Cosmetic Dentistry

Twenty some years ago I received a post card from a patient who was traveling in Africa. The front of the card showed a woman, wearing a very colorful robe, necklace, ear rings and she was balancing a bowl on her head. She had a great smile on her face, but there was something else. Embedded in her lower lip was a 4-inch diameter “plate”. My friend wrote on the back of the card, “a new look for your Cosmetic Dentistry patients.”

I laughed and thought – right, some people in the states will want this look! I don’t think so…

Of course, these tribal people have been doing this for eons; it has meaning in their culture.

In this country, it seems like there has always been fads. In the movies there are vampires with long pointed fang teeth, James Bond had “Jaws” to combat in “Gold Finger”; in “Home Alone”, Harry the burglar, had a shiny gold tooth. We have seen patients with sparkly diamonds or glittery stars glued to their teeth. Sometimes we see and smile; sometimes we shake our head and wonder why. One thing is for sure, these add-on’s definitely draw attention!

In our world of dentistry, we usually don’t accept this as “Cosmetic.”

Today it seems that all procedures we perform must be pleasing to the eye. Gone are the days of using filling material that is a dark gray silver amalgam. It was useful for decades. Now most patients want the tooth colored fillings. Fortunately, these materials are very good and function well for a long time.

All the materials we use today to achieve “cosmetic” results are very good. They all have the potential of longevity if the procedure is performed properly and the appropriate material is utilized. Predictability and longevity are integral components of dentistry and must be incorporated into the treatment plan.

Cosmetic dentistry should use nature as a guide. As we look around at different people in daily encounters, we see “Beautiful, Natural” smiles. In studying these smiles, we notice certain characteristics that can be duplicated and transferred from one person to another. The shape of teeth varies, as does size, color, texture, angles, etcetera. It’s not a “one size fits all” business.

To achieve cosmetic results in dentistry, the patient needs to be involved. The dental team needs to know, beforehand, what the patients’ desires are so that a predictable outcome can be accomplished.

We need to “start with the end in mind”.

In a single front tooth restoration, we need to consider the condition of the surrounding teeth, gum tissues and bone support, to determine longevity and predictability. Also, what future needs will be required. Does the patient want whiter teeth? Is it necessary to whiten or make other changes before we begin, so we don’t have to back track or re-do work.

In more advanced situations, say 8-10 front veneers or crowns, look at photos of “Beautiful Smiles’. Discuss these photos’ with your dentist before treatment, so size, shape, color, angulations, thickness, smile line, gum line, etcetera can be determined before the case is started.  It’s very important to know how the finished smile will function with the remaining teeth so as to avoid future complications.

Again, “start with the end in mind.”

I used to tell my post graduate students at Tuft’s Dental School in Boston, to look at the face, thinking that the lips are the curtain, with the teeth being the stage and scenery, “The Picture.”

When the curtain goes up, what do we want to see and what do we see?

This is the essence of Cosmetic Dentistry!