It seems that our perception of dental health and beauty has changed over the last 20 years or so. Social media posts, TV shows and movies portray a perfect smile dominated by wide pearly white teeth.
The idea of this kind of “perfect” smile was born in early Hollywood and popularized by actresses such as Julia Roberts. Advertisements for toothpaste or other oral health products typically use models with wide, bright smiles, creating an aesthetic ideal.
Now some dentists are beginning to identify themselves as “cosmetic dentists“. And new technologies and materials allow dentists to make significant changes to the shape and color of teeth.
But are these changes purely for looks? And what they do to people’s natural teeth.
What are veneers?
One way to change your smile is to use dental veneers.
Veneers are covers (usually from porcelain) was fabricated in a laboratory and then glued to the teeth.
Dental veneers can be used to change the color and shape of teeth. They are usually used in the front of the mouth and more often on the upper teeth as this is the area of the mouth with the most visual impact.
However, veneers can be applied to the lower anterior (front) teeth, but this is technically more difficult due to the smaller size of these teeth and the reduced surface area for effective bonding. Veneers can be applied to single or multiple teeth.
The shape of the veneers matches the shape of the adjacent teeth. It should be in proportion to the profile of the face and in harmony with the lips. Veneers are technically demanding for the dentist and technician to manufacture, mix and apply. The cost of each veneer can vary depending on the level of complexity of each case, patients should request a written quote before beginning care.
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What lies beneath
What patients should know about dental veneers is that the dentist will most often have to shave down the front of the tooth to make room for the veneer.
And veneer don’t last forever. They may need to be replaced if they become chipped, discolored or peeled off. Each time a veneer is replaced, the amount of tooth remaining can decrease in size, making each round of care more difficult.
Ultimately veneers may not be a viable option. Then the patient may need to proceed with more extensive treatment options such as e.g crownswhich are thicker and more permanent.
To help patients make informed decisions, dentists have the ability to provide testing digital or hand-made mock-ups for patients to evaluate before committing to a treatment approach. This “try before you buy” step can be valuable in ensuring that the patient’s expectations are likely to be met after veneers are applied. If this step is omitted, then the veneers may not meet the esthetic needs of the patient requiring removal and replacement.
High levels of patient oral hygiene are essential to maximize the fit quality of bonded veneers as well as longevity in the mouth.
Read more: Doctors may soon get official ‘licensing’ to practice cosmetic surgery – but will this protect patients?
Professional guidelines
Recently the Medical Council of Australia issued Guidelines for doctors carrying out cosmetic procedures, with stricter regulations coming into effect at the beginning of July this year.
They include screening patients for physical deformity – a mental health condition characterized by excessive concern about one’s appearance or specific physical characteristics. This is to ensure that each patient’s assessment of their own needs can be met in a biologically safe and predictable manner by their treating physician.
Veneers may be the right choice for some people. But before starting this form of irreversible care, there should be an informed discussion of risk versus benefit between the patient and the clinician. If the individual patient still wants cosmetic improvement but decides they do not want veneers, other treatment options are available.
Alternatives
Bleaching and orthodontics can also change the color and position of teeth.
Whitening (or bleaching) has been a standard clinical activity since the late 1980s and is usually performed using custom trays and prescribing a series of bleach treatments. Ideally, this is done in consultation with a dentist to understand the cause of tooth discoloration. This will determine if bleaching is an appropriate option and if it is likely to work.
Orthodontics is the controlled movement of teeth using attached components and activated orthodontic wires (braces). In recent times, dentists have been able to provide custom clear aligners to move teeth in a controlled manner. The principle of tooth movement using gradually modified aligners is available through many providers, but should always be carefully and regularly checked by the treating dentist or orthodontist.
A patient should understand the risks and benefits of each of these options as they relate to their individual needs rather than a blanket approach to planning.
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Teeth for life
Dentists are trained to provide lifelong care and should be willing to explain and adjust treatment options for informed and educated patients.
Patient-centered care should guide treatment choices and support the best interests of patients. Therefore, we must maintain a balanced approach to providing an idealized appearance, keeping in mind the importance of dental function for a healthy diet and well-being.
