What is cosmetic dentistry?

Many people seek dental treatment to improve the appearance of their smile rather than for health reasons. There is an ever-expanding range of dental treatments available purely to create a brighter, whiter and more appealing smile.

There are many reasons why a person may want to improve the appearance of their smile. Teeth can be stained, misshaped or chipped. There may be visible fillings that are old and discoloured, or the teeth may be crooked. The following procedures are available to improve the appearance of your smile.

Porcelain veneers

Porcelain veneers are a thin, tooth-coloured facing that are custom-made to fit your teeth. They are made of a reinforced porcelain type of material that closely resembles natural enamel and can be made in any shade or colour. Only the front of the tooth and sometimes the edge is covered by the veneer.

Porcelain veneers are an excellent choice for improving the appearance of teeth that are:

  • Discoloured and not able to be bleached sufficiently;
  • Chipped in multiple places;
  • Misshaped or too small;
  • Slightly crowded or overlapping, or;
  • Slightly spaced with gaps between them.

The process for having porcelain veneers made involves a number of visits to your dentist or prosthodontist (a dentist who specialises in making crowns, veneers, bridges and false teeth).

First, your dentist will examine your mouth, discuss your needs and advise possible treatment options. Once you have both decided on porcelain veneers, a series of appointments will be made for you.

The first appointment can take 1-3 hours to complete. The teeth are prepared for the veneers by shaving away a thin layer from the front of your teeth and the bottom edges if needed. This allows room for the porcelain veneer to fit onto your tooth. An injection of local anaesthetic around the teeth may be needed during this step to numb the teeth. Photographs and a mould will be taken of your teeth to send to the dental technician, who makes your veneers by hand. A temporary veneer is often glued onto your teeth by the dentist for you to wear between appointments, as the technician can take 1-2 weeks to make your veneers.

The second appointment involves removing the temporary veneers and 'trying in' the porcelain veneers, with your dentist checking their fit and colour. It is important that you are satisfied with the appearance of the veneers before they are glued in place. The colour can be altered slightly by using varying shades of cement to glue them in. Your dentist should try the veneers in with various shades of try-in paste until you are both happy with the appearance. Once the veneers are bonded into place, the colour cannot be altered. A third appointment may be needed to try-in the veneers again if significant changes need to be made. The technician will make the alterations in the laboratory and send the veneers back for the next try-in appointment.

Once you are happy with the fit and appearance of your veneers, the teeth are cleaned and prepared for the bonding of the veneers. A bonding resin cement is placed on the tooth and the veneer is bonded into place. A special light is used to set the bond. Excess cement is then cleaned away and the veneers are polished.

Advantages and disadvantages of porcelain veneers

Porcelain veneers are made of a strong durable ceramic that is nearly as strong as a natural tooth. When bonded well and cared for properly, they can last many years. The colour of the veneers will not change over time and is resistant to staining from food and drink. They have a highly-polished surface that can be custom-made to any colour. Veneers are a more affordable alternative to full crowns and require less tooth structure to be shaved away. If the underlying natural tooth is strong and intact, veneers are also a more conservative option than full crowns.

Porcelain veneers are difficult to repair if they are chipped or broken. Often the entire veneer needs to be replaced, which requires at least two visits to the dentist. Another disadvantage of porcelain veneers is that some natural tooth structure must be removed to make room for the veneer. This means that the treatment is not reversible. Also, the veneers will not last forever; they need to be replaced every 8-15 years, depending on how well they are cared for. If the gum shrinks away from the top edge of the veneer, a line may become visible at the top of the veneer where it joins the natural tooth. This can be unsightly and require the veneer to be remade. It is essential that good gum health is maintained around veneers to avoid this problem.

The teeth may also become sensitive to cold immediately after veneers are placed. This can take some time to settle. There is also a risk, as with all dental procedures where tooth structure is shaved away, that the nerve inside the tooth will be damaged and require root canal treatment to save the tooth. It is important to ask your dentist to explain any possible risks that may apply to you.

 

Crowns

Also commonly called a cap. This is an artificial shell of porcelain, or metal, or both that is made in a laboratory designed to fit over all or part of the surface of a tooth. It restores the tooth’s form, function and desired colour and is permanently cemented to the underlying prepared tooth.

Local anaesthetic

A type of medication that, when administered to an area, creates a localised loss of sensation by blocking nerve activity.

Porcelain

A white and translucent ceramic.

Composite resin veneers

Composite resin veneers are also referred to as 'bonding' or 'bonded veneers'. They are a less expensive and more conservative alternative to porcelain veneers and are suitable for teeth that are:

  • Discoloured and not able to be bleached sufficiently;
  • Chipped in multiple places;
  • Misshaped or too small;
  • Slightly crowded or overlapping, or;
  • Slightly spaced with gaps between them.

Rather than having to shave back the natural tooth to make room for the veneer (as is necessary for porcelain veneers), a composite veneer is bonded directly on top of the natural tooth, effectively creating an extra layer on the tooth. Making composite veneers is a quicker process than making porcelain veneers.

This can take from 1-3 hours depending on how many teeth are to be veneered. The teeth are thoroughly cleaned and painted with adhesives to bond the composite resin. Layers of composite resin material in the chosen shade are placed onto the tooth to create a new facing in the desired shape. This is set with a curing light and then polished and shaped to create a realistic-looking tooth. A short second appointment is sometimes needed to complete any final polishing and make adjustments if needed.

Advantages and disadvantages of composite resin veneers

Composite resin veneers are a much cheaper alternative to porcelain veneers. They allow the natural tooth to be preserved beneath the veneer and do not require the tooth structure to be shaved back. They are not as strong as porcelain or natural teeth, but are easily repaired if needed. Only one visit to the dentist is required to place composite veneers and injections of local anaesthetic are rarely required. The surface of composite veneers is not as glossy and hard as porcelain veneers and since there is a limited range of colours available, the result can sometimes look less natural than porcelain veneers. Teeth that have had composite veneers will appear thicker than usual, since the composite resin sits on top of the natural tooth. If the natural teeth are already very prominent, the composite veneers will accentuate this.

Composite veneers are sometimes used as a temporary measure to improve aesthetics when other treatments, such as crowns or porcelain veneers, are planned for a later stage. Composite veneers are especially suitable for children or teenagers who wish to improve their smile before their teeth and gums mature and become stable enough for porcelain veneers in adulthood.

Crowns

Also commonly called a cap. This is an artificial shell of porcelain, or metal, or both that is made in a laboratory designed to fit over all or part of the surface of a tooth. It restores the tooth’s form, function and desired colour and is permanently cemented to the underlying prepared tooth.

Local anaesthetic

A type of medication that, when administered to an area, creates a localised loss of sensation by blocking nerve activity.

Porcelain

A white and translucent ceramic.

Crowns

A dental crown is a thin shell of porcelain, or porcelain and gold alloy, which fits over an existing tooth. They are commonly made for teeth that are chipped or broken, heavily decayed, or extremely discoloured and misshaped. Teeth that have had root canal treatment also sometimes require a crown to strengthen the weakened tooth and improve its appearance.

Unlike a porcelain veneer, a crown requires the natural tooth to be shaved back around the entire surface, not just the front.

Dental crowns can be made from a variety of different materials. Porcelain varieties are usually the most aesthetically appealing. There are different types of porcelain with varying strengths and bonding capacity to the underlying tooth structure. On molar teeth, where chewing forces are heavier, a gold alloy with a porcelain coating may be preferred for its superior strength. These require slightly more tooth to be shaved away, but provide greater strength and durability. Newer varieties of ceramic crowns are now proving to be as strong as traditional gold alloy fused to porcelain crowns. Crowns made of gold alloy alone are less popular because of their gold colour, but provide superior strength without the need to shave away large amounts of tooth structure. They are less obvious when used on back teeth and are known for their longevity. Gold crowns are especially useful when very little natural tooth structure is remaining.

Making dental crowns involves a number of visits to your dentist or prosthodontist. The first appointment can take 1-3 hours. The teeth are prepared for the crowns by shaving away a thin layer from the entire surfaces of your teeth. This creates room for the crown to fit onto your tooth. An injection of local anaesthetic around the teeth is needed during this step, unless the teeth have had root canal treatment and no longer have nerves inside them. Photographs and a mould will be taken of your teeth to send to the dental technician, who will custom-make your crowns. Your dentist will discuss with you whether an all-ceramic crown or a ceramic-fused-to-metal crown is best for you. Temporary crowns are placed onto your teeth at this appointment and are worn until your next appointment. The technician can take 1-2 weeks to make your crowns.

The second appointment involves taking off the temporary crowns and 'trying-in' the permanent crowns, with your dentist checking their fit and colour. It is important that you are satisfied with the appearance of the crowns before they are glued in place. Once the crowns are bonded into place, the colour cannot be altered.

A third appointment may be needed to try-in the crowns again if significant changes need to be made. The dental technician will make the alterations in the laboratory and send the crowns back for the next appointment.

Once you are happy with the fit and appearance of your crowns, the teeth are cleaned and special chemicals are painted on to help bond them in place. A bonding cement is used to secure the crowns onto the teeth. Excess cement is then cleaned away and the crowns are polished.

Advantages and disadvantages of dental crowns

Dental crowns are usually recommended if teeth have been heavily broken down, decayed or worn out. Crowns, when made correctly, will strengthen a tooth as well as improve its appearance.

Your dentist or prosthodontist will assess your teeth to determine if there is enough tooth structure to support a crown. If the tooth is very small and weak, or in a position of strong chewing force, there is a risk that it may break beneath the crown. The tooth may need to be reshaped or reinforced before making a crown.

There is also a risk, as with all dental procedures where tooth structure is shaved away, that the nerve inside the tooth will be damaged and require root canal treatment to save the tooth. It is important to ask your dentist to explain any possible risks to you. Sometimes teeth can become very sensitive after a crown procedure. This sensitivity usually subsides over time, but in some cases requires further attention. It is important to ask your dentist to explain any possible risks that may apply to you.

Dental crowns will not last forever; they will need to be replaced every 10-15 years, depending on how well they are cared for. If the gum shrinks away from the top edge of the crown, a line will become visible above the crown. This can be unsightly if the crown is on a front tooth, so it may be necessary to remake the crown. It is essential that good gum health is maintained around crowns to avoid this problem.

While the dental crown itself will not decay, it is possible for the natural tooth beneath to. If this happens and the decay is extensive, it may be necessary to remove the crown, attend to the decay and, if possible, remake the crown. It is important to floss and brush thoroughly around all teeth whether they have crowns or not.

Crown

Also commonly called a cap. This is an artificial shell of porcelain, or metal, or both that is made in a laboratory designed to fit over all or part of the surface of a tooth. It restores the tooth’s form, function and desired colour and is permanently cemented to the underlying prepared tooth.

Local anaesthetic

A type of medication that, when administered to an area, creates a localised loss of sensation by blocking nerve activity.

Porcelain

A white and translucent ceramic.

Caring for teeth after cosmetic dentistry.

To ensure that your teeth last a long time after cosmetic dentistry, it is important that you maintain good oral hygiene. Brush and floss your teeth twice daily and use a fluoride toothpaste. Avoid very hard toothbrushes and abrasive toothpastes, as these can wear away the teeth. Take care not to use your teeth to hold hard objects such as pens or nails. Do not bite your fingernails, or use your teeth to tear things open, as this may damage or dislodge your teeth.

Avoid biting into very hard foods such as ice, nuts or hard lollies. Visit your dentist regularly to maintain your teeth and be sure to tell your dentist if you have noticed any problems. To help protect your teeth, wear a mouthguard when playing contact sports, or a night-guard if you grind or clench your teeth at night-time.

Teeth whitening

Teeth whitening can be very effective for teeth that are stained or discoloured, but otherwise in good condition. Teeth can become discoloured for various reasons, including:

  • Staining from coloured foods or drinks such as tea, coffee or cola;
  • Smoking;
  • The natural ageing process, and;
  • Some medications that can cause teeth to become discoloured.

Ask your dentist to examine your teeth and ensure that they are healthy and free of disease before considering whitening. This is essential, as some causes of tooth discolouration cannot be treated with whitening products. Broken or diseased teeth and gums can also become painful and irreversibly damaged by the inappropriate use of whitening products. Remember that any fillings, veneers, crowns or bridges that you have will not change colour with teeth-whitening treatments. These will stand out if they are visible in your smile.

There are two methods of teeth whitening:

Home whitening

This method involves a bleaching gel that is applied to the teeth at home, either overnight or for a short time during the day.

Custom-made professional whitening kits can be obtained from your dentist. These consist of a thin plastic tray that is custom-made to fit closely to your teeth. A professional-strength whitening gel is applied to the tray and the tray is worn over the teeth at home. Depending on the strength and composition of the active ingredient, your dentist will instruct you on how long it is safe to wear the gel-filled trays. A custom-made kit ensures that the whitening gel stays in contact with your teeth, has minimal contact with the gums and prevents large amount of gel from being swallowed.

Over-the-counter whitening kits can be bought in shops or online. They are often cheaper that custom-made kits, but generally contain a weaker whitening solution and a standard-sized tray that does not custom-fit your mouth. The gel may leak out of the tray when placed in the mouth, causing irritation to the gums. Leaking gel can be swallowed accidentally. If saliva enters the tray, it will deactivate the gel and reduce the whitening effects. If you have undetected tooth decay, leaking fillings, sensitive teeth or gum problems while using a home whitening kit, you may develop serious problems.

Teeth whitening strips. 

In-office whitening

This method of teeth whitening takes place in the dental clinic and is suitable for people who would like a quick whitening result, or are unable or unwilling to apply their own whitening products at home.

This process involves your dentist polishing and drying your teeth, before applying a barrier to your gums to protect them from the whitening gel. A whitening gel is then applied to your teeth while you lie in the dental chair. The dentist will shine a light or laser or other activating method onto the whitening gel to speed up the whitening process. The treatment usually takes 30 minutes to two hours to complete. After in-office whitening, you may be given a take-home kit to continue the whitening process at home.

In-office whitening uses very strong whitening products and is more likely to result in sensitive teeth after the whitening. This usually reduces over time, but can cause considerable discomfort to some people, particularly those who already suffer from sensitive teeth. Your dentist will advise you whether in-office whitening is suitable for you.

Crowns

Also commonly called a cap. This is an artificial shell of porcelain, or metal, or both that is made in a laboratory designed to fit over all or part of the surface of a tooth. It restores the tooth’s form, function and desired colour and is permanently cemented to the underlying prepared tooth.