The “makeover” reality shows have caused increased interest in cosmetic dentistry. Some of the techniques that turn back the dental clock are very simple and inexpensive. Tooth colored fillings (dentists prefer the term “restoration”) can replace aging silver ones. Then, after your dentist treats any tooth decay you may decide to whiten your teeth. Often the only complaint a new patient has about their teeth is the presence of blackened silver fillings. They feel fine, but they look like cavities or stains. For patients who prefer a more natural look most dentists offer esthetic alternatives to old silver amalgam fillings – restorations made of porcelain or composite.
Dentists fill cavities with porcelain by removing the decay and then manufacturing a solid piece of porcelain to replace the missing piece of tooth. The restoration may be carved out of a solid block of porcelain, built up by stacking ground porcelain like wet sand and melting it together in a very hot furnace, or by making a wax pattern of the missing piece of tooth out of wax, creating a mould and forcing molten glass into the mould. Dental restorations made this way are inlays or onlays. Any of these techniques create beautiful, lifelike results. Porcelain fillings are bonded into teeth with adhesives that hold tightly to teeth and porcelain.
Another option for natural looking restoration of tooth decay is tooth colored composite. Composite is a mixture of about 75% ground glass or ceramic and 25% acrylic. These fillings are formed inside and chemically bonded to teeth. Composite fillings tend to wear away faster than others do. The placement of composite is very technique sensitive. Many dentists use this material universally insisting that it provides the best combination of cost, appearance and strength.
Composite restorations are best for small cavities. Larger cavities and broken teeth are better off with porcelain inlays, onlays, or crowns (also called caps) to repair them.
After the dentist treats any decay and replaces the leaky fillings, you might want to lighten your teeth. Before choosing any whitening procedure, it is very important to consult your dentist. Bleaching will not change the color of most dental materials used in crowns and fillings. Therefore, it is possible to bleach the natural so as not to match attractive dental work. Medications taken in childhood (most commonly tetracycline and overdoses of fluoride) discolor adult teeth. Teeth deeply discolored by medications will not respond to surface bleaching as quickly as teeth that discolored by smoking and colored beverages.
Ask your dentist to recommend a bleaching system for you. Over the counter systems are less expensive, but work more slowly. The system your dentist dispenses or applies in office will work faster and may be easier to use.
The effect of bleaching may seem uneven during treatment. The necks of teeth bleach more slowly than the edges and sides; some spots may bleach more slowly. Don’t worry. The color soon evens out.
Most people find that their teeth become sensitive to cold while bleaching. The sensitivity is usually worse for younger patients. Using the bleach for shorter times and less frequently will ameliorate this side effect. Another option is to use bleach that is of a lower strength. Generally, this sensation goes away soon after the applications of bleach stop.
The effect of bleaching lasts for a long time. Some people will have a touch up done annually. Others will not need to bleach again for years.
Dr. David Leader is the Chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs.