Cosmetic Options ........

If you are one of those people who lack confidence in their smile or instinctively hide your teeth when you have your photograph taken or when you laugh then smile because you do not have to worry anymore!

Over recent years the techniques available to your dentist to enable you both to work together to create something to smile about have transformed your opportunities to have a brighter, whiter smile. This can often be achieved using simple techniques that can really transform your smile.

Everyone knows the benefits of a great smile – in the workplace it can make the difference between your customer rating your service as satisfactory and telling their friends about the excellent care they received. In our personal lives a smile gives increased self confidence and can help brighten up someone else’s day as well.

A lot of people still see cosmetic dentistry as the preserve of Hollywood film stars but this is not true as everyone deserves to feel good about themselves when they smile.

I often ask my patients a simple question “If you had a magic wand what one thing would you change about your teeth to make you happy with your smile?”. Very often my patients will say “Well I really don’t like….. But there is nothing that can be done about it. I’ve always been told I have just got to live with it but it has always bothered me.”

Normally they have several options that can improve their smile and they are really pleased to have the opportunity to discuss these and find out just what is available. Just think for a moment what would you change if you could?

Very often the wishes fall into one of the following groups

• “I hate that you can see my silver fillings when I laugh”
• “I wish my teeth were whiter, they seem to have darkened and stained over the years”
• “Well they are really crooked”
• “I once had to have this tooth out and now I am really conscious of the gap”
• “My teeth are all worn down and heavily filled and they do not show when I smile anymore”

Of course cosmetic dentistry is only successful if it is based on good oral health. It is important that a thorough oral health assessment is carried out by your dentist and that you ensure that your gums and your teeth have been restored to a good healthy condition. This is an essential pre-requisite and is often all the work you need to smarten up your smile. It will help you keep your breath fresh too and many dentists work with hygienists to achieve this primary goal. Regular cleaning from your hygienist or dentist is important if you wish to keep your mouth and smile healthy and bright.

Let’s look at those questions and see what we can offer them:

“I hate that you can see my silver fillings when I laugh”

Silver amalgam is the most common filling materials that we have available to us as it is strong, long lasting, economic and is considered to be safe by all the respected scientific bodies. However it is not cosmetically pleasing and can spoil a smile if it shows. This patient (right) has been seeing a dentist regularly for many years and has a very stable mouth. Over the years the patient has needed several fillings and these have been provided using silver amalgams. The patient wanted to change the fillings for tooth coloured ones. There are two ways this can be done. Firstly tooth coloured direct restorations can be made by the dentist in your mouth. Secondly the dentist may prefer to take impressions and have restorations made out of tooth coloured porcelain or composite crafted by a technician in the laboratory that, once the fit and bite have been checked, can be bonded into your tooth at a second visit. These are called indirect restorations; they are often stronger than conventional tooth coloured restorations so are best used if a large filling is required. Tooth coloured restorations can look great, cost from £65 per restoration and can make a great difference to your smile!

“I wish my teeth were whiter as they seem to have darkened and stained over the years”

This is perhaps the most common comment my patients make and yet this is one of the easiest problems to solve. Recent advances in tooth whitening allow us to rejuvenate your smile. There are two basic ways of having tooth whitening. It can either take place in the surgery or by use of an at home kit. The home kit is simple and easy to use. After having some simple moulds made of your teeth your dentist will provide you with whitening trays that you wear over your teeth overnight. In these trays you place a thin layer of a special whitening gel and while you sleep your smile is whitened. The results can be seen in as little as 7-14 nights! Tooth whitening is a simple, effective and safe way to brighten your smile. Home whitening normally costs around £340 for both upper and lower teeth. It is a simple and cheap alternative to other techniques which usually involve removing tooth tissue.

“Well they are really crooked”

Young people these days are lucky in that modern orthodontics allows us to correct the position of their teeth at an early age however many adults were not so fortunate. Many still have “crossed over” or crooked teeth. These can now be treated with fixed orthodontics. As in children brackets can be bonded to the teeth and these allow us to reposition the teeth to straighten them. Modern brackets can be made so that they barely show at all. Adult orthodontics costs from around £1800 and can take 18 months to 2 years to complete.

An alternative is to use dental veneers. Veneers are made of thin porcelain that is bonded onto the tooth. They usually cover just the front and tips of the tooth. Once in place they are very strong and can be colour matched to your teeth. It usually takes two appointments to provide veneers. At the first appointment your teeth are carefully recontoured to allow space for the veneers, impressions are taken and temporary veneers are fitted. The impressions then go to the laboratory where the technician will carefully craft your veneers. Veneers can be use to straighten crooked teeth, lighten dark teeth or repair broken or heavily filled teeth. The case on the left shows how veneers can be used to straighten crooked teeth. The cost of a veneer is usually about £335.00 and they take 1-2 weeks to provide.

“My teeth are all worn down and heavily filled and they do not show when I smile anymore”

As people get older they can wear their teeth down which can be caused by several factors. It often results in their teeth looking worn and chipped and hardly showing when they smile. This can also lead to difficulty in chewing and can cause joint problems and other associated problems such as headaches and migraines. By using crowns and bridges worn and broken down teeth can be restored to give a natural good looking smile once again and also allow you to enjoy your food better!

This lady had lost several teeth and those that were remaining were wearing down. Various treatment options were discussed and in the end we decided to restore the broken teeth with a mixture of crowns and bridges. These are made in a laboratory once the teeth have been prepared. They are usually made of porcelain bonded on to gold. The gold gives them strength whilst the porcelain matches the colour of your own teeth. Once they have been constructed and checked in the mouth for fit they are cemented onto the teeth. Crowns and bridges provide a strong and hard wearing restoration and are ideal for the heavily filled or a badly broken down tooth. They cost from £350 per tooth and with correct care last for approximately 10 years. As you can see they can really restore your mouth and if you look at the lady smiling in the first picture you will see they can create a super smile!

“I once had to have this tooth out and now I am really conscious of the gap”

Years ago many people just had the tooth removed when they had tooth ache. Whereas these teeth can now often be saved with root canal therapy. However for those who have lost a tooth it can often be a very traumatising event that can affect their self confidence. Modern techniques allow us to replace missing teeth with permanently retained solutions. We have already discussed bridges in the previous section. This is an important technique that is still the treatment of choice in many instances. Recent advances have led to the increasing use of dental implants. Dental implants were discovered and developed by Per-Ingvar Branemark in the early 1960’s with the first fixtures placed in humans in 1965. Since then many thousands have been placed according to his principles. Published international data shows a success rate of around 85% in the upper jaw and 95% in the lower jaw. A small hole is made in your gum and a titanium implant is placed in the bone beneath. The implant is then left to firmly become attached into the bone. When this has occurred, usually after 4-5 months, the implant is exposed and the definitive restoration is placed on top. Implants can be used to replace single missing teeth as these pictures show or can be used to carry several missing teeth or even to retain full dentures. They feel just like real teeth and allow you to smile, talk and eat with confidence. Implant costs vary depending in the type of work required but they normally cost around £1800 pounds per implant. These last two photographs show you a smile restored by the use of an implant. It looks perfect!

So do not let your smile get you down, book an appointment with your dentist to discuss your options. Remember that good cosmetic dentistry must be based on good dental health and this must always be achieved before undergoing cosmetic treatment. Also good after care is important. Regular visitors for dental health examinations from your dentist and regular maintenance appointments with your hygienist are an important factor in making sure you enjoy having something to smile about!

Dr. Graham Stokes is the senior partner at LHDP Smilecare based at 15 Chapel Street, Bromsgrove, Worcestershire. He qualified in 1984 from Birmingham and received his MFGDP(UK) in 1997. The whole team at LHDP Smilecare works hard to provide its patients with a relaxed and friendly environment in which they can receive the dental care they deserve. LHDP Smilecare was recently proud to be presented with the “Investors In People Award” and The British Dental Association’s “Good Practice Award”. If you have any questions or wish for further advice please contact Dr. Stokes at LHDP Smile care or by phone on 01527 872098 or e-mail at grahamstokes@supanet.com