Tooth whitening, sometimes referred to as bleaching, has been around for decades. The active ingredient in virtually all systems is some form of hydrogen peroxide, which has been shown to be completely safe for teeth and perhaps even beneficial to the gums. The major drawbacks to whitening are sensitivity and unpredictability. The major advantage is low cost. Various “whitening strips” can be purchased over the counter for around $40. They work well for light staining on otherwise normal, healthy teeth. Stock bleaching trays purchased over the Internet provide about the same level of whitening, but perhaps with more sensitivity.
Custom bleaching trays provided by a dentist provide even better results, if you are willing to wear them every night for a few weeks. One-hour bleaching in a dental office or spa does the same or better job very quickly, but may also result in some short-lived sensitivity. The cost of in-office bleaching ranges from $400-$1,000, but the results are still variable. Some patients experience amazing results from these methods, while others are disappointed. For people with normal healthy teeth that would like predictable results, a system known as “Deep Bleaching” developed by dentist Rod Kurthy will deliver predictable results, even in deeply stained teeth. This system is a combination of in-office sessions and specialized take-home trays that gives amazing results every time.
The cost of deep bleaching ranges from $1,200-$1,800, and there is very little or no sensitivity with this system. However, if your teeth have other issues in addition to color, then you will probably be looking at “permanent whitening”, also known as porcelain veneers.
PORCELAIN VENEERS AND CROWNS
Porcelain veneers are thin facings that are bonded to the front of your teeth to restore your smile. They can completely cover stains, as well as even out crooked teeth and make chipped teeth look like new. Traditional porcelain veneers require numbing of the teeth, and removal of the top stained layer to provide space for the new white porcelain layer. The results can be dramatic and immediate, and the veneers can last for decades. The drawbacks are high cost, sensitivity sometimes lasting for weeks or months, and irreversibility. But for certain cases the advantages far outweigh the disadvantages. If you prefer not to have your teeth numbed, another option is Lumineers.
Lumineers are very thin porcelain veneers that don’t require numbing of the teeth in most cases, and no drilling into sensitive areas of the teeth. While they can’t correct everyone’s smile issues, they should at least be considered, especially for the nervous patient. Both Lumineers and traditional veneers are expensive, around $1,500-2,000 per tooth, but they can be completed in just a few visits. This makes them perfect for patients wanting “immediate gratification.”
Porcelain crowns are similar to traditional dental crowns, but do not contain any dark metals on the inside of the crown. For patients who are tired of the “dark line” around the gums of their crowned teeth, all-porcelain crowns are a fantastic alternative. The newer crowns are very strong and bonded to the tooth to prevent the cement wash-out that used to occur with traditional crowns. Porcelain crowns typically cost a bit more than traditional crowns, but are well worth the extra expense in any area where the edge of the crown shows.
If you don’t mind waiting some months for your new smile, orthodontics may be a much better option than porcelain veneers. For patients with nice looking natural teeth, just crooked or gapped, orthodontics is a more natural and cost-effective approach. Of course, in the field of cosmetic dentistry most adults do not want railroad track braces on their teeth, so manufacturers have developed “clear braces” where all you notice is a thin wire on the teeth. Plus, modern orthodontics has embraced the “low-force, low friction” philosophy, making braces much more comfortable than ever before.
If the thought of braces still turns you off, then you should consider Invisalign (www.invisalign.com). Invisalign is a series of clear plastic trays, similar to bleaching trays, which gently move your teeth to their new, straight position. At an average treatment time of only 11 months, Invisalign is quicker and easier than traditional braces, plus there are no diet restrictions and no issues brushing and flossing. The disadvantage of Invisalign is the time involved, and the chance that porcelain veneers may still be needed to achieve the patient’s esthetic goals. The advantage is preservation of natural teeth, and relatively low cost at around $6,000 total.
If you are missing some teeth, whitening, veneers and braces may not solve all your needs. In the past, missing teeth meant partial or full dentures, or sometimes a bridge. With recent advances in technology, we can now replace missing teeth with artificial teeth that look and feel just like natural teeth. And with a better than 95% success rate, implants have become almost routine in many dental practices. The advantages are obvious; the disadvantages are high initial cost and the need for minor surgery to place them. Over the long term dental implants may actually be less expensive than other options, since they potentially can last the rest of your life.
Most patients would prefer to avoid surgery, but sometimes it really is the best option. Gum surgery to improve a gummy smile, a chin implant to improve a receding chin, jaw surgery to correct a disfiguring overbite or cleft – these are situations where the other options just may not be enough. Surgery is often considered the last option, but in some cases the results are worth the risks.