Cosmetic Dentistry

Nothing since that Ancient Sumerian fashioned the first toothbrush from a simple twig has impacted the dental field more than cosmetic dentistry. Today it is possible for the average American to sport the same picture perfect smile as any celebrity.

Cosmetic dentistry encompasses several different procedures which we will investigate. You may even have some of these procedures in your mouth right now. . .in fact the odds are that you have had some type of cosmetic dental procedure in your lifetime.

It”s important to meet with your dentist for an initial examination to determine if you are a candidate for cosmetic dental work. Your teeth must be in good condition before any cosmetic work is undertaken. If any type of dental disease is present, your dentist will explain what needs to be accomplished before proceeding with cosmetic work.

Once that is determined the dentist will explain the various cosmetic options available that are suitable for your needs, whether it be braces, bridges, bonding, veneers, bleaching and so on.

Whitening is one of the primary reasons that people consider cosmetic procedures. But, it”s important to realize that often whiteners alone may not help. In fact, studies by the American Dental Association have shown that teeth with a yellowish tone will whiten well with a bleaching process whereas teeth that are brownish may not bleach well and grayish teeth may not bleach well at all. If you have had other cosmetic processes done and then decide to try whitening, you could end up with a very undesirable effect of not having all your teeth uniform in color. It”s important to follow the advice of your dentist and not be swayed by advertising or how your best friends’ work turned out!

Let”s explore the cosmetic options:

While you may have worn braces as a child, braces are now a treatment option for adults as well although realignment may take longer for an adult. In some cases an adult will require more than just an orthodontic procedure. Braces are the recommended treatment to correct an orthodontic problem called malocclusion or “bad bite.” A few of the causes of the bad bite are extra, missing or crowded teeth. This condition is usually inherited although some may be caused by accident or other means. Having a tooth knocked out and chronic thumb or finger sucking may contribute to a bad bite.

Before treatment can begin, a thorough history is necessary for the dentist to render a proper prognosis. The dentist may take numerous xrays, plaster molds and photos of your face and teeth before determining whether orthodontics is an appropriate method to apply to your individual situation.

If the dentist determines that your treatment requires mechanical appliances, the information gathered in his preliminary examination will help to create your custom appliance(s). There are many different types of appliances and the best recourse is the one created specifically for you.
Once created and put in place, the appliances will require periodic adjustments. The dentist needs to monitor the progress frequently in order to assure that the teeth are shifting in position accurately. Finally, once the appliances have done their work, they will be replaced by a “retainer.” The retainer will stay in place so that the newly aligned teeth will remain in their proper location.

One of the first questions from patients is usually, “how long will I have to wear this?” This not a “one size fits all” situation as the time varies from patient to patient. It will take as long as it takes and greatly depends on patient cooperation. Average time for orthodontic treatment is around 24 months with adult treatments requiring just a bit longer. Other factors apply, of course, such as how severe the bad bite, overall gum and tooth health not to mention how well the patient cooperates with the procedure. Most people who have worn braces report years later that it was well worth it!

Sometimes permanent teeth need to be replaced. Teeth can be lost through dental decay, knocked out in accidents or, in some rare cases, never grow in the first place. When this occurs a cosmetic process is used to fill in the blank space with one or more teeth. The dentist will create what is known as a “bridge.” Just as the name implies, it entails creating an appliance that will place a tooth precisely where it needs to be. This is considered a cosmetic process even though sometimes the bridge is more functional, for instance in the molar area. The bridge also helps maintain the integrity of the bones.

There are three types of bridges that your dentist might use depending on your circumstances. They come in porcelain, alloys or a combination of both.

Fixed partial bridge. This appliance is used to “fill the gap” created by a missing tooth or teeth, is considered permanent and bonds directly to the surrounding teeth for support.

Removable bridge. This bridge is the same as the fixed partial bridge with the exception that you can remove it.

Implant bridge. Implants are the most recent choice in the family of bridges. Implant bridges are permanently affixed to the jaw. Simplistically, a hole is drilled into the jaw below the gum line where a prosthetic tooth is embedded directly into the bone. The gums will then grow back around the “root” of the artificial tooth and voila’ out pops a brand new smile. Even though they are expensive, many people have voiced their approval of the procedure. This is especially true of more mature patients who may suffer from long term, ill fitting dentures. The implant bridge is the closest to natural teeth that a patient can ask for. They are a far cry from the wooden dentures worn by George Washington in 1776!

Many people who have discolored teeth opt to use a “crown” as a remedy. Just as the name applies, this is a prosthetic device that covers the tooth. Sometimes a tooth may have a large filling and there is very little tooth left to support the filling. This would be an effective treatment for that situation. They are often used in conjunction with the dental implants we discussed above. A crown makes your tooth stronger as well as prettier!

Bonding is a cosmetic treatment for teeth that involves placing tooth colored bonding material directly to the surface of the tooth using resin. First the tooth is prepared by slightly etching the enamel. This is done in order to give the bonding material “mechanical retention” allowing the bonding material to adhere to the tooth properly. Then the bonding material is applied, shaped and sculpted. A ultraviolet “laser” light is used to harden the resin material. When the process is complete the tooth is polished to a high shine.

Bonding is also used now for “fillings.” In fact, it is favored over the old silver (amalgam) fillings because the bonding resin can be matched to the rest of your tooth color. The downside to bonding, is the expense. Bonding is more expensive to silver. The bonding material is also porous making it a poor choice for smokers as it will yellow.

This is considered a permanent procedure because of removing small amounts of the natural tooth enamel.

Enamel shaping.
This process is often done in conjunction with bonding. The enamel is sometimes removed or reshaped. Shaping allows the dentist to sculpt chipped, cracked or broken teeth using bonding material as discussed above. In both procedures the catalyst is usually done with a laser light which insures that the material is securely merged with the natural tooth material.

You may have heard the term “veneer” in conjunction with wood working. The process for cosmetic dental applications is much the same. Very thin covers are custom created for each individual tooth. They fit the front side of the tooth and are another option to bonding or shaping. The same basic process is used to attach the veneers to the teeth. Veneers are very popular because they are so thin and somewhat resistant to staining.

There are two different options for veneers. Porcelain, or “indirect” veneers are handcrafted in a laboratory especially to fit your teeth. They are expensive but are said to last from 10 to 15 years. Composite, or “direct” veneers are enamel which is bonded directly to the tooth are significantly less expensive but their “shelf life” is only 5 to 7 years. If you have Almost translucent they can literally breath new life into damaged or discolored teeth.

This process involves the application of a rubber shield or a gel to your gums before work commences. This is necessary in order to prevent harm to the soft tissue. Bleaching material is then applied, sometimes using a laser light to enhance the procedure. The process may require several visits to the dental office.

Kits for bleaching are available for home use and you might discuss choose to discuss that possibility with your dentist. The actual bleaching agent is carbamide peroxide solution. It usually comes as a gel and placed in a mouthguard. The frequency and length of treatment will vary from person to person depending on the amount and intensity of whitening you desire. This should be discussed with your dentist before proceeding. Occasionally there is some soft tissue irritation. If you experience any side effects from using the agent, contact the dentist immediately.

Teeth whitening strips.
Teeth whitening strips are simply cool! These are probably the most convenient advancement in dental care in decades taking the concept of tooth bleaching to an entire new level of speed and convenience. The whitening strips contain hydrogen peroxide which is embedded in transparent material that fits over the teeth. Almost totally undetectable when worn, the peroxide goes to work as soon as they are activated by the moisture in your mouth. (Another good reason to avoid dry mouth!)

There are several brand names on the market and all work pretty much the same. They are applied over the teeth and worn for 30 minutes twice a day for 21 days, or you may select the type that can be worn overnight whitening the teeth while you are sleeping. How long the effects last will vary depending on diet and lifestyle. Your teeth will stain again, but you can lengthen the time between incidences by avoiding tobacco, tea, red wine, colored juices, curry, soy and soft drinks. If you are on well water, you might want to have the water tested. High concentrations of minerals in your water will cause staining of your teeth. Or, you may just opt for bottled water. The results from the teeth whitening strips are absolutely incredible and you would do well to give them a try.


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