Smile Therapy

By staff March 1, 2004

A survey conducted by the American Academy of Cosmetic Dentistry (AACD) found that 92 percent of those who responded cited an attractive smile as an important social asset, yet only half were happy with their own dental appearance. In another survey, 74 percent of the respondents believed that an unattractive smile could actually harm their chance for career success.

It's no secret that in addition to a good bite, straight teeth also build self-esteem. (Be honest: Who hasn't stared down actress Julia Roberts's throat and wondered where all her fillings went.) But what surprises many is just how much reshaped teeth can improve one's total appearance. Look through the before and after pictures of cosmetic dentists, and you'll see men who seem stronger and bolder after the procedure; women who look years younger; and ordinary people whose newly straight teeth make them dazzlers. So it's little wonder that those who prefer not to endure up to two years of painful orthodonture for a happier outlook on life are turning in increasing numbers to cosmetic dentistry.

"In the right hands, this is very predictable, reliable dentistry," says Dr. Steven Krouse, a reconstruction and cosmetic dentist with the Sarasota practice of Krouse and Crane. In contrast to most plastic surgery, it's a quick way to improve your appearance, and unlike other more complicated surgeries, dentistry comes with almost immediate satisfaction and nary a bruise to indicate you've been under the knife.

Nearly 90 percent of today's dentists are offering some type of cosmetic enhancement. The most popular procedure is simple whitening. According to the AACD, it has grown more than 300 percent over the past five years and is the most requested procedure in patients up to 50 years old (it's second only to crowns and bridges in patients over 50).

The organization attributes this rise to the ease of take-home kits that use a gel-like solution to bleach teeth over a period of one to two weeks. For those seeking faster results, a high-intensity light will activate the same solution in a matter of hours. The results can take years off an aging smile when it's done correctly, but patients should be aware that not everyone's teeth will react the same.

"There really is an art to whitening," explains Krouse. "Because there are differences in everyone's enamel, you can't guarantee the same end result for any two patients." He also cautions against going overboard on the bleach: "Ten years ago the lightest shade we'd use would be considered dark today." He prefers a more natural look to the blinding white smiles popping up everywhere.

A growing number of whitening products are available at the drugstore, and while Krouse doesn't oppose them, he says, "They're very difficult to use for most people." He adds that dentists have access to stronger solutions than those in over-the-counter kits. Whitening usually has to be repeated about every six months. Plus, not everyone is a candidate. "Bleaching works best on stains of age," says Dr. Jill Morris or World Class dentistry in Sarasota. "Tetracycline stains and certain tooth colors just won't respond. Crowns, porcelains and fillings do not bleach."

In these cases, she and Krouse recommend veneers, ultra-thin laminates made of porcelain or composite resin that adhere directly to the tooth's surface. In addition to providing a stain-resistant surface, they're especially useful for repairing large cracks or severely worn teeth. When used to replace large, conventional metal fillings, the tooth-colored resin can render cavities virtually invisible. (The AACD maintains resin is often more wear-resistant than traditional silver and gold fillings.)

Veneers are bonded directly onto the surface of the tooth with a material similar to enamel. "When bonded, veneers actually become part of the tooth," says Krouse. From start to finish, the application takes an average of only two to four visits.

Veneers are also similar in strength to human teeth, and seem to last as long. "Ten years ago we were hoping for five years, and it's 10 years later and they're still in perfectly good condition," says Krouse. He believes they could conceivably last up to 20 years.

Plus, says Krouse, they do not require metal underlays or removal of as much tooth as traditional crowns. "Natural teeth don't come with gold layers underneath them," he says. And because bonded veneers have the same translucence as enamel, they look natural. When combined with a procedure called gum sculpting, which shapes the gums to the teeth, they can transform a crooked smile into a work of linear art.

But cosmetic dentistry is not just about procuring Julia Roberts' dazzling chops. For those who've lost teeth due to advanced gum disease, automobile accidents, sports injuries or cancer, it can be a godsend. Dental implants are a prime example. "Even the dental community doesn't always know what's new in implant dentistry," says Dr. Craig Misch, a dual specialist in oral and maxillofacial surgery and prosthodontics who lectures throughout the country on the subject.

Dental implants are titanium alloy screws that are inserted into the jawbone. Once in place, the bone grows around them, providing a secure, permanent anchor for replacement teeth. They've existed for years, but recent technological advances have drastically curtailed treatment time and pain. Years ago, says Misch, months passed between the initial implantation and attachment of replacement teeth. Today, those teeth go on during the implant surgery. "If we put teeth on right away, patients experience less pain," he says. (Since the bone itself has no nerve endings, the surgery is usually done under light or surface sedation). "We don't know why. It could be a psychological factor, or it could be that having the teeth in right away takes pressure off the implants themselves."

Misch has long urged his denture patients to trade up to implants. "Once a tooth is removed, the bone is no longer stimulated," says Misch. "If the bone is not stimulated, it begins to dissolve. Then it can't support facial muscles or overlying skin. Denture wearers continue to lose bone density until it becomes difficult to even wear dentures." Because implants preserve the remaining bone, patients can speak, chew and function better than they do with dentures.

None of these options come cheaply. While many of Krouse's (and Morris') patients receive about 20 veneers (treat any fewer, and people may see color inconsistencies when you speak or smile), if teeth are severely worn, it's not unusual to treat all of them. "Ten years ago, if we could put something white on a tooth, that was considered cosmetic dentistry," says Krouse. "Now we're thinking in terms of treating the whole mouth."

That whole new mouth can cost as much as a luxury automobile. Lab costs vary from 300 percent to 400 percent, and insurance covers cosmetic dentistry only under the most extreme circumstances. While whitening is relatively inexpensive (take-home kits cost an average $250, and high-intensity light whitening can reach $650), bonded veneers start at $1,000 and can run as high as $1,600 per tooth.

Many of Morris' clients find their own financing; some have even taken out home equity loans to pay for their new smile. "People who want it find the money for it," says Morris. "That's the American way of life."

Apparently, it's also a bargain for those who are willing to embrace these "instant orthodontics" so they can avoid years of metal wires and painful bands to improve their self-esteem and, finally, smile for the camera. 

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