Smiles: custom-made.

You can smile when you can't say a word." Since kindergarten we have known there is magic in a smile. Even the plainest face is improved with a smile. The English poet Hartley Coleridge, writing about a woman who was "not fair", said:

Her loveliness I never knew

Until she smiled on me:

Oh! then I saw her eye was

bright. . . .

A good smile can magically make you look your best. But crooked or worn teeth, neglected or diseased teeth, stained teeth or fillings, will ruin the magic of your smile. Fortunately, cosmetic dentistry can take care of many of these problems.

New Cosmetic Techniques.

Recent advances in cosmetic dentistry help achieve better appearance while permanently altering teeth less. Traditional treatment emphasizes the use of porcelain "caps" on front teeth; however, placement of caps requires considerable grinding of the teeth. If more treatment is needed in the future, caps must be replaced, causing additional drilling. New cosmetic techniques leave more of the teeth intact. Procedures such as composite bonding, porcelain laminates (veneers), and tooth bleaching have revolutionized the cosmetic restoration of teeth. So if you are considering improving your smile, you should know more about these techniques.

While most cosmetic dental treatments require less destruction of the tooth, they are still technically demanding, requiring considerable skill by the dentist. There are also risks involved, as with any dental treatment. Therefore, you should always carefully consider not only the benefits gained by cosmetic dental treatment but also the risks. Your dentist can give you the risks and precautions on any of the procedures described in this article.

Orthodontics.

Crooked teeth will usually require orthodontics, which includes braces. Improved techniques with orthodontics can now give more satisfactory results in a shorter time. Many oral surgeons now work closely with orthodontists to combine braces with the surgical repositioning of portions of the jaw (orthognathic surgery). The combination of braces and surgery can shorten the treatment time for many complex and even some routine cases of tooth straightening. The result will be a more beautiful smile than you would have if only braces were used. Your orthodontist can give you a recommendation on which treatment would be best for you.

Tooth Bleaching.

Dark or discolored teeth can now be lightened with tooth bleaching. For many years people and dentists have attempted to bleach teeth, generally with unsatisfactory results. Most tooth bleaching uses a hydrogen peroxide solution placed on the teeth for various amounts of time. If a strong solution of peroxide is used, the procedure must be done in a dentist's office, where the teeth are isolated with a piece of rubber dam, and the peroxide is placed on the teeth with cotton. Then the teeth and peroxide are heated with either a small heating device or with a special heat lamp. The treatment usually has to be repeated several times before results are satisfactory. Recently, tooth-bleaching techniques use a gel of a weaker peroxide solution placed into a thin, clear plastic tray made by your dentist from a model of your teeth. You wear the tray for three or four hours a day until the bleaching takes place. Bleaching is still a somewhat controversial treatment, and the results are not predictable; therefore you should consider all the alternatives your dentist offers before choosing a bleaching treatment.

Tooth Bonding.

To repair, reshape, or cover mis-shapen front teeth, dentists can now use a tooth-colored plastic material. The composite plastic materials have been greatly improved during the past few years and, when they are placed properly, it can be very difficult to determine the difference between the teeth and the filling material. The procedure requires the removal of small amounts of enamel, the use of a mild acid to prepare the enamel for bonding, then placement of a composite plastic to the desired shape and correct color of your teeth. The composite plastic is hardened with a special bright light and then polished. The disadvantages are that composite plastic is weaker than enamel and can be broken if you bite into hard foods. It also stains more rapidly than enamel. Composite-bonded teeth, therefore, require more-frequent checkups for polishing and repairing of small fractures. Composite bonding can last up to 10 years, but generally lasts from 5 to 10 years before needing to be replaced.

Use of Porcelain.

A better looking and more permanent way to improve the look of unsightly teeth is to use porcelain laminates, or porcelain veneers. Porcelain laminates require that more enamel be removed from the front surface of the teeth than does composite bonding; therefore it is not a reversible procedure. Years later if porcelain laminates need replacing, either new porcelain laminates or crowns will be required. However, porcelain laminates generally last much longer than composite bonding, and resist breaking and staining. The dentist removes a thin layer of enamel and makes a model of your teeth. A laboratory then fabricates the laminate. At the second appointment the dentist will bond the porcelain laminate to the teeth, using the same techniques as used in composite bonding. Although porcelain laminates can look the most natural of all cosmetic dental treatments for front teeth, laminates do not preserve as much of the teeth as does composite bonding. Therefore many dentists prefer to use composite bonding if possible.

Cosmetic dental treatment for back teeth is not as successful as for front teeth because of the heavy loads placed on the tooth-colored filling materials during chewing. As newer, stronger materials are developed, cosmetic procedures for back teeth will become more practical. Consult your dentist on the procedures that seem most promising before deciding to have tooth-colored fillings used in the back teeth.

Because of the complexity of cosmetic dental treatment, many dentists do not treat such cases, especially if they are extensive. If you wish to improve your smile, call your local dental society or a dental school for a referral to a dentist who has experience in cosmetic dentistry.

Dr. James Dunn is associate professor of restorative dentistry at Loma Linda University.