Introduction
What is Cosmetic Dentistry?
Bleaching/Whitening
Bonding
Porcelain Veneers
Tooth-Colored Fillings
Porcelain Crowns (Caps)
Orthodontics
Periodontics
Conclusion
Are you afraid to smile? Would you rather take a picture than be in one because you are too self-conscious of the color, shape, or positioning of your teeth? Are you afraid to open your mouth or yawn for fear of revealing all of those silver fillings?
I routinely ask these same questions to my patients and very rarely will anyone answer that they are not self-conscious of their smile and do not wish that they could improve it in some way.
I often find that many of my patients perceive their teeth to be either too dark, too crooked, overcrowded, chipped, or just misshapen. Many patients want that “Hollywood” smile. They often bring a magazine to my office, point to the cover and say, “I want a smile just like that!” How you feel about your smile is critical to your self-confidence overall.
Cosmetic dentistry is the art and science of smile design. Almost everyone can enjoy the benefits of cosmetic dentistry. Dentistry has many new materials and techniques that enable me to help my patients improve their self esteem through a more beautiful smile. This article provides a general introduction to some of the latest cosmetic techniques.
Health
Almost everyone wants whiter, brighter teeth. Teeth naturally darken with age. If you are a cigarette smoker or drink a lot of coffee and tea, your teeth are more likely to stain. Extrinsic stains, stains on outer surfaces of the teeth, can usually be removed during a thorough professional dental cleaning. However, intrinsic stains, stains within the tooth itself, must be removed through bleaching. This can be accomplished with the same results either at home when overseen by your dentist or in the dental office with a carbamide-peroxide or hydrogen-peroxide solution. Most patients go two to three years before it is necessary to undergo the bleaching process again. Other patients just require a touch-up sooner. I caution you to avoid any whitening procedure without supervision by your dentist for several reasons that include:
- Not everyone is a candidate for bleaching and must be evaluated first by a dentist. One reason to check with your dentist is to ensure that you will not be sensitive to the procedure. It may be necessary to replace some older fillings with new fillings prior to the procedure to avoid sensitivity. Also, because porcelain and tooth-colored fillings tend not to bleach, you may want to replace them after bleaching in order to improve aesthetics.
- Not all over-the-counter bleaching solutions are pH-balanced. Some may cause irritation of the gums.
- Bleaching can sometimes lead to sensitive teeth, which your dentist can help by changing the concentration of the solutions or administering fluoride.
- It is important to have a custom-fitted mouth guard so that the bleaching gel remains on your teeth rather than on your gums.
In-office whitening
As a matter of convenience, many of my patients choose in-office whitening. Through this procedure a special external light source, or laser, is used to activate the bleaching gel solution. The process is safe, easy, and fast. Results are accomplished in just one appointment. Sometimes it may be necessary to use a combination of in-office and at home bleaching in order to achieve the patient’s desired results.
Whitening toothpastes
Although whitening toothpastes may remove stains, I only recommend them for maintenance after the bleaching process has been completed.
Bonding is actually a process by which we affix a tooth-colored material (hard plastic) to your teeth, creating a bond. We can use bonding to change tooth color, shape and size, or to repair fractured teeth. We can also use bonding to give the appearance of straight teeth. However, we caution our patients to avoid hard foods, as this may cause the bonded restoration to chip or fracture. A bonded restoration can be polished to look the same as your natural teeth and may also stain in a similar manner as your own teeth. These stains are removed during our patient’s regular cleaning appointments by polishing these restorations.
If my patients want something that is more stain-resistant and less likely to chip than bonding, I recommend porcelain veneers. Like bonding, porcelain veneers are also used to change tooth color, shape, and size. We can also use porcelain veneers to give teeth a straighter appearance and to close spaces. Porcelain veneers are thin porcelain shells that are fabricated in a dental laboratory. I often liken porcelain veneers to fake fingernails. We bond the porcelain veneers to the teeth using a special cement. Porcelain veneers are more expensive than bonding since there is a laboratory process involved. I prefer porcelain veneers to bonding when there are several teeth involved because I can achieve a more consistent cosmetic result.
Due to recent technological advances and improved materials, there are now alternatives to silver fillings. I have never had a patient thank me for a silver filling because they like the way it looks. I personally get more gratification and many more thanks from patients when I perform a cosmetic procedure such as tooth-colored fillings. (However, I still place silver fillings in my practice when requested and where cosmetics is not a big concern.) When teeth require smaller restorations, we can fill them in the office with a tooth-colored material (hard plastic) that is bonded to the tooth. If the filling is large, I prefer to use a tooth-colored inlay or onlay, which is custom-fabricated in the laboratory to fit the tooth and is permanently cemented in place. If there is a considerable amount of tooth structure missing, we must crown the tooth.
In my practice, I use both all-porcelain crowns and porcelain-fused-to-gold crowns (a gold crown that is covered by porcelain). I use porcelain to match the shade of a natural tooth. Since more light is reflected in the front of the mouth, I feel that all-porcelain crowns look more natural when restoring front teeth. Crowns are custom-made in a laboratory and are cemented in place.
I work with orthodontists in our practice to straighten teeth, reduce crowding, and close spaces in order to achieve the best possible smiles. Although it often requires a much longer time frame, I often prefer orthodontics over porcelain veneers or bonding. Orthodontics may take at least two to three years to achieve the desired results. Sometimes I find it necessary to use both orthodontics and bonding or veneers to achieve the best aesthetic results.
Sometimes it may be necessary to work with a periodontist (gum specialist) to alter gum tissue to enhance a patient’s smile. You may have seen at one time or another a person who will show a lot of gum when they smile, thus limiting the attractiveness of their smile. A periodontist can help correct this problem.
There are several alternatives available to the cosmetic dentist. Some cosmetic results can be achieved in a relatively short amount of time. However, for more complex cases, it may take several years to achieve the desired results. Everyone is entitled to the smile they deserve.
