Dental Articles

Smile Makeovers: Cosmetic Dentistry Today

In the United States today, there is an increasing focus on maintaining a youthful appearance. This, of course, extends to our mouths because when we smile, we show our teeth. In recent years, more people have become concerned about having teeth that are straight and free of stains, chips or other obvious imperfections.

This is encouraged by popular television shows that provide makeovers. Advertisements for whitening agents have become very common on television and in newspapers and magazines. Numerous articles are written about bleaching agents and smile makeovers. As a result, people often want their teeth to be perfectly uniform and dazzlingly white. Dental offices have responded to consumer demand, and offer many services such as porcelain laminates, bleaching, replacement of amalgam (silver) fillings with white fillings, and bonding procedures.

No one's sure how many cosmetic dental procedures are done each year in the United States. Since 1996, the American Academy of Cosmetic Dentistry has doubled its number of dentists to about 4,700 members. More than 95% of dentists offer bleaching products and virtually all dentists perform some types of cosmetic services.

Most cosmetic procedures are not covered by dental insurance unless they are done to repair a cavity or replace a defective filling, crown or other restoration. Services that are considered cosmetic, but that might be covered by insurance, are crowns, porcelain laminates and composite fillings. The cost of some cosmetic procedures can easily exceed $1,000 per tooth. Despite the cost and inconvenience, many people feel that a "smile makeover" is just as important as buying nice clothes or having attractive hair.

Advances in cosmetic techniques have also made it possible for dentists to repair damaged teeth without using amalgam or gold.

"I had crooked teeth for years," recalls Mike Gagliardi, 43, an account supervisor at the Philadelphia Inquirer and Daily News who decided to have his upper teeth capped to give them a straighter look. "At one point, when the dentist took a break, I went into the bathroom and looked in the mirror. It was awesome."

Good as New

Dentists have been doing cosmetic restorations for decades, but the materials that were used, such as the early composite resins, tended to stain, chip and change color over time, which limited their use.

New composite resins (tooth-colored fillings) and porcelain veneers are strong, long-lasting and resist color change over time. A few decades ago, people who chipped or broke a tooth either lived with it or had a crown (also called a cap) installed, a time-consuming and often expensive procedure. Crowns still are used sometimes, but it's often possible to "patch" minor imperfections, chips or fractured teeth with bonding composite resin that can be smoothed and color-matched to the surrounding teeth.

A computer imaging technique is available that allows dentists to create "virtual restorations" on a computer screen. A patient who is thinking about having work done can see what the results will look like before he or she makes the decision to go forward. This imaging technique is relatively new and is not common in dental practices.

Many Choices

Teeth with space or chips can be corrected with a technique called bonding. For example, your dentist can repair damaged areas by applying a "paste" made of a material called composite resin. The resin comes in a wide variety of shades. It is shaped by your dentist and then hardens almost instantly when it's exposed to a special high-intensity blue light. It can be sanded, smoothed and polished until it closely matches your natural tooth shade.

The most popular cosmetic dental procedures include bonding front teeth, whitening the teeth and using tooth-colored fillings, which blend with the natural color of teeth.

Because of advances in dental adhesives, many cosmetic techniques can be done with less preparation (cutting) of the tooth's enamel structure. Older dental materials were held in place by the shape of the tooth, so dentists had to remove more of the tooth enamel to make sure that a filling would remain securely in place. However, the dental adhesives used today are very strong and can hold a filling in place without the need to cut away as much of the tooth surface.

There are many cosmetic options to choose from, depending on what you need to have done. For example:

• Stained or discolored teeth - The enamel that covers the teeth isn't impervious to stains, and the underlying tooth structure (the dentin) often yellows over time. Bleaching is an option for healthy teeth.
• Chips or rough spots - These can be filled with a tooth-colored material called composite. The color of the composite can be chosen so that it matches the color of your teeth. Once the material has been smoothed and polished, it will look virtually the same as the surrounding area.
• Cavities or cracks - Traditional amalgam fillings work fine in the back of the mouth, but most people don't want to reveal a "metal mouth" when they smile. An alternative is to use tooth-colored fillings," which match the color of the teeth. These fillings are made with composite material similar to that used to repair chips or cracks. Some white fillings (direct composites) are pressed into the cavity and cured (hardened) with a special high-intensity blue light. Others (indirect composites or porcelain inlays) are made in a laboratory and then cemented in place. They cost much more than amalgam fillings, but are much more attractive.
• Uneven teeth - It’s not uncommon for a tooth to be slightly longer or have a different shape than its neighbors. With a procedure called recontouring, your dentist can reshape the tooth so that it's a better match.
• Gaps between the teeth - Small gaps can be closed by applying composite material between the teeth. For large gaps or other imperfections on the surfaces of the teeth, your dentist may recommend veneers. Veneers are among the most expensive cosmetic procedures. Made from ultra-thin shells of porcelain that come in every shade of white, veneers are permanently bonded to the fronts of the teeth, giving them an entirely new esthetic appearance. Your dentist also may refer you to an orthodontist to correct your gaps. The approach used to correct the gap depends on your cosmetic concern. Some people like or don't mind a gap. Others are very aware of it and want it closed. You and your dentist can determine the best treatment option. In some cases, the best option is no treatment. In others, it is bonding, veneers or an orthodontic consultation.
• Broken or crooked teeth - If a tooth has been badly broken or is structurally weak, you may need a crown. Today, crowns on front teeth are made of tooth-colored porcelain that can appear very life-like. The crown may be a porcelain jacket (all porcelain) or porcelain-fused-to-metal crown, in which a very thin metal coping supports the porcelain. Both crowns offer excellent results. The choice of crowns depends on your bite (occlusion), your preferences and your dentist's preferences.

The procedures available to correct dental defects and cavities or to improve your appearance vary in technique and cost. Before starting a treatment plan, you should consider all the options and make an educated decision because these procedures cannot be reversed.

"It was worth every penny," says Gagliardi, who had his teeth capped in 1985. "I was told that they would probably last about 10 years, but it's been about 15 years and I haven't had any problems."

Perfect Smiles

Although there is a significant demand for cosmetic dentistry in the United States and many of us want to achieve an ideal, youthful smile, be cautious about starting an extensive and costly elective procedure to change your appearance. If you want to change the color of your teeth, be aware that teeth are rarely pure white and you might not be satisfied once that shade is on your smile. A less-intense shade may be more likely to give you the look you are seeking.

In addition, excessive or frequent use of bleaching agents can lead to tooth sensitivity. Whitening procedures can be done in your dentist's office or at home. If you are whitening your teeth at home, it is important to follow the directions and to consult with your dentist.

Cosmetic dentistry can improve your self image, particularly for people with damaged or discolored teeth. Even simple procedures such as bleaching or bonding can be real confidence-boosters.