Cosmetic dentistry and teeth whitening

Cosmetic dentistry is a broad term for dental procedures that change the appearance of your teeth. You may want to whiten your teeth, repair a chip, or change the colour, shape or position of a tooth or teeth. The first step, though, is always to make sure your teeth and mouth are healthy.

Before you start treatment#

Before any cosmetic procedure, it is important to see a dentist to check your whole mouth thoroughly. This is to:

• treat any disease first, because your health is the priority
• find out what is causing the appearance you are unhappy with
• talk through the range of treatment options
• work out a realistic plan that suits you

Treating tooth decay, gum disease or other problems first, cleaning the area well and eating a healthy diet all give cosmetic treatment the best chance of lasting.

Thinking about what you want#

Before you see your dentist, think about:

• what you like and don’t like about the appearance of your teeth
• any symptoms you may have, such as pain or difficulty eating
• treatment you have had in the past, and whether you were happy with it
• what you would like to change (bring a photo if it helps, for example showing how a tooth looked before it was chipped)
• how much time and money you would be prepared to invest
• how much effort you would put into looking after your teeth at home afterwards, as most cosmetic treatment needs extra home care

If you have private health insurance, check what kind of dental treatment is covered. It may help to write your thoughts down.

Questions to ask your dentist#

During your appointment, talk about your concerns using the list above as a starting point. Your dentist may take x-rays and do other tests. Ask about:

• what options are available, and the pros and cons of each
• what results can reasonably be expected
• what costs, in time and money, are involved, and whether payment options are available
• any possible side effects or complications

A simple procedure may be done on the day. A complex procedure may need time to consider, or visits to specialists over several appointments. Together, you and your dentist can agree on a plan that suits you.

Whitening#

A bleaching gel is applied to the tooth surface to lighten the colour of the enamel. It can be done in two main ways:

• in the dental clinic, where a high-concentration gel is painted on the teeth for about an hour
• at home, by placing the gel in a custom-fit whitening mouthguard and wearing it for a few hours or overnight, for around 1 to 2 weeks

A third type, called internal whitening, is for teeth that have discoloured from the inside and involves placing the bleach inside the tooth in the dental clinic. Products sold in supermarkets and pharmacies may use a similar ingredient but only in small amounts, so they are not as effective.

The main risks are that whitening commonly causes temporary tooth sensitivity, and if the gel overflows it can cause temporary gum irritation. Fillings, crowns, bridges, veneers, false teeth and some types of discolouration do not whiten. Whitening is not permanent; for longer-lasting effects, visit the dentist every 6 to 12 months for professional cleaning.

Filling using resin composite#

Resin composite is a tooth-coloured material that is bonded (glued) onto the tooth. It repairs chips, holes or decay, replaces old fillings and covers up some surface defects.

The tooth is prepared by removing decay and old fillings where needed. The resin composite is placed directly on the tooth and set immediately with a light, then polished smooth so your bite feels natural. It is one of the fastest options and is usually completed in one appointment.

The main risks are that it can chip or fall out and need replacing, and colour options are more limited, so it may be hard to get a good match.

Veneers#

A veneer is a thin covering over the outer surface of the tooth, made from tooth-coloured resin composite or ceramic. It covers up some surface defects and changes the colour and shape of the tooth.

The tooth is prepared by removing decay and old fillings where needed, and a thin layer of tooth may be removed to make space. Resin composite veneers are placed directly on the tooth and polished smooth, usually in one visit. For ceramic veneers, a mould (impression or digital scan) is taken and sent to a lab for the ceramic to be custom-made, with a second appointment usually needed to glue it in. Some clinics have lab equipment on site and may finish on the day.

The main risks are that a veneer can chip, break or stain at the margins and need replacing, and the treatment can be irreversible; once a tooth is cut for a veneer, it may always need one.

Crowns#

A crown is a metal or ceramic shell placed over the entire tooth. It changes the colour and shape of the tooth and protects a tooth weakened by large fillings or past decay.

The tooth is prepared by removing decay and old fillings, and a thin layer of tooth may be removed from the top and all around to make space. A mould (impression or digital scan) is taken and sent to a lab for the crown to be custom-made. A second appointment is usually needed to glue in the crown, so a temporary crown is provided in the meantime. Some clinics have lab equipment on site and may finish on the day.

The main risks are that a crown can chip or break and need replacing. A layer of tooth must be removed, which in some cases gets close to the nerve and blood vessels inside the tooth (the pulp), so the tooth may need further treatment such as root canal treatment. It is irreversible; once a tooth is cut for a crown, it will always need one.

Bridges#

A bridge is made of metal or ceramic crowns attached to supporting teeth to replace one or more missing teeth. It changes the colour and shape of the teeth involved.

The teeth next to the gap are prepared by removing decay and old fillings, and a thin layer of tooth may be removed to make space. A mould (impression or digital scan) is taken and sent to a lab for the bridge to be custom-made. A second appointment is usually needed to glue it in, so a temporary bridge may be provided. Some clinics have lab equipment on site and may finish on the day.

The risks include:

• it can chip or break and need replacing
• sometimes the supporting teeth need little preparation, but other times a lot of healthy tooth structure is removed on either side of the gap
• in some cases preparation gets close to the pulp, so further treatment such as root canal treatment may be needed
• it can be hard to clean under the bridge, and tooth decay or gum disease around it can be difficult to treat; in severe cases the supporting teeth may develop problems
• it is irreversible for the surrounding teeth; once a tooth is cut for a crown to support a bridge, it will always need a crown

Implants#

A dental implant has two main parts: a titanium screw that fuses with the jaw bone, and a ceramic tooth that fits over the screw. It replaces a missing tooth or teeth without damaging neighbouring teeth.

The area is first assessed to make sure it is suitable, looking at gum and bone health, available space, your bite and your general health. The titanium screw is placed into the jaw bone, and it can take up to 6 months for the bone to fuse strongly to the screw. A temporary tooth may be provided in the meantime. When the bone is ready, a mould (impression or digital scan) of the screw’s position is taken and sent to a lab for the ceramic tooth to be custom-made, then the tooth is attached to the screw.

The risks include:

• the ceramic can chip or break and need replacing
• the bone may not fuse to the implant, which would then need to be removed; people at greater risk include those who smoke, have diabetes, have some bone conditions such as osteoporosis, or are immune compromised
• it is more difficult to clean around an implant than a natural tooth, and gum disease around an implant can be very difficult to treat; if severe, the implant must be removed and the area may no longer be suitable for future implants
• depending on your anatomy, there may be some risk of damage to nearby structures such as nerves or sinuses

Dentures#

Dentures are removable replacement teeth. The base plate may be made from acrylic (cheaper) or cobalt-chrome metal (thinner and stronger, but more expensive). Full dentures are for people with no teeth left; partial dentures are for people with one or more teeth left. Dentures are the most cost-effective way of replacing multiple teeth.

A few moulds (impressions or digital scans) and measurements are taken over several appointments to make a wax denture to try in. Once you and your dentist are happy with the colour, shape and position, it is sent to a lab to set in acrylic. Another appointment is needed to fit it and make adjustments, and often more adjustments are needed over the following weeks.

The risks and things to know include:

• dentures must be removed every night for cleaning; if not cleaned properly, food can get caught and lead to decay of neighbouring teeth and gum disease
• it is difficult to make dentures as stable as your own natural teeth
• it can take a month or so to get used to the feeling, and speaking and eating will feel a little different at first, although most people adjust

Braces (orthodontic treatment)#

Orthodontic treatment moves teeth into a preferred position. It may involve:

• braces, which are clips and wires glued onto the teeth during treatment and removed once the teeth are in their final position
• removable clear aligners, thin plastic trays that fit over the teeth and are changed every few weeks
• plates, which may be plastic or metal, removable or glued in

Treatment changes the position of the teeth, often to fix rotated, crowded, overlapping or misaligned teeth, and corrects bite problems where upper and lower teeth do not meet properly.

Moulds (impressions or digital scans) and x-rays are taken to study your teeth and jaws. In some cases teeth may need to be removed to create space. Whichever appliance is used, multiple appointments are needed to check the teeth are moving correctly. Treatment can take from 6 months to a few years. Afterwards, retainers, either removable clear trays or a wire glued behind the teeth, are usually recommended to keep the teeth in position.

The main risks are that it is harder to clean your teeth during treatment, so without extra care you can get tooth decay and gum disease. Teeth and gums can feel uncomfortable when treatment starts or when a new wire or aligner is fitted, and scratches and ulcers on the gums and cheeks are common. In rare cases, tooth roots can shorten and become loose, or need root canal treatment.

Other treatments you may need#

Some procedures are not cosmetic in themselves but allow cosmetic treatment to go ahead:

• oral surgery, such as tooth removal in cases of severe crowding, an extra tooth, or an impacted tooth (fully or partly under the gum) without enough space
• jaw surgery, for example to extend or reduce the jaw where the upper and lower jaw sizes do not match
• bone grafting, for example to thicken bone for implants
• endodontic (root canal) treatment, if there is a problem inside the tooth such as an infection

The risks vary depending on the procedure, so be sure to ask your dentist before going ahead.

General and specialist dentists#

In many countries, the term “cosmetic dentist” is not an officially recognised title. Dentists are generally registered as either “general” or “specialist”. General dentists can all provide some form of cosmetic treatment, and some have a particular interest in areas such as veneers or orthodontics.

A number of dental specialties are formally recognised, including:

• prosthodontist (veneers, crowns, bridges, dentures)
• periodontist (implants, gum disease)
• orthodontist (tooth and jaw alignment)
• oral and maxillofacial surgeon (tooth removal, jaw surgery, implants)

There is no recognised specialty of “cosmetic dentist”, although some dentists run a practice that does a lot of cosmetic work. Depending on how complex your treatment is, you may be referred to various specialists for the best outcome. If you prefer to see a specialist, ask your dentist for a referral.

Looking after your teeth#

To help your results last, brush your teeth twice a day and floss once a day, do not smoke, and limit food and drinks with strong colours such as black coffee and red wine.

Key points#

• Before any cosmetic dental procedure, see a dentist to check your whole mouth thoroughly.
• Talk through the range of treatment options.
• Note any symptoms you may have, such as pain or difficulty eating.
• Think about treatment you have had in the past and whether you were happy with it.
• If you have private health insurance, check what kind of dental treatment is covered.

Where to get help#