Mouth to Mouth: Cosmetic Dentistry and You

Posted Friday, September 7, 2007 to PROCEDURES > Smile

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Dr Susan Goran, principal of a leading practice in Westwood talked to Jodi Thiessen about the growing demand for cosmetic dentistry.

Why is cosmetic dentistry in such demand today?

A beautiful smile emanates youthfulness, health, cleanliness, warmth and beauty - qualities that are important to all of us.

What are the specific reasons people seek cosmetic dentistry?

Most people who visit my office for cosmetic treatment are seeking resolution of aesthetic issues that fall into two categories. First are the naturally occurring problems, such as gaps and teeth with unappealing shape or color. Second are the aesthetic changes that result either from trauma or gradually develop as people age.

What happens to our teeth as we age?

If you look at the teeth of a healthy young person, you will notice crisp, sharp biting edges and a degree of translucency to the teeth. Less obvious is the relative size difference of the teeth. These features tend to disappear as people age, as a result of wear on the teeth and changing color. Most people experience some degree of yellowing, and many people develop meaningful staining after years of smoking or drinking coffee, tea or red wine.

Teeth wear is inevitable because we use our teeth every day. But many people wear down their teeth much more rapidly, often due to habits of which they are not even aware. Significant tooth wear or staining can be aesthetically unappealing, and certainly makes a person look older. Also, as we age, the likelihood of losing teeth through trauma or decay increases. Lost teeth that are not replaced can lead to bone loss - which again can make a person look older.

How do you determine what kind of cosmetic treatment will create the best result?

Treatment planning begins by understanding exactly what the patient would like to achieve. I then evaluate and discuss with the patient how we can get there. The best result is what will make the patient happiest - and that is beautiful, natural looking teeth. Frequently though, people have an idea what they want, without understanding the subtleties that make cosmetic restorations look completely natural. Beauty is subjective - but there are certain rules of aesthetics that a cosmetic practitioner learns from study and observation.

What are the subtleties involved in trying to make a person's teeth look more youthful?

I begin by evaluating basic structural issues. Do the size and shape of the teeth match the person's bone structure? Is the color of the new or repaired teeth natural and consistent with the color of the person's natural smile and amount of gum line that shows? Does the person want more masculine teeth, which tend to be slightly larger and squared off, or more feminine teeth, which have softer corners? The next step is what I call the "What can we get away with?" evaluation. How perfect can I make the teeth and still have them look natural? In a case where I see a young woman or man whose teeth are chipped, stained or worn, nearly perfect teeth may be appropriate. In the case of a 60-year-old man, absolutely perfect teeth probably would not look natural. In that case I would change the color slightly,and maybe add a subtle irregularity,such as an insignificant stain or overlap on lateral teeth. On a 60-year-old man we generally cannot "get away with" teeth the color of an 18-year-old's.But we may have success making the teeth the color of a healthy 30-year-old, especially if we add a slight irregularity to belie the fact that any cosmetic enhancement has been performed. Of course, some patients want perfect looking teeth no matter how old they are, and I respect that wish as long as the patient has fully evaluated his or her options.

What about cases where teeth have been lost?

With lost teeth, the best solution is generally dental implants. These are beautiful, natural looking teeth attached to root form implants placed in the jaw bone. With implants, a person can eat, smile and talk with complete confidence they will not slip or demonstrate any clue that they are anything other than natural teeth. Patients who have had their removable dental appliances (such as full or partial dentures) replaced with implants have told me they feel younger and more confident.

We often see people with obvious caps on their front teeth. Many people are afraid to seek cosmetic work because they don't want a result like that. What is the likelihood of such a result?

I cringe when I see that kind of work. In my opinion there is no excuse for work like that considering what is available today in cosmetic dentistry.

Just how advanced are the techniques available today?

The wonderful thing about cosmetic dentistry is that we are able to create almost anything a person wants. The field has seen tremendous advances in the application of technology - and it continues to advance. Bleaching can be accomplished using different chemicals or focusing a laser to the outside of the teeth.

Bonding and veneers can change the color, shape and configuration of teeth. A variety of new, non-metal, ceramic or polymer crowns display a strong, highly pleasing aesthetic. Crowns made of porcelain fused to white gold work particularly well in many circumstances. Tooth colored onlays and inlays made of ceramic and porcelain can be used to fill cavities or replace broken amalgams, and are virtually undetectable. Missing teeth can be permanently replaced by implants, as we discussed earlier.

Who are the people seeking cosmetic dental treatment?

They cover a wide spectrum - business people, actors, students, home-makers, retired people and professionals. It doesn't require any particular background to want beautiful, young looking teeth.

The type of work also varies widely - from repairing a single chipped tooth to reconfiguring an entire smile. I see young actors who want perfect "Hollywood white" teeth. I also see successful executives in their 40s and 50s who want to look as young and healthy as they feel - but without anyone being able to tell that they had cosmetic restorations. Nature takes its toll through the aging process and we do all we can to fight back.

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