Cosmetic (Aesthetic) Dentistry

Mar 03

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WHY ARE MY TEETH YELLOW?

Very few people have really white teeth. If your teeth are yellowish, it does not necessarily mean that your teeth are weak or unhealthy.
The bulk of teeth is formed by dentine which is yellowish in colour. This colour can be seen through the relatively translucent enamel.
Teeth darken with a person’s age. This is thought to be due to changes in the structure of the enamel and an increased thickness of the underlying dentine.

MY TOOTH LOOKS GRAYISH AND DISCOLOURED. WHAT CAN BE DONE?

If the discolouration is due to defective enamel or dentine it could be masked by a layer of tooth-coloured filling or a veneer or crown of porcelain.
If the discolouration is due to decay, an old discoloured filling, or the tooth being dead, then the underlying cause needs to be treated first. For example, in the case of a dead tooth, root canal treatment may need to be done first.

These are fillings that match the colour of the tooth. They will discolour over time and may need replacement.

TOOTH COLOURED RESTORATIONS

VENEERS

-WHAT ARE THEY?

Veneers are thin shells, or facings, made of porcelain or plastic material that are cemented onto the front of the teeth in order to improve the colour or shape of the teeth. They can be thought of very much like artificial fingernails.

+WHEN ARE VENEERS USED?

When the teeth are discoloured or stained, veneers can greatly improve the shade and uniformity of the colour.
When the teeth are poorly shaped, e.g. if they are too narrow with gaps between the teeth, veneers can help to make the teeth look broader and help to close the gaps.

+HOW ARE VENEERS DONE?

In many cases, the dentist may need to shave off a little of the front surface of the tooth to make space for the new veneer. This can often be done without an anaesthetic.

Impressions, or moulds, of the teeth will be taken for the laboratory technician to make the new veneer out of porcelain.

About a week later, the veneers will be placed on the teeth and checked for colour and fit. If satisfactory, the veneers will then be cemented on to the tooth.

+HOW MUCH DO VENEERS COST?

The cost will vary according to materials used, the complexity of the case and the skills of your dentist. Please consult your dentist to get a quotation after examination and diagnosis.

+ARE THERE CHEAPER ALTERNATIVES TO VENEERS?

Yes. Tooth-coloured filling-material could be used however veneers give much better colour and smoothness.

+WHAT ABOUT CROWNS?

Crowns cover the entire tooth and are usually done if there is extensive damage to the tooth. Veneers are more conservative because very little of the tooth needs to be trimmed.

+WHAT ARE THE DISADVANTAGES OF VENEERS?

Veneers are made of porcelain or plastic so they can crack or chip, just like natural teeth. One would need to be careful not to bite on ice or bones. If cracks or chips occur, then the whole veneer will need to be replaced.

+HOW DO I TAKE CARE OF THE VENEER?

Brush and floss daily to ensure that the margins of the veneer are kept clean. Do not bite on hard foods that may crack the veneer. Go for regular dental checkups so that any little defects or problems can be detected and treated quickly.

CROWNS

A crown is commonly called a cap. It may be thought of as a “cover” as it covers, or replaces, that part of the tooth seen in the mouth.

-WHY DO A CROWN?

A crown can be done for many reasons. Most often, it is done when a tooth is

badly decayed or chipped
discoloured or mis-shaped

+HOW IS A CROWN DONE?

To put it simply, the tooth is trimmed to make space for the final crown. Moulds are then taken of this tooth for a custom-made crown to be made in the laboratory according to your dentist’s instructions. When the crown is ready, it is slipped over the tooth and firmly cemented in place.

+WHAT IS A CROWN MADE OF?

It can be made of porcelain or metal or combinations of gold alloys or other metals like titanium and porcelain. Special types of glass and plastics can also be used. Your dentist will choose the material best suited for your case.

+HOW DO I CARE FOR MY CROWN?

Careful daily brushing and flossing are essential to keep the gums around the crown healthy. Also don’t crack ice, bones etc. as this may chip the porcelain. Regular check-ups by your dentist are also necessary. Remember, crowns and bridges are only as good as they are maintained.

+HOW MUCH DOES A CROWN COST?

The fee will depend on, the materials used, the complexity of the case and the skill of the dentist. Full porcelain and gold-based crowns are more expensive. Crowns made of non-precious metals are cheaper but less attractive. Consult your dentist for actual fees that will be incurred.

+WHY DO CROWNS COST MORE THAN FILLINGS?

Crowns are long-term restorations. Making them requires the considerable skill and time of your dentist and a technician working in a specially equipped laboratory. The crown itself is often made precious metals. When you pay for your crown, you’re paying for all these.

+ARE THERE ANY ALTERNATIVES WHICH COST LESS?

If you desire the ultimate in function and appearance, then there are very few alternatives which are truly satisfactory. In certain limited situations, bonding will provide an adequate alternative to crowns. When discoloured teeth are concerned, bleaching may prove to be the cheaper alternative to crowns, though the result may not be predictable. Veneers to cover discoloured surfaces of teeth may be considered as alternatives to crowns.

+FREQUENTLY ASKED QUESTIONS ABOUT CROWNS

WHAT WILL BE PLACED ON MY TOOTH WHILE THE PERMANENT CROWN IS BEING MADE?

As there will always be an interval of a few days to a few weeks before the permanent crown is fitted, the dentist will ensure adequate protection of the prepared tooth with a temporary crown or temporary dressing. For the front teeth, temporary plastic crowns offer very satisfactory cosmetic results, which means you will have nice teeth to smile with at all times. For molar tooth, a soft metal temporary crown may be fitted which continues to be functional until the permanent crown is fitted. In all cases, the temporary crowns or dressings are fairly easily and quickly removed before you are fitted with your new permanent crown.

IS IT ALWAYS NECESSARY TO REMOVE THE NERVE OF A TOOTH PRIOR TO CROWNING IT?

No. A normal, healthy pulp or nerve of a tooth is seldom removed prior to crowning it. Possibly the only exceptions to this role would be when it is necessary to insert a post into the nerve canal as an anchor for the crown in cases where the tooth is badly broken down and not much is left to support the crown. The other instance arises when a crown is made to re-align a crooked tooth. The nerve may be in the way of the newly aligned crown and thus may have to be removed.

Of course in cases when the nerve has reached a stage of infection or irritation where the condition is irreversible, then, it will be best to remove the nerve and treat the root canal prior to crowning the tooth.

WHY DOES MY DENTIST SUGGEST CROWNING MY MOLAR, WHICH HAS BEEN ROOT TREATED?

A dead tooth, having lost its blood and nerve supply, becomes more brittle and less resilient. In the case of the molar teeth, which bear the brunt of heavy chewing, fracture of the tooth is a very common occurrence with this dead tooth. Often, if the fracture is not severe, crowning or other suitable procedures may still save the tooth. However, if the fracture line runs unfavourably, you may lose the tooth. Crowning, as a preventive measure, therefore serves to prolonged the life of a tooth which you have chosen to preserve by undergoing root canal treatment.

WILL CROWNING MAKE MY TEETH LESS PRONE TO DECAY?

Yes, if you maintain a reasonable standard of oral hygiene and home care. A crowned tooth has much less of its structure exposed to all the decay causing agents in the mouth, hence it will resist decay more effectively if you practice good oral hygiene. Cleaning would involve both correct brushing and flossing to clean the margins of the crown.

WHY IS MY CROWNED TOOTH SO SENSITIVE TO HOT AND COLD DRINKS?

A newly crowned tooth may be sensitive to hot and cold initially, but this should not persist for long. A hypersensitive tooth often indicates all is not well with the tooth nerve and, if persistent, will necessitate root canal treatment. Therefore, during the preparation of a tooth for a crown, the dentist takes a lot of care not to injure the underlying nerve, so as to avoid post operative sensitivity. Precautions he will take include using lots of water in the form of a spray during preparation of the tooth, providing a temporary crown during the interim period and cementing the permanent crown with a non-irritant cement best suited to the case.

I SOMETIMES HEAR EMBARRASSING STORIES ABOUT CROWNS FALLING OUT AT AWKWARD MOMENTS. DOES THIS HAPPEN OFTEN?

No. This does not usually happen. As with most unpleasant things, we only hear of the instances where crowns have dropped but not of those countless crowns which have stayed in place and functioned for years. Generally speaking, the crowns with the greatest likelihood of dropping out are those with minimal tooth support, i.e. very short teeth and very badly decayed teeth. In these situations, the proper design and preparation of the teeth would be of utmost importance to ensure the stability and retention of the crown.

WILL I HAVE TO BE EXTRA CAREFUL WHEN CHEWING ON MY FRONT CROWNS? CAN I SAFELY CRACK NUTS AND BONES WITH THEM?

In most cases, normal eating habits with the usual diet are fine and do not jeopardize the crowns. However, it is definitely not advisable to chew on or crack bones or shells as the chances of fracturing the porcelain are high. Crowns on the front teeth are only as strong as your natural teeth. What may be hazardous to your own teeth would definitely be harmful to the crowns.

MY TEETH ARE CROOKED AND DISCOLOURED AND I LONG TO HAVE A BEAUTIFUL SMILE. WILL CROWNING THEM HELP ME?

Yes, modern dentistry, with all its newer materials and techniques available today, can transform a person by giving him or her the confidence of a beautiful smile. Among other ways, crowning often can solve the problem of slightly crooked teeth, discoloured teeth or even malformed teeth, all of which may be the cause of a self-conscious and inhibited smile.

SOME OF MY FRIENDS’ CROWNS LOOK SO FALSE. WHY?

One of the most difficult aspects of constructing a crown is the reproduction of the natural tooth’s translucence. Porcelain approaches natural tooth translucence very closely but when used in conjunction with a gold alloy for strength, this translucence decreases and the problem of opacity of the crown increases. It is often this opacity that gives crowns the artificial look. However, newer developments in this field are making more natural looking crowns more easily attainable by the dentist. Of course other aspects also go a long way towards avoiding the “false tooth” look: aspects such as shade (colour) selection, crown shape, size and position. Ultimately it is the artistry and skill of both the dentist and the technician that makes a crown look like a natural part of you.

BLEACHING

First of all, your dentist will have to find out what sort of stains they are. If the stains are on the surface (extrinsic stains), they can be polished away. Stains on the tooth are most often caused by smoking (tobacco stains). Drinking large amounts of coffee or tea can also cause them.
Accumulated calculus, also known as tartar, can appear as brown areas near the gum margins. Calculus has to be removed by your dentist by scaling.
If the stains are within the structure of the tooth (intrinsic stains), they cannot be brushed or polished away. They may need to be masked or covered by a layer of tooth-coloured material such as composite or porcelain.
In some special cases, the tooth may be ” bleached” to make it look whiter. Your dentist can advise you on this. Of course, if the intrinsic stain is minimal, you can choose to leave it alone.

DIASTEMA CLOSURE: CLOSING A GAP BETWEEN TEETH

Depending on the size of the gap and the size, shape, position and health of the teeth, your dentist may suggest any of the following methods:

Adding tooth-coloured material to the adjacent teeth. This increases the width of the adjacent teeth and closes the gap. This procedure is simple and painless. If the tooth-coloured material gets discoloured or chipped, the procedure can be repeated.
Widening the adjacent teeth by placing veneers or crowns on them. This is a longer- term solution but involves more time, work and cost.
If the gap is wide, the above two methods may not completely close the gap but narrow it and make it less conspicuous.
In very wide gaps, an artificial tooth may be inserted into the gap. This can be done by means of a removable denture or fixed denture (bridge or implant). A removable denture is cheap but may be bulky and take more time to get used to. Either a bridge or an implant are more compact, comfortable and lasts longer.
In some cases, the teeth on either side of the gap may be moved closer together. This can only be done if you are willing to wear braces. This treatment may take several months but may give the best result.
In a few cases, the two front teeth may be set apart because of an extra tooth buried in the bone between them. An X-ray will show if an extra tooth is present. It must be removed surgically before treatment can be done to move the teeth together with braces.
In short, your dentist will thoroughly examine your mouth and explain to you the treatment methods appropriate to your condition. With this advice, you can decide on the method best suited to you.

Tags : cosmetic, tooth sensitivity