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The Pros and Cons of Cosmetic Dentistry

Read this before upgrading your pearly whites.


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Have you always felt self-conscious about your teeth but overwhelmed by the countless options out there? We feel you. Thanks to a growing number of cosmetic dentistry procedures, the days of hiding your smile are numbered. Trained in the latest techniques, cosmetic dentists can restore integrity to damaged teeth or upgrade so-so smiles to ones that light up a room. And while the beauty boost is real, so are the benefits to the body and mind.

“I want to dispel the idea that cosmetic dentistry is superficial,” says Jerry Stahl, former president of the Greater New York Academy of Cosmetic Dentistry and a Fair Lawn-based dentist. “A decent smile has a huge impact on someone’s life.” Good oral aesthetics not only boost self-esteem and social confidence, but also overall oral health. As we age, teeth suffer all sorts of wear and tear: darkening, yellowing, chipping, cracking, shifting, crowding, erosion and decay.

Improving their look can one-up their fitness and function, as well. “Straighter teeth in the right position are easier to maintain, and create a healthier environment in your mouth,” says Ed Romano, a 20-year member of the American Academy of Cosmetic Dentistry (AACD) and former president of its New Jersey chapter. From bleaching to veneers, here’s the lowdown on the most popular options.

WHITENING

For a quick pick-me-up—and the best bang for your cosmetic dentistry buck—you can’t beat bleaching, “as long as your teeth are fairly straight,” says Romano. Home brighteners like white strips will do the trick (albeit modestly and slowly over a few weeks), while an in-office laser treatment will lighten your teeth several shades in just an hour. Expectations need to be managed, though. The reality is that whitening teeth is an ongoing process requiring maintenance.

Pros: Numerous options at various price points; noncommittal and noninvasive

Cons: Doesn’t work for certain stains; can cause temperature sensitivity; must avoid certain foods and drinks like berries, red sauce and wine

BONDING

Narrow gaps and chipped, broken teeth can look as good as new with bonding, the application of porcelain or composite resin (a high-density plastic) filling material matched to a tooth’s original enamel and dentin. “Composite can look great quickly,” says Romano, making it ideal for a quick fix, like a chipped tooth right before a big event. Durable, if not especially long-lasting (expect five to seven years), bonding is ideal for developing smiles or as a placeholder for a more permanent treatment.

Pros: Teeth can often be fixed in one visit; relatively affordable ($400-800 per tooth)

Cons: Bonding stains over time and lasts only 1/3 as long as veneers

CROWNS

Unless you’ve been blessed by the tooth fairy, you probably already have at least one of these babies topping a damaged or decayed tooth. Traditionally customized in a lab to replace and improve the shape and function of original teeth, crowns typically take two weeks or two appointments. However, crowns and partial crowns can now be done in office in about 90 minutes using 3-D imaging and a magical milling device that carves crowns out of a block of porcelain. There’s even a treatment in the works that combats decay by regrowing teeth using stem cells—no fillings or crowns required.

Pros: Versatile; long-lasting; looks natural

Cons: Requires drilling healthy areas; possible gum recession and sensitivity; color may not match teeth over time; insurance may not cover full cost.

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VENEERS

If you want a dazzling starlet smile, you’ll need veneers. They’re thin porcelain or composite resin shells fitted and bonded to teeth in order to transform stained, chipped, crooked, worn, uneven or oddly-spaced chompers. There’s a price to pay for perfection, however, beyond the $800-2,000 you’ll pay per tooth (four to eight are usually required for a makeover). Even though newer, thinner versions such as Lumineers allow dentists to be less aggressive, healthy teeth still need to be shaved down to make room for the shell, according to Romano. Given the cost and commitment, look for an AACD member with experience in occlusion since a poor bite will shorten veneers’ lifetime (as long as 20-25 years). Ask to see before and after pictures. The best veneers boast customized color, so if you see chalk-colored teeth, move on.

Pros: A faster fix than braces; Hollywood-level perfection

Cons: Expensive and irreversible, but don’t last forever; people who grind and clench teeth may need to wear a night guard

IMPLANTS

Implants are customized crowns that cover metal screws anchored in the jaw or skull bone. The two-part procedure (initial implants need several months to heal before the crown can be placed) is a bit of a haul, but nothing beats results in terms of natural looks, oral stability and facial structure support. Implants thwart sagging, bone loss and aged looks that come from missing teeth. They can also be used to provide superior support for dentures and bridges.

Pros: A secure, natural-looking smile; improved long-term oral health

Cons: Expensive; risk of infection

ORTHODONTIA

Are your teeth crooked despite spending your preteens in headgear? Aging can cause teeth to shift and crowd, requiring an orthodontic revisit. From conventional bracket-and-wire braces to removable clear aligners, options depend on the severity of spacing, crowding and bite issues. If straighter teeth are all you want, Stahl suggests looking into short-term braces focused on aesthetics.

Pros: Straight teeth; a properly aligned bite; long-lasting (assuming you wear a retainer)

Cons: Expensive; typically requires at least a one-year commitment

PERIODONTAL SURGERY

Periodontists graft gum tissue to hide and protect recessed roots, sculpt gum lines into more pleasing, symmetrical shapes or excise tissue at the crown to make teeth appear longer. Called crown lengthening ($1,000-4,000 all in), the procedure can turn the clock back a bit. “To a point, longer teeth, especially incisors, give the illusion of a more youthful smile,” says Stahl. Although most gum procedures require a periodontist, some cosmetic dentists can reshape minor asymmetries using a laser. Healthier gums are a happy side effect of making them prettier.

Pros: A dramatic new look; healthier gums and teeth in an hour or less

Cons: Post-surgical tenderness; risk of infection, sensitivity and post-surgery bleeding

Jennifer Kantor is a parenting and lifestyle writer. She lives in Maplewood with her husband and two kids.

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