Over the summer, in the midst of an unbearable heatwave, I started to feel a persistent sting on my gumline. At first I shrugged it off, a minor discomfort, but when it didn’t go away something told me to investigate. A prick or two of blood later, I realised that the slight gum recession I’d developed as a result of wearing orthodontic braces in my late 20s had progressed into a rather nasty little problem in my mouth – one that needed fixing, and fast.
When I cast my mind back to my first appointment with a cosmetic dentist over 20 years ago, I have no recollection of being warned about the potential risks. I was far too excited about the prospect of straight teeth, and a smile that would rival Catherine Zeta-Jones’s, to hesitate before committing to a complex two-year plan of adult braces. Any disclaimers were completely eclipsed by the computer-generated projection of my future smile – one that I’d dreamed of for so long.
Growing up, my front teeth were especially crooked, so much so, that when my mouth was closed they’d poke through. I remember putting my hand over my lips when I laughed or smiled, and finding any pictures taken from the wrong angle extremely unflattering. It’s what prompted that first appointment – plus another round of clear retainers in 2019. Now, two decades on from the start of my journey, I found myself back in the dentist’s chair. This time, though, I was having periodontal surgery – all in a bid to save my teeth.
Because in ignoring the small print that first time around, I’d acquired an issue that had been slowly compounding in my gum tissue and jaw bone. And I’d dismissed all the signs. During my original treatment, I noticed a strange sensitivity and an awkward feeling on my bottom front four teeth. Before long, I found I was able to whistle through the gaps there, and to add insult to injury, had to use interdental brushes to poke out pieces of food that would get caught in the ever-widening crevices. It was inconvenient but perhaps, I thought, the price I had to pay for straight teeth. What never crossed my mind, however, was the possibility that I might actually lose them.
As it turns out, my experience is not uncommon. In our increasingly perfect-teeth-obsessed world, gum and jaw issues as a result of teeth alignment is something Dr Reena Wadia, founder of Harley Street’s RW Perio, is noticing more of. “As a periodontist, I increasingly see patients who have achieved the straight, white teeth they wanted,” Dr Wadia tells me, “but have subsequently developed gum recession, sensitivity or other aesthetic concerns involving their gums.” Teeth sit within a supporting framework of bone, covered by gum tissue, Dr Wadia explains. “When teeth are moved too far towards the outside of this framework, the supporting bone can become thin and the overlying gum tissue may become vulnerable to recession.”
General dentist Dr Rhona Eskander echoes her words, and offers a theory: “Dentistry is now sold like a beauty product,” she tells me. “It’s fast, filtered and finance-friendly. I now regularly see patients in their 20s and 30s with recession that has nothing to do with gum disease. A decade ago that patient was rare. Now they’re routinely in my chair.” Because of this, Dr Eskander finds herself continually referring individuals to periodontists – the experts tasked with treating the delicate tissue and bone foundations holding everything in place.
The issue, says Eskander, is that cosmetic goals often overlook the core anatomy of the patient. “The ethical problem isn’t cosmetic dentistry itself,” she tells me. “It’s when speed and price set the treatment plan and the patient’s anatomy doesn’t.” Gum recession is especially common, but the early warning signs are often subtle: teeth that appear longer as the roots appear more exposed; increased sensitivity to cold or touch; noticeable changes to the gumline or wider gaps between teeth. All are worth getting checked out. But short-term aesthetic results seem to have eclipsed long-term oral health.
The change is undoubtedly driven by a culture that views a “perfect” smile as an accessible beauty standard. Composite bonding. Veneers. Inlays. Onlays. But perhaps most commonly, straighter teeth. It’s a shift reflected in data from the British Orthodontic Society, which reports that over 80 per cent of UK orthodontists have seen a sustained surge in adult patients seeking alignment. “Fixing” your teeth was once a luxury reserved for the rich and famous, but thanks to celebrity culture, and now social media, it has come to be regarded as an essential by ordinary mortals too. From gaps to chips, characterful or unique elements of a person’s smile are now often perceived as an unaddressed flaw.
Dr Wadia tells me that this pressure is why high-earning, often health conscious individuals are falling into a consumer trap that prioritises visual symmetry over biological longevity. “We’re living in an era where people are investing more than ever in preventative medicine, skin health and regenerative treatments,” she says, “Yet, when it comes to dentistry, the conversation is still so often dominated by straightness, whiteness and symmetry.” The gums, she adds, are “the forgotten part” of a smile. It’s something Eskander has noticed, too: “It’s a strange contradiction,” she muses. “People are tracking their sleep, glucose and hormones, then trading irreplaceable gum and bone for a six-month smile.”
And it has become increasingly normalised. “I think dentistry has undoubtedly become more consumer-driven – particularly with the influence of social media and the growing demand for quick aesthetic transformations. But a beautiful smile should never come at the expense of a healthy one,” says Dr Wadia, who says she isn’t afraid to have difficult conversations with her patients. Looking back, informed consent shouldn’t have just meant signing off on a computer projection after asking if I could still have crisps and fizzy drinks. I ought to have been told about the baseline health of my gums and encouraged to consider whether my naturally thin gum tissue – typically more susceptible to recession – could even withstand the pressure of orthodontics.
According to Dr Wadia, that should have involved a detailed examination by a certified , rather than a general practitioner. These experts possess expertise in jaw alignment and tooth positioning, and can assess everything from gum inflammation and existing recession to the depth of the spaces between teeth and gums – not to mention any signs of existing gum disease. Perhaps most importantly, I needed a frank conversation about the long-term biological risks and not just the short-term aesthetic pay-off. Potential pitfalls must be properly explained before treatment begins, adds Dr Wadia, particularly if teeth are being moved significantly forwards or outwards.
In the summer, back when I first tasted blood in my mouth – a potential sign that another burst of gum recession had started – I saw my dentist, who made an immediate referral for urgent gum graft surgery to keep my teeth stable. With the recession now severe, I found myself in the care of Dr Wadia. By now I was under no illusion that she was on a last-ditch rescue mission. I tried not to think about the tissue she was harvesting from my soft palate and sewing onto my lower jaw. It was a very different feeling from the excitement that abounded while having treatment in my 20s. Complex gum graft surgery can cost between £1,000 and £2,000 privately and with NHS treatment generally reserved for severe cases, many patients can expect to foot the bill themselves.
Funnily enough, I don’t remember feeling anything, but for the next two weeks, I ate a lot of soup, scrambled eggs and drank many, many protein shakes. It was awkward to speak, so I didn’t unless I really had to. Brushing my back teeth required a magnifying mirror and a torch, just to make sure I didn’t brush too close to the raw, healing surgical site, and swishing with medicated mouthwash became a thrice-daily ritual.
Having covered the beauty industry for decades, I still believe cosmetic dentistry is unmatched in its transformative power, even outpacing Botox and filler for sheer structural impact. With that in mind, I don’t regret wanting – and pursuing – straight teeth. Unlike a botched tweakment, though, a dental misstep isn’t something you can wait to fade or pay to have dissolved.
In the two weeks post-surgery, when I was practically mute and eating only mushy food, silently willing my grafts to take, I was hit with the cold realisation that if they didn’t, I’d have to live with the consequences of trading a living, healthy biological foundation for an off-the-peg digital dental ideal. I got incredibly lucky in that microsurgery and catching things just in the nick of time was sufficient to bail me out, but if I’ve learnt anything, it’s that a beautiful smile isn’t necessarily the straightest or whitest. It’s one that’s healthy.