Something to Smile About

New Dental Techniques Can Make A Big Difference In How You Look

by Steven E. Bornfeld, DDS

When most people think about the dentist (if they think about the dentist at all), they tend to have unpleasant associations--pain, expense, even fear. But while treating and preventing oral disease will probably remain the bulk of what most dentists do day-to-day, there has been a quiet explosion in the number and variety of dental procedures aimed primarily at improving the way people look and feel about themselves and their smile.

Dentistry has been successful in allowing people to hold on to their teeth longer than ever. Techniques and materials have been developed that make it possible to make vast improvements in the way a smile can be restored. But the major reason cosmetic dentistry has become a big deal is because people demand it. While people used to expect to lose their youthful appearance with age, women (and men) are more knowledgeable about cosmetic procedures today, and many have the desire and means to do what is necessary to look their best. This is certainly the case with dentistry.

Bonding resin and recontouring teeth

Some cosmetic flaws can be quickly treated in one visit. Teeth that are chipped, rotated, crowded and stained can be treated by selective grinding. There are limits, of course, to how much grinding you can do. But sometimes it just takes a bit to make teeth appear more pleasingly shaped, eliminate apparent chips, and even minimize the appearance of crowding, tilting, and the rotation of teeth.

If it is necessary to add contour or size or repair a larger chip, it can be quickly accomplished by bonding composite resin. Resins have been continually refined over the years and, when combined with stronger bonding agents, can make highly cosmetic, longer-lasting restorations than was possible in the past. Used along with judicious recontouring, it is possible to remake a smile -- quickly and effectively.

White, whiter, whitest!

Sometimes it's possible to make a major improvement in your smile without a drill touching it. By now, most people have heard of vital tooth bleaching. It's relatively quick, pain-free and low risk; it does not weaken the enamel when done properly. Usually your dentist will make a custom "tray" for either or both jaws, and send you home with the trays, some bleaching agent, and instructions on proper use. It is also possible to have in-office bleaching with the aid of laser or light activation. This is quicker but usually more expensive and more likely to temporarily leave you with sensitive teeth. There are also over-the-counter bleaching methods. Some, such as bleaching strips, are relatively inexpensive but generally give slower results than bleaching in a dentist-supplied custom tray.

A few words of caution: Bleaching does not work uniformly for all kinds of stain. It will not (for example) bleach old, stained resin fillings, so if after bleaching, the old fillings stick out, you may want to have them replaced. Whitening may need periodic "touch-ups" to maintain your best tooth shade. Last, it's best to avoid bleaching gels sold over-the-counter and intended for use in "boil and bite" night guards. These bleaches don't have a long shelf life, and if they aren’t stored well, they may not work as intended. Worse, the "boil and bite" night guards simply don't fit your mouth well enough to keep the bleach where it belongs--on your teeth. Occasionally you will see ads for bleaching gels to be used in these poorly fitting trays that are quite concentrated--powerful enough to irritate and burn your gums when the bleach leaks out.

Get your bite right

Many of us had braces when we were kids. But with the birth rate down, orthodontists have discovered--ADULTS! Orthodontic technology has come a long way since the "railroad tracks" of years ago. The most well-known of these new techniques is Invisalign, a high-tech method of moving teeth without bands, brackets, wires--or any metal at all. The dentist takes impressions of your teeth; the laboratory makes a series of "aligners"--each just a little different in tooth position from the preceding one. Every two weeks or so the patient "graduates" to the next aligner. After a series of perhaps 10 to 15 aligners, if all goes well, the teeth have been moved to the intended position. Other companies are now introducing similar technology, which might bring prices down.

Invisalign is not appropriate for all orthodontic situations. Go to an orthodontist who does multiple orthodontic techniques so you can be treated with the method best for you. Even if Invisalign isn't for you, there are clear braces, lingual braces (that go on the inner surface of the teeth)--in short, it is very likely you can be treated with little or no metal showing.

If you can't bleach it, cover it

There are some situations where bleaching, resin bonding and cosmetic recontouring will not be enough to give you the smile you want. Severe discolorations from childhood antibiotic use, dental fluorosis, and other defects of the enamel generally cannot be adequately treated by bleaching or cosmetic bonding alone. Porcelain laminate veneers are often the best way to handle these problems; they are custom-made on a model of your teeth and bonded in position on the front surface of the teeth. When made by a skilled ceramist, they are beautiful and sturdy and can last many years. It is possible to even obscure minor orthodontic problems--crowding, tipping, rotations of teeth. While they can be expensive, they make for a striking improvement in your smile that will last a long time, so they are often a worthwhile investment.

What if the problem is with your gums?

Most people associate periodontists (gum specialists) with periodontal or gum disease, but there are several situations where a periodontist can address specific cosmetic problems--some of which are unrelated to gum disease per se.

Sometimes, because of tooth position or lip position, an unpleasantly large expanse of the upper gum is exposed. The gum line may not be even from tooth to tooth. In less severe situations, some gum tissue can be removed selectively from teeth to achieve a much more even and attractive gum line. More severe situations may have excessive growth of the jawbone. These can be addressed too--generally by a combination of orthodontic and surgical treatment--but this is a far more aggressive treatment and should be discussed with your dentist.

Sometimes there is a deficiency of gum--often cleft-like defects on the facial surfaces of teeth--especially the lower incisors, upper canine and first molar teeth. While not all these problems can be successfully treated, advances in guided tissue regeneration have enabled periodontists to correct many of these defects that previously could not be treated.

These are just a few of the newer techniques in dentistry that can help give you a dazzling smile. Some of the newer materials and techniques have become part of everyday practice, so in a very real sense ALL dentistry has become cosmetic dentistry. If your smile is of concern, know that dentists now have the tools to give you the smile you've always wanted.

Steven E. Bornfeld, DDS, was a clinical instructor in operative dentistry at NYU College of Dentistry. He is a longtime member of the Academy of General Dentistry and the Brooklyn Dental Study Group. An active participant in many professional and public dental forums, he has practiced general and cosmetic dentistry in Brooklyn, New York, in partnership with his twin brother, Mark, since 1977.