How to keep your teeth picture-perfect

Imagine never smiling. Or talking with your hand over your mouth. Many people don't know what it's like to grin from ear to ear-all because they are ashamed of their teeth. Now, thanks to the many alternatives of cosmetic dentistry-from whitening to braces-we can all have something to smile about.

Tooth Whitening

Anyone can buy over-the-counter whitening products that improve the flat surface of the tooth, but for more thorough results there are home whitening kits and laser bleaching. With whitening kits, patients wear custom-made trays filled with a carbamide peroxide gel every night for 10 to 14 days. Dentists handle tooth sensitivity by adjusting the concentration of the gel solution. Results can be touched up when needed, usually every six to eight months, or before special events. "When you bleach teeth, old dental work may look dark," says Dr. James McKenzie of the Whistler Dental Office, B.C. Bleaching won't harm veneers or crowns but it won't bleach bonding either. When scheduling cosmetic dentistry work, bleach first so you can match the work to the new colour.

Laser bleaching is an in-office procedure where different concentration of laser light helps activate the brushed-on bleaching solution. The light is applied in a cycle lasting from one to two hours, and "teeth can lighten up to ten shades," says McKenzie. Touch-ups are done with your own custom at-home bleaching trays. This instant result costs about three times as much as gel bleaching.

Tooth and Gum Contouring

"I had a patient who always thought she had short, stubby teeth," says McKenzie. "In reality, her gums had overgrown." Gum contouring revealed long, beautiful teeth. Although tooth contouring is used to file minor chips and to shape, most contouring takes place with the soft tissues, says McKenzie. Done under local anesthetic, gum contouring may be performed with electrosurgery, blades or soft-tissue laser. Prior to putting on veneers or crowns, some dentists prefer to balance the symmetry of the mouth or solve a "gummy smile" through gum contouring. Done in-office under local anesthetic, healing takes about two to four weeks. More extensive cases may be referred to a periodontist (gum specialist).

Bonding & White Fillings

Bonding is the term for applying a soft composite material directly to your teeth and hardening it with light. This can be used for white fillings or on front teeth, where dentists usually use a combination of colours to achieve the natural creamy colour along the gum line, lighter colour mid-tooth and translucence on the edge. "It's great for small chips and gaps," says Dr. Deborah Cooper-Lall, clinical director of Dental One in Calgary. "It's also an opportunity to not invest a lot and still have a nice smile." Bonding is best for children or teens, emergency applications, or someone with gum disease who can't invest long-term in the mouth. It costs less than veneers and crowns but it also doesn't last as long (five to ten years) and will stain. "A lot depends on the personal hygiene and habits of the patient," says Cooper-Lall. Smokers, coffee and tea drinkers may want to cut down. Usually performed under local anesthetic, the procedure can take anywhere from an hour for a chipped tooth to fours hours for more teeth.

Crowns and Veneers

Unlike bonding, porcelain veneers and crowns are created in a lab from moulds of your teeth. They won't stain, and last 10 to 15 years. Patients should be adults in good health and free from gum disease. These procedures works best for gaps, mildly crooked teeth and replacing old dentistry (discolouration, bonding, worn crowns and veneers).

Crowns cover the entire tooth while veneers cover the front only. Keep in mind old crowns can only be replaced by new crowns. Porcelain-only crowns are revolutionizing dentistry, says Cooper-Lall, replacing the popular porcelain-fused-to-metal crowns that may leave a dark line, which becomes visible as gums recede. As well, your practitioner may opt for a crown instead of a veneer to stabilize the bite.

Overall, the procedure consists of a series of steps, starting with an initial consultation to analyze the smile and determine treatment. Too often the practitioner treats too few teeth "because we only see the front when we smile," says Cooper-Lall. "But when you talk, you can see where the good dentistry stops and the bad begins." Once the overall plan is established you'll need local anesthetic while the teeth are reshaped, impressions taken and you are fitted with temporaries. At the next appointment, also under anesthetic, you'll try on the teeth and critique the shape and colour. Finally, a couple days later you are fitted with your polished veneers. Altogether, the treatment can be 10 to 15 hours and is spread over several weeks.

Implants

In the past it was necessary to cut down the teeth adjacent to a missing tooth to use them as handles for a bridge that replaced the missing tooth. With implants, the adjacent teeth are not altered. In the first of a two-step process, a titanium rod replaces the root of the tooth. It's as invasive as a tooth extraction, says McKenzie, and is done under a local anesthetic, taking about one hour per tooth. After the implant is placed, the gum is stitched over it and left for three to six months as the titanium integrates with the bone. At that point, the gum is lifted and the implant is topped with a crown.

Orthodontics

"There are two different types of orthodontics," says Dr. Kevin Davis of Davis Orthodontics in Richmond Hill, Ont. "Comprehensive orthodontics straightens all the teeth and corrects the bite whereas limited orthodontics 'sets the table' so the cosmetic dentist can finish the job."

If the shape and size of your natural teeth is satisfactory and you want to avoid any artificial materials in your mouth, then comprehensive orthodontics is the answer. It might involve clear braces or removable invisible trays, and take anywhere from six to 24 months.

Pre-cosmetic orthodontics is necessary if the general dentist cannot do his/her job because of the current position of the teeth. Examples include a very large space between the front teeth that would look unsightly if corrected with oversized veneers, or a bite problem that would break your new veneers if the orthodontics were not completed first. Limited orthodontics usually requires less time than comprehensive orthodontics.

Teeth never lose their ability to be moved, so adults are excellent candidates for orthodontics. "Unlike days gone by, one-third of my orthodontic patients are adults," notes Davis, "because today's tooth-moving tools are much more invisible than the metal braces of the past."

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