Cosmetic Dentistry for Better Teeth
We all get obsessive about our skin, monitoring every incipient line, splotch, and hint of sagginess. But we don’t always give that kind of scrutiny to our teeth. "Our teeth age, just as our skin does," says Jeff Golub-Evans, DDS, of the New York Center for Cosmetic Dentistry. "Most people don’t even notice the changes until you point them out in the dentist’s chair."
Fortunately, the signs of wear, tear, and time on your teeth can be much easier to reverse than the ones on your skin. "I have many patients who walk in thinking their next stop is the plastic surgeon’s office," says Michael Apa, DDS, a cosmetic dentist in New York City, "and they find they can wait indefinitely." The trick is pinpointing the procedures that will make the biggest difference. Here, our beginner’s guide to improving your smile.
Age Change: Shorter Front Teeth
Why:Teeth wear down with use. "By the time you reach 40, the two upper front center teeth are as much as two millimeters shorter than they were in your 20s," Golub-Evans says.
How It Ages You:"When you smile and reveal little or no top teeth, you can look toothless," Golub-Evans says. "As your teeth shorten, they can also cause your lips to sag inward, creating a thin, tight-looking smile — instead of the fuller, softer look you have when you’re younger."
How to Fix It:Your dentist can elongate the front teeth slightly with bonding or, more dramatically, porcelain veneers. With bonding, tooth-colored material is applied and hand-sculpted to the teeth by the dentist. Veneers are thin porcelain jackets that cover the front of teeth. Whichever method they use, good dentists are adept at choosing colors that will complement those of your natural teeth. Teeth aren’t actually white; they’re slightly yellow with a tiny bit of blue just before the edge. "We’re using shades of white that have some blue and even yellow in them," notes Marty Zase, DMD, a dentist with an emphasis on cosmetic dentistry, in Colchester, Connecticut. "Natural is always more flattering than matte, stark white, which not only looks artificial, it’s like you’re trying too hard to look younger."
What It’s Like:"Bonding was a no-brainer," says a 44-year-old therapist from Wilton, New Hampshire. "After an hour and a half, I walked out with younger, whiter teeth." Veneers require two, sometimes three appointments, and one of them will be a bit grueling. "Your teeth have to be ground down," says Wendy Lewis, 48, a coauthor of America’s Cosmetic Doctors and Dentists. "When I had mine done, it didn’t hurt, but I was very aware of the temporaries, which also felt weird when I ran my tongue over them. Once the permanents were in, the end result was beautiful."
Caveats:If your dentist will be treating just the two front teeth, it’s important to ask about how their colors will look. "We can lighten what’s already there to make them blend or choose a natural shade for the cosmetic work," Zase says.
Age Change: Worn-Down Teeth
Why:Wear and tear smoothes and flattens tooth edges and surfaces.
How It Ages You:The tiny ripples at the bottom of your teeth, and the slight ridges on their surface, give your teeth dimension, character, and youthfulness. When they wear down, "your teeth look square, boxy, and unnatural," says Ada S. Cooper, DDS, a dentist in private practice in New York City.
How to Fix It:Most cosmetic dentists recommend veneers. "Porcelain veneers are created from a mold of your own teeth," says Zase, "so you can get a lot of the detail back."
What It’s Like:Depending on how many of your teeth you want to correct, you’ll sit through two and often three appointments lasting an hour to two hours each. But you’ll be able to correct most aesthetic concerns: color, position, shape, and texture.
Fix Crooked and Chipped Teeth
Age Change: Crooked Teeth
Why:Over time, teeth begin to shift position and angle inward. "Fewer than 10 percent of us have teeth in the same position in our 50s as we did in our 20s," Golub-Evans says. "And that includes adults who had braces when they were younger."
How It Ages You:As your teeth move inward, they provide less support to your cheeks and lips, creating a hollowed, gaunt appearance. "Crooked teeth can look more severe on an older face than on someone in their teens or even 20s," Golub-Evans says.
How to Fix It:You have two choices: braces or veneers. "Many patients who are not thrilled with the idea of veneers are opting for Invisalign braces," Golub-Evans says. "These clear acrylic molds gradually move your teeth back into position. They’re noticeable from only a few feet away. One of my patients, who is in TV news, even wore them on the air."
If you want the additional perks of whitening and reshaping, you can realign your teeth with porcelain veneers. You’ll also be adding a little extra bulk to the teeth to support facial tissue. "When you fill out your teeth a bit with bonding and veneers, it may pull the smile back up, like a mini lift," Golub-Evans says.
What It’s Like:"I used the braces because other than the fact that my teeth were crooked, they were in very good condition," says a 43-year-old salon owner in Louisville, Kentucky. "Most people didn’t notice the braces until they came right up to me. It took about nine months to get all of my teeth where they belonged, but it was worth it."
Caveats:While Invisalign braces are a popular choice, keep in mind that they correct only position. "I have people finish up braces and then realize that they also want bleaching," Apa says. "And then they wonder if they really should have had veneers in the first place. Just make sure you’ve fully explored how your expectations will match up with the results."
Age Change: Chips and Cracks
Why:Thinning enamel and years of wear can cause fine cracks on the surface of your teeth.
How It Ages You:Cracks trap food and beverage particles that can darken and stain teeth.
How to Fix It:Consider bonding, veneers, or crowns.
What It’s Like:Applying a crown requires two visits: one for making the mold and applying a temporary, and the other to apply the finished crown. You will most likely need novocaine at at least one visit, because a relatively deep crack can expose nerves.
Caveats:Crowns are the longest-lasting dental restoration — up to 20 years, as opposed to about seven years for bonding. Keep that in mind when doing the cost-benefit analysis of the two procedures.
Get Whiter Teeth
Age Change: Your Dental Work Discolors
Why:"We think of them as being permanent, but most crowns, fillings, and bridges last 10 to 15 years," Apa says. "They darken and discolor over time, just like real enamel."
How It Ages You:When you smile, you get a rainbow effect; that multihued jumble of discolored crowns, darkened fillings, and your own teeth is an instant ager.
How to Fix It:Replace and upgrade your old dental work. "Because so many materials have improved during the past 10 years, you’ll be amazed at how much better these corrections can look," Golub-Evans notes. "You can opt for invisible porcelain fillings, more translucent crowns, and maybe a bleaching treatment to even everything out."
What It’s Like:"It took two visits to replace three crowns and my old metal fillings," says a 48-year-old pharmaceutical executive in Summit, New Jersey. "It looked as good as veneers because everything was uniform."
Caveats:Since your goal is undetectable dentistry, you may want to whiten your own teeth first and then choose whiter, brighter dental restorations. If you don’t choose to whiten, selecting toned-down shades for your replacement dentistry will keep everything in the same color family. "Either way," Cooper says, "you’ll be amazed at how much better your smile looks when everything blends together."
Age Change: Yellow or Dark Teeth
Why:Over the years, your teeth’s protective enamel thins, becoming less white and more prone to stains. That means the yellowish internal part of the tooth, the dentin, begins to show through the enamel. The pulp inside the tooth may or may not shrink: if it does, it adds to the darkness.
How It Ages You:"The combination of thinning enamel and stains," Zase explains, "makes your teeth look gray."
How to Fix It:Bleaching may be the answer. To test whether it will work for you, hold a piece of printer paper up to your teeth under incandescent light. If your teeth are yellow compared with the paper, you should get good results from bleaching. "You can often get nine or 10 shades lighter with a custom-made tray for home use or an in-office bleaching appointment," Golub-Evans says. "But you can also get good results from over-the-counter strips. They’re a milder version of the active ingredient we’re using in the office — around eight percent, as opposed to 15 or 20 percent — and they can often take you six shades lighter."
If your teeth look brown when you use the paper test, it means that both internal and external changes are responsible for the discoloration and your results from bleaching won’t be as dramatic. It may even turn your teeth slightly gray. And if your teeth look gray with the paper test, the change is caused by internal trauma, and bleaching won’t do a thing. You’ll need veneers or bonding if you want to make your teeth look white again.
What It’s Like:In-office peroxide bleaching, with or without a laser (in the laser procedure, a light activates the bleaching chemicals), takes about an hour and is relatively painless, unless you have sensitive or receding gums. "In that case, the doctor can protect sensitive areas with a gel mask or avoid treating those areas with peroxide — but you may feel some stinging," Zase says. Bleaching can also make your teeth temporarily sensitive to temperature; this will resolve in a day or two after the whitening session. If you opt to use custom-made trays for at-home bleaching, you’ll have to sit through one appointment so the doctor can create molds, but then you can use the trays indefinitely. "You wear them every night for an hour or more for two weeks. Though some people don’t have the patience and others find it a bit uncomfortable, it works just as well as the in-office treatments," Golub-Evans says.
Caveats:Ask your doctor to show you on a color chart just how light your teeth may get from bleaching. "Even though I got a few shades lighter," Lewis says, "it wasn’t as big a transformation as I’d envisioned for $1,500."
Laser bleaching is certainly more expensive, but is it necessarily better? "As long as the dentist is experienced, you’ll get similar results from any of the methods," Golub-Evans says.
Resist overdoing it with home bleaching systems. "People try to get better results by wearing the products for longer than directed or by using them too frequently," Zase says. "Not only can that cause gum irritation and tooth sensitivity, but overwhitening can also make the teeth look bluer or more translucent, especially along the edges."
The Price of a Younger Smile
Over-the-counter strips, about $40 for a two-weeks supply; at-home whitening system, $200 to $500; in-office bleaching, $300 to $2,000
$500 to $750 per tooth; restorations last three to five years
About $3,000 to $6,000
$1,200 to $2,500 per tooth
About $850 to $1,600 each; lasts 10 to 15 years
$1,000 to $3,000 per tooth; lasts 15 to 20 years
The Dental Mini-Lift
Your skin looks tighter, your lips fuller, your smile wider — without a single incision or a nanosecond of healing downtime: Say hello to the dental mini lift. "No matter what your age, a good cosmetic dentist can help play down certain features and enhance others just by strategically shaping and contouring your teeth," says Anthony Vocaturo, DDS, a cosmetic dentist in private practice in Bayonne, New Jersey.
Basically, your dentist uses bonding material, crowns, or veneers to build up some of the teeth along the sides of your mouth. The number of teeth treated depends on your facial structure and the condition of your teeth. (Often the bottom teeth don’t need to be built up. If you think of how a face "hollows," it’s more pronounced in the upper regions.)
"At our office, many patients try this procedure before they consider plastic surgery," Golub-Evans says. "Adding some bulk to the front surfaces of the top side teeth widens the smile, softens nasal labial lines, and perks up the midsection of the face. Depending on how much we build up the outer corners, it can also give you a softening of lipstick lines and turn the corners of the mouth up."
"My friends all thought I had done something surgical," says one New Yorker in her 50s who underwent the bonding procedure. "I really felt as if I had erased five to 10 years in an afternoon." And a woman from Long Island, whose dentist used veneers, reports: "I looked like I just had the nap of my life. Everything moved up a bit."
Have a clear idea of a budget when you walk into the dentist’s office. And if you find a doctor who uses computer imaging, you’ll be able to see a realistic picture of the results you can achieve with the amount of money you want to spend.
How to Choose a Cosmetic Dentist
"There is no legal definition of a cosmetic dentist, and too many dentists, seeing the promise of huge profits, are venturing into the field without so much as a single seminar on the subject," warns Michael Apa, DDS, a cosmetic dentist in New York City. Both the American Dental Association (ada.org) and the American Academy of Cosmetic Dentists (aacd.com) have stringent credentials programs and provide lists of local doctors on their Web sites. "You’re looking for a dentist who does cosmetic work on a regular basis, not someone who does veneers or bonding occasionally," Zase says. Here, other key things to consider.
Ask to see before and after photographsof a dentist’s patients to make sure you like the results. Specifically ask whether the doctor took the photos and didn’t just download them from the Internet. "If all the photos are similar 8-by-10 glossies, they may have been purchased," Golub-Evans warns.
Ask which lab the doctor usesfor creating veneers and crowns, and ask to see several samples. "The dentist can’t create the final product on his own," Apa notes. "It’s also his ceramicist, the one who makes the restorations, who makes a difference."
Inquire whether the dentist has performed cosmetic restorationon anyone on the office staff, so you can see the results. Or ask if any patients who had procedures similar to the ones you’re considering would be willing to talk with you.
When you go for your consultation, bring photos of smiles you like and smiles you don’t with you. Ask the dentist for his or her opinion. It’s all about collaboration. "Everyone has different tastes and cultural biases," Golub-Evans notes. "In cosmetic dentistry, success for the patient is as much about style as it is fit and comfort."
Originally published inMORE magazine, July/August 2007.
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