Cosmetic Dentistry

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.

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 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.

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. I have found that a combination of in-office and at-home systems works the best, and routinely achieve 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 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 gets 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.

I prefer the all resin bonded bridge because it is more esthetic (no metal shows through and "grays" the surrounding teeth) and does not fall out and have to be re-cemented nearly as much as a metal bonded-bridge. The procedure takes about a half an hour and costs between $700 and $1200. For comparison, a bridge to replace one tooth can cost anywhere from $1600 to $3000 and an implant from $1800 to $3500.

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. When I do a veneer case, I often include a gum-lift, if needed, at no extra cost.

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.

I sometimes recommend braces to my adult patients for cosmetic reasons, but very few are interested. They would rather use other cosmetic options that get results faster, usually within two weeks, and often for less money.

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.]