age.

“It’s routine, getting into the habit and maintaining it,” says Patrice “I never scrimp on the toothpaste. I use Oral-B 3d White Advanced, which is a little more expensive than others, but it’s worth it. I use an electric toothbrush. I floss. I used to do that excessively, and the gums were nearly gone from my head.”

Patrice also makes sure to consume his soft drinks and even his coffee through a straw “so you’re hitting the back of the gullet and bypassing the teeth” and he keeps a mini toothbrush handy for when he’s about to go on camera “just to give them a freshen up”.

“It’s very important to have good teeth in television,” says the 36-year-old. “The teeth and the eyebrows are the anchors of the face. It’s important to put the best foot forward or the best fiacla forward. I keep them as clean as possible, and if, in the process, you happen to look sparkly, even better. Some people can go down the veneer route. I have yet to do that myself but never say never.”

Although Patrice admits to having “one or two teeth that are pushing forward a little”, he was advised by his dentist that the impact of aligning them on his smile would be minimal. So far, it hasn’t bothered Patrice or impacted his career, and he feels there’s no need to get anything done anytime soon.

Dr Paul O’Dwyer is a dentist and national clinical advisor to the dental group Portman Dentex Ireland and a trustee of the Dental Health Foundation. “Every patient’s treatment needs are individual to them,” says O’Dwyer. “While there are many options for improving smiles, it’s important first to complete a full dental check-up and ensure that the patient has a healthy mouth, sound teeth and restorations such as fillings. From there, dependent on what serves the patient’s needs, a treatment plan can be put in place to improve both function and aesthetics.

“A dental scale and polish will also help to remove excess staining or plaque build-up. From there, regular maintenance, brushing, and good hygiene will support a clean, bright smile. The fundamentals of brushing twice a day, flossing, regular checks, and reduced alcohol consumption, along with the elimination of tobacco, are still the key elements of good oral health.”

For Boyd, several factors need to be considered before addressing any perceived issues with your teeth.

“Number one is to make sure you do your research on the dentist, whether that’s in Ireland or abroad,” he says. “Number two is to make sure you understand what you’re trying to achieve. And number three would be to remember that less treatment is always best. Less dentistry means less maintenance burden and fewer issues arising.

“Try to maintain healthy teeth structure at all costs, which may involve doing orthodontic treatment. Aligning your natural, healthy teeth is better than cutting teeth and covering them and camouflaging them in porcelain.”