Rapper AKA got a set of 18 carat gold grillz with ruby insets last May. Picture: Instagram
Once seen as a popular fashion trend - and even a sign of wealth and prosperity - getting one’s teeth ornamented with gold has always carried with it its own set of pros and cons.

Over the years, the trend has evolved in many ways - losing ground in some areas, and totally transforming in others - as having one gold tooth has sometimes been replaced by a mouthful of gold or gemstones, popularly known as "grillz".

But what of the impact of this procedure on one’s overall oral health?

Dr Nosipho Mzobe, head of education at the South African Dental Association, said: “A person with restoration or fillings, irrespective of the filling material or restorative material used (including jewellery), needs to practice good oral hygiene habits more vigilantly, such as brushing and flossing of teeth at least twice a day.

“They also need to have an oral check up with their dentist at least twice a year. So as to maintain the longevity of the restorations.”

For 29-year-old Joburg resident Thulani* (not his real name), getting a gold slit between his two front teeth at the age of 15 was a protective measure to keep his teeth, instead of the more horrifying option of extracting them.

“I think my family has a history of oral or dental health issues. My mother had her back teeth extracted, and I’ve also had three extractions. So when I had a cavity in Grade 9, I decided to cover it up with a gold slit,” he said.

For him, it wasn’t so much about being “cool”, but “to save my tooth”.

According to Cape Town-based dentist Dr Zac Ferris, while the trend of having gold on one's teeth was once popular, over the years there has been a sharp decline in people wanting to bedazzle their teeth or get gold crowns or stick-ons.

“In the 1990s, the medical aids used to fully cover such operations, but nowadays we do it on a cash basis. That’s why I think there’s been a decline. And depending on the price of gold, we can charge from R800 upwards for a full tooth, or R350 for a partial inlay,” he said.

Ferris said in SA, the trend of having gold teeth picked up not only because of its aesthetic value, but because of the impact it had on the fashion culture.

“(Getting a gold tooth) was like buying a new pair of top-brand shoes; it was about showing off mostly. And it was mostly black Africans who had and still have them done. Gold is still probably the best way to fill a rotten tooth. I’ve seen people who’ve had gold crowns for over 40 years because gold lasts longer than other materials,” Ferris explained.

But, for certain segments of the population gold teeth do come with a very particular stigma.

“For coloured people for instance, the stigma attached is that if you have one you’re a gangster,” Ferris said.

According to a recent National Geographic documentary called The Secret History of Grillz, when grillz first emerged in the US in the 1980s it was through immigrants from the African diaspora who were going through tough economic times.

And while they may be finding more ground in the popularity stakes as hip hop rappers actively endorse grillz in their videos, both Ferris and Mzobe said restorations or fillings needed to be placed on sound enamel irrespective of the restorative material. The basic tenets of oral care also needed to be maintained.

“I only do the procedures for people with good oral health care - if I see the patient has a mouth full of rotten teeth, I’d rather deal with that issue first. But a lot of the time people who come in do have good oral health care,” Ferris said.

According to the American Dental Association (ADA), at present there are no studies that show that grills or having teeth altered with gold crowns is harmful to the mouth.

“But there are no studies that show that their long-term wear is safe, either. Some grills are made from non-precious (base) metals that may cause irritation or metal-allergic reactions. If you wear a grill, you should be especially careful about brushing and flossing to prevent potential problems,” the association said.

Further, the ADA cautioned that food and other debris might become trapped between the teeth and the grill, allowing bacteria to collect and produce acids.

“The acids can cause tooth decay and harm gum tissue. Bacteria may also contribute to bad breath. There is also the potential for grills to irritate surrounding oral tissues and to wear the enamel away on the opposing teeth,” the association said.