INTRODUCTION
Dentistry is becoming a style statement now-e- days but a decade back it was related to pain, fear and discomfort but gradually time have changed.1 Today, everyone is becoming increasingly self- conscious about their appearance and smile.2 Younger generations follow their self made rules for looking fashionable and it applies to dentistry as well.3 With the increase in modernization, everybody wants to create their own visual style which is unique for themselves and yet identifiable for others. As a dentist, we might come across to people who demand something more from us than treating only diseases. Like any other treatment, dentistry and dental treatments are now one of the necessary aspects of having a healthy life.1 Various treatments like body art and cosmetic dental treatments are becoming so attractive to achieve their desired aesthetic appearance, attention, to make a fashion statement and to be unique among the crowd. Body art includes tooth jewellery, tooth rings, tooth tattoo, removable tooth jewellery and many more.2
Tooth jewellery is one of the form of self expression and when done properly, it really can add a special confidence to smile.4 Infact, this results in increased self confidence of the person. Most commonly tooth jewellery worn by 18 to 35 year old hip-hop artists and disc jockeys to add on to their performance.2 Infact, It is becoming very popular now-a-days, like any other kind of fashion trend, it is also being used in order to increase the standard level of people among their relatives, friends infact society as it is a non-invasive, harmless procedure with less side effects. It is not very costly procedure with price varies according to the designs of the jewel which is being used and depends upon the clinic to clinic. It is a painless procedure takes upto only 1015 minutes for its completion.3
Moreover, tooth jewellery is a cosmetic dental procedure in which diamond or any other stone is attached on the tooth surface. With the increasing interest of cosmetic dentistry among people the use of dental jewellery has been gaining importance day by day.5
HISTORICAL IMPORTANCE
Tooth jewellery is not come in trend recently, it has been introduced decade back when most skillful and artistic work was done by craftsman of the maya.6 In the 9th century Mayan culture where teeth were embellished with jade and turquoise, but current trends in dentistry include the addition of gold, jewels or crowns that appear similar to stainless steel crowns, previously considered non- aesthetic.7 Mayans were accomplished smelters and forgers of gold, silver and bronze. They were skilled in the fabrication and placement of beautifully carved stone inlays in precisely prepared cavities in the front teeth2. Later on the glittering grills of some hip-hop stars were not exactly unprecedented. But, according to the new study, this concept of Native Americans added bling to their teeth as far back as 2500 years ago.8 Even now-a-days there’s a lot of craze about this fashion trend among people of all ages. These days women take more interest in making their personality so beautiful and attractive as compared to men. Like different kinds of makeup, dresses they wear, the food they eat in restaurants, the kind of luxurious and rich lifestyle they live, even they add dental jewellery to it in order to show how glamorous they live their life and how their standards are so high.1
According to a recent analysis of thousands of teeth examined from collections in Mexico’s national institute of anthropology and history, it was shown that ancient people of southern North America went to the dentists to beautify their choppers with notches, grooves, and semiprecious gems. They began to be worn by hip hop artists in the early 1980’s and upgraded during the 90s in New York City, but they became more widely popular during the mid-2000s due to the rise of dirty south rap and the more mainstream pop culture status hip hop attained.5 Even now in 21st century, people use dental jewellery while going to parties, ceremonies or any event, people have add cosmetic dentistry to their life in order to enhance their living style.3
TOOTH JEWELLERY
Tooth jewellery is a cosmetic dental procedure in which diamond or any other stone is attached to the tooth surface in order to gain the spark and to look more fashionable.5 Diamond faceted smiles is one of the newest and most interesting trends sweeping across the planet all over in both men and women. Tooth jewellery are the type of small glass crystals that come in many sizes, colors and shapes that are quickly becoming fastened to teeth all over America.9 A tooth gem is a small rhinestone jewel is attached to the surface of a tooth using an adhesive. Some are small stones in the center of the tooth, other times people elect to place a jewel-encrusted cap over their teeth. Finally, some go for the grill: a decorative cover that fits over most of a person’s front teeth, popularized by artists such as Lil Wayne and Jonathan Davis.10 These glass crystals are real 18k white gold and 24k or 22k yellow gold jewels, designed specially for dental use. These crystal teeth jewel are made in germany. Their flat back is surfaced with a special coating to create a sparkle and shine like a diamond. The crystals have a special coating on the back and their facet cut reflects the light and makes it sparkle like a diamond. Unlike earlier methods which involved drilling and setting the jewel into the tooth, a little bit of dental composite material can attach the crystal onto the teeth and lasts upto year or longer.11
TYPES OF TOOTH JEWELLERY
Tooth jewellery can be of different types, following are as given below:
TOOTH GEMS
Tooth gems are crystals glass mounted on a thin foil of aluminium. They help in creating spark available in different shapes and colors. Available shapes are including; round crystals, shapes crystals, white and yellow gold tooth jewels, gold letters and numbers, gold facings, gold tooth jewels with real gemstones and many more whereas in case of colors, there are different range of glass crystals that are available in nine different colors i.e. diamond, rainbow, ruby, sapphire, emerald, emerald green, aquamarine, pink, sapphire light.12 TOOTH GEMS include SKYCE and SAPPHIRE crystals. Skyce (ivoclar vivadent AG, schaan, leichtenstein) are clear whereas sapphire are white or blue crystals. Skyce and sapphire both are high quality tooth jewels but skyce put an extra sparkle into every smile.1
Tht KRYST are SWAROVSKI CRYSTALS that are specially treated making them ready for dental use so that they easily attach and can be easily removed without causing any damage to the natural tooth. KRYST has a spectacular collection of 12 colours and 3 different sizes from where we can pick our favourite colour and design.1 It is a harmless procedure, can be placed on the tooth surface without any preparation. It can be used on a place of injured enamel or any pigmented spot, mixture of a photopolymeric fillings and so on. It is a painless procedure and takes only 10-15 minutes for the completion of the procedure.3 A small glass crystal is placed by using special adhesive, avoiding the tooth from becoming damaged, without any risk, to the oral health, this bold trend has been adapted by using the dental jewellery proposed by vivident.1 Just like an orthodontic bracket, the desired design can be bonded on the patients tooth structure. Skyce is very easy to apply. First, a retentive pattern is produced on the enamel using 37% phosphoric acid. Then, Skyce is bonded to the tooth with the transparent, flowable Heliobond. It is important to encircled skyce by a little heliobond to ensure macromechanical retention. It can be removed anytime or can be replaced with any other stone, as there’s no drilling involved in the procedure therefore it can be directly bonded on to the tooth surface.5 These crystal glass stones are available in two different sizes i.e. 1.8 mm or 2.6 mm in diameter. Rainbow crystals are the least expensive version of tooth jewellery. They are ideally for short term attachment, by taking into consideration of customers desire with a smaller budget rainbow crystals that are available in 10 different colors and two sizes(1.8mm and 2.5mm).8
TWINKLES
Twinkles are specially designed to be bonded to the tooth and its patented backside is similar to an orthodontic bracket which makes them to stay so long. Twinkles are pure gold and precious stones like diamonds, sapphire and ruby.8 The bonding is not as durable but can easily last for more than 6 months. These are the collection of 24-carat gold and white gold jewellery which is available in 50 different designs with some including diamonds, sapphires and ruby. Available twinkles are (twindent AB, Uppsala, Sweden). Most commonly used tooth for attachment are upper incisal and canines.8 The procedure of bonding any stone on the tooth surface is a painless, harmless, needs only 1015 minutes to apply. Along with dental jewellery some other options that helps in increasing persons personality and are used to make the fashion statement among others are Dental rings, Dental tattoos, and many more.3
TOOTH RINGS
Another option which helps in establishment of the standard of living among youngsters is the use of tooth rings. This is similar to dental jewellery but the procedure is little different from dental jewellery. In dental rings, a small hole is placed towards the disto-incisal corner of the maxillary incisors and the ring is hung through it. Most commonly used preferred teeth are maxillary central incisors and the size of the perforation depends on the thickness of the ring selected. The perforation should be prepared as smoothly as possible and polished. Sometimes these rings are embedded with precious stones. Most important thing that should be taken into consideration is the available overjet while selecting the diameter of the ring to avoid interference in occlusion. The rings are sometimes made connecting the two central incisors or the central incisor to the lateral incisor.2
DENTAL TATTOO
Dental tattoo is also known as Tooth Tattoo, use of word tattoo is most commonly used to define ornamental designs on teeth which is a bit of a misnomer, as a tattoo, simply by definition, is a pigment mark made by piercing the skin. But in case of dental tattoos, the teeth are not pierced or even touch with a needle, and the material which is covered is enamel, not skin. Dental tattoos are custom designs which are added to dental crowns before the crowns are sealed and set in the mouth. Dental tattoos can be applied to any tooth and they have wide range of styles, colors, and designs. Most commonly used in the age group between 14-35 years.1 There are different catagories of tattooing that are used as dental tattoo including celebrities, flowers, religion, devotion to person or issue and animals. Tattoos can also be temporary used, they mostly are the designs in the form of templates that are stuck on the teeth. Sticking of temporary tattoo takes just 15-20 minutes. It is an indirect procedure and tooth reduction is required to make crown. Modern dentistry gave rise to the idea of dental tattoos. And the concept of dental tattoo originate 8-10 years ago when hip hop singers and rappers started sporting them in their music videos. Applying Dental tattoo is very simple and some steps are to be followed in order to apply the desired dental tattoo. First of all, dentist takes impression of tooth, makes a mold and confirms that it is correct sized for the tooth, it is sent to a lab where specialized in making tattoos and skilled artists does the tattoo work on the artificial crown first, they carefully paints miniature design onto the tooth crown and then after getting desired tattoo, it is cemented on natural tooth. After long duration if patient wishes to remove the tattoo, they can be done by grinding away the upper layer of the crown.2 It is a painless procedure but can give rise to some complications as well.3
REMOVABLE TOOTH JEWELLERY
Another fashion trend which is similar to the tooth jewellery is known as REMOVABLE TOOTH JEWELLERY, the dissimilarity between other fashion trends and removable tooth jewellery is just, the stones that are permanently mounted on an invisible glass clear micro-skin which fits accurately on to the teeth inspite of directly bonded on the tooth. Neither etching nor preparation of the teeth is required. The impression is made and the micro- skin is fabricated in the lab on which the precious stones are attached. They are safe to wear in the mouth and will not damage the teeth or soft tissues, a wide selection of precious stones and gems are available in different sizes and colors. One of the advantage of removable tooth jewellery is that it can be removed by the patient itself and can also be fitted back when necessary.2
DENTAL GRILLS
They are little more “bling” than the different tooth gems. Grills are most popular with American hip-hop stars and rappers. It is something that we might have seen in TV or in a magazine with this sort of tooth accessory. Usually they are made of solid metal such as gold and can also be used with precious stones. Most commonly they are used to cover the entire section of the front teeth, but moreover the design, positioning and material is completely unique to the individual. As it is a dramatic addition to the mouth but still it’s a sort of style for some.4
COMPLICATIONS ASSOCIATED WITH TOOTH JEWELLERY
However, researches indicates that knowledge of risks associated with body art is not a deterrent even for persons who have had complications. Documented complications related to tooth jewellery have been discussed below in order to aware the people because now-a-days most of the people are recommended to use tooth jewellery in order to enhance their aesthetics and to improve the self esteem and self confidence as well, but there are certain complications associated with it because of that tooth jewellery is highly recommended only in those patients who are having good oral hygiene maintenance.5 The reason behind are many, some of them are illustrated below:
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Aspiration, allergy or chronic injury to adjacent teeth/mucosa, including tooth fracture is the one of the major complication associated with it.
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this is because the attachment area of the tooth jewellery is highly prone for plaque accumulation, the area has to be clean as possible.
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It should not be advised to the patient having high caries as some of the tooth jewellery require tooth preparation which causes a permanent defect on the teeth and these areas are prone to caries then.
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Gingival inflammation, diminished articulation and metal allergy are also the some of the major complications associated with tooth jewellery.2
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Sometimes movable jewellery can cause abrasion of teeth. Fixed teeth grills are very difficult to be kept clean and hence a removable type should be chosen.
Therefore in order to get rid of these complications, patient should be instructed carefully and should be advised to follow some precautions, they are as illustrated below:
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For attaching precious stones elaborate etching should be avoided.
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Tooth jewellery which does not require any tooth modification is more advisable. The jewellery may sometimes cause ulceration of the lips when lip function is hampered.8
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However, the presence of gem will not make any difference on the dental hygiene but it is recommended not to use an electric toothbrush for the first few hours after the tooth jewel has been attached.
The American academy of pediatric dentistry( AAPD) recognizes the importance of educating the public and health professionals on the health implications of oral jewellery/accessories.11 If adequate precautions are taken and the patient is well educated regarding the subject, tooth destruction from jewellery can be minimized.12
CONCLUSION
Patients want a sparkling smile in order to improve their beauty even more and the dentists want their teeth to be healthy. Dentists are committed in maintaining the health of teeth at all costs. Therefore, newer advances and trends in dental procedures are making dentistry more interesting among patients as well as dentists. These days tooth jewellery is becoming latest trend among youngsters specially. Unlike other, tooth jewellery, there is no pain, infection, no drilling and no damage to tooth, easily removable and at the same time add more attractiveness and sparkle to the smile, makes them more user friendly. Therefore, this trend has been gaining importance among people of all ages.