Know ALL your options

Various surveys report that when you meet someone for the first time, you notice their smile more than any other feature. This partly explains the huge interest in cosmetic dentistry in the past 20 years. Major advances in technology and techniques are the other side of the picture.   With so much information available, deciphering this complex subject can be quite daunting, even for the average dentist. This article will help to clarify the subject by explaining the pros and cons of each option, so you can make an informed and intelligent decision about which option is best for you.

Cosmetic dentistry is often equated with porcelain veneers, perhaps due to the success of the extreme makeover shows. Veneers are a great option, but are by no means the only option. Cosmetic dentistry includes whitening, orthodontics (braces), dental implants, oral surgery, gum lifts, tooth colored fillings, and even a new set of dentures. And depending which type of dentist you go to, you may only be offered one or two of these options.

Let’s examine the following analogy: suppose you have a sore joint. If you go to an orthopedic surgeon, most likely surgery will be recommended. A chiropractor might suggest adjustments, a physical therapist would try physical therapy and exercises, a nutritionist might recommend glucosamine, and a pharmacist would recommend Advil or Aleve. All are appropriate treatments for sore joints, but not all would be appropriate for every patient. In fact, the best treatment might be a combination of several different modalities.

Now suppose you have a smile which needs improvement. A general dentist might recommend whitening and/or bonding, a cosmetic dentist will often recommend veneers, an orthodontist would certainly consider braces, and a surgeon or gum specialist may yet offer more solutions. And like the analogy, the best treatment may be a combination of several different approaches.

So let’s review the options available in the field of cosmetic dentistry and for each provide an idea of the risks, benefits, cost, and time involved.

 

Whitening

Tooth whitening, sometimes referred to as bleaching, has been around for decades. The active ingredient in virtually all systems is some form of hydrogen peroxide, which has been shown to be completely safe for teeth and perhaps even beneficial to the gums. The major drawbacks to whitening are sensitivity and unpredictability. The major advantage is low cost. Various “whitening strips” can be purchased over the counter for around $50. They work well for light staining on otherwise normal, healthy teeth. Stock bleaching trays purchased over the Internet provide about the same level of whitening, but perhaps with more sensitivity. Custom bleaching trays provided by a dentist provide even better results, if you are willing to wear them every night for a few weeks. One-hour bleaching in a dental office or spa does the same or better job very quickly, but may also result in some short-lived sensitivity. The cost of in-office bleaching ranges from $500-$1,500, but the results are still variable. Some patients experience amazing results from these methods, while others are disappointed. For people with normal healthy teeth that would like predictable results, a system known as “Deep Bleaching” developed by dentist Rod Kurthy will deliver predictable results, even in deeply stained teeth. This system is a combination of in-office sessions and specialized take-home trays that gives amazing results every time. The cost of deep bleaching ranges from $1,200-$1,500, and there is very little or no sensitivity with this system. However, if your teeth have other issues in addition to color, then you will probably be looking at “permanent whitening”, also known as porcelain veneers.

 

Porcelain Veneers and Crowns

Porcelain veneers are thin facings that are bonded to the front of your teeth to restore your smile. They can completely cover stains, as well as even out crooked teeth and make chipped teeth look like new. Traditional porcelain veneers require numbing of the teeth, and removal of the top stained layer to provide space for the new white porcelain layer. The results can be dramatic and immediate, and the veneers can last for decades. The drawbacks are high cost, sensitivity sometimes lasting for weeks or months, and irreversibility. But for certain cases the advantages far outweigh the disadvantages.   Porcelain veneers are expensive up front, around $2,000 per tooth, but they can be completed in just a few visits and last for decades. This makes them perfect for patients wanting “immediate gratification.”

It’s important to select a dentist who has had post-graduate training in cosmetic dentistry. A typical dental school graduate has completed only a handful of veneers, if any, and the results depend heavily on experience. The dentist should have a complete set of pre-op photos, study models, a wax mock-up and a prep-guide prior to starting any treatment. The patient should be involved in the smile design process, and given the chance to make any changes before cementing the final veneers.

Porcelain crowns are similar to traditional dental crowns, but do not contain any dark metals on the inside of the crown. For patients who are tired of the “dark line” around the gums of their crowned teeth, all-porcelain crowns are a fantastic alternative. The newer crowns are very strong and bonded to the tooth to prevent the cement wash-out that used to occur with traditional crowns. Porcelain crowns typically cost a bit more than traditional crowns, but are well worth the extra expense in any area where the edge of the crown shows.

 

Orthodontics (Braces)

If you don’t mind waiting some months for your new smile, orthodontics may be a much better option than porcelain veneers. For patients with nice looking natural teeth, just crooked or gapped, orthodontics is a more natural and cost-effective approach. Of course, in the field of cosmetic dentistry most adults do not want railroad track braces on their teeth, so manufacturers have developed “clear braces” where all you notice is a thin wire on the teeth. If the thought of braces still turns you off, then you should consider Invisalign (www.invisalign.com). Invisalign is a series of clear plastic trays, similar to bleaching trays, which gently move your teeth to their new, straight position. At an average treatment time of only 11 months, Invisalign is quicker and easier than traditional braces, plus there are no diet restrictions and no issues brushing and flossing. The disadvantage of Invisalign is the time involved, and the chance that porcelain veneers may still be needed to achieve the patient’s esthetic goals. The advantage is preservation of natural teeth, and relatively low cost at around $6,000 total.

 

Dental Implants

If you are missing some teeth, whitening, veneers and braces may not solve all your needs. In the past, missing teeth meant partial or full dentures, or sometimes a bridge. With recent advances in technology, we can now replace missing teeth with artificial teeth that look and feel just like natural teeth. And with a better than 95% success rate, implants have become almost routine in many dental practices. The advantages are obvious; the disadvantages are high initial cost and the need for minor surgery to place them. Over the long term dental implants may actually be less expensive than other options, since they potentially can last the rest of your life.

Surgery

Most patients would prefer to avoid surgery, but sometimes it really is the best option. Gum surgery to improve a gummy smile, a chin implant to improve a receding chin, jaw surgery to correct a disfiguring overbite or cleft – these are situations where the other options just may not be enough. Surgery is often considered the last option, but in some cases the results are worth the risks.

 

The Comprehensive Approach

The comprehensive approach utilizes all of the above options. Often this means combining two or more of the above treatment modalities.   It starts with identifying the patient’s desired result, budget, lifestyle issues, and time frame. All of these factors can influence a patient’s decision about treatment and should be taken into consideration by the dentist.