A beautiful smile makes a great first impression. It is one of the key reasons people are perceived as attractive, successful or youthful. Misaligned, badly shaped, gapped, crooked or discoloured teeth, on the other hand, may not only look unattractive and unhealthy but literally drag the face down. A flawed smile can also be one of the most ageing features of the face and contribute to health problems such as snoring, jaw pain and chronic headaches. Here’s the first part of the three-part series on smile and cosmetic dentistry by fashionista Shameena, in the regular column, exclusively on Different Truths.

One smile can make all the difference in the world. One smile has the power to release stress, calm you down, make you attractive, make someone else happy and believe it or not, smiling can actually cause happiness.

A beautiful smile makes a great first impression. It is one of the key reasons people are perceived as attractive, successful or youthful. Misaligned, badly shaped, gapped, crooked or discoloured teeth, on the other hand, may not only look unattractive and unhealthy but literally drag the face down. This, in turn, affects a person’s overall appearance. A flawed smile can also be one of the most ageing features of the face and contribute to health problems such as snoring, jaw pain and chronic headaches. 

Why Smile Ages

A smile is a facial expression formed primarily by flexing the muscles at the sides of the mouth. Teeth primarily hold the facial bones in place. As we get older or lose teeth, the jawbone is less supportive and the face sinks, contributing to an older appearance. They may result in uneven lips and reduced lip support, which in turn contributes to deep grooves between the nose and mouth corners, known as nasolabial folds. 

People nowadays will spend hundreds, even thousands, of dollars on dermal filler injections to counteract these hallmarks of ageing. Yet, in many cases, they are not addressing the real problem the structure of the smile. 

Maintaining a healthy, attractive smile becomes increasingly challenging, especially after age 35. However, aesthetic and functional solutions are available into a person’s 80s and beyond. 

Today’s cosmetic dentistry techniques enable more people to benefit from a more aesthetically pleasing smile. It is important to be aware of all available options when seeking advice – not the most invasive or expensive. 

Porcelain Veneers 

Dental veneers (sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-coloured materials designed to cover the front surface of teeth to improve your appearance. These shells are bonded to the front of the teeth changing their colour, shape, size, or length.

Dental veneers can be made from porcelain or from resin composite materials. Porcelain veneers resist stains better than resin veneers and better mimic the light reflecting properties of natural teeth. You will need to discuss the best choice of veneer material for you with your dentist.

Veneers generally last between seven and 15 years. After this time, the veneers would need to be replaced. They range in cost from $1,000 to $2,000 per tooth. 

Veneers are Routinely Used to fix

• Teeth that are discoloured – either because of root canal treatment; stains from tetracycline or other drugs, excessive fluoride or other causes; or the presence of large resin fillings that have discoloured the tooth
• Teeth that are worn down
• Teeth that are chipped or broken
• Teeth that are misaligned, uneven, or irregularly shaped (for example, have craters or bulges in them)
• Teeth with gaps between them (to close the space between these teeth)

What’s the Procedure for Getting a Dental Veneer?

Getting a dental veneer usually requires three trips to the dentist – one for a consultation and two to make and apply the veneers. One tooth or many teeth can simultaneously undergo the veneering process described below.

• Diagnosis and treatment planning: This first step involves your active participation. Explain to your dentist the result that you are trying to achieve. During this appointment, your dentist will examine your teeth to make sure dental veneers are appropriate for you and discuss what the procedure will involve and some of its limitations. He or she also may take X-rays and possibly make impressions of your mouth and teeth. 

• Preparation: To prepare a tooth for a veneer, your dentist will remove about 1/2 millimetre of enamel from the tooth surface, which is an amount nearly equal to the thickness of the veneer to be added to the tooth surface. Before trimming off the enamel, you and your dentist will decide the need for a local anaesthetic to numb the area. Next, your dentist will make a model or impression of your tooth. This model is sent out to a dental laboratory, which in turn constructs your veneer. It usually takes 2-4 weeks for your dentist to receive the veneers back from the laboratory. For very unsightly teeth, temporary dental veneers can be placed. 

• Bonding:  Before the dental veneer is permanently cemented to your tooth, your dentist will temporarily place it on your tooth to examine its fit and colour. He or she will repeatedly remove and trim the veneer as needed to achieve the proper fit; the veneer colour can be adjusted with the shade of cement to be used. Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished, and etched — which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and the veneer is then placed on your tooth. Once properly position on the tooth, your dentist will apply a special light beam to the dental veneer, which activates chemicals in the cement, causing it to harden or cure very quickly. The final steps involve removing any excess cement, evaluating your bite and making any final adjustments in the veneer as necessary. Your dentist may ask you to return for a follow-up visit in a couple of weeks to check how your gums are responding to the presence of your veneer and to once again examine the veneer’s placement.

Veneer Pros and Cons

Advantages

• They provide a natural tooth appearance.
• Gum tissue tolerates porcelain well.
• Porcelain veneers are stain resistant.
• The colour of a porcelain veneer can be selected such that it makes dark teeth appear whiter.
• Veneers offer a conservative approach to changing a tooth’s colour and shape; veneers generally don’t require the extensive shaping prior to the procedure that crowns do, yet offer a stronger, more aesthetic alternative.

Disadvantages

• The process is not reversible.
• Veneers are costlier than composite resin bonding.
• Veneers are usually not repairable should they chip or crack.
• Because enamel has been removed, your tooth may become more sensitive to hot and cold foods and beverages.
• Veneers may not exactly match the colour of your other teeth. Also, the veneer’s colour cannot be altered once in place. If you plan on whitening your teeth, you need to do so before getting veneers.
• Though not likely, veneers can dislodge and fall off. To minimise the chance of this occurring, do not bite your nails; chew on pencils, ice, or other hard objects; or otherwise, put excessive pressure on your teeth.
• Teeth with veneers can still experience decay, possibly necessitating full coverage of the tooth with a crown.
• Veneers are not a good choice for individuals with unhealthy teeth (for example, those with decay or active gum disease), weakened teeth (as a result of decay, fracture, large dental fillings), or for those who have an inadequate amount of existing enamel on the tooth surface.
• Individuals who clench and grind their teeth are poor candidates for porcelain veneers, as these activities can cause the veneers to crack or chip.

Inlays and Onlays

Inlays and onlays are dental restorations used by a select number of dentists. In certain cases, they are a more conservative alternative to full coverage dental crowns. Also known as indirect fillings, inlays and onlays offer a well-fitting, stronger, longer lasting reparative solution to tooth decay or similar damage. These restorations are beneficial from both an aesthetic and functional point of view.

Inlays and onlays can often be used in place of traditional dental fillings to treat tooth decay or similar structural damage. Whereas dental fillings are moulded into place within the mouth during a dental visit, inlays and onlays are fabricated indirectly in a dental lab before being fitted and bonded to the damaged tooth by your dentist. 

The restoration is dubbed an ‘inlay’ when the material is bonded within the centre of a tooth. Conversely, the restoration is dubbed an ‘onlay’ when the extent of the damage requires the inclusion of one or more cusps (points) of the tooth or full coverage of the biting surface.

The Benefits of the Conservative Approach

Superior Fit: They offer a conservative preparation that preserves as much healthy tooth as possible. They are a great choice if you have minimal to moderate tooth decay that extends into a flossing area, offering an excellent alternative to full coverage crowns.

Tooth Colour: Boasting aesthetic longevity, they are not likely to discolour over time as tooth-coloured resin fillings often do.

Tooth Structure Safeguard: They preserve the maximum amount of healthy tooth structure while restoring decayed or damaged areas, helping to ensure functional longevity.

Easy Tooth Cleaning: Because the fit is tailored at all edges and the preparation minimal, your tooth can be easier to clean than it would be with full coverage restorative alternatives such as a dental crown. Composite fillings can shrink during the curing process, whereas prefabricated porcelain or gold inlays/on lays will not (ensuring a precise fit).

Tight Space Fulfilments: If you have a cavity between your teeth, consider an inlay rather than a direct composite filling. They are better at sealing teeth to keep out bacteria; they are easy to clean, will not stain and offer exceptional longevity.

Strength and Stability: They are extremely stable restorative solutions for the treatment of decay. The superior fit and durable material make them a stable choice that can actually strengthen a damaged tooth.

Weak Tooth Protector: An onlay can protect the weak areas of the tooth. The procedure does not require the complete reshaping of the tooth.

The Procedure

Typically, an inlay or onlay procedure is completed in two dental visits.

During your first visit, your dentist must prepare the damaged tooth. A moulded impression of the tooth is then taken and sent to a dental laboratory, where the restoration is fabricated.

Inlays and onlays can be made from gold, porcelain or resin materials. The difference is in the appearance of the finished restoration. A fitted, provisional restoration (sometimes known as a temporary or “temp” for short) in the shape of the final restoration can be created during this visit to protect the tooth while the final restoration is being fabricated.

Your dentist might discuss with you the best type of material to use. If aesthetics are not a concern (for example, with back molars), gold is the best option. Porcelain offers the best aesthetics and is often used in the “smile line” areas. Resin materials may be the best option for people who grind their teeth and/or those with a misaligned bite (malocclusion).

During your second visit, the provisional temporary is removed and your inlay or onlay is placed.

They are extremely stable restorations that seldom fail. Your dentist will check all margins to ensure a smooth fit with tight adjacent contacts. Your dentist will also check your bite to ensure that there are no occlusion-related problems affecting the margins of the restoration. Once fitted, the restoration is bonded onto the tooth and the margins are polished.

(To be continued)

Shameena Abdurahiman

Photos from the Internet by the author

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Shameena Abdurahiman

Shameena is a Self-made independent entrepreneur, Fashion Designer and Stylist, Artist, Photographer, Fitness freak, Poet, Blogger, Graphic Designer, Life strategist and many other things. Her collections cater to a broad range of women, from classic to modern, fusion and embrace all attitudes from romantic to dramatic. She is currently situated in Kuala Lumpur, Malaysia.

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