Goodbye tombstone teeth, hello smile

Goodbye tombstone teeth, hello smile
23/05/2005
health.telegraph
Cosmetic dentistry is no longer the preserve of celebrities, and a good 'dental face-lift' can prevent future tooth decay, says Christine Doyle
Not so long ago, most of us went to the dentist simply to save our teeth from the ravages of decay. Though some of us may have aspired to own the perfect smile, expensive restorative work was considered to be the realm of celebrities.
Nowadays, though, dentists are in the business of beautifying everyone's teeth, and it seems that many of us are prepared to pay handsomely for our ideal smiles: in some cases, much more than we would consider paying for medical treatment.
Nearly all dental practices have added cosmetic dentistry to their services: perfecting a smile could involve a combination of techniques that dentists call the "dental face-lift" which, as well as improving your teeth and smile, can remove up to 10 years from the age of your face.
Attitudes to making the most of our teeth are going through a radical change, says Oliver Harman, a cosmetic and restorative dentist with the City branch of London firm Dentics (www.dentics.co.uk).
"Mainly, we see people in their twenties to forties, who are highly image conscious," he says. "They are also affluent and, if their teeth are misshapen, or there are awkward gaps - perhaps because of an accident - or their smile is too gummy, they see no reason to live with it.
"They want to improve on nature. We can do that and, in the process, help to smooth out wrinkles around the lips to give a wider smile and a more youthful appearance."
More dentists are beginning to offer computer simulation so that patients can discuss precisely the smile they wish to achieve. Harman also encourages patients to bring a picture of the smile they prefer.
The British are not only following America, the world leaders in cosmetic dentistry, says Harman. "We seem to be following the rest of the world as well. In Australia and South Africa, most dentists offer cosmetic techniques, and their patients expect it as part of the service." But we are still way behind much of Europe, according to the Association of Dental Implantology. For example, in Italy, around 200,000 tooth implants are carried out each year, compared with just 50,000 in Britain.
Those who spend money on cosmetic dentistry often see it as an investment. Implants, for example, which can cost 見2,500 per tooth, may be a sensible alternative to dental bridges, which can cost about as much but may cause future damage to, and long-term discolouration of, the adjoining teeth.
The bonus for good cosmetic dental work could be stronger, healthier teeth years later, and cosmetic dentistry goes hand in hand with the current drive towards minimally invasive techniques.
These include identifying and treating mineral deficiencies in teeth and detecting the early build-up of bacteria that cause caries. Success could mean the end of the old-style "drill and fill" craters.
How to get the best treatment
How do you find a good cosmetic dentist?
The grapevine is a good place to start, though your regular dentist should also be able to help with a referral. They may also be able to carry out the treatment you want, so check their advice and the cost before getting a second opinion from a cosmetic specialist.
Check with the General Dental Council if you are unsure what the qualifications on the dentist's wall mean. The British Academy of Cosmetic Dentists, a two-year-old association based on a similar, long-standing American academy, has established a rigorous training course which it hopes will lead to improved standards.
Always say clearly from the start what you can and cannot afford. Set priorities on what you wish to achieve. Your dentist should always explain the options available.
Do dental care plans cover cosmetic treatment?
No. About 1.3 million people pay on average 見16 a month for comprehensive cover by Denplan, the market leader. This covers all check ups, X-rays, fillings, hygienist visits and major restorative work, but not the laboratory fees. Implants, teeth whitening and braces are not covered, though you can pay an extra 見2 a month to include implants in the event of an accident.
Who regulates cosmetic dentists?
The General Dental Council (the equivalent of the General Medical Council) regulates training and establishes lists of specialist dentists. While it does have the power to discipline dentists or, occasionally, strike them off, it has no influence over costs.
The cosmetic dental industry is expected to grow by several billion pounds during the next decade. Professor Richard Palmer, professor of dental implantology at Guy's Hospital, London, is among those who would like to see tougher regulation of costs. "Replacing a full set of upper or lower teeth with implants can cost 見25,000, but some surgeons charge twice that amount."
Hollywood mile-wide or English eccentric: what kind of smile do you want?
For years, the dazzling, mile-wide smiles of Hollywood stars were highly sought after, but recently the more subtle and less perfect European smile has become more desirable.
"Europeans tend to have smaller chins and more heart-shaped faces. A hugely expansive American smile would look out of proportion," says Oliver Harman, a cosmetic and restorative dentist. "We try to make the smile fit the shape of the face."
Often, he says, English people ask for a touch of irregularity in their restored teeth in case they end up looking fake. The aim for most people is to soften discrepancies with the minimum of treatment and to get rid of yellowing and stains. "We want to give normal people a decent smile."
Popular treatments
Veneers Thin shells of porcelain or plastic are glued to the front of the teeth, to disguise those that are severely discoloured, chipped, have holes or are misshapen. Porcelain veneers will last 10 to 15 years against seven to 10 for plastic ones.
Gum sculpting Gum specialists use a range of surgical techniques, including implanting gum tissue from the roof of the mouth, to counter teeth that are too long or to correct a "gummy" smile. They can also lengthen the appearance of a tooth, so that less gum is seen.
Crowns These are long-lasting substitutes for severely damaged teeth that have intact root systems. They are usually made in porcelain, reinforced resin or porcelain fused to gold or another metal.
Braces The latest are also known as "accelerated orthodontics" as out-of-position teeth can be moved faster than with traditional braces - in under a year, instead of up to three years. The beauty of modern "railway tracks" compared with the more prominent braces of the past is that they are invisible and popular with adults who missed out on this cosmetic treatment when younger.
Implants These replace a lost tooth or teeth where there is no root to support a crown. Implants are being used as an alternative to bridges, which have to be fixed to adjoining teeth with a high chance that they will cause long-term damage. Not everyone, though, is suitable for this procedure. For years, the dazzling, mile-wide smiles of Hollywood stars were highly sought after, but recently the more subtle and less perfect European smile has become more desirable.
"Europeans tend to have smaller chins and more heart shaped faces. A hugely expansive American smile would look out of proportion," says Oliver Harman. "We try to make the smile fit the shape of the face."
Often, he says, English people ask for a touch of irregularity in their restored teeth in case they end up looking fake.
The aim for most people is to soften discrepancies with the minimum of treatment and to get rid of yellowing and stains. "We want to give normal people a decent smile."
'Now, I probably grin too much'
Yasmine Newman, 32, has 10 porcelain veneers, which cost 見6,000. Although she wore braces when she was younger, her teeth never seemed quite straight.
"I also had one tooth that was quite prominent," she says. "I wanted a nice, wide, arched smile, but did not want braces again as these can take a long time to work. After a session with computer imaging, veneers seemed to offer the smile I wanted."
Yasmine's teeth were filed down by the dentist to provide a surface to which the veneers could be cemented, but this did not worry her. She describes herself as a perfectionist and was happy to go back and forth for about 15 appointments to achieve her desired smile. "I had seen people who had bodged jobs and was determined it get it right. It was a great help having several trial sessions with model veneers.
"A bit of gum was cut away from the margin of my two front teeth to create a more rounded arch; this makes an amazing difference," she says. "The bottom of my front teeth were squared off as they looked fractionally long. Teeth at the side of my mouth were bulked out slightly to help provide a wider smile. And, my slightly jagged bottom front teeth were filed down to straighten them. There was also some fiddling around to get the bite right.
"I had previously had tooth bleaching done, so my veneers were made to be just slightly whiter. I wanted a natural, transparent white, not a dead white look."
Yasmine paid for the veneers with money that she inherited. "Now I smile much more confidently. I probably annoy some people by grinning too much."