Esthetic Dentistry: Cosmetic Dentistry to Improve Your Smile

Jan 2, 2018

People almost always want to appear ‘normal’ in most ways, and like their appearance to be acceptable to the people they interact with. In general, very little of our bodies is observable to the public when we are clothed. Surveys have shown that when we first meet someone, the areas they observe the most are the eyes and smile, and therefore, by default – our teeth. Our head and face are almost always observable, and the mouth and eyes are the major features of our facial expressions. Because of this, a deformed, diseased or abnormal facial appearance can lead to poor or misinterpreted expressions, and low self esteem. Therefore, while the primary function of our teeth is to aid eating, this combination of functions makes our mouth important to us in many different ways. Learn the many ways in which cosmetic dentistry can improve your smile.

The capabilities of modern dentistry allow for the alteration and upgrade of appearance of almost any objectionable oral condition you may have seen or could imagine. The wide reach of dentistry and its specialties and subspecialities, combined with some of the fields associated with dentistry such as plastic surgery, mean almost any alteration imaginable is possible. Let take a closer look at what changes and upgrades can be made, and how they are achieved:

What you see or feel

Conditions, symptoms or signs related to esthetic dentistry

Discolored Teeth (Dark, Light, Mottled, Spotted, Striated)

There are many conditions that can lead to teeth becoming discolored (gray, brown, orange, green, blue, white, yellow, etc.). Some causes of tooth discoloration include:

  • Certain chemicals ingested during the early, developmental years of life
  • Injury or trauma or injury to the primary (baby) teeth that harms the developing permanent teeth
  • Excess ingestion of fluoride during the early years of life
  • Certain drugs and medications taken for a variety of early-childhood diseases
  • Metallic fillings that give color to a tooth
  • External stains caused by consuming certain foods and beverages

If you have discolored teeth, some of the available color restoration options currently available include:

  1. Thorough cleaning of the teeth by a dentist or dental hygienist
  2. Tooth bleaching
  3. Microabrasion
  4. Bonding
  5. Replacing metallic fillings with white fillings
  6. Veneers
  7. Crowns (caps)

Gaps Between The Teeth (Diastemas)

While spaces between the teeth are considered ‘normal’ in some cultures, they are not the ‘normal’ appearance in many others, and many people wish to eliminate them.

Some of the causes of spaces between the teeth include:

  • Teeth that are too small relative to the size of the jaw
  • Past removal of a tooth
  • Lack of development of some teeth
  • Orthodontic movement that didn’t completely close gaps
  • Tight muscle attachments (frena) that prevent teeth from coming together

Some gaps can be closed with very little effort, whereas others can be much more difficult to eliminate. However, all spaces can be closed if that is what the patient sincerely desires. The most commonly used methods for closing gaps between teeth are:

  1. Orthodontic therapy
  2. Bonding
  3. Veneers
  4. Crowns

Worn Teeth

Wearing of the teeth to some degree is a natural occurrence throughout our lives, and research has shown that the act of eating wears natural teeth slightly more than the thickness of a human hair per year. This normal wear will not be noticeable until we are in our later years in life. However, there are those – up to one third of the population – that habitually or unknowingly bruxes or clenches their teeth together, resulting in wearing their teeth significantly more and faster than usual. This leads to their teeth quickly deteriorating both in a appearance and function. In some cases, the teeth become so worn that they appear to have no teeth when they smile.

Although those with significantly worn teeth usually present complex treatment challenges, some of the possible treatment options available include:

  • Bonding
  • Veneers
  • Crowns
  • Orthodontics
  • Periodontal surgery (gingivectomy) to remove a portion of the gum tissue to make the teeth appear longer
  • The use of a plastic mouth guard to reduce further tooth wear

Fractured Teeth

It’s not uncommon for children to damage their teeth at some point, and as many as half of all children in some countries break a front tooth. This can be upsetting to parents as it can impair the appearance of their child. It’s also not uncommon for adult to fracture their teeth.

If a fracture reaches the dental pulp, root canal therapy is often required before a suitable restoration procedure can take place. If the fracture reaches below the gumline, then a gingivectomy (contouring the gum tissue) may be necessary before the tooth can be properly restored.

Although it does happen, it is unusual for a tooth to be fractured so badly that it requires extraction, which then creates a space which should be restored. Depending on the circumstances and level of damage, the following treatments can take place to restore or remove a fractured tooth:

Restoration is always the preferred method, but sometimes damage can be so severe that an extraction is the best option.

Irregularly Shaped Teeth

There are various conditions that cause teeth to develop in irregular shapes. These include damage or injury to the primary (baby) teeth, childhood diseases during tooth development, prenatal diseases of the mother, genetic disorders, and many others.

In cases where the teeth are spaced relatively normally, there are usually three options that can be used to improve the esthetics of irregularly shaped teeth:

In most cases, only one of these options is required to provide an excellent improvement in esthetics.

Too Much Gum Tissue on Display

A ‘gummy’ smile isn’t particularly unusual, and is usually caused by a disproportion of the gums and the underlying tissue of the jawbone. While not usually harmful, the appearance can be displeasing to some. Some possible treatments include:

  • Periodontal surgery (gingivectomy)
  • Orthognathic surgery
  • Plastic surgery

Speak to your dentist about your options if you’re unhappy with your ‘gummy’ smile. Remember, this condition typically isn’t harmful to you, but options are available if you wish to alter your oral esthetics.

Too Much Tooth Root Surface on Display

Our gums naturally recede as we get older, meaning more surface of our tooth roots are displayed. The roots of our teeth are darker than our crowns (the visible portion of the tooth above the gumline) as they contain more brown pigments. Teeth also get narrower the closer they get to the root. A receding gumline often exposes the darker, narrower portion of our teeth, often resulting in an overall unattractive appearance. This condition is common in those over age 50, but thankfully there are many esthetical improvement options. Bonding, or placement of veneers or crowns are all suitable procedures to improve the unsightly appearance caused by receding gums.

Too Little Tooth Structure on Display

There are many conditions that lead to too much gum tissue growing – sometimes so much so that it almost grows over the teeth – resulting in the appearance of teeth being shorter than the really are. The upper lip can sometimes be excessively long, which can give the appearance of short teeth, even when smiling. There are many corrective procedures available for this condition, such as:

  • Periodontal surgery (gingivectomy) for removal of some of the gum tissue
  • Bonding
  • Veneers
  • Crowns
  • Orthognathic surgery for lengthening the upper jaw

Teeth Appear Too Long

Sometimes teeth can develop to be unusually long, and occasionally, an individual’s occlusion (dental bite) doesn’t wear their teeth in a normal manner, meaning their teeth remain long even after many years of use. Thankfully, there are at least three possible alternatives:

  • Tooth recontouring
  • Orthodontic treatment
  • Orthognathic surgery

Teeth Are Crooked or Not Straight

When teeth do not erupt in straight alignment, the result is teeth that are crooked in appearance. Orthodontistry is the major area of dentistry that deals with the realignment of crooked teeth, and offers many treatment options:

  • Orthodontic treatment
  • Orthodontic treatment combined with orthognathic surgery
  • Tooth recontouring
  • Bonding
  • Veneers

Irregular Smile

There are many types of smile irregularities – the most common are:

  • Slanting edges of the upper or lower teeth. This puts the smile out of alignment with the rest of the face.
  • The teeth develop normally, but the gums have developed irregularly giving the appearance of teeth that are too long or too short.
  • The midline of the upper teeth are misaligned with the midline of the lower teeth.

Thankfully, many alternative options exist for creating these conditions:

Upper or Lower Jaws Backward or Forward Compared With Normal Relationship

This type of skeletal malformation does not occur too often, but for cases when it does, it is not difficult to surgically correct. The position of the jaws can be changed by surgically lengthening the upper or lower jaws, or both. Some minor malformations can be corrected through orthodontic treatment. Other alternatives for this type of malformation include:

Teeth Not Present

In situations where many or all of the natural teeth have been removed or are otherwise missing, the result significantly diminishes both functionality and esthetics. Current options include:

  • Complete dentures
  • Implants followed by removable dentures
  • Implants followed by fixed dentures

One or Several Missing Teeth

The appearance of missing teeth in parts of the mouth that are readily observable have become socially acceptable in many developed countries. Thankfully, there are a range of options:

  • Implant followed by crown
  • Fixed bridge
  • Bonded bridge
  • Removable partial denture

What Your Dentist Can Do to Improve Your Esthetics

There are many procedures dentists can perform to improve the appearance of your mouth. These techniques are generally considered to be esthetic or cosmetic procedures. However, some procedures are also routinely used in other divisions of dentistry.

Teeth Bleaching

In many cases, teeth that have become discolored can be bleached to improve their color using various chemicals applied either in your dentist’s office or at home. When performed in your dentist’s office, a strong bleach is applied to your teeth to change their color.

Many home tooth bleaching kits have become readily available, both commercially and available from your dentist. However, it is always advisable to obtain your tooth bleaching equipment and solutions from your dentist, rather than from a store, as your dentist will provide appropriate instructions for your personal requirements.

When performed at home, teeth bleaching usually consists of applying the bleach chemicals to the teeth using a tight-fitting, specially adapted tray or mouthpiece. The chemicals are applied to the teeth for 30 minutes to several hours each day, usually over the course of several weeks.

Both in-office and home techniques are effective for treating yellow, brown, or orange stained teeth.

Advantages of Teeth Bleaching

The color of the teeth can be improved and customized to a patient’s requirements without the need to alter the structure of the teeth. Other than color, the tooth remains unchanged. Unsightly yellow, brown, and orange tooth stains bleach out incredibly well, and the cost of both in-office and home teeth bleaching is relatively low, especially compared with other methods for altering tooth color.

Disadvantages of Teeth Bleaching

A large time commitment is required to achieve the desired results offered by teeth bleaching, as well as some cost to the patient. Some types of stains such as blue, gray, striated, and mottled do not bleach as predictably or as well as other colors. However, the advantages of teeth bleaching generally outweigh the disadvantages.

Risks of Teeth Bleaching

Some side effects can occasionally occur as a result of teeth bleaching.The most common side effects are:

  • Tooth sensitivity to cold food or drinks for a short period of time after bleaching has taken place.
  • Irritation of the gums for a short while after bleaching has been completed.
  • In situations where bleaching is done outside the dentist’s office, some users may experience jaw pain or tiredness if the mouthpiece or tray is used too much.

None of these potential side effects pose a serious risk, and millions of patients have undergone teeth bleaching treatment without experiencing any side effects.

Alternatives to Teeth Bleaching

Some alternatives to bleaching your teeth exist, some of which may be suited to your needs.

  • Microabrasion – this method removes surface stains by safely wearing away a small amount of the tooth.
  • Bonding with plastic – this covers up the stains rather than remove them from the tooth.
  • Placing porcelain or plastic veneers over the stained tooth or teeth
  • Placing crown(s) over the stained tooth or teeth.

 

Costs of Alternatives to Teeth Bleaching

Microbrasion is a suitable, low-cost alternative. Bonding is in the mid-level price range, and veneers and crowns are generally the most expensive alternative option.

Results of Not Bleaching Teeth

There are no physical risks presented by not bleaching teeth. However, the unpleasant appearance of stained teeth may lead to psychological issues.

Microabrasion

In many cases of tooth staining, the stain is superficial, and can be easily treated by removing a small amount of the surface of the tooth. This procedure is known as microabrasion and is safe, simple, and takes very little time to do. It works similarly to a woodworker sanding a stain from the surface of a piece of wood, but on a much smaller and lighter scale. Microabrasion works especially well on many superficial brown or white spots on a tooth.

Advantages of Microabrasion

Surface stains can be removed relatively easily, quickly, painlessly, and at a low cost.

Disadvantages of Microabrasion

This method is not suitable for removing tooth discolorations that are deeper within the tooth enamel.

Risks of Microabrasion

Occasionally, the treated tooth or teeth may feel sensitive after microabrasion has taken place, although this typically isn’t long-lasting.

Alternatives to Microabrasion

Teeth with superficial discoloration may be safely treated by bonding small, thin tooth-colored pieces of plastic of the stain or discoloration. Bleaching is not usually considered an alternative to microabrasion, and crowns are usually too expensive an alternative to achieve the desired effect.

Cost of Microabrasion

Other alternatives such as bonding, or placing veneers or caps are considerably more expensive than microabrasion treatment.

Results of Nontreatment

Leaving stains and discoloration on teeth generally have no physical effect, but their appearance may have a negative psychological impact.

Tooth Recontouring

Irregularly shaped teeth can be changed to improve their appearance by reshaping them slightly with abrasive tools. As this procedure is simple and inexpensive, it has become the treatment of choice for many patients with minor tooth irregularities.

Advantages of Tooth Recontouring

This procedure is simple, quick, inexpensive, and requires very little commitment from a patient.

Disadvantages of Tooth Recontouring

While suitable for minor tooth alterations, recontouring is not suitable for major tooth irregularities.

Risks of Tooth Recontouring

As the slight removal of tooth contour cannot be reversed, patients may want to watch their dentist perform this procedure. Some patients may also experience tooth sensitivity for a short while after tooth contouring has taken place.

Alternatives to Tooth Recontouring

Orthodontic repositioning of teeth is an acceptable alternative to tooth recontouring, but takes considerably longer to complete. In some circumstances, bonding or veneer placement can straighten misaligned teeth.

Costs of Tooth Recontouring

This procedure is significantly less expensive than both bonding and placement of veneers.

Results of Nontreatment

There are typically no physical or psychological issues, and the results of nontreatment are simply continued misalignment of the teeth.

Bonding

The term bonding has now come to mean placing thin pieces of tooth-colored plastic onto the surface of a tooth to change its shape or color. It works by etching the tooth’s surface with a mild acid to create a ‘key’ for a semiliquid plastic to flow into any irregularities on the surface of the tooth, which then later hardens. The bond of the plastic to the surface of the tooth is as strong as the bond of tooth enamel (the outside layer of a tooth) to the dentin (the inside of a tooth). In other words, it’s an extremely strong bond.

Advantages of Bonding

This type of procedure is simple, inexpensive, painless, and quick to apply – usually only requiring no more than one appointment. Bonding is also long-lasting and it can be several years before retreatment is required. The shape and color of teeth can be altered in a short amount of time, making bonding a quick and efficient method for improving a smile.

Disadvantages of Bonding

Unlike many other alternatives, bonding requires an upkeep regime, including occasional re-smoothing to remove stains, and reattach any pieces of bonded plastic that might have chipped away. Bonding is not a permanent solution, and eventually the material will need to be replaced. Due to the additional contouring of bonded teeth, food particles are much more likely to build up, so a meticulous oral care regime must be adhered to.

Risks of Bonding

Some patients experience chronic irritation of the gums, and occasionally dental caries (decay) around the bonding materials of the treated tooth or teeth.

Alternatives to Bonding

Tooth contour can sometimes be changed through the placement of veneers, or crown placement if there is a major change in shape or color needed. If only minor color or shape changes are required, tooth bleaching or microabrasion may be acceptable alternatives to bonding.

Costs of Bonding

When compared with other options such as veneers or crowns, bonding is a relatively inexpensive procedure for making minor alterations in tooth appearance. However, tooth bleaching and microabrasion cost less.

Results of Nontreatment

Other than the continued misalignment and/or discoloration of teeth, there are no resulting physiological issues, although psychological issues may occur.

Veneers

This type of treatment can drastically improve the appearance of teeth in as few as two appointments. Veneers, which consist of thin pieces of porcelain or plastic, have significantly impacted esthetic dentistry. Similarly to the bonding process, a mild acid is used to create microscopic irregularities in the tooth’s surface which allow the custom-made, laboratory-created veneers to bond to the tooth using a tooth-colored adhesive. This process usually results in an incredible improvement in the appearance of the teeth.

Advantages of Veneers

Veneers can be placed without severely cutting the tooth or teeth, as is needed for crowns.

Disadvantages of Veneers

Removal of a small portion of the tooth structure is often required to place veneers without the tooth becoming too large (overcontoured). Patients are often advised to be cautious when eating hard foods, as veneers also infrequently fracture as a result of trauma. Teeth that have had veneers placed also require meticulous oral hygiene.

Risks of Veneers

Due to the altered contour of a veneer-placed tooth, the risk of developing chronic gum irritation and dental caries (decay) around the tooth increases.

Alternatives to Veneers

Depending on the circumstances, crowns, bonding, bleaching, microabrasion, or orthodontic treatment may be suitable alternatives to placing veneers.

Costs of Bonding

The cost of veneers is usually equal to, or less than crowns, but are more expensive than bonding, and significantly more so than teeth bleaching and microabrasion.

Results of Nontreatment

Other than a lack of improvement in esthetics, there are no other consequences of not having veneers placed. However, due to the continued potential unsightly appearance, some psychological issues may occur.

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About the Author:

Dr Aust is married to Mrs Dr Aust and has two children and a dog Max. You can read more here.

He is sharing his expertise with you. Download 5 Things I Learned After Treating Over 10,000 Patients from here.