Cosmetic Dentistry: An Overview of Options to Improve Your Smile

For decades, dentistry has remained focused on the treatment and prevention of dental disorders or diseases. It was commonly referred to as “need-based dentistry,” but since the mid-late 20^th century, the field of dentistry has progressed with advanced methodologies, treatments, professionals, and competent protocols for successful treatment of dental diseases. (1)

With the development of materials known as “tooth-colored restorative material,” both patients and dentists began to realize the improvements which can be attained through these advances for aesthetic sense.

During the period of the late 20^th century, dentists observed a shift in terms of treatment which the public was seeking.(2) They found that patients were not anymore interested in the selection of restorative material, which was metallic; instead, they preferred material matching to tooth-color for esthetic improvement of dentition.

Dentistry practice of this age is now “want-based” practice.

Cosmetic dentistry or Esthetic dentistry is a discipline of dentistry in which the primary focus is to alter or modify the appearance of oral structures of a patient, along with the prevention and treatment of functional, structural, and other oral diseases.

With the help of cosmetic dentistry, a person can achieve mouth appearance close to the patient’s perception of visually-pleasing mouth. (3)

In the disciple of cosmetic dentistry, the practitioner requires sufficient artistic and esthetic skills along with medical knowledge and art to recognize the nature and type of esthetics needed by the patient or client.

Guiding principles in cosmetic dentistry:

There are several guidelines for the practitioners to follow during the planning of esthetic work.(4) But a few points should always be emphasized by practitioners, and patients must have awareness about them:

• A practitioner should have the best understanding of ethical principles as macro esthetics or micro esthetic before performing the procedure. (5)
• Start working with the more extensive features and incline towards working on smaller features.
• Before performing the actual tooth assessment, look at the patient’s gingiva, lips, and overall face (see the forest before seeing trees).

Types of cosmetic dentistry:

Bleaching or tooth whitening:

1n 2004, AACD (American Academy of Cosmetic Dentistry) surveyed the public’s opinion about what they disliked the most about their smile and answer, which was most commonly given by the public was the darkness of tooth color.

Under these results, it was found that a smile can have an impact upon self-image, physical attractiveness, employability, and self-confidence of an individual.

Tooth discoloration can be classified into extrinsic staining factors and intrinsic staining factors.

Extrinsic staining factors are:

• The natural process of aging
• Staining of teeth from drinking tea, cola, coffee, wine, and smoking
• Dental materials as composites, posts, pins, and amalgams

Intrinsic staining factors are:

• Use of pharmaceutical drugs as the antibiotic tetracycline
• Excessive ingestion of fluoride during the formation of tooth
• Different systemic diseases or conditions.

Cosmetic teeth whitening is referred to as teeth bleaching, which helps in whitening and brightening of stained or discolored teeth.

Vital tooth bleaching is a conservative and safe procedure for teeth whitening. It is thought to be an alternative method for composites, veneering, or crowning. This procedure should be the first option of choice for patients requiring esthetic and restorative care.

OTC-Home bleaching was introduced first in 2001, in which whitening strips of hydrogen-peroxide are used. In this technique, polyethylene strips, which are impregnated with the hydrogen-peroxide solution (standard dose of 6.5% hydrogen peroxide), are used for teeth whitening.

Cosmetic Dentist-based home bleaching is a technique involving the use of designed trays for holding the teeth whitening products against dentition for the specific period prescribed by the cosmetic dentist. The significant advantage of these trays is that accurate or selected teeth can be bleached with the use of them.

Dentist-assisted In-office bleaching uses bleaching agents with a higher concentration of hydrogen peroxide. In this procedure, patients are advised that they may suffer from tooth sensitivity for up to 6 weeks.

Dental veneers:

Dental veneers are shells with thin diameter made up of composite material or porcelain. Veneers are always custom made and are cemented to the front side of teeth. Application of veneers is in different dental conditions as:

• Slightly crooked teeth
• Discoloration of teeth
• Chipped teeth
• Spaces between the teeth.

Composite veneers are alternatives for indirect veneers. These veneers are especially attractive for patients having limited resources, or patients with young age. Composite veneers can also be used for masking the discolored teeth, peg laterals, or to close the diastema (the gap between teeth in the same arch).

In this procedure, the enamel of teeth is not removed, which makes it an esthetic, conservative, or reversible treatment. But this procedure can not be long-lasting due to risk or tendency to stain or discolor over time.

Dental implants:

The implant is a device made of metal used for replacing the missing teeth. The most common material which is used in the preparation of this device is titanium. The dental implants are placed by surgery over the missing place of teeth. Implants are permanent, unlike dental bridges.

A dental implant is capable of acting as:

• Tooth root
• Anchoring artificial teeth, crowns, bridges, or dentures.

Dental implants are generally indistinguishable from natural teeth.

Dental crowns:

Dental crowns are referred to as dental caps or tooth caps, which are custom made to fit over the tooth perfectly. The materials used in the preparation of these caps are mostly porcelain or acrylic, which are fused to metal for bearing the biting pressure.

Crowns or tooth-caps can be used:

• To shape the poorly-shaped tooth
• Fill the large filling between teeth
• For covering spaces in between teeth
• To reshape the broken or decayed teeth.

Teeth shaping:

This process is also known as enamel shaping in which a cosmetic dentist reshapes the tooth by removal or filling of enamel.

This procedure is:

• Mostly painless
• It can give instant effects.

Tooth bonding:

Dental bonding is a process of binding tooth-colored restorative material with the tooth.

The application of this technique can be in:

• Improvement and repairment of tooth appearance
• Repair of chipped, broken, and stained teeth.

Orthodontic treatment:

Orthodontic treatment is another cosmetic approach most correctly used in children, but its applications are not only limited to children; many adults are also opting for this procedure for different aesthetic purposes. If a patient has buck teeth or crooked teeth, then cosmetic dentists can use this technique for the restoration of teeth.

Gingival esthetics:

In cosmetic dentistry, there are two concepts for outcome in orthodontic treatments which are:

• Gingival shape
• Gingival contour

An assessment of the gingival architecture of anterior teeth is taken. Gingival shape describes the curvature of the tooth’s gingival margin, which is determined by the osseous crest and cemento-enamel junction. Cosmetic dentists can reshape the distorted shape and contour with careful handling and choice of appropriate treatment.

Even More on Cosmetic Dentistry…

More on Teeth whitening/bleaching

it is the most commonly sought after cosmetic dental treatment which has prompted many toothpaste brands to launch whitening toothpastes to appeal to the masses, given its popularity. In fact, cosmetic dental treatment has become synonymous with teeth bleaching to improve the overall smile of a person. However, the professional bleaching procedure has various advantages over teeth whitening toothpastes, gels or whitening strips. Professional bleaching provides apparent results from the very first appointment while also being longer lasting as compared to over-the-counter bleaching products which take longer time for the results to be visible and fade away prematurely.

More Dental laminates/veneers

these are thin chip-like restorations made of usually ceramic and are in fact so thin that they may appear translucent. They are custom made for each patient and color matched to the adjacent teeth, thereafter cemented onto the tooth surface by use of dental cements specifically designed for this purpose to provide the most natural finish. Popularly known as Hollywood smile, veneers are used to not only repair minor chips and cracks in teeth, close small gaps in between teeth but also are the primary choice for tooth discoloration treatment since they have the power to instantly transform your smile into a dazzling one. Moreover,  affixing the veneers doesn’t take a lot of time and can be done in a single appointment.

More on Enameloplasty

in common terms enameloplasty is alteration in the outermost layer of teeth called enamel. Sometimes to improve the appearance of a tooth, the enamel has to be reshaped by removing a very thin portion of it and is usually done in cases of minor overcrowding.

More on Composite bonding

Composite resin is a plastic like mold-able material which hard sets on exposure to the light of a specific wavelength. It is a tooth colored material and is quite versatile in utility in terms of dental treatment. Composite resins can be used for restoring carious teeth; the process involves removing caries from the tooth and treating it with a slightly acidic solution to remove the debris layer to facilitate better bonding to composite. Thereafter, thin layers of composite resins are placed in increments and treated with a specific wavelength light.

Closing gaps between teeth is another one of the uses of composite resins. They can, in fact, be used to repair chipped or cracked teeth, alter the shape size and appearance of teeth and thereby restoring your smile.

More on Dental implants

Dental implants can be used not only to close gaps between teeth by replacing missing teeth but can also act as a support for bridges and dentures. They are the most natural replacement for a lost tooth since they mimic the structure of a tooth in many ways. A dental implant consists of a metal screw like structure that is drilled into the jaw bone and then the artificial crown is placed onto it when the wound healing is complete and the metal has fused to the jaw bone. Although a bit expensive, a dental implant is a long term investment in your oral health.

Invisalign/clear braces

Mild to moderate crowding of teeth can be orthodontically treated and that too without being apparent. Invisalign is a set of clear aligners and braces that exert mild forces on teeth to move them to a more favorable position. Though a bit on the expensive side, these are most aesthetic option to straighten misaligned teeth.

Snap-on smile

Just like clear aligners, a snap-on smile is custom made for each patient by taking impression of the teeth and fabricating a well fitted prosthesis that snaps onto your original teeth and completely transform your smile instantly. You don’t have to invest in expensive cosmetic treatments while also getting the results.

Inlays and onlays

Inlays and onlays are used to restore grossly damaged teeth and are also known as indirect restorations since they are prefabricated in a dental lab after taking impression of the prepared tooth cavity and thereafter cementing it into the prepared cavity. The major advantage of these over dental crowns is that there is no loss of tooth material since the tooth doesn’t have to be reduced in size to make space for the crown. The only difference between inlays and onlays is that while inlays lie completely within the bounds of tooth, onlays cover one or more cusps of the tooth.

More on Dental crowns and bridges

Dental crowns and bridges are the traditional restorative cum cosmetic procedures that are done to close gaps between teeth, restore grossly damaged tooth or even change the color of tooth. A dental crown is a cap like prosthesis that is cemented onto the tooth and which not only restores its functions but also strengthens it to better bear the masticatory forces.

A dental bridge is used to replace one or more missing teeth by drawing support from the adjacent teeth.

Both, dental crowns and bridges require some amount of tooth size reduction to accommodate the thickness of the crown or bridge and can be made of tooth colored material to give an all natural look to the restoration.

Smile makeover– a smile makeover is not a specific cosmetic treatment but is rather a combination of cosmetic and restorative treatments to provide you with the ideal smile that you desire. Smile makeover deals with an array of cosmetic issues such as metal fillings, gaps between teeth, misaligned teeth, discolored teeth and so on. A smile makeover is done to provide an overall better aesthetic appeal to your smile.

How to Become a Cosmetic Dentist

Becoming a cosmetic dentist typically involves completing a four-year undergraduate degree, followed by four years of dental school. After completing dental school, you will need to pass a licensing exam in order to practice as a dentist.

In addition to completing the required education and passing the licensing exam, many cosmetic dentists choose to complete additional training or certifications in order to specialize in cosmetic dentistry. This may include taking continuing education courses, attending workshops or conferences, or completing a fellowship or residency program in cosmetic dentistry.

Some cosmetic dentists also choose to become members of professional organizations, such as the American Academy of Cosmetic Dentistry (AACD), which can provide additional opportunities for networking, continuing education, and professional development.

In order to be a successful cosmetic dentist, you will need to have strong clinical skills and a keen eye for aesthetics. You should also be able to communicate effectively with patients and understand their goals and concerns.

In addition to having the technical skills required to perform cosmetic dental procedures, it is also important to have the ability to market yourself and your practice. This can involve developing a strong online presence, building relationships with other healthcare professionals, and attending networking events.

Another important aspect of being a cosmetic dentist is staying up-to-date with the latest techniques, technologies, and materials in the field. This may involve attending conferences and workshops, reading dental journals, and participating in ongoing education and training.

Conclusion

In the past, dentistry was only focused on treatment of diseases associated with teeth, but with the evolution of time, a trend change was observed, and now in this age, dentistry is not only limited to cure the dental diseases but also aids in restoration of decayed teeth, replacing missing teeth, contouring, whitening and reconstructing teeth into desirable shape for perfect oral appearance and smile.

The outcomes of these procedures depend upon the artistic skills of the practitioner, in addition to medical and surgical skills. A few essential guidelines necessary to be followed by health practitioners, and patients should also know the basics of any treatment they are deciding to go through.

Cosmetic Dentistry References

Centers for Disease Control and Prevention. “Fluoridation Basics.” U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2021, https://www.cdc.gov/fluoridation/basics/index.htm.