Cosmetic, or aesthetic, dentistry focuses on improving appearance and facial self-image by correcting the alignment, shape, and color of teeth. Dental professionals who offer cosmetic options can improve the appearance of stained, chipped, and misshapen teeth, and correct uneven gums and replace old fillings with nearly invisible filling materials. Cosmetic dentistry procedures are elective and, therefore, often not covered by insurance.
The most popular option in cosmetic dentistry is tooth bleaching, an area that is experiencing a 15 to 20% growth a year. Most dental practices offer tooth bleaching, which involves the use of at-home and in-office supervised whitening systems that brighten stained, discolored, or dull-looking teeth.
Veneers are the second most popular cosmetic dentistry option. Used to correct chipped, cracked or worn teeth, veneers are ultra thin tooth coverings, sometimes made of porcelain or composite materials. Bonding is another process also used to correct chipped, cracked, or worn teeth.
Crowns, dental bridges, and dental implants can be used to replace missing teeth or correct bite dysfunction. Today's newer technology includes porcelain and ceramic tooth replacements that look real and blend with existing teeth.
Cosmetic dentists can correct excessive or uneven gums with cosmetic surgery. Many patients with old or unsightly fillings also can opt to have them replaced by a dentist, who can use resin and porcelain filling materials or crowns to eliminate the look of the previous fillings.
Causes and symptoms
Anyone who is unhappy with his or her smile is a candidate for cosmetic dentistry. The reason might be a general displeasure with the look of one's teeth or a specific aesthetic dental concern. While the reasons for improvement vary, the most common causes are staining due to aging, tobacco use, coffee intake, fluorosis, and tetracycline use. Patients also often want to improve the shape and position of their teeth. Diastemas (spaces between teeth), slight rotations, and malformation of the teeth (e.g., peg laterals, barrel shape teeth) are common reasons for correcting the shape and the position of the teeth.
The diagnosis of an aesthetic problem involves looking at the entire face; the color of the eyes, skin, and lips often influence the appearance of teeth. The face evaluation is usually divided into imaginary thirds: the first section goes from the hairline to eyebrows, the second from eyebrows to the base of the nose, and the third from the base of the nose to the lower border of chin. Aesthetic smiles are diagnosed by the dentist, who looks for asymmetry and mobility of the upper and lower lips; midline in relation to the front teeth; gumline; tooth and gum contours; tooth color; tooth to length proportion and relationships; and, finally, restorations. Several factors must be taken into account when assessing these variables, including age, gender, race, and personality.
When examining the tooth shade, specifically, certain factors should be considered, such as the light source and surrounding colors. Bleaching of teeth will change the shade of the tooth structure only, which can pose a problem if the patient has several tooth-colored restorations.
Minor corrections in shape and positions can be done with direct resin bonding and ceramic veneers. If the problem is related to position and is considered to be moderate to severe, it is possible to correct it through the placement of veneers, full crowns, or by orthodontic treatment.
Bonding involves applying an enamel-like material to the tooth's surface and sculpting it to an aesthetically pleasing shape. Once it hardens, the dentist polishes and refines the new tooth. One of the advantages of direct resin bonding over ceramic veneers is that bonding can be done in one session without laboratory involvement, which helps to control cost. The major advantage of direct composite resin restorations is conservation of the tooth structure because, in some cases, little or no enamel removal is required. Longevity, the main advantage of ceramic veneers, is superior to resin bonding.
Discoloration caused by extrinsic staining, such as coffee, tea, red wine, tobacco, aging, and some types of medications, are usually yellow or brown in color and can be improved by vital bleaching, using a 10% carbamide peroxide solution. The concentration may be slightly higher or lower, depending on the stains. Discoloration caused by intrinsic staining, such as after root canal treatment, pulp bleeding, tetracycline medication, fluorosis, and some types of inherited disease, are usually blue, gray, or brown and often requires a non-vital bleaching treatment. Non-vital bleaching treatment is done internally to the tooth structure, meaning the bleaching agent is placed inside the tooth crown.
The term aesthetics takes into consideration the psychological interpretation of beauty. Because of this subjectivity, it is extremely important to establish a common goal and line of communication between the dentist and the patient. Communication is particularly important when the patient's expectations exceed the reality of what is possible to achieve. Studies support significant differences among the preferences of dentists and patients for cosmetic dentistry.
The results of aesthetic dentistry vary according to the different procedures. It should be noted that the results of the bleaching treatment are not predictable, since it varies according to each case. For the most part, it is possible to lighten the tooth shade on the first few days of treatment.
The success of any restoration depends on patient compliance. It is important that the patient be informed about maintenance of his or her treatments, and understand that the results of bleaching are not permanent. Explanations of the etiology of oral diseases, risk factors, and preventive measures are also warranted; these may help to motivate patients keep their new smiles healthy.
Health care team roles
Identification of imperfections in patients' smiles might be done by dental hygienists during care. They may refer patients to the dentist for cosmetic dentistry. Trained dental hygienists can coordinate patients' bleaching procedures. Dental assistants help explain what is involved in the cosmetic dental solutions and inform the patient that, in most cases, insurance does not reimburse for cosmetic dentistry. Dental assistants also work with dentists during cosmetic dental procedures and can assist patients and dentists in selecting tooth shades.
Patients can help to keep their teeth healthy and white with good nutritional and lifestyle habits. Preventive measures to reduce or eliminate dental disease, including caries, periodontitis, and oral cancer, are essential to obtaining and maintaining an optimal dental health and aesthetic appearance.
Maintenance remains important after cosmetic dentistry. The proper maintenance of tooth color restorations is important to improve and increase the lifetime of the restorations. This includes cessation or decrease in tobacco use, and cessation or decrease in the intake of caffeine products and stain-producing foods and beverages. Acidic products can also cause erosion of the tooth structure. The use of soft toothbrushes and non-abrasive toothpaste will avoid unnecessary tooth abrasion. Some types of whitening toothpaste can have large particle size, which can act as an abrasive on the restoration surface.
Bleaching— Tooth whitening using a chemical such as carbamide peroxide or hydrogen peroxide.
Bridge— A fixed or removable dental appliance used to replace missing teeth and to restore the mouth to function.
Caries— Demineralization or calcified tooth tissue, which, if left untreated, results in soft, discolored areas, pain, and eventual loss of the tooth.
Crown— A gold, porcelain, or stainless steel cover used to replace a tooth structure that has been lost to decay, accident, or injury.
Dental implant— A fixed dental appliance that replaces missing teeth.
Diastema— An abnormally large space between two teeth.
Periodontitis— Inflammation and infection of gingival tissue, ligaments, and alveolar bone that support teeth.
Veneers— Porcelain or composite laminates that are bonded to the surface teeth to improve aesthetics and function.
Academy of General Dentistry. 211 East Chicago Ave., Chicago, IL 600611. (312) 440-4800.〈http://www.agd.org〉.
American Academy of Cosmetic Dentistry. 2810 Walton Commons West, Suite 200, Madison, Wisconsin 53718. (800) 543-9220. 〈http://www.aacd.com〉.
American Dental Assistants Association. 203 North LaSalle Street, Suite 1320, Chicago, IL 60601-1225. (312) 541-1550. 〈http://www.dentalassistant.org〉.
American Dental Association. 211 East Chicago Avenue, Chicago, IL 60611 (312) 440-2500. 〈http://www.ada.org〉.
Gordan, Valeria V., DDS, MS. Assistant Professor. University of Florida, College of Dentistry, Operative Dentistry Department, Gainesville, FL. Interview with Lisette Hilton.