Tuesday, 26 July 2011

Cosmetic Dentistry - Creating the Perfect Smile

Published in Panorama

Creating the perfect smile…..

The inputs for this story have been provided by the following practitioners in Dubai:
1.Dr.Punnoose George, Dental Surgeon and Orthodontist, Al Rafa Poly Clinic
2.Dr.Lars Thorwid, Orthodontist, Al Zahra Private Medical Centre, Dubai and Al Zahra Private Hospital, Sharjah
3.& 4. Dr.Ms.Gabriel, Dentist and Dr.M.F.Talass, Head and Chief Orthodontist, Talass Orthodontic & Dental Centre, Jumeirah.

A smile is the key that opens the door to the heart.

Yet, if ignored, seemingly little things can conspire to ruin that winsome smile – tiny spots, discolouration, a chip here, a crack there, gaps between teeth, irregular or mal-aligned teeth and noticeable fillings in the front teeth. If that’s not a handful, a missing tooth is a hole in your smile! In a world so dizzily propelled by appearances, a brilliant smile is a statement of personality, a confidence booster, enhancing one’s opportunities for success.

Thanks to the strides in medicine and technology, ‘cosmetic dentistry’ can improve the looks of a person by improving his smile! Bleaching, braces, bridges, crowns, inlays and onlays, veneers and dental implants are just some of the processes involved that make improve teeth, functionally as well as cosmetically.

Besides heredity and other factors, ‘toothy’ problems of mal-alignment, irregularity, decay, et al, may actually have their roots in improper care of milk teeth, according to dentists and orthodontists. How you maintain your milk teeth will decide whether you will have to use braces as a teenager, since it is the milk teeth that actually guide the permanent teeth into the correct position in the mouth, opine the doctors.

Incorrect and insufficient brushing, increased intake of junk food, lack of oral hygiene are contributing substantially to dental problems, requiring one of the above treatments.

Braces are widely used even by adults today, according to the dentists since they have become more conscious of looks, have become aware of a solution and they are now able to afford it. The surprising aspect is that cosmetic dentistry is not restricted to the fairer sex; an increasing number of men are coming in for treatments of various kind, to enhance their looks, claim the doctors!

Braces are used to get teeth into the best possible order to prevent accidents from happening. For, teeth could be sticking out, ready to get fractured in the process of swimming, diving, knocking little siblings over and in a host of other activities. Yet another indication for braces is when there is a mix of milk and permanent teeth, when the last milk teeth are going and crowding appears. This makes for difficult brushing, gums could get inflamed. The teeth may not be in order in the jaws and the jaws themselves may not be fitting together! This makes for difficult chewing! Both functionally and aesthetically, such teeth need correction and braces may be the best answer – done and supervised over 12 sittings, lasting over 12-18 months.

Conventionally made from stainless steel, braces, lately made from transparent ceramic and titanium have become popular. In very, very rare cases, steel braces could cause allergic rashes around the mouth, ears and face. It is important for those wearing braces to be careful about diet and oral hygiene. Since there are extra things fitted on to the teeth, cleaning, brushing becomes difficult. By adding on junk and sticky foods, possibility of food collecting under the braces is increased, making cleaning that much more difficult, causing white patches to develop on the teeth.

Bleaching is a relatively inexpensive process which leaves the teeth while, free of discolourations from excessive coffee, tea or red wine drinking, cigarette smoking and chewing tobacco. Staining could also result from long term or too much intake of antibiotics like tetracycline.

The safest bleaching agent used today, may be carbamide peroxide at different percentage levels. The safety of the procedure is directly related to the dosage given, the frequency and duration of treatment and the concentration of the agent used. Though relatively safe, it is best done in clinics under the supervision of the dentist. While in clinics dentists use a solution that contains about 30% carbamide peroxide to effect teeth whitening, the prescribe a solution containing 5-10% of carbamide peroxide for home use. The carbamide gel is applied to the teeth on top of which is then affixed a rubber tray, the mouthguard, generally transparent in colour.

Doctors however caution using Over the Counter (OTC) bleaching agents which may cause more harm than good. Besides, bleaching may not be used on those who have sensitive teeth, periodontal disease or teeth with worn enamel. Besides, the mouthguard used in the process, must be tailor-made to suit individual needs to ensure perfect fit.

However, bleaching which may require 5-6 sittings, costing a total of Dhs.1000, is not a permanent solution for discoloured teeth. If very good oral hygiene is maintained and the use of coffee, tea, and such items is minimized to the maximum, the while colour may be sustained for 2-3 years.

Laminates or veneers offer a permanent solution to this problem. Moreover, modern dentistry strives towards conservation, preserving as much of the original teeth as possible, making laminates the first choice.

The process involves bonding a thin shell of porcelain to repair damaged top or bottom front teeth and side teeth, correct gaps and conceal discolourations. This 3-visit procedure is virtually painless and involves removing 1.5-2 mm of tooth material and preparing a laminate of porcelain of exact thickness in the dental laboratory, which is then adhered to the affected tooth, just under the margin of the gum. The procedure done under local anesthesia is safe since the laminates are made from porcelain which is a very inert material. Similarly, the adhesive used is a composite, safe for use.

The veneers are highly resistant to permanent staining from tea, coffee, tobacco, wine, etc., and can last for over a decade if high levels of oral hygiene are maintained and regular flossing is done. However, one has to be extremely careful with diet, abstaining from biting hard foods, since there is a chance that the laminates get dislodged.
The risk from the procedure is practically nil, though on very rare occasions, less than 1% cases, a reaction may occur which could develop into a tooth pain.

Where teeth are missing, a bridge is the most obvious choice for filling the void left by the missing teeth. The process involves fitting a false tooth between two porcelain crowns in the gap left by the lost tooth. The pair of crowns holding the false tooth in place, are cemented onto the teeth on each side, thus bridging the gap between the two teeth. The process, done under local anesthesia, involves two visits to the dentist, roughly 1 ½ hours per visit. The teeth receiving the new crowns in some cases, may be mildly sensitive to extreme temperatures for a few weeks after the treatment.

When teeth are chipped, fractured, malformed, discoloured, mal-aligned or have broken down fillings, crowns may be the best answer. The requirements in these cases may be more functional than for aesthetic purposes alone. The idea is to build up the tooth with a little metal and top it with ceramic caps, aimed at restoring the tooth to its normal shape and size while strengthening and improving its appearance.

The routinely used material is ceramic, though gold alloys, acrylic or composite resin are also used. Though cosmetic appearance of ceramic crowns are excellent they suffer the disadvantage of being brittle hence easily prone to damage from fractures. Done under local anesthesia, fitting a crown requires two visits to the dentist. The outer portion of the affected tooth is removed to accommodate the thickness of the crown, an impression of which is taken to provide an exact model for the tooth which is prepared in a laboratory.

Inlays and onlays are quite similar, being in the nature of fillings, when tooth decay is present. In an inlay procedure, the decayed tooth is cleared off the cavity, a shape is then given to the cavity and measurement of the tooth taken. A filling to fit exactly the cavity, is prepared in the laboratory, either in gold, white metal or ceramic. This preparation which is of much higher strength and colour stability, with much better morphology or shape, is then cemented into the tooth cavity.

However, inlays suffer from certain disadvantages in that, first of all, they have a cement lining which can dissolve to small degrees if one is not too careful with diet. Secondly if the filling is not prepared with care and accuracy and does not fit properly into the cavity, it leaves a wider cement margin, giving scope for it to dissolve faster with possibility of food collection in it. Thirdly, the process involves wedging the lab-processed filling into the tooth, leading to a mild pressure. If, however, the tooth is slightly weak, even this mild pressure may cause fracture of the tooth, though this is a very rare occurrence since a thorough check-up is done before going in for the process.

Onlays involve covering the cusps of the tooth, requiring a much bigger restorarion. If the teeth are severely decayed, then there is one part of the cusp missing. Onlays enable to cover the cusp as well as the outer part, thereby protecting the entire tooth.

Dental implants are artificial teeth, surgically anchored to the jawbone. They are extremely durable and unlikely to break or fracture. Most people between the ages of 20-40 who’ve lost a tooth due to accident, extraction or decay, go in for the procedure which takes an hour to complete, under local anesthesia. The solution is permanent and may cost anywhere between Dhs.4000 – Dhs.40,000 per tooth! They require follow up treatment by way of check-up once in six months for the first year, every three months for the next two years and then every year.

However, implants are contra-indicated in certain cases as when the person is a diabetic, is suffering from oral inflammation, tumours, etc. In all these cases, the underlying cause needs to be treated before implants may be carried out.

Gums may be sore after an implant, for about 7-10 days and ice packs may be used to keep down the swelling.

Whatever the form of treatment, they all come at a high cost – prevention then, may be the best course of action – prevention that should begin at the baby stage!


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