I Hate My Smile – What Can I Do?

By Simon W. Rosenberg, D.M.D.

Published on July 20, 2007

It all depends on what is causing your smile to be unsightly

If you cover your mouth when you talk, meet new people, or attempt to smile, then there is help for you. Let’s look at some of the reasons people hide their smiles, and the modern dental solutions that can give them more confidence.

Why People Hate Their Smiles

People find many reasons to hate their smiles. Here are some of the major culprits:

• Aging and stains from food and drink, which darken the teeth.
• Decay that has begun to take its toll between the teeth.
• Older fillings that have darkened with time or leaked at the margin, showing a black line between the tooth and filling.
• Broken, chipped teeth, which can be unsightly and give people the impression that you don’t take care of yourself.
• Twisted, rotated and mal-aligned teeth, which also compromise the impression you make when you smile.
• Spacing between the teeth, which, while viewed as “sexy” by some people, is considered unsightly by others.

Modern Dental Solutions

CEREC 3D for Decay, or “Caries”

Decay, or “Caries,” can darken and destroy tooth structure. For small cavities, tooth-colored composite resin can be used in place of the old silver amalgams (mercury-containing metal fillings). For larger fillings, porcelain inlays, onlays or crowns are used to restore the missing tooth structure.

The latest cutting edge technology in this area is Sirona’s CEREC 3D (Ceramic Reconstruction) system. It is a same-visit CAD/CAM (computer designed and manufactured) technology that produces the most life-like, gorgeous restorations available. Because the porcelain material has been manufactured to simulate tooth structure in appearance and physical characteristics, CEREC 3D restorations last longer than other restorations. If the front teeth are chipped or cracked, we can restore the teeth with porcelain veneers (also known as laminates) or all-porcelain crowns – with no black metal line at the gums to give away that it is a restoration.

The older dental method for making porcelain crowns or veneers can be unpleasant. First, anesthesia (a shot) is administered, then the tooth is prepared (the drilling), a gloppy impression is made of the prepared tooth, and a temporary crown is made and temporarily cemented. Then you wait two weeks, during which time the temporary may come off, become irritating to the tongue or oral tissues, or not look or feel very good.

Traditional methods of placing crowns also take time from your busy schedule (for travel and the visit). Finally, they require a second anesthesia shot in order to have the crown or veneer that the lab fabricated fit and cemented by your dentist.

In contrast, CEREC 3-D technology enables dental patients to receive an all ceramic crown onlay or veneer that fits well and is highly esthetic and durable – all in one visit. Because CEREC uses electric dental handpieces, the preparation phase is 40 percent quieter, with less of the vibration and loud, grating, jet whir sounds that were associated with the 1960s-era air turbine handpiece. And instead of taking a gloppy impression, the teeth involved are sprayed with a white powder – the same one used to put the “M” on “M & Ms.” Finally, a digital 3-D picture is taken with a thin camera attached to a specially designed computer.

Next, the dentist designs the crown or veneer on the computer, and a block of porcelain that matches the tooth is milled right there for cementing about 15 minutes later. The 50-micron (50 thousandths of a millimeter) precision of the process provides a much closer fit than what you get with indirect lab processes, which often result in mistakes when making models and wax copings, casting metal copings, and hand layering porcelain.

CEREC porcelain blocks are factory-made, with greater strength and consistency for less chipping and a more natural appearance. With twenty years of follow-up research (now using state-of-the-art Biogenic 3D design software) and the precision-milled porcelain block technologies, the results look great and will last and last.

Bleaching, aka Tooth Whitening: Improvements and New Choices

While we all grow new skin cells and hair on a daily basis, our teeth have been there chewing and bathed in staining foods since we were six or seven years old. Over time, many people’s teeth begin to darken or turn yellow due to stains and/or age. If it’s only surface stains, a routine or extended dental cleaning can sometimes make a dramatic improvement. For deep staining and aging of the enamel and dentin, dental bleaching or teeth whitening can be helpful.

There are two broad types of bleaching available: over-the-counter products and professional bleaching supervised by a dentist. Think of the bleaching choices as similar to the choice presented when you want to remove stains from clothing: would you rather buy something at the store or have a dry cleaner use their professional judgment and stain removal systems to see if the stain can safely be removed from the fabric.

The products available in stores and over the Internet generally use a much lower dose of the active ingredient, Carbamide Peroxide. They carry it to the teeth on plastic strips or a one-size-fits-all tray. The gel cannot be uniformly applied to the tooth, nor can these systems keep the chemicals off of the gums and soft tissues of the mouth. Unless you are very educated on what to look for, you may not notice damage to the gums and soft tissues.

Professional dentist-supervised bleaching is more predictable, and the dentist’s staff can modify treatment to maximize the whitening while decreasing the sensitivity.

Professional dentist-supervised bleaching offers two choices:

• Take-Home Custom Trays, or
• In-Office Procedures that may include light activation.

Your dentist will advise you as to which choice is best for you after assessing prior bleaching experience, sensitivity, gum recession, and whether you prefer wearing trays overnight for several weeks or want single visit power whitening.

The tray treatment is slower but more predictable, and can be extended for several additional weeks until the desired lightening is achieved. There is also less sensitivity of the teeth after tray bleaching than with in-office one-visit bleaching. In almost all cases, the sensitivity can be controlled with special gels applied to the teeth and gum margins after bleaching (but it may take more time with in-office bleaching.) An advanced tray fabrication technique that maximizes bleaching gel contact with the tooth and minimizes seepage of the saliva under the tray was developed and is in use by offices employing the Deep Bleaching system developed by Dr Rod Kurthy.

The most popular light-activated in-office bleaching systems are the Zoom! Advanced Power system and Brite-Smile. For chemical-only bleaching, Ultradent Boost and a group of other systems can be used for patients who have medical conditions that make the use of light activation more complicated. For take-home custom tray bleaching, there are more than a dozen dental companies that provide comparable products.

For patients who have tetracycline staining, a more prolonged three-phase program of in-office bleaching, take home trays for several weeks, and an in-office deep bleaching procedure may be needed to get extra decolorizing of the tetracycline stain as well as whitening the teeth beyond what single approach bleaching procedures can accomplish.

Orthodontics without Braces – a Good Technique for Adults

Invisalign offers an alternative to braces that is nearly invisible. With Invisalign, the dentist gathers the same information as with any Orthodontic patient, and if the patient is a candidate for these nearly invisible aligners, the dentist sends dental impressions for computer analysis. A simulation of the final result (a “ClinCheck”) showing a proposed result with all of the steps needed to accomplish the goal is e-mailed back to the dentist. If the dentist is satisfied, this ClinCheck visualization of treatment and its results are shown to the patient for final approval.

Therapy starts two weeks later. The patient wears the first of a series of thin, comfortable, clear plastic aligners (similar in thickness to a bleaching tray) 24 hours a day, except during eating and brushing the teeth. A new aligner is used every two weeks. This therapy is gentler than traditional braces and wire orthodontics were. Teeth can be moved 0.2 mm with little discomfort, and if held in the new position for two weeks, the body will remodel the bone and periodontal ligament attachment to the tooth to hold the new position. Then the next aligner is inserted to move the tooth 0.2mm closer to the esthetic goal.

Where to Go from Here?

A comprehensive dental evaluation, complete with dental X-rays, periodontal pocket charting, photographs, and dental casts, can help the dentist determine which options your individual situation warrants. To find out which of these treatments is best for you, be sure to discuss any of these areas with your dentist.

Simon W. Rosenberg, D.M.D. is a general and maxillofacial prosthodontic specialist with a practice in Manhattan focused on applications of High Technology for Cosmetic Dentistry. More information on each of the problems and treatment options discussed in this article can be found on his website: www.drsimonrosenberg.com