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There’s nothing like a healthy, white smile to make us look and feel good. Dentists regularly see a big boost in confidence and self-esteem when they rejuvenate a patient’s smile, whether it involved a thorough cleaning, straightening, or cosmetic care.
They are well-versed in helping people with all manner of concerns, weighing the pros and cons of the many different options available. Sometimes, patients have a problem area that bothers them, such as discolored teeth. Other times, it’s a bigger issue, like a chipped or missing tooth.
In every case, dentists have the expertise, the cutting-edge technology, and the latest in materials to make your smile shiny and new again. Read on for some of their solutions to common dental scenarios.
Problem: You have discolored or stained teeth
Solution: Teeth whitening is one of the most common and cost-effective ways to make a big impact on your smile. Whiter, brighter teeth often make people look younger and feel better about themselves. There are two main options. One is getting a set of professionally made custom trays and safe hydrogen peroxide bleach from your dentist to use at home. Or you can do whitening treatments at the dentist’s office with bleach activated by a special light or laser. They are equally effective, says Dr. Tom Morgan of Morgan Family Dental in Prior Lake. The home trays might take a bit longer to achieve the same result, but they cost $300–$500 versus office treatments of $500–$800.
Problem: Whitening just doesn’t do the trick
Solution: Some teeth are stubborn when it comes to whitening because the stain comes from inside the tooth, underneath the enamel. (Traditional whitening attacks stains on the surface of the enamel.) For internal stains, common whitening tools will not work no matter how many times people try. In these cases, Dr. Amy Hughes of Hughes Dental in Deephaven recommends veneers to cover the discolored teeth with a thin layer of porcelain.
Problem: You chip a tooth
Solution: When a tooth is pristine and hasn’t had any dental work done to it, the best fix for a chip is composite resin bonding, says Dr. Gesica Horn of Serene Oaks Dental in North Oaks. Dentists use the putty-like material to sculpt the tooth back to the original shape, then cure and harden the resin with a light. Bonding is the best choice if the chip isn’t big. But if the tooth already has a filling or the chip is significant, Horn prefers placing a protective crown to safeguard the underlying tooth structure. Without it, the tooth could chip more.
Problem: You had braces, but your teeth shifted back
Solution: Many people want to avoid wearing the brackets and wires of their youth again, if possible. When teeth shift over time, an easy solution is to turn to aligners to move them back. Wear them for a few short months, and you’re back in business, Horn says. The trick to preventing this problem from happening in the first place—or again—is to wear your retainer every night, indefinitely.
“Cosmetic dentists are skilled at using veneers or crowns—or a combination of the two—to visually straighten teeth without needing to use braces.”
—Dr. Nancy Norling / Nancy Norling, DDS
Problem: You don’t want braces of any kind
Solution: Cosmetic dentists are skilled at using veneers or crowns—or a combination of the two—to visually straighten teeth without needing to use braces, says Dr. Nancy Norling, who practices in St. Louis Park. It’s a permanent straightening solution that can be achieved more quickly than braces. The downside is that dentists do need to remove some tooth structure to place these restorations, though they strive to take the bare minimum.
Problem: You have a small gap between your teeth
Solution: There are two main options for closing a pesky space between teeth: a few trays of Invisalign to quickly close the gap or composite bonding, Horn says. Bonding materials have come a long way over the years, providing dentists with a diverse array of shades that they can match seamlessly with patients’ teeth. The concern with bonding, though, is that the composite material may start to break down in four to six years, which can lead to staining.
Problem: You have one crooked tooth that drives you crazy
Solution: The most conservative answer is to reshape the tooth with composite resin—what Morgan calls instant orthodontics. “We’re just optically making sure it looks straight in the person’s mouth,” he says. There are other options, including a short course of clear aligners like Invisalign to move the tooth into place or getting one porcelain veneer to make that tooth appear straight.
Problem: A tooth gets entirely knocked out
Solution: Dentists can do wonders with a knocked-out tooth, provided that you can find it and get to a dentist in 20–30 minutes. Then the dentist often can successfully reimplant it, says Dr. Steven Gorman of The Gorman Center for Fine Dentistry in North Oaks. In this most ideal situation, the dentist will bond the lost tooth to its adjacent teeth, essentially putting it in a cast. Then bone and tissue eventually reattach to the tooth. Sometimes the nerve in the tooth dies, leading to a root canal. But this is still the best approach because having a natural tooth is always the first choice, he says.
Problem: You have a large gap between your teeth
Solution: In this scenario, Dr. Atif Rizvi of Dentistry by Design recommends either a porcelain crown or an onlay—essentially a veneer for a molar. Both are custom-made based on the patient’s mouth and goals. Which option to choose really depends on the size of the gap. A crown will fully encircle the tooth and works well if a tooth is compromised and needs other repairs. An onlay works well for a relatively healthy tooth that just needs a different or larger shape, and it does not generally require the removal of tooth structure like a crown.
Problem: An adult tooth falls out
Solution: The gold standard for a missing tooth is an implant. That’s because implants replace the natural tooth root in the jawbone, which helps maintain that bone structure, says Norling. “If you don’t have something there, the bone will shrink up, and you lose bone volume,” she adds. With an implant, a dentist inserts a titanium screw in the jaw and gives it four months to heal and fully integrate into the bone. Next, the dentist places a crown on top of the screw that looks and works just like a natural tooth.
Problem: You want to avoid a dental implant
Solution: Sometimes patients reject the idea of implants out of fear. But there is very little pain involved because the jawbone has no nerves, Horn says. A bit of ibuprofen to handle minimal swelling usually is enough. However, dentists do have another option: a bridge with a false tooth or teeth. Inserting the bridge requires removing enamel on both sides of the missing tooth to place crowns, which serve as anchors for the device. It’s a more aggressive procedure than an implant, she says. Many dentists are reluctant to use bridges when the neighboring teeth have never had dental work, seeking to avoid damaging otherwise healthy teeth.
Problem: You have a gummy smile
Solution: Sometimes the gumline can become uneven, revealing more gum than tooth during a smile. A simple solution is a gum lift (also called gum recontouring). The dentist uses a laser that pushes back the gum tissue, Rizvi says. After a roughly one-hour appointment, your gums are reshaped and the teeth again become the star. Healing is almost instantaneous. “This helps balance everything out so that it all looks uniform and natural,” he says.
“[A gum lift] helps balance everything out so that it all looks uniform and natural.”
—Dr. Atif Rizvi / Dentistry by Design
Problem: You have a hodgepodge of dental work
Solution: It’s not uncommon for people to have a wide array of restorations, including gold and silver fillings, veneers, and metal crowns. Dentists regularly rejuvenate worn-down, mixed-up smiles with a whole-mouth approach. They utilize a combination of full crowns, three-quarter crowns, and veneers to get everything working well together and looking consistent. Gorman designs plans that help patients reach their goals, creating fresh smiles that restore form and function with a uniform appearance.
What is the biggest misconception about cosmetic dental care?
Dr. Steven Gorman
The Gorman Center for Fine Dentistry
Some people think cosmetic dentistry is fluff—that it’s just cosmetic. But I can tell you that 90 percent of the time, it’s about function and structure. The cosmetic is just the icing on the cake. And like anything else, there are people who do it really well and people who don’t do it so well. I recommend that people see before-and-after pictures of dentists’ work to learn what they are able to provide.
Dr. Gesica Horn
Serene Oaks Dental
People think they need 20 veneers to get the results they are looking for. Really, what they may need are a few aligners of Invisalign, some whitening, and some composite bonding. There are minor changes that can be done that make a huge, impactful difference.
Dr. Atif Rizvi
Dentistry By Design
More and more patients are getting educated through social media, and that has its pros and cons. People are more willing to get things done. They are thinking about their self-improvement, and it enhances their self-esteem. But sometimes patients can have unrealistic expectations about what it takes to achieve the results they want.
Dr. Tom Morgan
Morgan Family Dental
You don’t have to spend $30,000–$40,000 to have a beautiful smile. Oftentimes, something as simple as whitening someone’s teeth for a few hundred dollars will give them the confidence they wanted. My approach is to start with something simple like teeth whitening and see what they think, and then we can move forward and do other conservative things.
Dr. Amy Hughes
Hughes Dental
With veneers, some people think that their teeth are going to be ground down to a nub or that they will look fake. Both are huge misconceptions. I tell patients that with properly done veneers, very little tooth is removed—0.3 to 0.5 millimeters—and it does not weaken the tooth structure. Veneers are very thin and do not look fake if they are done right.
Dr. Nancy Norling
Nancy Norling, DDS
A lot of people think cosmetic dentistry will last forever. But what you can do to break your own tooth also can harm a veneer. You’ve got to be careful with your diet, with clenching and grinding—which is so hard on a restoration. You have to be committed to proper oral care and hygiene and take good care of the investment you made in your mouth.
Tips for maintaining your new, beautiful smile at home
You took the plunge and invested in yourself, renewing your smile with cosmetic dentistry. Now it’s time to make sure your teeth stay looking their best. Dentists share their favorite tips and tricks for keeping that smile fresh and beautiful.
Dental Guardians
A great way to protect your cosmetic dentistry is with a nighttime appliance, says Dr. Gesica Horn of Serene Oaks Dental. During sleep, most people move their teeth without even knowing it. These movements get compounded by sleep apnea, clenching, or grinding. A protective device will prevent damage.
Healthy Tooth Diet
What you eat and drink plays a big role in your oral health. Plaque and gum disease still can affect the tissue around restorations like implants and veneers, says Dr. Nancy Norling. Sugary and acidic foods and drinks can do a number on dental health, so restrict your intake of sports drinks, pop, water with lemon juice, and sugary treats.
Big No-Nos
Protect your teeth by avoiding common bad habits. Don’t use your teeth as tools for opening packaging, tearing tags off of clothes, or trimming your fingernails. It seems harmless, but such actions create tiny cracks that ultimately can cause a tooth to fracture, much like a chip in a car windshield, says Dr. Amy Hughes of Hughes Dental.
Bite Carefully
If you can’t give up those culprits that can be harmful to your precious new smile, be careful! Try to be extra cautious when biting into things like hard candy, ice cubes, or frozen treats to prevent damaging veneers or other dental restorations, says Dr. Steven Gorman of The Gorman Center for Fine Dentistry.
Water Works
Brushing and flossing are core dental hygiene steps, but Horn adds another big difference-maker: a water flosser. Floss first, then use a water pick to remove any remaining plaque or food particles from hard-to-reach areas. Brush your teeth last, she says, but don’t rinse with water, so that your teeth absorb fluoride from the toothpaste.
This article originally appeared in the September 2022 issue of Mpls.St.Paul Magazine.