Dr George Druttman from CAP City Dental shares some cosmetic dentistry questions and answers


What happens if I get an infected nerve under a tooth that has been crowned or veneered?

Answer: The nerve inside the tooth can sometimes 'die' after a dental procedure has been done on the tooth. Often it's not predictable. It is more likely to happen to a tooth that has been crowned rather than one that has been veneered, as the former is certainly a more 'invasive ' procedure than the latter. It is important to appreciate that crowns and veneers are used in different situations. Either way, root canal treatment (usually completely painlessly) is carried out with access to the nerve from the 'inside' surface of the tooth (with is later filled with a tooth coloured composite filling material). Consequently the appearance of the crown or veneer should not be affected by the root treatment.

I have crooked upper teeth , I hate them and I don't want train-track braces .

Answer:  Generally, crooked teeth can be treated in one of two ways...... Straightening them or making them ‘look as if they have been straightened’. The former involves physical movement (and so , actual change of position of the teeth ) and is called orthodontics. The latter involves changing the appearances of the front surfaces of teeth and is called 'veneering' …. a sort of ‘instant orthodontics’. It may also sometimes require some reshaping , which requires a little cutting of tooth enamel , to be done instead of or together with veneering of a tooth.  Today, orthodontics can involve 'internal' braces or clear  removable plastic aligners( eg. 'Invisalign').... both are not visible to others. Obviously , orthodontics is much more time consuming than veneering . It is important to speak to an experienced dentist , who would explain the 'pros and cons' of each treatment approach for an individual patient.

I want whiter teeth . Does it hurt , how much will it cost and how long does it last ?

Answer: Teeth can be  whitened ( often called ' bleached') in a variety of ways. Most commonly this is done by placing an oxidising gel  into small thin mouth guards that fit over top and bottom teeth and are left in place for an hour or more a day ; even overnight.... for between a few days or weeks. Additionally a stronger form of the gel can be applied directly to the tooth surfaces by a dental professional in the surgery for a couple of hours, often under a 'special' light. Another technique sometimes advocated are strips  or tapes of material, containing the oxidising agent, placed over the teeth surfaces , each day for a while . The oxidising gel is either hydrogen or carbamide  peroxide. What has been shown not to work  generally are tooth whitening pastes and solutions sold over the counter at chemists .  Many patients seek tooth whitening as a solution to their dental aesthetic problems , when in fact, other dental procedures are more appropriate for the individual case. Moreover , synthetic materials such as composite or porcelain cannot be whitened. So often tooth whitening is done prior ( and not after) , say, veneering or crowning  in the 'aesthetic' or smile zone. Over the counter tooth whitening material or ‘special’ toothpaste has been shown to be relatively ineffective .

There should be no pain with these procedures, although occasionally there may be some wild sensitivity fro a day or so.

I have a dark front tooth , what can I do about it ?

Answer: Almost always a 'dark' tooth is one that at some stage ( sometimes, many years before' ) has had the nerve removed and been root canal treated. If that had been done properly , such teeth are 'healthy', although they are 'dead'. Occasionally a chronically  infected tooth that has been untreated may show as that , despite there being little or no discomfort.... and so , needing root canal treatment.  Also it is not uncommon , after trauma to a tooth, for nature to do its own root canal treatment  over a long period of time ( the nerve canal  'closes up') internally naturally and result in a yellower tooth..... painlessly and not requiring root canal treatment . It is imperative that any dark tooth is checked and x-rayed by a dentist to check its health status. For aesthetic , and sometimes 'strengthening' reasons such teeth often need crowning or veneering . This is often done in the 'smile zone' for aesthetic reasons .... to colour match such a tooth to its neighbour. occasionally ‘individual’ tooth bleaching can be effective.

I am really conscious of my 'goofy '  upper front two teeth, what can I do ?

Answer: ‘Goofy'  looking front teeth are usually the result of  central incisors that are actually large, particularly compared , to their neighbouring  second incisors and / or are protruding forward of them. Different  approaches can be taken depending on exactly what the condition is.

If the two front teeth are  ‘in line' or closely so with the other  teeth in the upper  arch then they can be slightly re contoured to make them look smaller. This requires  perhaps a little enamel taken off the edges to shorten them and the sides 're shaped' a little to make these seem narrower.

On the other hand, the adjacent 2nd incisors may be  relatively too small. Placing composite or porcelain veneers on these second incisors to increase their size will definitely make the central or first incisors look relatively and proportionally smaller ....and more ' in harmony' with the other teeth in the smile zone.

If, however, the problem  is that the     teeth are  physically protruding from the other upper teeth, then the obvious answer is orthodontics ( physical tooth movements) ….. to ‘push’ them back. This can be done with  either internal ( invisible) or external tooth wires and braces or with aligners ( such as ‘Invisalign’). Removal of one upper  premolar tooth on either side of the upper jaw 'to make space' to pull in the upper front teeth may sometimes be required to make space for all the teeth to be ‘in line’.

I have a really important occasion coming up very soon and I want to improve my smile quickly and not too expensively , can I ?

Answer: Yes you almost certainly can. From the point of view of both time and keeping costs down, the material of choice would be quartz composite rather than porcelain. Veneering a number of teeth ( anywhere between two and twelve , usually upper ones) in this material can be done in one visit on the same day. Again, depending on how many teeth are involved , such an appointment can take anywhere between one hour and the best part of an entire day.  You can walk out on the same day with your smile 'transformed'. Moreover , the procedure is unlikely to need  a local anaesthetic .... so you won't even be numb AND it certainly should  cause no discomfort at all. The fee obviously also depends on the number of teeth and time taken . Generally the range is about £400 to £3,000…… depending on how many teeth are involved ; could be anywhere from two to twelve. Obviously if the treatment is carried out in the harder , stronger and longer lasting porcelain material, the fees are likely to be about three to five times larger .

My teeth are short and stubby . I hardly show them when I smile . What can be done ?

Answer: This depends on why they are 'short and stubby'. If the cause is that they are naturally small and maybe there are even unsightly gaps between them , then these teeth can be made wider and longer by  bonding tooth coloured veneers on them ....made of either quartz composite or porcelain. If the cause is that these teeth have been 'worn done' over a period of time by the aggressive , usually at  night,  tooth grinding ( bruxing) habit of the individual , they can be built up the same way with veneers. However, this latter case tends to be more complex , in that sometime the bite needs to be 'opened' to allow for more space to place these restorations. Porcelain , as a material , is more likely to be advised , rather than composite, because it is much harder and far more wear resistant . An experienced dentist would advise appropriately.

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