Make Over Your Mouth
From a mere cleaning to tooth whitening to "smile design," a trip to the dentist can be a cosmetic experience these days.
By Martin Downs
Reviewed By Brunilda Nazario
If you're in the market for a makeover, there are many beauty specialists who can help you. You might turn to a hair stylist, cosmetic surgeon, or dermatologist. You probably wouldn't think of going to the dentist, yet dentists can do things for your appearance that no one else can.
It goes far beyond scraping the plaque off your choppers during a biannual checkup. "We have procedures where we can change the shape, size, and color of the teeth," says Michael Malone, a cosmetic dentist in Lafayette, La., and president of the American Academy of Cosmetic Dentistry.
Cosmetic dentistry isn't exactly a dental specialty. Those who call themselves cosmetic dentists do cleanings and drill cavities, too. They're just particularly interested in aesthetics, and they have extra training to do cosmetic procedures.
The simplest and most common thing they do, akin to having Botox shots, is tooth whitening. This is nothing new, but it is cheaper and easier today than it used to be.
"We were doing it 30 years ago," Malone says. "We were using at that time a very, very strong solution of hydrogen peroxide -- so strong that if it touched the lips or the gums it would actually injure a person."
In this type of tooth-whitening treatment, called "power bleaching," teeth are isolated with rubber dental dams, and the peroxide solution on the teeth is heated up with lamps.
"It worked, but it was so much trouble that very few people would go through it," Malone says. "Also, it was quite expensive because it took so long in the dental chair."
Power bleaching is still available, but there's a cheaper alternative. A new tooth-whitening technique uses lower-strength peroxides that are left on the teeth longer. Nevertheless, you don't pay for so much of the dentist's time.
After the dentist makes sure your teeth are healthy enough for the treatment -- fillings, bridges, cavities, or a gum infection may rule it out -- you have an impression of your teeth taken, and the impression is used to make a tray that holds a peroxide gel on the teeth. You wear this tray at home for a few hours every day, over the course of one to five weeks.
The resulting brilliant whiteness still isn't cheap. Depending on where you live, a take-home tooth whitening can cost anywhere from $150-$1,000. Double that for an in-office bleaching.
Tooth whitening can be just the beginning. If you want to get serious, you can have your teeth and gums overhauled completely. "Smile design" is what San Francisco cosmetic dentist Jerry Bellen calls it.
"Smile design is looking at the positions of somebody's teeth, and how the teeth are framed by the lips," he says.
For example, if your gums show too much when you smile, that can be fixed. "We do what's called a gum lift," Bellen says. "The technical term for it is crown lengthening."
This is a surgery that can be done in the dentist's office, whereby the gums are pushed up so that more of the teeth show. "Surprisingly, there isn't much pain," Bellen says. "It's a fairly minor surgery."
You can also have your teeth shaped any way you want them to be. Bellen says that lengthening and rounding the edges of your front teeth can actually make you look younger. A lifetime of chewing (and especially of nail biting) wears down your teeth. Even after a facelift, worn teeth can add years to your appearance.
To shape a tooth, a cosmetic dentist may bond a resin or porcelain veneer or crown to it. Resin bonding is the older method. "It still is good and used a lot today," Malone says, but it doesn't last as long as porcelain, the newer material.
Resin may, in time, wear out or become discolored, whereas porcelain doesn't. The other difference is that resin bonding is done in the dentist's chair. For a porcelain veneer, a mold is sent away to a dental lab to be made, then bonded on later.
In addition to shaping teeth attractively, a cosmetic dentist can give you pouty lips. "We take profile photographs of the lips," Bellen says, "If somebody wants a fuller lip, we can actually increase the bulkiness of the veneer," so that it pushes the lip outward.
Tetracycline stains can also be covered with veneers. "When tetracycline [a commonly used antibiotic] is given as a child, it tends to stain developing teeth," Bellen says. "It happens in bands -- striations across the teeth."
If your molars are a mess of metal fillings, that can be fixed by grinding them down and capping them with new porcelain crowns.
The Architecture of a Smile
Bellen says a cosmetic dentist can do just about anything needed to improve your smile, but he stresses the work must be carefully planned. "I go though a pretty detailed evaluation before I start any work at all," he says.
Your bite -- the way your teeth fit together when your mouth is closed -- is an important consideration. "You can put porcelain on everything and not pay attention to the bite, and have everything break down," Bellen says.
That means that before any veneers or crowns go on, your teeth may need to be realigned, and you may even need jaw surgery. "I, as a cosmetic dentist, will diagnose and plan the treatment," Malone says. Then he may involve other professionals, such as an orthodontist or an oral surgeon.
When teeth need to be realigned, it's usually an orthodontist who takes care of it. And you may not need braces. Many people can have their teeth straightened with the Invisalign system, which uses clear plastic "aligners" to gradually move the teeth around. Although it is widely accepted, "You cannot use Invisalign for every case that you can use braces for," Malone says.
Often the jaw can be repositioned without surgery, but sometimes an oral surgeon may need to join the team. As part of a "whole mouth rehabilitation," as Bellen terms it, some people need to have a severely recessed or protruding jaw corrected.
How much you want done depends on how much time you're willing to commit to it, and how much money you have at your disposal. Strictly cosmetic dental work isn't covered by insurance, and the cost can be steep. Veneers, for example, may cost as little as $250 and as much as $2,000 -- per tooth.
Again, you would be paying for a lot of time in the chair. Bellen says he sometimes works on a single patient for a full eight-hour day. What's more, the end result can take many months to accomplish. "There are cases I have in progress right now that have been going on for a year," he says.
But for some, an elaborate and costly production may be worth it in the end. "People smile more when they have nice-looking teeth," Bellen says. "Your whole face brightens up."
Published Aug. 4, 2003.
SOURCES: Michael Malone, DDS, president, American Academy of Cosmetic Dentistry. Jerry Bellen, DDS. AACD cost estimates.
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