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 Cosmetic dentistry - could it
make you smile?
Jeanne Davis talks to Robert Wallace, BDS(Lond.) LDS., RC’s (Eng.) of the Bryer
Wallace Dental Practice.
Jeanne Davis: Cosmetic dentistry used
to be something only movie stars and celebs indulged in. Why do you think it is becoming
so popular in Britain now? Americans have been flashing brilliant smiles for years. Are we just catching up with the Americans?
Robert Wallace: There is a little bit of a carry
on from the Americans. And one sees politicians smiling with white teeth on TV and movie stars with brilliant smiles. People want to emulate that to some extent.
But it really came on the back of the
health craze of the 80s. Everyone was going to gyms
and health studios. They were getting their bodies
in shape and suddenly they saws they had a lousy smile. They
said, “maybe we should do something about this.”
People were much more aware of how they looked. A good smile makes you look younger
and healthier.
JD: What is cosmetic dentistry?
RW: It
encompasses a number of techniques to make teeth look good.
For example, bleaching natural teeth to brighten and lighten them. You might want
to reposition them orthodontically so that
they are nicely aligned. You might crown or build up teeth that are chipped or broken, or
discoloured from fillings.
JD: There seem to be
a variety of treatments. Teeth whitening, Veneers, crowns, implants. What do these do for you?
Which do you choose for what imperfections? Stains,
worn down teeth, missing teeth, buck teeth, broken teeth…
RW: Ideally
you want to make teeth look good without doing
anything to them. If you’ve got very nice teeth, but you have stains from over time
--tea and coffee and wine-- then you can just bleach them.
You still have the same teeth, just brighter.
The next simplest thing is bonding. Bonding is a composite -- a mix of a plastic with a ceramic – that you shape like
a paste. With it you
can lengthen the teeth. You can widen
the teeth and, of course, use it to fill a chipped tooth.
JD: Can you tell me about
veneers?
 RW: If bonding isn’t suitable, this is
the next stage - to veneer or laminate the
teeth. Veneers are made from tough porcelain about the thickness of an eggshell which is
bonded on to the tooth. Very little of the natural
tooth needs to be removed and the veneers are individually made for each tooth. Veneers have great longevity, are resistant to breakage,
do not discolour and, because they do not
attract plaque, are easy to look after. With a veneer you can whiten the tooth, lengthen
or widen.
JD: When are crowns needed?
RW: If
bonding or veneers aren’t right, ultimately, you are going to crown the teeth. You
cut the tooth down until you have a broad stump. On to that goes the crown which covers
the whole tooth. You can change the size and shape. Crowns are very strong. But
you have to sacrifice a lot of tooth, although in most cases the tooth is already very
broken down.
JD: Now teeth whitening. There
seem to be many different ways of achieving this. From
just using a whitening toothpaste to gels and
to processes that require a professional dentist to apply.
What are the pros and cons of each of these?
RW: I
am slightly sceptical about the whitening toothpastes. I
think they do reduce stains but they certainly don’t whiten the teeth. The home-use bleaching system offered by dentists will increase the brightness of your
teeth and work on stains, but not change the
colour. The best system is with a custom-made tray
or mould of acrylic that fits over the upper and lower teeth. You put gel in it
and leave it on overnight. You need to do this for
two weeks to be effective. It’s possible to
buy home-bleaching kits from the chemists but the tray may not fit accurately enough to
hold the gel. You could remould the acrylic tray in
hot water, but it’s best to get a custom-made
tray from your dentist.
JD: What about bleaching that uses a light on the teeth?
RW: That’s
the one where they shine a very bright light on your teeth with a gel on it. It’s done in the surgery. You get instantly very
white teeth. But it is only transient. To keep the
teeth white, you then go on to home bleaching.
JD: Is laser
bleaching effective?
RW: They are doing a lot of this in the States and
some here. It tends to produce a very white sugary
type of bleach. The surface is quite a cakey white. It doesn’t look very natural. It certainly is not
something that is sweeping the dental world, and it has not caught on as a proven method.
JD: I’ve read that bleaching won’t work on crowns, bridges and veneers or some stains…
RW: It
won’t alter any prosthetic restorative work in the mouth. It will not brighten the prosthetic, but it will remove
the stains. There are some stains that are intractably dark. For example, tetracycline, an
antibiotic given to children years ago for bronchial illnesses, left a very
grey browny stain that is impossible to remove satisfactorily.
The solution here is to crown those
teeth or veneer them.
JD: How do you go
about finding a dentist who does good cosmetic work?
RW: Fundamentally all dentists will do cosmetic
work, though your regular dentist may refer you on to someone who is a specialist in one
area, for instance implants. To find a good practitioner, ask friends, colleagues, anybody
who has had work done and see how they got on. There’s
nothing like a recommendation.
JD: What questions should you ask the
dentist before you proceed with cosmetic
work?
RW: First,
you must make sure you have healthy teeth and gums. So any gum disease, decay, infection
in the mouth has to be corrected. Then you can start building the teeth up and making them
look nice. Explain to the dentist what you really want. Do
you want big white teeth, do you just want the teeth to look natural but just a little bit
lighter? Do you want them to look more even? Do you need orthodontic treatment to move the
teeth first, or have crowns or bridges fitted? Do
you need to lengthen the teeth? This may be
essential in midlife and for older people when years of grinding the teeth can make them
worn down.
You also need to ask how long the
work will take, how long it will last. How many
hours will there be sitting in the chair. How much is it going to cost. If something goes wrong, will you do something about it without charging me
again. And what kind of maintenance will be needed - check-ups, visits to the hygienist.
 Most important, you need to get a clear idea of
what your teeth will look like after the proposed treatment, so you won’t be
disappointed.
Next month Jeanne
covers the costs of cosmetic dentistry, implants, and caring for your teeth.
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A vast industry is out there to help with all and every beauty concern. In
this column every month laterlife.com will report on ideas and products, old and
new. The practical results of everything from creamy cleansers to mud baths will be
brought to you. All with the focus on maturity of course.
