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Smile Makeovers: Cosmetic Dentistry Today

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space placeholder.Good as New.
space placeholder.Many Choices.
space placeholder.Perfect Smiles.
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In the United States today, it seems that everyone wants to look young. This, of course, includes the teeth we show when we smile. In recent years, more people have become concerned about having teeth that are straight and free of stains, chips or other obvious flaws.

Popular television shows that provide makeovers encourage this point of view. So do articles and advertisements about whitening agents and smile makeovers. As a result, people often want their teeth to be perfectly uniform and dazzlingly white.

Dental offices have responded to consumer demand. They offer many services, including:

  • Porcelain laminates
  • Bleaching
  • Bonding
  • Replacing amalgam (silver) fillings with white fillings

Virtually all dentists perform some types of cosmetic services.

Most cosmetic procedures are not covered by dental insurance. However, procedures done to repair a cavity or replace a defective filling, crown or other tooth restoration may be covered. The cost of some cosmetic procedures can easily exceed $1,000 per tooth. Despite the cost and inconvenience, many people want a "smile makeover." They think it's just as important as having nice clothes or attractive hair.

Older restorative materials such as gold or amalgam are durable and strong but are not tooth-colored. Newer techniques and materials allow for the placement of tooth-colored fillings.

"I had crooked teeth for years," recalls Mike Gagliardi, an advertising sales manager in Philadelphia. Gagliardi decided to have his upper teeth capped to give them a straighter look. "At one point, when the dentist took a break, I went into the bathroom and looked in the mirror. It was awesome."

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space placeholder.Good as New
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Dentists have been doing cosmetic work for decades. But the materials that were used had serious drawbacks. For example, the early composite (plastic) resins tended to stain, chip and change color over time. This limited their use.

New composite resins (tooth-colored fillings) are much better. Porcelain veneers cover the entire front of the tooth. They also can be placed with minimal cutting of the enamel. They are another option when the color and shape of the teeth need improvement. Composites are not as strong as gold or amalgam, but they have been much improved over the years. Newer composites are long-lasting and strong.

When a tooth has minor chips or a small fracture, many people choose to live with it. Others decide to have a crown (also called a cap) made and placed in the mouth over the tooth. This process is time-consuming and often expensive. However, it's often possible to "patch" minor flaws, chips or broken teeth with bonding composite resin. This can be smoothed and color-matched to the surrounding teeth.

Computer imaging is another useful technique. It allows dentists to create "virtual restorations" on a computer screen. A patient can see what the results will look like before deciding to get cosmetic work done. This imaging technique is relatively new, but more dentists are acquiring it.

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space placeholder.Many Choices
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Chipped teeth can be fixed with a technique called bonding. Your dentist can repair damaged areas by applying a "paste" made of a material called composite resin. The resin comes in a wide variety of shades to match your tooth color. First your dentist applies and shapes the plastic filling material. Then it is exposed to a special high-intensity blue light. It hardens almost instantly. The resin can be sanded, smoothed and polished until it closely matches the natural shade and shape of your tooth.

The most popular cosmetic dental procedures include:

  • Bonding front teeth
  • Whitening the teeth
  • Veneers
  • Crowns
  • Using tooth-colored fillings, which blend with the natural color of teeth.

Dental adhesives also have improved. Older dental materials were held in place by the shape of the tooth. Dentists had to remove part of the tooth to make sure that a filling would stay securely in place. But today's adhesives are very strong. They can hold a filling in place without the need to remove as much of the tooth.

There are many cosmetic options, depending on what you need to have done. For example:

  • Stained or discolored teeth — The enamel that covers the teeth can get stained. The underlying tooth structure (the dentin) also can get yellow over time. Bleaching is an option for healthy teeth. Bleaching can be done in the office or at home using molds made by the dentist to fit your mouth. The first option might be an over-the-counter bleaching product.


  • Chips or rough spots — These can be filled with a tooth-colored material called composite resin. This material can be chosen to match the color of your teeth. Once it's smoothed and polished, it will look virtually the same as the surrounding area.


  • Cavities or cracks — Traditional amalgam fillings work fine in the back of the mouth. However, most people don't want to reveal a "metal mouth" when they smile. Silver amalgam contains mercury. This can be toxic to the nervous system. However, leakage of mercury into the mouth is believed to be very low. The U.S. Food and Drug Administration has not found any reason to limit the use of amalgam. But some dentists and patients prefer not to use silver amalgam.

    An alternative is to use tooth-colored fillings. These fillings are made of a plastic material similar to that used to repair chips or cracks. Some white fillings (direct composites) are pressed into the cavity and cured (hardened) with a special high-intensity blue light. Others are made in a laboratory and then cemented in place. These include special composites and porcelain fillings called inlays and onlays. They cover a larger surface area of the tooth. Laboratory-made composites and porcelain fillings cost much more than amalgam fillings, but are much more attractive.


  • Uneven teeth — It's not uncommon for a tooth to be slightly longer or have a different shape than its neighbors. With a procedure called recontouring, your dentist can reshape the tooth so that it's a better match.


  • Gaps between the teeth — Small gaps can be closed by applying composite material between the teeth. This makes each tooth a little wider than before. For large gaps or other surface flaws, your dentist may recommend veneers. Veneers are among the most costly cosmetic procedures. They are permanently bonded to the fronts of the teeth. This gives them an entirely new appearance. Veneers are made from ultra-thin shells of porcelain that are matched to your exact tooth color. Your dentist also may refer you to an orthodontist to close the space between your teeth. Some people like or don't mind a gap. Others are very aware of it and want it closed. You and your dentist can determine the best treatment option. In some cases, the best option is no treatment. In others, it may be bonding, veneers or braces.


  • Broken or crooked teeth — If a tooth has been badly broken or is structurally weak, you may need a crown. Today, crowns on front teeth are made of tooth-colored porcelain. It can appear very natural. The crown may be all porcelain, or, more typically, porcelain with metal inside that fits over the tooth. Both types of crowns offer excellent results. Your choice depends on your bite and what you and your dentist prefer.

Cosmetic procedures vary in technique and cost. Before you start a treatment plan, consider all the options and make an educated decision. Remember, these procedures cannot be reversed.

"It was worth every penny," says Gagliardi, who had his teeth capped in 1985.

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space placeholder.Perfect Smiles
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Be cautious about starting an extensive and costly elective procedure to change your appearance. If you want to change the color of your teeth, be aware that teeth are rarely pure white. You might not be satisfied to see that shade on your smile. A less-intense white may be more likely to give you the look you are seeking.

In addition, excessive or frequent use of bleaching agents can lead to tooth sensitivity. Whitening can be done in your dentist's office or at home. If you whiten your teeth at home, be sure to follow the directions and to consult with your dentist.

Cosmetic dentistry can improve your self-image, particularly if you have damaged or discolored teeth. Even simple procedures such as bleaching or bonding can be real confidence-boosters.

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