People seek cosmetic dentistry for a variety of reasons. Some people simply
want to look younger, and cosmetic dentistry is like a dental facelift that can
quickly "reverse" the natural aging process of the teeth. Others, the majority,
have had unattractive teeth their whole lives and have always felt
self-conscious because of them. They will rarely smile, which can often hide a
warm side of their personality.
Modern dentistry offers a wide variety of treatment options for people
seeking to enhance their smile. The options range from porcelain veneers to
braces! In many cases, a combination of these techniques is required to deliver
the best results.
In this section, Dr. Jerry Gordon explains the many different techniques
available in the field of cosmetic dentistry and shows you the benefits and even
the prices of each! If you have ever thought about cosmetic dentistry, this
guide can be extremely helpful in understanding what is possible.
Porcelain Veneers
Porcelain Laminate Veneers, or simply "veneers," are custom-made
porcelain wafers that the dentist places over the fronts of the teeth to enhance
their appearance and also to repair damage. Veneers can dramatically change a
person's smile and help improve their self-confidence.
In the 1920's and 30's,
actors, actresses and other performers would often go to the extreme measure of
having their teeth extracted and dentures (false teeth) made to improve their
smile. Fortunately, this radical procedure has given way to veneers, a far more
conservative approach. Veneers are what give many Hollywood movie stars that
dazzling smile we see on the silver screen.
Veneers can be used to improve a wide variety of cosmetic dental problems.
They can whiten stained or discolored teeth, close gaps between teeth, "correct"
a crooked smile without the need for braces, repair chips and imperfections, and
create a more attractive or youthful looking smile. The procedure usually
involves removing only a thin amount of the outermost layer of the tooth, called
the enamel. The dentist then takes molds (impressions) of the mouth. Temporary
veneers are then placed for the patient to wear while the permanent veneers are
being made. The procedure usually takes between one and a half and two hours.
Next, the laboratory carefully crafts the porcelain into veneers. In about
two weeks, the veneers are ready for the dentist to fasten to the fronts of the
teeth. This process improves the teeth's appearance and strength.
Porcelain veneers in combination with a gum-lift
procedure (see below) helped this smile.
There is no doubt that veneers are an excellent option, but how about the
cost? That largely depends on how many veneers are required to produce the
desired results. In most cases, a minimum of six veneers are needed, and are
usually placed on the upper six front teeth, from the canine (sometimes known as
the eye tooth) on your right side, to the canine on your left side. Prices vary,
but an average fee for most cases will run several thousand dollars (500 to 900
dollars per tooth*).
Tooth Whitening
Tooth whitening involves the use of peroxide-based materials to whiten
teeth. Most dentists use an in-office and/or at-home whitening system to achieve
the desired results. Before tooth whitening, the patient must get all cavities
filled, and the gums must be healthy. The in-office systems use 35% hydrogen
peroxide gels coupled with a high intensity light to whiten the teeth. The gums
need to be protected with some systems, and then gels are placed on the teeth. A
laser or plasma arc light source activates the peroxide to oxidize stains on the
tooth surface. In about an hour, the teeth become four to six shades lighter.
Before and after pictures showing the
positive effects of tooth
whitening
At-home systems most often use 10 to 20% carbamine peroxide gels to oxidize
stains. The dentist makes impressions (molds) of the mouth, and then has soft
mouth trays made. The patient is fitted with the trays, and then is instructed
to place a thin ribbon of the gel into the tray and wear while sleeping. Most
whitening occurs in one to two weeks. In difficult cases, trays may need to be
worn for up to six weeks. Generally, a combination of in-office and
at-home systems works best, and routinely achieves between 12 to 15 shades of
whitening. The procedure is safe when monitored by a dentist, and does not
damage the tooth in any way.
White fillings (resin, bonding) or porcelain crowns (caps) and bridges will
not whiten significantly with either method. Some patients will experience minor
tooth sensitivity during whitening procedures. The dentist can remedy this by
alternating concentrated fluoride with the peroxide in the mouth trays.
The cost of in-office whitening is between $500 and $1100, the more expensive
end when a laser is used. At-home systems cost between $400-$800. Store bought
bleaching systems are not as effective as dentist-managed systems. Unsupervised
use of store-bought bleaching systems can cause painful sensitivity to untreated
dental cavities. The mouth trays are not custom made, which can cause gum
irritation, and the peroxides are not as strong or effective.
Tooth-Shaping
Tooth shaping involves removing a small amount (generally 1 to 2
millimeters) of the enamel of the teeth. Tooth shaping can shorten long teeth,
round off pointed teeth, and help create a pleasing smile that gently follows
the contour of the lower lip. The procedure is quick and painless (the enamel
has no nerves), and is usually completed in less than 30 minutes. A small
minority of patients get slight sensitivity after tooth shaping. This can be
remedied with prescription strength fluoride or in-office desensitizers. The
procedure does not appear to cause any long-term damage to the teeth. Tooth
shaping is relatively economical, and generally costs about $25 to $75 per
tooth.
Resin or Tooth Colored Fillings
Resin fillings, also referred to as composite, white fillings or bonding,
can make a substantial improvement in the appearance of the teeth in a short
period of time. Resin is what dentists use to repair small cavities or chips in
front teeth, as well as fill cavities cosmetically in back teeth. Resin can do
virtually the same thing as porcelain veneers with respect to improving the
appearance of the teeth.
Using resin instead of porcelain veneers for cosmetic
dentistry saves time and money, however there are disadvantages with resin. They
are not as strong as porcelain veneers, and require repairs every few years.
Resin can discolor over time, and does not have as much natural beauty as
porcelain veneers. Resin cosmetic procedures can usually be completed in about
an hour. The cost ranges from about $100 to $400 to per tooth.
Bonded-Bridge
A bonded-bridge can replace a missing tooth in far less time and for less
money than a porcelain bridge or an implant. It is basically a resin or
porcelain tooth with resin or metal wings on each side of it. It is ideal for a
missing tooth in the front of the mouth, where biting forces are not that
strong. The procedure involves removing a small amount of the inside of the
teeth on either side of the missing one and then taking an impression or mold.
The laboratory makes the bonded-bridge, which can then be adhered to the backs
of the teeth surrounding the missing one.
Gum-lifts
Gum-lifts (gingivectomy) involve the removal of gum to make the teeth
appear longer, and the gum-line even. People who have excess gum covering the
front teeth and an upper lip that comes up high when they smile are often
self-conscious about their "gummy" smile. An uneven gum-line can make the teeth
appear to have different lengths, which takes away from the appearance of an
attractive smile.
To correct these problems, the dentist numbs the area and removes the excess
gum. The patient is instructed to use an antiseptic mouth rinse such as Peridex
on a Q-tip and apply upward pressure on the gums as they heal. The procedure is
not painful, but some mild discomfort can be expected a day or two after the
procedure. The gum is not damaged due to the procedure as long as the dentist
has experience, and removes the proper amount. The procedure can usually be
completed in about 30 minutes. Gum-lifts generally cost about $75 to $175 per
tooth.
Braces
Orthodontics or braces can improve the appearance of teeth in children
and adults who have crooked teeth or teeth with wide gaps. The procedure usually
takes about 18 to 24 months and costs about $3,500 to $4,500. Having teeth moved
with braces is very time consuming, requires multiple visits (at least twenty)
and can be uncomfortable. It is most useful for children to straighten their
teeth. The procedure can improve the appearance of the face and jaw during
growth.
Conclusion
Before you invest your time and money in cosmetic dentistry, you should
consider the following: Is the dentist experienced in cosmetic dentistry and has
he or she taken advanced continuing education courses in current techniques? Can
you see before and after pictures and testimonial letters of people who have had
similar treatment in the past? Does the dentist have imaging or presentation
devices to help demonstrate how the procedure is done, and what results might be
expected? If the answer is no to these questions, you should consider getting a
second opinion.
Cosmetic dentistry is really more of an art than a science. I will often use
a combination of the above methods to get the results that the patient is
looking for. Training and experience matter and should be considered when
choosing a dentist for cosmetic procedures. The most important thing to remember
is that you and your dentist should talk about what outcome you expect before
you begin treatment, and you should explore all the alternatives available in
the exciting area of cosmetic dentistry before starting treatment.
[* All price ranges are estimates based on 1999 prices. Remember that prices
will vary according to dental office overhead, location, expertise and
experience of the dentist, and other factors.]
