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Cosmetic dentistry is an important part of overall dentistry. In some cases, people elect to have cosmetic dentistry performed in order to improve their smile and overall appearance. In others, cosmetic dentistry is chosen in order to reverse or repair a defect that, while not harmful to overall health, has a negative impact on appearance. Moreover, some procedures can improve oral problems, such as a bite.

Many treatments are used to treat teeth that are discolored, chipped, misshaped, or missing. Cosmetic surgery can reshape teeth, close gaps, restore worn or short teeth, and even change the length of teeth.

Common procedures include:

Whitening and Bleaching - procedures used to whiten teeth.
Bonding - tooth-colored material used to fill in gaps or change the color of teeth.
Veneers - placed over the front teeth to change color or shape of your teeth. Veneers are used on teeth with uneven surfaces or are chipped, discolored, oddly shaped, unevenly spaced or crooked.
Contouring and reshaping - a procedure to correct crooked teeth, chipped teeth, cracked teeth or even overlapping teeth in a single session.

Cosmetic surgery

In addition to procedures to treat periodontal disease, many periodontists also perform cosmetic procedures to enhance your smile. Often, patients who pursue cosmetic procedures notice improved function as well. Cosmetic procedures include:

• Crown lengthening
  
• Soft tissue grafts
• Ridge augmentation
  

Veneers

Teeth that are badly stained, shaped or crooked may be improved by a veneer placed on the surface of the affected teeth.

Veneers are thin pieces of porcelain or plastic cemented over the front of your teeth to change their color or shape. Veneers are used on teeth with uneven surfaces or are chipped, discolored, oddly shaped, unevenly spaced or crooked. Little or no anesthesia is needed. Veneers have a longer life expectancy and color stability than bonding, and highly resist permanent staining from coffee, tea, or even cigarette smoking.

Veneers are usually made by a dental lab technician working from a model provided by your dentist. Veneers are usually irreversible because it's necessary to remove a small amount of enamel from your teeth to accommodate the shell.

Porcelain veneers can mask undesirable defects, such as teeth stained by tetracycline, by an injury, or as a result of a root-canal procedure, and are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider porcelain veneers.

Typically, veneers entail at least three appointments: diagnosis and treatment planning, preparation, and bonding.

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Teeth Whitening

The National Institutes of Health estimates that more than 10 million Americans have TMD, or problems affecting the jaw joint and/or muscles.

As we age, the outer layer of enamel on our teeth wears away, revealing a darker tissue underneath, at the center of the tooth around the nerves and blood vessels. Smoking, drinking coffee, tea, and wine, and even taking certain medications as a child such as tetracycline also contribute to loss of brightness in your teeth.

Normally, our mouths cover tooth enamel with a clear colorless, yet sticky, layer of protein known as pellicle. But food stains stick to this protein, ruining our white smiles. Known culprits include soy sauce, berries, curry, coffee, red wine, and tea. These foods easily stain teeth. Extremely hot or cold liquids are especially harmful to the whiteness of your teeth, because they change the temperature of your teeth. This expansion and contraction allows stains to more easily penetrate your teeth. Foods that are slightly acidic open up the pores of the tooth enamel, allowing stains to more easily move into your teeth.

There are two types of tooth stains: Intrinsic (internal stain) and extrinsic (external stain).

Intrinsic stains occur from within the tooth, and cannot be removed by brushing and flossing; bleaching may also not be effective. Some causes of intrinsic staining occur from tooth injury, certain medications such as tetracycline, or an excess fluoride ingested during the formation of teeth.

Extrinsic stains usually only involve the tooth surface. Common sources of extrinsic stains include cigarettes, cigars, coffee, tea, or foods that contain a lot of spices. This type of staining can sometimes be removed by good oral hygiene or professional cleaning.

Teeth whitening can restore your teeth to their earlier brightness. There are a number of options today, so take care in choosing the right one for you.

Whitening toothpastes can help remove surface stains through the action of mild abrasives. Some whitening toothpastes have special chemical or polishing agents that provide additional stain removal, but unlike bleaches, don't change the color of your teeth. Whiteners may not correct all types of discoloration. For example, yellow teeth will probably bleach well, while brownish-colored teeth may bleach less well, and grayish teeth may not bleach well at all. In addition, bleaching or whitening may not be effective if you have had bonding or tooth-colored fillings placed in your front teeth. In such cases, you may want to consider porcelain veneers or dental bonding.

Teeth bleaching safely lightens the color of your teeth, and can last up to five years. The most effective and safest method of tooth bleaching is that performed by your dentist.

In general, bleaching works for most people. Tooth bleaching is most effective if your teeth are darkened from age, coffee, tea or smoking. Teeth darkened with the color of yellow, brown or orange respond better to lightening. Other types of gray stains caused by fluorosis, smoking or tetracycline can be lightened, but satisfactory results may be more difficult to achieve.

If you're interested in brightening your smile, have your teeth evaluated by your dentist. Not everyone is a good candidate for bleaching. In some cases of serious discoloration and pitted teeth, for example, veneers may be more appropriate than bleaching. Moreoever, crowns, bridges, and fillings do not bleach, so it may be necessary to replace dental work to make it blend with the new color of your bleached teeth. An X-ray of your teeth may be the only accurate way of making a true assessment.

The whitening process could cause you a lot of pain down the road if you have receding gums. Occasionally, people experience some sensitivity in their teeth and gums during the bleaching process. A Journal of the American Dental Association study recently found that 50% of people experience temporary tooth sensitivity as a result of home whitening treatment. Don't try to get your teeth too white, because you may have trouble matching new fillings later on.

Stained, discolored, or dull-looking teeth

Often, people with stained or discolored teeth may just need a whitening procedure in order to restore their smile.

People with stained or dull teeth usually benefit from whitening, which is a safe and effective way to brighten stained, discolored or dull teeth. Even a stubborn single tooth that is noticeably duller or less white than your other teeth can be individually brightened.

In-office and supervised at-home whitening systems are available. At-home systems should be individually fitted and monitored.

Bleaching

There are basically two kinds of teeth whitening: bleaching and non-bleaching products.

Non-bleaching products, many of which are available over the counter, work by physical or chemical action to help remove surface stains only.

Teeth bleaching products, which contain peroxides, actually changes your natural tooth color anywhere from five to seven -- but even up to twelve -- shades brighter.

One process known as chairside bleaching involves applying either a protective gel to your gums or a rubber shield to protect the soft tissues in the mouth. A bleaching agent is then applied to the teeth, and a special light is used to enhance the chemical action.

If your teeth aren't very dark or very stained, you may need only one bleaching session. Some tooth-whitening systems are available for home use. These usually use a gel that is placed in a custom-fitted mouth guard formed from a mold of your teeth. The guard is typically worn either twice a day for 30 minutes or overnight for two to three weeks. The length of time can range from one week to one month depending on how much whitening you need. Over-the-counter products are less expensive but will not brighten your teeth as much as professional products.

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Bonding

Thanks to modern technology, today's false teeth are largely indistinguishable from real teeth. This wasn't always the case. Perhaps the most famous false-toothed American was the first president, George Washington. Popular history gave Mr. Washington wooden teeth, though this was not the case. In fact, wooden teeth are impossible; the corrosive effects of

Bonding is a process in which an enamel-like material is applied to a tooth's surface, sculpted to an ideal shape, hardened, and then polished for an ideal smile. This procedure usually can be accomplished in a single visit.

Bonding is often performed in order to fill in gaps or change the color of your teeth. It typically only entails one office visit, and the results last for several years.

Bonding is more susceptible to staining or chipping than other forms of restoration such as veneers. When teeth are chipped or slightly decayed, bonded composite resins may be the material of choice. Bonding also is used as a tooth-colored filling for small cavities and broken or chipped surfaces.

In addition, bonding can be used to close spaces between teeth or cover the entire outside surface of a tooth to change its color and shape. Crowns, also known as caps, are used in cases where other procedures will not be effective. Crowns have the longest life expectancy of all cosmetic restorations, but are the most time consuming.

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Root Canal

Before root canal therapy came into practice, if you had a tooth with a diseased nerve, you'd probably lose that tooth.

Deep beneath each tooth's outer shell is an area of soft tissue called the pulp, which carries the tooth's nerves, veins, arteries and lymph vessels. Root canals are very small, thin divisions that branch off from the top pulp chamber down to the tip of the root. A tooth has between one and four root canals.

When the pulp becomes infected, usually from a deep cavity or fracture that allows bacteria to creep in, or injury due to trauma, it can die. Damaged or dead pulp causes increased blood flow and cellular activity, and pressure cannot be relieved from inside the tooth. Pain in the tooth is commonly felt when biting down, chewing on it and applying hot or cold foods and drinks.

Left untreated, pus builds up at the root tip, in the jawbone, forming a "pus-pocket" called an abscess. An abscess can cause damage to the bone around the teeth. Without root canal therapy, the tooth may have to be pulled, causing surrounding teeth to shift crookedly, and resulting in a bad bite. The space left behind may require an implant or a bridge, which can be more expensive than root canal therapy.

Root canal therapy is performed in order to save the damaged or dead pulp in the root canal of the tooth. The procedure involves cleaning out the diseased pulp and reshaping the canal. The canal is filled with a rubber-like material to prevent recontamination of the tooth. The tooth is then permanently sealed with either a post or gold or porcelain crown. This enables you to keep most of your original tooth.

In most cases, a root canal is a relatively simple procedure with little or no discomfort involving one to three visits.

Root canals have an extremely high rate of success (usually higher than 95 percent).

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Crowns

Crowns are synthetic teeth-like coverings that are designed to make your tooth stronger and improve its appearance. Crowns are necessary when a tooth is generally broken down and fillings won't solve the problem. A crown is a restoration that covers, or "caps," a tooth to restore it to its normal shape and size, strengthening and improving the appearance of a tooth.

If a tooth is cracked, a crown holds the tooth together to seal the cracks so the damage doesn't get worse. Crowns are also used to support a large filling when there isn't enough of the tooth remaining, attach a bridge, protect weak teeth from fracturing, restore fractured teeth, or cover badly shaped or discolored teeth.

A crown can cover and support a tooth with a large filling when there isn't enough tooth left. In many cases, crowns are used after a root canal therapy, and are used to restore portions of the tooth (typically the top surface) removed during root canal treatment.

Crowns also can be used to attach a bridge, protect a weak tooth from breaking or restore one that's already broken. A crown is a good way to cover teeth that are discolored or badly shaped. It's also used to cover a dental implant.

Procedures

To prepare the tooth for a crown, it is reduced so the crown can fit over it. An impression of teeth and gums is made and sent to the lab for the crown fabrication. A temporary crown is fitted over the tooth until the permanent crown is made. On the next visit, the dentist removes the temporary crown and cements the permanent crown onto the tooth.

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Bridges

If you're missing one or more teeth, you may notice a difference in chewing and speaking. A bridge is one option that can help restore your smile.

Bridges help maintain the shape of your face, as well reduce the stress in your bite by replacing missing teeth.

Sometimes called a fixed partial denture, a bridge replaces missing teeth with artificial teeth. In most cases, bridges are very natural and unnoticeable. They literally bridge the gap where one or more teeth may have been.

Bridges can be made from gold, alloys, porcelain or a combination of these materials and is bonded onto surrounding teeth for support. Unlike a removable bridge, which you can take out and clean, a fixed bridge can only be removed by a dentist.

An implant bridge attaches artificial teeth directly to the jaw or under the gum tissue. Depending on which type of bridge your dentist recommends, its success depends on its foundation. So it's very important to keep your remaining teeth healthy and strong

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Dentures

A denture is a removable replacement for missing teeth and adjacent tissues. It is made of acrylic resin, sometimes in combination with various metals.

Types of dentures

Complete dentures replace all the teeth, while a partial denture fills in the spaces created by missing teeth and prevents other teeth from changing position.

Candidates for complete dentures have lost most or all of their teeth. A partial denture is suitable for those who have some natural teeth remaining. A denture improves chewing ability and speech, and provides support for facial muscles. It will greatly enhance the facial appearance and smile.

Complete or full dentures are made when all of your natural teeth are missing. You can have a full denture on your upper or lower jaw, or both.

Complete dentures are called "conventional" or "immediate" according to when they are made and when they are inserted into the mouth. Immediate dentures are inserted immediately after the removal of the remaining teeth. To make this possible, the dentist takes measurements and makes the models of the patient's jaws during a preliminary visit.

An advantage of immediate dentures is that the wearer does not have to be without teeth during the healing period. However, bones and gums can shrink over time, especially during the period of healing in the first six months after the removal of teeth. When gums shrink, immediate dentures may require rebasing or relining to fit properly. A conventional denture can then be made once the tissues have healed. Healing may take at least 6-8 weeks.

An overdenture is a removable denture that fits over a small number of remaining natural teeth or implants. The natural teeth must be prepared to provide stability and support for the denture.

Partial dentures are often a solution when several teeth are missing.

Removable partial dentures usually consist of replacement teeth attached to pink or gum-colored plastic bases, which are connected by metal framework. Removable partial dentures attach to your natural teeth with metal clasps or devices called precision attachments. Precision attachments are generally more esthetic than metal clasps and are nearly invisible. Crowns on your natural teeth may improve the fit of a removable partial denture and they are usually required with attachments. Dentures with precision attachments generally cost more than those with metal clasps.

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Dental Implants

Dentures are no longer the only way to restore a mouth that has little or no non-restorable teeth. Strategically placed support such as implants can now be used to support permanently cemented bridges, eliminating the need for a denture. The initial cost tends to be greater, but the implants and bridges more closely resemble the "feel" of real teeth. Dental implants are becoming the alternative of choice to dentures, but not everyone is a candidate for implants. Call your dentist for advice.

Dental implants are tooth root substitutes that are surgically placed in the jawbone and act as anchors to stabilize artificial teeth. They can replace one, some, or all missing teeth and help eliminate the instability associated with surface adhesives and removable bridges. Individuals with adequate bone level and density who are not prone to infection and can maintain stringent oral hygiene are good candidates for dental implants, according to the American Association of Oral and Maxillofacial Surgeons.

The benefit of using implants is that they don't rely on neighboring teeth for support, and are permanent and stable. Dental implants can also be used to attach full or partial dentures.

Dental Implants are a good solution to tooth loss because they look and feel like natural teeth. Implant material is made from different types of metallic and bone-like ceramic materials that are compatible with body tissue. There are different types of dental implants: the first is placed directly into the jaw bone, like natural tooth roots; the second is used when the jaw structure is limited, therefore, a custom-made metal framework fits directly on the existing bone.

The success rate for implants depends on the tooth's purpose and location in the mouth. The success rate is about 95 percent for those placed in the front of the lower jaw and 85 percent for those placed in the sides and rear of the upper jaw. These rates are continuously improving with the advent of new techniques.

Not everyone is a candidate for a dental implant, however. Because implants require surgery, patients must be in good health, have healthy gums, have adequate bone to support the implant and be committed to good oral hygiene and regular dental visits. If you suffer from chronic problems, such as clenching or bruxism, or systemic diseases, such as diabetes, the success rate for implants decreases. Additionally, people who smoke or drink alcohol may not be ideal candidates, although placement of implants cannot be ruled out.

If you are considering implants, a thorough evaluation by your dentist will help determine if you would be a good candidate.

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