If traditional dental practice could be viewed as the mouth's caretaker – fixing and maintaining healthy teeth and gums and treating decay – cosmetic dentistry would be the mouth's interior decorator. Its mission is enhancing the beauty of the patient.
Yet like the practice of plastic surgery, cosmetic dentistry sometimes uses the same techniques and materials as traditional dental services. Many people who have had injuries or diseases that have damaged their teeth or enamel may need repairs that both make them look better and ensure that their teeth remain strong or useful. These repairs can be done by cosmetic dentists or often by dentists with a more general practice. But the bulk of the practice for cosmetic dentists are elective procedures.
Improvements in dental hygiene have dramatically affected the practice of dentistry. Sealants, fluorides and electric toothbrushes have cut the number of cavities. About half of all schoolchildren have no cavities, compared with 28 percent who were cavity-free in the early 1970s. Adults lose fewer teeth and get less gum disease now. This good news on oral health has meant a sharp decline in dental business.
The advent of cosmetic dentistry has rejuvenated some practices. Cosmetic dentistry is not recognized as a specialty by the American Dental Association, and general-practice dentists can offer these services without meeting any special requirements. Dental magazines are filled with tips on how dentists can boost their business by offering and promoting cosmetic services, while dentistry schools are offering more courses on cosmetic procedures. Some dentists now help patients visualize proposed changes with fancy new video and computer equipment.
Cosmetic dentistry is not cheap. For example, it can cost thousands of dollars to get a newly designed smile through the miracle of veneering, or adding synthetic enamel, which must be replaced after three to 12 years. Insurance generally doesn't cover cosmetic procedures, so the cost is entirely out of pocket.
Some of the techniques used in cosmetic dentistry are:
– Bleaching. Using peroxide gels to make teeth whiter is especially popular because it is relatively simple and cheaper than covering over stained teeth with bonding materials or veneers. Dentists can bleach in the office in a series of two to seven sessions or can make a plastic dental tray for patients to use with bleaching gel at home, a process that takes longer to get the same results. The process costs anywhere from $ 300 to $ 900 per upper or lower row of teeth.
– Contouring. Another relatively conservative procedure uses a sandpaper disc to give new shape to teeth or make them less crowded. This might cost $ 50 to $ 75 per tooth.
– Gum removal. Dentists also can surgically remove excess gum from above front teeth for people with "gummy" smiles. This can run several thousand dollars for the entire job.
– Bonding. This uses a composite resin material to close gaps and nicks. Requiring one office visit and little if any tooth reduction, it was an advance over capping (also called crowning), which involves grinding teeth down to stumps and covering the stumps with porcelain crowns. Crowns are still needed to fix some severely damaged or decayed teeth, but bonding will cover less serious flaws. Bonding can cost between $ 200 and $ 1,000 per tooth and lasts anywhere from three to 10 years.
Cosmetic dentists sometimes also advise patients to replace their old silver-colored amalgam fillings in back teeth with white composite resins. The resins last five to eight years, while silver amalgam can last for decades.
– Veneers. These fingernail-thin porcelain shells are bonded to the fronts of individual teeth to whiten and reshape them and fill in gaps, after a thin layer of enamel has been ground off. It takes two office visits, one to make an impression of the tooth to send to a laboratory and one to apply the veneer. The cost ranges from $ 500 to $ 2,000 per tooth. Veneers generally last anywhere from three to 12 years. They must then be replaced, because the natural enamel is gone.