Medically reviewed by Dr. Mary Alice Mina, MD, FAAD, board-certified dermatologist and Mohs surgeon | Last updated: September 8, 2026
When patients ask me why their face looks different in their 40s and 50s, we usually talk about collagen, sun damage, and volume loss. But there’s another piece that rarely comes up in a skincare conversation, and it sits right under everything I treat. Your jawbone and your teeth are changing too, and those changes shape your face as much as any wrinkle. On The Skin Real, I sat down with oral and maxillofacial surgeon Dr. Erin Sheffield to talk about what is actually happening in the mouth as we age, and a few of her answers surprised me.
The Short Answer
Your teeth shift, your jawbone can shrink, and both affect how your face looks and functions over time. Most of that is manageable with a couple of low-cost habits and good professional care. The trendy fixes tend to matter far less than the boring basics of flossing, fluoride, and keeping your natural teeth healthy.
Your Face Ages From the Bone Out
When you lose a tooth, the bone that used to hold it in place starts to melt away, because bone maintains itself only when it is being used. Researchers call this alveolar ridge resorption, and it begins soon after a tooth is gone. Over years, that lost bone changes the height and width of the jaw, which can make the lower face look shorter and more sunken. As a dermatologist, I can soften lines and restore some volume at the surface, and none of that replaces the structure a healthy jaw provides. Keeping your teeth is one of the most underrated things you can do for your face.
Flossing Is the Small Habit That Does the Most
The point from Dr. Sheffield that stayed with me is how much return you get from flossing well. Gum disease is common, and it is linked to broader health concerns, including cardiovascular disease, though the research shows an association rather than firm proof that flossing prevents heart problems. What is clear is that daily flossing protects your gums and the bone that supports your teeth, and it costs almost nothing. Most people floss too fast, so ask your dental team to watch you once and correct your technique.
Your Teeth Keep Moving, and So Does the Rest of Your Mouth
Teeth drift forward slowly throughout life, even if you never had braces, which is why crowding can show up in your 40s. Grinding and clenching speed up wear, and if you grind at night, a custom guard protects your enamel. Some patients ask about Botox in the masseter muscles for clenching. The evidence suggests it can reduce grinding-related pain and muscle activity for some people, though it treats the symptom rather than the cause.
Dr. Sheffield also had a grounded take on veneers and crowns. Both can be excellent when they are needed, and both usually require shaving down healthy tooth structure that does not grow back. A slightly imperfect natural smile is often the healthier long-term choice than a uniform set of restorations you will maintain for life.
What Perimenopause and Bone Medications Mean for Your Mouth
Hormonal shifts in perimenopause and menopause can bring dry mouth, more sensitive gums, and changes in the bone around your teeth). If your mouth feels drier than it used to, mention it, because saliva helps protect against cavities.
One point deserves care. Certain osteoporosis medications, including bisphosphonates and denosumab, carry a small risk of a jaw complication called osteonecrosis, where an area of bone fails to heal, usually after a dental procedure. The risk is low for most people taking these drugs for osteoporosis, but it is real and worth noting. So be sure to tell your dentist about any new medications and plan any dental work with both of your doctors.
The Two Habits Worth Building
At the end, I asked Dr. Sheffield for her highest-yield, lowest-effort advice, and it was refreshingly simple. Floss well, and use fluoride. Neither is exciting, and both do more for your long-term oral health and your face than most of what goes viral.
Final Thoughts
Facial aging is not only skin deep. Your jawbone and teeth are part of the structure that holds your face up, and protecting them is quiet, inexpensive, and worth the effort. Keep your natural teeth, floss with real technique, use fluoride, and loop your dentist in on your medications and your hormones. Dr. Sheffield also busts several viral myths in this episode, and those are worth hearing in her own words.
I noticed my teeth changing in my early 40s which prompted me to have a real conversation with my dentist about my dental hygiene. I realized I wasn’t flossing correctly and needed to improve my water intake. Thankfully a few strategic changes improved everything!
Frequently Asked Questions
Can losing a tooth really change the shape of my face? Yes. Once a tooth is gone, the bone that anchored it begins to shrink, and over time that loss can make the lower face look shorter and less supported. Talking with your dentist early about replacing it helps preserve that structure.
Does flossing affect more than my gums? Flossing protects your gums and the bone that holds your teeth, and gum disease has been linked to broader concerns like heart disease. The evidence shows an association rather than proof, so think of flossing as protecting your mouth first, with possible wider benefits.
Do veneers or crowns damage healthy teeth? They can be the right call when a tooth genuinely needs them, and both usually involve removing healthy enamel that does not grow back. If your teeth are healthy, weigh that permanent trade-off before choosing a cosmetic set.
I take medication for bone density. Should I avoid dental work? Not on your own. Some osteoporosis medicines carry a small risk of a jaw healing problem, though the risk is low for most people taking them for osteoporosis. Tell your dentist what you take and plan any procedures with both of your doctors.
Watch the Full Episode
For the full conversation with Dr. Erin Sheffield, including her myth-busting on wisdom teeth, cavitations, and mewing, watch this episode of The Skin Real on YouTube.