DENTAL AESTHETICS
Like cosmetic surgery, dental aesthetics is not just a matter of appearance. Often, in addition to correcting certain physical “flaws,” the improvement will also benefit your physical and mental health.
Dentistry includes specialties such as orthodontics and oral surgery, and different clinics do not all offer the same services. It is important to consult your regular dentist first so that you can be referred to the professional best able to meet your dental aesthetic choices.
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Teeth whitening
Teeth whitening is an increasingly popular procedure. Before undergoing any treatment, it is best to discuss it with your dentist at your next visit. Your dentist must first clean your teeth and make sure you do not have cavities or defective restorations. He or she can then determine why your teeth are no longer as white as before, a crucial step for the success of the treatment.
Several factors can cause a change in tooth colour. First, teeth may be covered with a buildup of dental plaque and tartar. These deposits become stained if a person frequently drinks coffee, tea or red wine, or if they smoke. A simple cleaning and polishing of the teeth is enough to remove superficial stains. However, discolouration may be lodged in the enamel and dentin of the teeth.
• At-home whitening:
Under your dentist’s supervision, it is possible to whiten your teeth at home. Before treatment, the dentist takes an impression of your teeth to make a plastic tray that fits your dentition perfectly. This tray holds a whitening liquid that must be applied to the teeth. The person wears the tray during the day or at night. Treatment lasts about two weeks, or as long as needed to achieve satisfactory results if the discolouration is stubborn. Side effects may include tooth sensitivity and/or gum irritation. Tooth sensitivity usually disappears when treatment stops. The dentist may prescribe neutral fluoride or a special toothpaste, such as Sensodyne, if sensitivity persists.
• In-office whitening:
People who do not wish to do at-home treatment can choose whitening performed by the dentist in the office. The dentist isolates the teeth and protects the gums with a protective gel or rubber dam. A whitening agent is applied to the teeth for the first time for a few minutes. The dentist then wipes off the product and applies it a second time. These steps are usually repeated three or four times during one session. This procedure lasts 30 to 60 minutes. More than one session may be necessary.
• Whitening chewing gum and toothpastes:
All toothpastes help remove superficial stains on teeth because they contain mild abrasives. Some “whitening” toothpastes contain chemical agents or abrasives that are more effective than others at removing stains, but none act on the natural colour of teeth, just as whitening chewing gums do not.
• Over-the-counter whitening products:
Several over-the-counter whitening products are available. Although it is tempting to try them because of the price and simplicity of the process, it is best to ask your dentist for advice. He or she can tell you whether it is appropriate for you and which product to recommend.
Crown and bridge
When a tooth is too damaged to be repaired with a partial restoration, the dentist must cover it with a crown to prevent further damage. A crown is an artificial covering or replacement for the visible part of a tooth. It can be used for broken teeth, teeth that have had root canal treatment, or to cover teeth with large fillings. Crowns can also correct poor position, shape, occlusion (the distance between teeth) and colour of a tooth.
A crown covers a tooth that is still present in the mouth. A bridge replaces one or more missing teeth and is anchored to neighbouring teeth. Fixed bridges and crowns are held in place with cement.
Crowns and bridges may be made of porcelain, metal alloy with a porcelain overlay, or gold alloy only.
It is important to replace one or more missing teeth to improve appearance, but also to maintain dental health. On one hand, remaining natural teeth are subjected to more pressure during chewing. On the other, they have room to shift in the absence of neighbouring or opposing teeth. This movement can cause alignment problems and gaps between the upper and lower jaw teeth.
Veneers and inlays
In some cases, a crown is not required to restore the appearance or function of a damaged tooth. In that case, the dentist will use a veneer or inlay to correct the problem.
Veneers are used to make aesthetic corrections on front teeth. Veneers are literally bonded to the visible surface of the treated tooth. A veneer placed in this way will correct shape, colour or eliminate gaps with neighbouring teeth.
Inlays can replace conventional amalgam or composite resin fillings. The dentist prepares a cavity in the tooth according to specific criteria, takes an impression, sends it to a laboratory and cements the veneer or inlay at a subsequent appointment.
Orthodontics
Orthodontics is a branch of dentistry concerned with the development, diagnosis, prevention and correction of tooth position abnormalities and dental malocclusions for functional and aesthetic purposes. The orthodontist detects or corrects, using fixed or removable corrective appliances, these positioning or alignment abnormalities of the teeth and jaws.
The main problems that can be corrected with orthodontic treatment are:
• An upper or lower jaw that protrudes too far forward.
• A chin that is too far back.
• A smile that shows too much gum above the upper teeth.
• Too much space between teeth or overlapping teeth.
• Lips that do not close completely, even at rest.
• An overly elongated face.
• Mouth asymmetry.
• Cleft palate (a congenital malformation of the palate).
Poorly positioned teeth and jaws can cause functional problems that may contribute to cavities and gum disease and, in extreme cases, tooth loss. Poorly aligned teeth and jaws that do not fit together well make chewing less efficient. This can cause excessive wear of teeth, jaw pain, headaches, neck pain and facial muscle pain. Finally, the aesthetic aspect is far from negligible.
It is never too late to begin treatment. Today, adults represent 20 to 25 percent of patients. Except in cases where growth is a major factor in success, the orthodontist lets the patient choose the best time to begin treatment.
Depending on the treatment required, the orthodontist will prescribe braces, retainers or other custom appliances. They may be fixed or removable, made of metal, plastic or ceramic. The length of treatment varies according to the problem to be corrected, but appliances are normally worn for one to three years.
Orthodontic problems can be treated in several ways.
Orthodontic braces
Braces are the main orthodontic treatment tool. More commonly called “braces,” they consist of four elements:
1. the anchor or metal band attached to each tooth
2. the cement that fixes the anchor to each tooth
3. the wires attached to the anchor points
4. the elastics or metal ties that hold the wires in place
Most anchors and bands are made of metal, but some anchors and elastics are clear, tooth-coloured or available in various colours.
Your dentist or orthodontist may recommend other treatments before, during or after braces are placed, or even other types of treatment that do not require braces to address your orthodontic problem.
Extra-oral anchorage
Extra-oral anchorage guides the teeth and jaw of a growing child. It can be worn before braces are placed or at any time during orthodontic treatment. There are various types of anchorage. The patient puts it in place and, most of the time, wears it in the evening and at night.
Removable appliances
Removable appliances are not as precise as braces, but they can move one or more teeth. These appliances may be worn:
• before braces are placed
• at the same time as braces
• independently, to treat specific orthodontic problems
Retainers
Retainers keep teeth in place once braces are removed. They may be removable or fixed to the teeth. Your dentist or orthodontist will tell you whether you need to wear your appliance at all times or only part of the day.
Oral surgery
Tooth extraction may be necessary if one or more teeth overlap or are in very poor position.
When the size or position of the upper and lower jaws do not match at all, maxillofacial surgery (or orthognathic surgery) can improve the situation. It allows a better relationship between the jaws.
If your orthodontist thinks such surgery is preferable in your case, he or she will refer you to an oral and maxillofacial surgery specialist.
