Cosmetic dentistry with honest expectations

Health first, then appearance

Cosmetic dentistry is one of Dr. Gogani's areas of special interest. He describes dentistry as a meeting point of art and science, and cosmetic work is where that's most visible: color, shape and proportion matter, but so do the health of the tooth underneath and how the bite works.

That's why cosmetic treatment starts with an exam. Whitening won't work well over untreated decay, and a veneer won't last on a tooth that's under heavy grinding forces. If there are cavities, gum problems or cracks, those are treated first. Then we talk about what you'd like to change and which options can realistically get you there.

Professional teeth whitening

Teeth naturally darken over time, and coffee, tea, red wine, tobacco and some medications can add stains. Whitening uses a peroxide-based gel to lighten the color of natural enamel.

What's involved

Professional whitening may be done in the dental chair, at home with custom-fitted trays and a whitening gel, or a combination of both. Custom trays hold the gel evenly against the teeth and help keep it off the gums. The dentist will recommend an approach, explain how to use any at-home products, and check your progress.

What to expect

How much lighter your teeth become varies from person to person, depending on the type of staining and your natural tooth color. Results aren't permanent; staining gradually returns, especially with coffee, tea, wine and smoking, and occasional touch-ups can help maintain the shade. If you already have front-tooth fillings or crowns, whitening may leave them looking darker than the surrounding teeth, which is something to plan for.

Cosmetic bonding

Bonding uses tooth-colored composite resin, the same type of material used in many fillings, to reshape or repair a tooth. It's often chosen for small cosmetic concerns because little or no enamel has to be removed.

Common uses

• Repairing a small chip or rough edge
• Closing a small gap between teeth
• Covering a stain or discoloration on part of a tooth
• Making a slightly short or uneven tooth look more even

The procedure

The dentist selects a shade to match your teeth, lightly roughens the surface so the material can grip, applies the resin in layers, shapes it, hardens it with a curing light, and polishes it. Many bonding repairs can be completed in a single visit, and anesthesia often isn't needed unless the repair is near the nerve.

Limitations

Composite is not as strong or stain-resistant as porcelain. Bonded areas can chip, especially on biting edges, and may pick up stains over time. Avoid biting fingernails, pens or ice, and expect bonding to need touch-ups or replacement at some point.

Veneers

A veneer is a thin, custom-made shell that is bonded to the front of a tooth to change its color, shape, size or length. Veneers are usually made of porcelain, which resists staining and reflects light much like natural enamel.

What's involved

Treatment usually takes more than one visit. The dentist plans the shape and shade with you, then removes a thin layer of enamel from the front of the tooth so the veneer sits naturally. Impressions or scans are taken so the veneers can be made, and temporary coverings may be placed in the meantime. At the final visit, the veneers are checked for fit and color and then bonded in place.

Important to know

Because enamel is removed, traditional veneers are considered irreversible; the tooth will always need some kind of covering afterward. Veneers can chip or come loose, and eventually may need replacement. They may not be recommended if you have active gum disease, significant decay, or a heavy grinding habit without protection, though a night guard can help protect them.

Comparing whitening, bonding and veneers

Combining treatments into a smile plan

Many people's concerns involve more than one tooth or more than one issue: a few stained teeth, an old crown that no longer matches, a missing tooth, a chipped edge. A smile plan puts these together in a sensible order. For example, whitening is often done before bonding or new crowns, so the new work can be matched to your lighter shade.

A plan can also include restorative treatment such as crowns to rebuild broken teeth, or dental implants to replace missing ones. The dentist will explain what each step involves, and roughly how long the whole plan may take. You can ask about costs before you start.

Is cosmetic treatment right for you?

Cosmetic dentistry works best when:

• Your teeth and gums are healthy, or any decay and gum disease has been treated first
• Your goals are realistic and you understand what each option can and can't change
• You're prepared for the upkeep that comes with the treatment you choose

If you have untreated cavities or bleeding gums, a checkup and cleaning comes first. Whitening is generally not recommended during pregnancy or for young children, and anyone with very sensitive teeth or receding gums should discuss it with the dentist first. Results vary between patients, and we won't promise a specific shade or outcome. We'd rather set expectations you'll be happy with.

Keeping your results

• Brush twice a day with fluoride toothpaste and clean between your teeth daily.
• Rinse with water after coffee, tea or red wine, and consider a straw for dark drinks.
• Don't use your teeth as tools, and avoid biting very hard objects.
• Wear a night guard if you grind, and a mouthguard for contact sports.
• Keep up with regular exams and cleanings so small issues are caught early.