Also called: Aesthetic Dentistry
Andrew M. Sicklick, D.D.S.
Cosmetic dentistry is a field of dentistry that focuses on improving the appearance of the teeth or gums (gingiva) caused by genetics, environmental factors, injury, neglect or age. Although cosmetic dentistry does not typically deal with the prevention or treatment of tooth diseases, cosmetic benefits are apparent in many dental treatments, including restorative treatments (e.g., composite resin to fill cavities or crowded or crooked teeth), orthodontics (e.g., braces) and prosthodontics (e.g., implants, inlays, onlays, crowns, veneers).
The type of cosmetic dentistry used generally depends on the imperfection being treated. Various imperfections that can be treated with cosmetic dentistry include:
- Stains and discolorations
- Misshapen or uneven teeth
- Spaces between teeth (diastema)
- Excessive or uneven gums
There are numerous different cosmetic dentistry procedures available to modify the appearance of the teeth and mouth. Among the most popular of these are bonding the front teeth to cover small imperfections and bleaching to whiten stained or discolored teeth. Other options include recontouring to reshape teeth and gingivoplasty to reshape the gums.
Important considerations for cosmetic dental procedures include cost and whether insurance will cover the procedure and care of any dental appliances. Computer imaging technology can help patients to evaluate whether a given procedure is worth the cost. Many cosmetic dentists have access to this technology, which allows dentists to show patients how their teeth and mouths may appear after the procedure.
About cosmetic dentistry
Cosmetic dentistry is a branch of dentistry that focuses on the modification of the appearance of teeth instead of the treatment or prevention of disease. Cosmetic procedures can improve imperfections caused by genetics, environmental factors, injury, neglect or age.
Patients interested in cosmetic dentistry need to have a dental examination so that the dentist can determine which procedures are right for them. Some patients are not good candidates for some procedures. For example, bleaching may not be recommended for patients with periodontal disease.
Many cosmetic dentists have access to computer imaging technology. Dentists can use this technology to show patients how their teeth are likely to look after a given procedure. Before and after images can be generated before patients commit to the dental work. This can help patients determine which procedures they are interested in, especially when there are numerous options. For example, an oddly shaped tooth may be corrected with recontouring or bonding. Different options may produce slightly different results. In some cases, dentists may recommend prosthodontic treatments, such as veneers or crowns, which are used to replace or cover missing teeth or structures.
Cosmetic dentistry procedures can be expensive, especially if many teeth are involved. In most cases, cosmetic procedures are not covered by insurance. However, restorative or preventive procedures, which may be covered in part or full by insurance, often also have cosmetic benefits. For example, composite resin, which matches tooth color closely, can be used instead of silver amalgam material to repair a cavity or replace a loose or otherwise defective filling.
Many cosmetic procedures (e.g., bonding) use artificial materials to modify the teeth. These materials may crack, chip or fall off. They may not match the color of the surrounding teeth exactly, or may appear a different shade in certain light (e.g., in a theater or nightclub). Some of these materials require special care, although many only require diligent dental hygiene. Some patients may experience sensitive teeth after a cosmetic dental procedure.
Cosmetic dentistry has limits. Many of the procedures (e.g., bleaching) may take weeks or months to produce results. Patients are encouraged to talk to their dentists about how much of a change they can expect from a given procedure, how long the procedure will take and what maintenance techniques need to be used.
Conditions treated with cosmetic dentistry
The type of cosmetic dentistry used generally depends primarily on the imperfection being treated. The various imperfections that can be treated with cosmetic dentistry include:
- Discolorations and stains. Superficial stains may be caused by beverages (e.g., coffee, tea, colas, red wine), foods (e.g., spaghetti sauce) or smoking. Stains from food or drink tend to cause yellow or brown discolorations, while smoking tends to stain teeth gray or black. The use of certain medications, especially the antibiotic tetracycline, can cause deeper stains in developing teeth when used by a mother during pregnancy or by a young child. This often causes a gray discoloration. Excessive fluoride use in young children may produce similar discolorations or white spots on teeth. Teeth also frequently yellow with age. Other potential causes of stains or discolorations include genetics, root canal treatment or an injury to the tooth. Yellow or brown stains, such as from food, drinks or age, tend to respond well to bleaching. Deeper or more severe discolorations, such as from smoking or tetracycline use, may require bonding to mask the stains. In some cases, dentists may recommend crowns or veneers, which are a type of prosthodontic dentistry.
- Misshapen or uneven teeth. Many patients have a tooth or a few teeth that are longer, shorter, or have a different shape than the surrounding teeth. The teeth may also have unsightly pits, grooves or bulges. Recontouring can correct these imperfections by cutting away and reshaping the enamel of the teeth. However, some patients may not be good candidates for this and may require bonding or veneers. Some dentists may recommend crowns for some patients.
- Spaces between teeth. Many patients have gaps between their teeth (diastema) that they may find unattractive. Small diastemas may be treated using bonding or veneers. Braces or retainers (a type of orthodontic appliance) may be needed for large gaps or crooked or crowded teeth.
- Chipped or cracked teeth. Minor chips or cracks in the surface of the teeth may be repaired with bonding or veneers. If these procedures are not an option because too much of the tooth is damaged, prosthodontic treatments (e.g., inlays, onlays, crowns) may be used.
- Excessive or uneven gums. Many patients show a large amount of gum (gingiva) when they smile, or the gumline may be uneven from one tooth to the next. Patients who are self-conscious of this may not open their mouths and show their teeth when they smile. Cosmetic surgery on the gums (gingivoplasty) or bones (orthognathic surgery) can repair this problem.
Types and differences of cosmetic dentistry
Numerous cosmetic dentistry procedures are available to modify the appearance of the teeth and mouth. Bonding and bleaching are the most popular procedures, as well as the most affordable. Various types of prosthodontics (e.g., crowns, veneers, inlays, onlays) and orthodontics (e.g., braces) can also have cosmetic benefits. Different types of cosmetic dentistry procedures include:
- Bleaching. According to the American Academy of Cosmetic Dentistry (AACD), bleaching is requested more than any other cosmetic dental procedure. Peroxide is used to whiten and brighten stained or discolored teeth. This may be done in the dental office, at home with dentist supervision, or with over-the-counter products. However, the American Dental Association (ADA) recommends that patients speak with their dentists about the use of any bleaching product, including over-the-counter products. Misuse of these products can cause tooth sensitivity or otherwise damage the teeth.
- Bonding. A composite resin that matches the color of the teeth is sculpted onto the teeth and hardened with a special high-intensity blue light. It is then polished by the dentist until is looks like a part of the natural tooth. Bonding can be used to mask chipped, broken, cracked or stained teeth and to close the spaces between teeth (diastema). Bonding may also be used to protect a portion of a tooth root that may have become exposed due to receding gums. The same material can be used in restoration to repair cavities as an alternative to silver amalgam fillings.
- Recontouring. Also called enamaloplasty or reshaping and contouring. The dentist removes and reshapes small portions of the enamel of a tooth or teeth in a procedure that is usually quick and painless. This can change the length, shape or surface contours of a tooth or make small adjustments to the position of the teeth. It may be used to repair misshapen, crooked, chipped or overlapping teeth. Recontouring is frequently combined with bonding. However, not all patients are good candidates for recontouring. The tooth needs sufficient enamel to safely cut away and the pulp of the tooth cannot be too shallow. X-rays are used to verify the ability to use recontouring.
- Gingivoplasty. Also called gum surgery, crown lengthening or a gum lift. This is a surgical procedure that alters the shape of the gums (gingiva) by cutting away excessive gum tissue. Patients who have had a gingivoplasty reveal less of the gum and more of the teeth when they smile.
Questions for your doctor on cosmetic dentistry
Preparing questions in advance can help patients to have more meaningful discussions regarding their treatment options. Patients may wish to ask their dentist the following cosmetic dentistry-related questions:
- Am I a good candidate for cosmetic dentistry?
- Are my gums and teeth healthy enough to withstand this procedure?
- What type of cosmetic dentistry is best for me?
- What is involved in this procedure?
- Will you need to refer me to a specialist, such as an orthodontist?
- How much of an improvement is this procedure likely to produce?
- How long will this procedure take?
- Considering my current health and condition, should I postpone cosmetic dentistry until a later date?
- When should I make an appointment for a follow-up?
- What if I don’t like the results?