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As we mature, teeth will naturally darken in colour. One simple way to improve the colour of older teeth is bleaching. Bleaching for lightening the colour of teeth has been in use for decades. Originally, it was used to lighten teeth that had discoloured after root canal therapy. Recent advances in the way bleaching is done mean dentists can use this process on almost all natural teeth, whether they have had root canal therapy or not.
There are four ways teeth can be bleached:
The in-office technique used by the dentist involves a process that combines heat and chemicals to create the desired effect. Several appointments are usually required to see the desirable result.
The home bleaching kits dispensed by the dentist are extremely effective. The dentist makes impressions of the teeth and fabricates a custom fitted bleaching tray. The patient receives instructions from the dentist as to how to use the kit and how to dispense the material into the tray. At home, the tray, filled with the bleaching gel, can be placed in the mouth and leave it for several hours or overnight. The results can be dramatic and can occur after only a few evenings. Usually the desired result can be achieved in about seven days.
Over-the-counter whitening toothpaste is the least effective method. Some of these toothpastes are very abrasive and care should be taken before using them. Consulting your dentist about whitening toothpastes would be most advisable.
Only the dentist who has the appropriate laser machine can do laser bleaching. Dental laser machines are very expensive and most dental offices do not have them. Laser bleaching is very fast and effective. However, there is very little scientific knowledge about the long-term effectiveness and the possible complications from using the laser on live teeth.
For teeth that have minor overlaps or uneven edges, selective reshaping to balance tooth form and position can make dramatic improvements in appearance. Because recontouring cannot be reversed, the dentist will take care to plan each step, keeping in mind the desired final result.
If mottled white spots on the surface of front teeth are unattractive, micro-abrasion may be successful. Using a mild acid in an abrasive paste, the stained surface can be polished away. For white spots that go deeper, microabrasion is not effective and this may be hard to determine in advance.
Bonding is the name of the process used to attach filling materials to teeth. Efforts at bonding began in the early 1950s. Since then, great advances have been made. Dentists now have a choice of many-coloured filling materials that can be applied directly to the teeth and cured in place.
To apply these materials, called 'filled resins,' often only one dental visit is needed. The change in appearance can be dramatic. As materials have improved, the life span for many of the restorations has also improved. Early efforts were believed successful if they lasted three to four years. Today we are seeing some bonding that has held up for 10 years and more.
Bonding techniques can be used to close spaces between front teeth, lengthen teeth that are too short or alter tooth shapes. These techniques can also mask deeply discoloured areas that cannot be removed with other methods.
While modern bonding uses materials that have improved colour, can be polished, and that are stronger, there are drawbacks. These materials are still not as strong as they sometimes need to be. There are times when the resins are not able to withstand the force of a patient’s bite. Where excessive clenching and grinding have resulted in increased tooth wear, direct bond resin restorations are likely to break down and may not be recommended.
As well as strength limitations, the appearance of bonded resin restorations depends on the artistic and technical skills of the dentist. Some simple cases can be managed in every dental office, but some of the more difficult ones require special talent. They should be handled by dentists who have the extra skill needed.
If the front surfaces of the front teeth are discoloured or stained, they can be covered with coloured veneers made to match the other teeth. These veneers of resin, porcelain or cast ceramic cover the coloured areas and return teeth to natural colours.
The resin veneers are usually added directly onto the teeth using the bonding process. The enamel of the discoloured teeth may need to be filed down before the resin is added. Resin veneers can often be applied in one appointment. The colour matches are usually excellent.
The most popular and commonly used veneers are porcelain or cast ceramic. Since dental laboratories make these, treatment usually takes two appointments. At the first appointment, the dentist files down the front enamel surfaces of the discoloured teeth by about .075 mm. This is an important step that, if not done, will give a bulky and thick look to the veneered teeth.
After the filing down, the dentist makes impressions to send a laboratory. The porcelain veneers can be made to match almost any shade of tooth. The completed veneers are cemented onto the teeth using a bonding process. Porcelain veneers have excellent long-term colour stability. They can produce beautiful life-like results. Care must be taken when chewing because they may not stand up well to excessive biting pressure.
Crowns, or 'caps' as they are sometimes called, are also effective for making appearance changes. They are often used in areas of heavy stress, for teeth that have had root canals, and for teeth that already have large fillings and need extra strength.
Over the past 40 years, crowns have been made with plastic veneers over gold, porcelain fused to metal, all porcelain and more recently, cast ceramic. They are the most involved of the esthetic dental options, needing several appointments. At first they are more expensive than some other dental procedures. However, if crowns are done well, the costs will be compensated for by the long lasting results.
When evaluating your dental needs, it would be wrong to limit your considerations to only one of the options available. Your best result will be obtained by discussing all the options with a dentist or dental specialist you trust. It may be necessary to combine several procedures to satisfy your individual needs. In the end your reward will be a bright, happy smile.
Remember, your dental options have never been better. Improving your smile is an investment in your dental health that will bring immediate benefits and lasting satisfaction.