Not so very long ago, people with gnarly-looking teeth often refused to visit the dentist as the anticipated treatment option was the removal of all teeth, and replacement with dentures. Fortunately, times have changed.

Modern cosmetic dentistry offers many options that will help preserve your natural teeth while enhancing your smile. These include veneers with little or no preparation, dental bleaching, orthodontic therapy, aesthetic re-contouring of teeth, and the re-contouring of gum tissue.

Green dentistry—which includes cosmetic dentistry—aims to provide treatment options with a minimal loss of natural teeth.  Your dentist might also call this “minimal biological cost”.

The basic premise of green dentistry is that natural teeth, the whole tooth, or the tooth enamel, should be preserved as much as possible. Green dentistry is also referred to as minimal intervention dentistry. Minimal dentistry seems like an obvious goal, but the history and practice of dentistry shows that this has not always been the accepted wisdom. Teeth that gave trouble were routinely pulled, and cosmetic enhancement of teeth and gums left a lot of destruction in its wake.

Now, patients with simple problems such as discoloured teeth or an uneven gum line who once may have anticipated treatment with veneers (which can do a lot of harm to teeth) often find their problems may be addressed using methods that do little or no damage to their natural teeth.

Even now, some dentists continue to recommend veneers without firstly considering the minimal biological cost.

Dr. David Penn, CEO and Head of Clinical and Technical Research at Southern Cross Dental Laboratories, coined the phrase “green dentistry” to teach dentists how to adopt a more conservative approach. “Green dentistry is about minimising your enamel footprint”, says Dr. Penn.

Holistic dentistry and green dentistry are uniquely different. Green dentistry advocates preserving the enamel in natural teeth.

Reasons to preserve natural teeth

Dr. Penn believes that dental practitioners should try to “protect our younger patients’ precious enamel at all costs, to prepare for the arduous journey ahead.” In other words, he wants your teeth to last as long as you do, which thankfully is increasingly longer.

In its early days, cosmetic dentistry used artificial materials, bonding technology and crowns to improve the appearance of front teeth. These methods required the removal of a lot of enamel. Cosmetic dentists believed that the dentine, the hard tissue lying under the enamel, was strong enough. They didn’t believe the tooth enamel needed to be preserved, but time proved otherwise. Veneers bonded to dentine had significant failure rates. Ceramic veneers bonded to enamel, on the other hand, were highly successful and had double-digit life spans. It is now clear that cautious and conservative preparation methods for veneers and crowns are the superior treatment option.

Dr. Penn believes that over-treatment with ceramic veneers is at an all-time high; even though there are many viable alternatives that can help conserve natural teeth. These methods are also often easier and more affordable.

Veneers with little or no preparation – Both fired-ceramic and pressed-ceramic veneers are popular because they are quick and easy to apply and do not require a local anesthetic. They can easily improve unsightly teeth and are in high demand to fix peculiar tooth contours, tooth spacing and gum recession that exposes roots. Malformed, worn or discoloured teeth can also benefit from veneers. If you must have ceramic veneers, request a technique that requires little to moderate preparation. Directly placed resin-based veneers were in vogue long before ceramics came onto the scene, and they were fixed to the tooth enamel rather than to the dentine. Either choice will help save your natural teeth and avoid some of the undesirable effects of enamel loss, such as tooth sensitivity, death of nerves in the pulp cavity and veneers becoming detached.

Dental bleaching – Patients often ask for and are sometimes given dental veneers when dental bleaching could solve the problem. If tooth colour is the only reason for treatment, in-surgery bleaching, take-home treatments or a combination of the two may serve the purpose efficiently. Bleaching is also more affordable than veneers. Try bleaching first, says Dr. Penn, before resorting to other methods mentioned here. If tooth colour has to match restorative resins, the bleaching procedure should be completed a few days before the colour of the bleached teeth is matched with the resin. This allows the colour of the bleached teeth to return to a stable shade. Dr. Penn prefers to “wait at least two weeks after bleaching is completed before starting the restorative procedures, still recognising that additional colour will return to the teeth after months or years.”

Orthodontic therapy – Minor to moderate overlapping of teeth, spacing and crowding issues can be resolved with orthodontic therapy. This therapy is not a quick fix: It can take from a few months to a few years to get your teeth into proper formation. Orthodontic therapies such as Invisalign also require a lot of discipline and commitment from the patient. In the end however the teeth in your mouth will be your own. It is worth the wait.

Aesthetic re-contouring of teeth – Where front teeth are of unequal lengths or slightly rotated, they can be fixed with a few minutes of re-contouring followed by smoothing and polishing. At minimal cost a fluoride application will help with discolouration and should reduce the need for future treatments. Some people may need aesthetic re-contouring after orthodontic therapy to treat teeth that in their previous position experienced significant wear.

Re-contouring of gum tissue – If a smile shows unsightly long and short tooth lengths even though all teeth are aligned at the biting edge, this is because they have unequal exposure at the gum line. Gum re-contouring with a laser or with electro surgery can remedy this problem in an inexpensive and relatively pain-free manner. Re-contouring the gum line requires sufficient gum tissue to begin with. Invisalign can be used to sculpt the gum heights of specific teeth to an ideal level by repositioning. In some cases, it may be necessary to reposition gum tissue even after an Invisalign treatment, with laser or electro surgery. While this is a more extensive procedure, those who prefer a natural look may still prefer it to ceramic veneers.

For the sake of good aesthetics, orthodontic therapy, tooth re-contouring and gum re-contouring may need to be followed with the placement of resin-based composite veneers. The combined result should produce the pleasing and aesthetic look you desire.

Getting the teeth right

Natural teeth should look pleasing and harmonious. Teeth that are too large, too long, too square or round, over contoured, too white, or lacking in imperfections appear unnatural, not just to experts, but to everyone. “In my opinion,” says Dr. Penn, “many veneers shown in journals and advertisements (and as I have observed in patients) violate the anatomy and/or colour characteristics of natural teeth, and they create a source of visual tension for the patient.”

Patients need guidance to move away from aggressive procedures

Ceramic veneers should not be considered the primary quick fix for slight or moderate issues of the front teeth. This article has discussed several quick, easy and affordable alternatives, which can be used alone or in a combination.

Dr. Penn holds the view that modern day professionals have an ethical responsibility to provide information for all possible treatment options. So the next time you visit a cosmetic dentist, ask for more information and discuss alternatives that can help preserve your natural teeth.

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