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Cosmetic (Aesthetic) Dentistry

A range of dental procedures can improve the shape and colour of your teeth and smile.

Discoloured Teeth

Very few people have really white teeth and yellowish teeth are not necessarily weak or unhealthy. The bulk of teeth are formed by dentine which is yellowish in colour. This colour can be seen through the relatively translucent enamel; and teeth darken naturally with age.

If the discoloration is due to defective enamel or dentine it can be masked by a layer of tooth-coloured filling or a veneer or crown of porcelain.

If it is due to decay, an old discoloured filling, or the tooth being dead, then the underlying cause needs to be treated. For example, in the case of a dead tooth, root canal treatment may be needed.

Tooth-coloured restorations are fillings that match the colour of the tooth. They will discolour over time and may need replacement.

Veneers

Veneers are thin shells, or facings, made of porcelain or plastic material that are cemented onto the front of the teeth in order to improve the colour or shape of the teeth. They can be thought of very much like artificial fingernails.

When the teeth are discoloured or stained, veneers can greatly improve the shade and uniformity of the colour.

When the teeth are poorly shaped, e.g. if they are too narrow with gaps between the teeth, veneers can help to make the teeth look broader and to close the gaps.

In many cases, the dentist may need to shave off a little of the front surface of the tooth to make space for the new veneer. This can often be done without an anaesthetic.

Impressions, or moulds, of the teeth will be taken for the laboratory technician to make the veneer. About a week later, the veneers will be placed on the teeth and checked for colour and fit. If satisfactory, the veneers will then be cemented on to the tooth.

A cheaper option is tooth-coloured filling material; however veneers give much better colour and smoothness.

Veneers are made of porcelain or plastic so they can crack or chip, just like natural teeth. If cracks or chips occur, then the whole veneer will need to be replaced.

To care for the veneer, brush and floss daily to ensure that the margins of the veneer are kept clean. Do not bite on hard foods that may crack the veneer. Go for regular dental check-ups so that any small defects or problems can be detected and treated quickly.

Crowns

A crown is commonly called a cap. It may be thought of as a "cover" as it covers, or replaces, that part of the tooth seen in the mouth.

A crown can be done for many reasons. Most often, it is done when a tooth is:

• badly decayed or chipped

• discoloured or misshaped

The tooth is trimmed to make space for the final crown. Moulds are then taken of the tooth for a custom-made crown to be made in the laboratory according to your dentist's instructions. When the crown is ready, it is slipped over the tooth and firmly cemented in place.

Crowns can be made of porcelain or metals, such as gold alloys or titanium. Special types of glass and plastics can also be used. Your dentist will choose the material best suited for you.

Crowns need to be maintained so careful daily brushing and flossing are essential to keep the gums around the crown healthy. In addition, don't bite down on hard material such as ice or bones as this may chip the porcelain. Regular check-ups by your dentist are also necessary.

Full porcelain and gold-based crowns are more expensive than crowns made of non-precious metals, but are more attractive.

Crowns are long-term restorations and hence are more expensive than fillings. Making them requires considerable skill and time on your dentist’s part, as well as the help of a technician working in a specially equipped laboratory. The crown itself is often made precious metals.

Unfortunately, there are very few alternatives to crowns which are truly satisfactory. In certain limited situations, bonding may be sufficient. When it comes to discoloured teeth, bleaching may prove to be the cheaper alternative to crowns, though the result may not be predictable. Veneers to cover discoloured surfaces of teeth may be considered as alternatives to crowns.

As there will always be an interval of a few days to a few weeks before the permanent crown is fitted, the dentist will ensure adequate protection of the prepared tooth with a temporary crown or temporary dressing. For the front teeth, temporary plastic crowns offer very satisfactory cosmetic results. For a molar tooth, a soft metal temporary crown may be fitted as protection, until the permanent crown is ready. In all cases, the temporary crowns or dressings are fairly easily and quickly removed before you are fitted with your new permanent crown.

A normal, healthy pulp or nerve of a tooth is seldom removed prior to crowning it. An exception may be when it is necessary to insert a post into the nerve canal as an anchor for the crown in cases where the tooth is badly broken down and not much is left to support the crown. Removal of healthy pulp may also be required when a crown is made to realign a crooked tooth. The nerve may be in the way of the newly aligned crown and thus may have to be removed.

If the nerve has reached a stage of infection or irritation, where the condition is irreversible, then it is usually best to remove the nerve and treat the root canal prior to crowning the tooth.

Dentists may suggest crowning a molar which has been root treated if the tooth is dead. A dead tooth, having lost its blood and nerve supply, becomes more brittle and less resilient. In the case of the molar teeth, which bear the brunt of heavy chewing, fracture of the tooth is a very common occurrence. Often, if the fracture is not severe, crowning or other suitable procedures may still save the tooth. However, if the fracture line runs unfavourably, you may lose the tooth. Crowning, as a preventive measure, therefore serves to prolong the life of a tooth which you have chosen to preserve by undergoing root canal treatment.

Crowning makes teeth less prone to decay if you maintain a good standard of oral hygiene and home care. A crowned tooth has much less of its structure exposed to decay-causing agents in the mouth, hence it will resist decay more effectively.

A newly crowned tooth may be sensitive to hot and cold initially, but this should not persist for long. A hypersensitive tooth often indicates all is not well with the tooth nerve and, if persistent, will necessitate root canal treatment.

Once fitted, crowns rarely fall out. In most cases, normal eating habits with the usual diet are fine and do not jeopardise the crowns. However, it is definitely not advisable to chew on or crack bones or shells as the chances of fracturing the porcelain are high. Crowns on the front teeth are only as strong as your natural teeth. What may be hazardous to your own teeth would definitely be harmful to the crowns.

Crowns can also help teeth that are crooked and discoloured.

One of the most difficult aspects of constructing a crown is the reproduction of the natural tooth's translucence. Porcelain approaches natural tooth translucence very closely but when used in conjunction with a gold alloy for strength, this translucence decreases and the problem of opacity of the crown increases. It is often this opacity that gives crowns their artificial look. However, newer developments in this field are making more natural-looking crowns more easily attainable by the dentist. Of course other aspects also go a long way towards avoiding the "false tooth" look: aspects such as shade (colour) selection, crown shape, size and position. Ultimately it is the artistry and skill of both the dentist and the technician that makes a crown look like a natural part of you.

Bleaching

For stained teeth, your dentist will first have to find out what sort of stains they are. If they are on the surface (extrinsic stains), they can be polished away. Teeth stains are most often caused by smoking or drinking large amounts of tea or coffee. Accumulated calculus, also known as tartar, can appear as brown areas near the gum margins. Calculus has to be removed by your dentist by scaling.

If the stains are within the structure of the tooth (intrinsic stains), they cannot be brushed or polished away. Instead, they may need to be masked or covered by a layer of tooth-coloured material such as composite or porcelain. In some special cases, the tooth may be "bleached" to make it look whiter. Your dentist can advise you on this. If the intrinsic stain is minimal, you can choose to leave it alone.

Diastema Closure (Closing Gaps in the Teeth)

Depending on the size of the gap and the size, shape, position and health of the teeth, your dentist may suggest any of the following methods:

• Adding tooth-coloured material to the adjacent teeth to increase the width of the adjacent teeth and close the gap. This procedure is simple and painless. If the tooth-coloured material gets discoloured or chipped, the procedure can be repeated

• Widening the adjacent teeth by placing veneers or crowns on them. This is a longer-term solution but involves more time, work and cost

• If the gap is wide, the above two methods may not completely close the gap but can narrow it and make it less conspicuous

• In very wide gaps, an artificial tooth may be inserted into the gap. This can be done by means of a removable denture or fixed denture (bridge or implant). A removable denture is cheap but may be bulky and take more time to get used to. Either a bridge or an implant are more compact, comfortable and lasts longer

• In some cases, the teeth on either side of the gap may be moved closer together. This can only be done if you are willing to wear braces. This treatment may take several months but may give the best result

• In a few cases, the two front teeth may be set apart because of an extra tooth buried in the bone between them. An X-ray will show if an extra tooth is present. It must be removed surgically before treatment can be done to move the teeth together with braces

Your dentist will thoroughly examine your mouth and explain to you the treatment methods appropriate to your condition. With this advice, you can decide on the method best suited to you.