Introduction: Straight & Pearly Whites 101
A beautiful smile is definitely an enviable asset to have.   Unfortunately a set of crooked, yellowed and chipped teeth will certainly subtract from a face no matter how attractive or sensual.  Today's cosmetic dental technology can transform a less than attractive mouth into a true, beaming Hollywood smile.  From straightening to whitening to lessening or increasing tooth and gum show, cosmetic dental can surely help you acquire a sensational set of pearly whites.  This isn't exactly considered facial plastic surgery, but it can add to your appearance.  I HATE when my teeth look dingy, in fact I didn't even realize until it was already too late!  EEEK!!  It was time to bleach!

There are many procedures to improve the appearance of your mouth -- even if you are missing several teeth.  We will discuss the various options and cover the costs involved as well...

Orthodontics
According to the American Association of Orthodontics, "Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention and treatment of dental and facial irregularities.  The technical term for these problems is malocclusion, which means "bad bite."  The practice of orthodontics requires professional skill in the design, application and control of corrective appliances, such as braces, to bring teeth, lips and jaws into proper alignment and to achieve facial balance." 
American Association of Orthodontists - FAQ about Orthodontics 2001

The general attitude towards braces is usually very negative, thankfully orthodontics have advanced significantly.  Granted, patients needing extensive straightening may not benefit from the newer techniques but usually all complaints can be remedied.  Not only do orthodontics improve your smile but they improve dental health, in general.  Dental problems which are not necessarily cosmetic such as gum disease and tooth decay are more likely to happen in individuals with orthodontic problems.

I am personally going to try the Invisalign® brand and cannot wait!!  Marc (my partner) had braces for about 3 years and it certainly helped his teeth so very much -- however his teeth have moved back since his braces so instead of a repeat of braces he got Veneers for his his uppers and about 7 crowns.   He is planning on Invisalign® for his lowers next year if he is a candidate.  He has also had tooth bleaching done (Professional Nite-White® brand).  BUT! Ha! Mine are whiter!! and all I have used are Crest Whitestrips and IGIA! Finally White Gel.

Common Complaints & Reasons for Orthodontics

  • Crooked Teeth
  • Teeth that are too close together
  • an overbite
  • protruding teeth
  • misalignment where the front teeth make no contact
  • an underbite
  • widely spaced teeth

Your Options In Orthodontics
Today's options are not like the train tracks of yesteryear.  Many new materials decrease the wear time for many patients and there are even clear or colored brackets like hot pink or neon green, invisible trays and invisible types which are placed behind the teeth, called lingual braces.

  • Standard metal braces: Such as Titanium alloy set ups with or without colored or clear brackets may take anywhere from 1 to 3 years on average and are costly to the patient.   
  • Non-invasive Straightening Products: There are even non-metal, removable trays which can effectively move the teeth as long as they are worn for the recommended amount of time.  Such a product is Invisalign® which is available for as little as $129.00US a month. (www.invisalign.com) . Results have been seen from 6 months to 1.5 years in average cases.
  • Orthognathic surgery/Surgical Alignment: This is reserved for misalignment of the jaw and other types of maxillofacial and mandible dysfunctions. 

Tooth Bleaching & Whitening Systems
Whiter, brighter, cavity-free teeth are a sure sign of good hygiene and vitality!  Although some us may brush and brush and brush some more but never are able to retain that sparkling white smile.  Even if your teeth yellowed from age or stained from your little habits (smoking, drinking tea, juice and coffee, etc.).  Even if your teeth are stained due to medical reasons you can find a dental specialist who whitens teeth and walk out of there smiling -- flashing your beautiful white teeth to the masses!  There are quite a few ways to bleach the teeth so let's start with the professional in-office types and work our way down.

Reasons Why Teeth May Appear Stained or Darkened
These reasons do vary so be sure to review the below causes to determine if they apply to you.  Even if your teeth are successfully whitened, retaining habits or exposing your teeth to these variables will only darken your teeth once again if you choose to continue.  There are quite a few ways to bleach the teeth -- some inexpensive, some very expensive.  

  • aging certainly has an effect on tooth color and brightness (from yellow to brown)
  • beverages such as coffee, tea, grape juice, dark sodas such as Coca-Cola® or Pepsi-Cola® (dark brown hues)
  • dark fruits such as black and/or blueberries (dark bluish hues)
  • excessive fluoride can cause darkening
  • genetics can play a significant part in tooth color and brightness
  • smoking can cause significant yellowing
  • medications such as tetracycline  [: a yellow crystalline broad-spectrum antibiotic produced by a soil actinomycete of the genus Streptomyces (S. virdifaciens) or synthetically; also : any of various derivatives of tetracycline]  can cause yellowing.

Over the Counter Remedies
There are many types of bleaching pastes, gels and strips available either at your pharmacy or at through the Internet.  But remember, it is possible.  Some of these include:

Crest Whitestrips 56 strips  $29.99
Use Crest Whitestrips every six months or as needed to maintain whiteness.  If your teeth are significantly discolored, you may need to use 2 boxes of Crest Whitestrips initially to get the desired result.  We recommend using a Crest whitening toothpaste to gently polish away surface stains daily.  

Here are the results after half a box of Crest Strips and believe it or not after a tip from a few online friends of mine, self filing with a metal nail file and Clorox bleach on a Q-tip.  Isn't that the craziest thing you have ever heard of?  I was desperate because I had a photo shoot in a week and had to rush it.  I still can't believe I did it. (8/2003)  I do recommend the Crest Strips but not the Clorox, the Crest Strips really whitened my teeth.  I am getting my teeth sealed until I  finally get my bottoms straightened and my veneers applied.  *I should have taken an after pic with my bite in its natural position.*

teethbleach.jpg (30518 bytes) afterfiling.jpg (22522 bytes)
before and after after - I really want veneers!

 


What you get with a box of Crest White strips:

  • 56 Tooth Whitening Strips
  • 28 for Upper Teeth, 28 for Lower Teeth
  • Noticeably Whiter Teeth Guaranteed in Just 14 Days
  • White Teeth for At Least 6 Months

Review: They work -- although don't expect miracles if you have seriously stained teeth.  Interesting information is that although Crest instructs that you do not brush your teeth beforehand, it WAS proven that pre-brushing significantly improved whiteness.  The downfall was that it increased tissue sensitivity:

"Pre-brushing prior to applying Crest Whitestrips significantly improves product efficacy in terms of reduction of the yellowness from the teeth measured. Elimination of the pre-brushing step may improve soft tissue tolerability with only a modest reduction in product efficacy.

Research presented at the 30th Annual Meeting of the AADR, March 7-10, 2001

YTF! Tip: Don't let your box of strips get super warm because the gel will stick to the hard plastic backing and not come off on the strips.  

On a Budget? There is a lot of left over product that you could probably get a good 2.5 more weeks of use out of so don't throw your left over strips away if you're thrifty.  The bottom strips have the most amount of left over.  Use a very sharp pair of scissors so you don't drag and smear the strip off of the backing. Pretty ghetto, but it works!    


Colgate Simply White Clear Whitening Gel  .34 fl oz  $14.99
Dreaming of a white...set of teeth? Colgate knows how to make your dream come true. With Simply White, just follow three easy steps, and in 14 days sport a sparkling smile.
Until now, whitening your teeth meant expensive trips to the dentist or struggling at home with messy, complicated or expensive products. Colgate® Simply White™ is an EASY, affordable way to sparkling white teeth... and it really works, in just three easy steps.

Whitens In 14 Days. The Easy Way to Sparkling White Teeth - Enough product for 14 days of use.

Money Back Guarantee
If not satisfied with results, send proof of purchase from box and original cash register receipt to: Colgate-Palmolive, Consumer Affairs, 300 Park Avenue, New York, NY 10022

Review:  I think it is a waste of money, just like the commercial shows, as soon as you close your mouth the gel gets washed away.


Mentadent Tooth Whitening System icon
Based on years of global research, Mentadent delivers a whitening system that is safe to use.  The unique delivery system pioneered in the oral care marketplace keeps Mentadent's ingredients separate until use.  Upon contact, the combination of the activator paste and the peroxide gel forms a powerful whitening agent with a low peroxide level that is safe for the enamel of your teeth.  You get an effective level of whitening and fast results that you desire while not exposing your teeth to high levels of peroxide.

Your Mentadent™ kit includes:

  • Dual Chambered Pump with equal amounts of activator paste and bleaching gel that combine to create a powerful whitening agent - 3.5 oz/99.2 g.
  • Oral Rinse - 4 fl oz/118.3 ml.
  • 1 Dosing Paddle - Exclusive dosing paddle takes the guesswork out of how much to use.
  • 2 Custom Designed Mouthtrays.
  • Instruction guide with a shade guide to monitor your progress.

Activator Paste Boosts Whitening by over 40%*


Whitening Toothpastes: These are generally called pellicle [(b) : a thin layer of salivary glycoproteins coating the surface of the teeth] removers.   Many times the pellicle is stained due to products consumed or smoking.  The pellicle is removed and the teeth appear somewhat brighter.  The pellicle does return rather quickly so be sure not to eat or drink any staining foods or beverages to retain the whiteness achieved.  Also you should not eat or drink and staining foods or beverages soon after the pellicle is removed due to the staining to the actual enamel which can happen without the protective pellicle coating present.  Such a product is:

SuperSmile® Pellicle Remover ($15. for 4.2 oz, $10. for 1.75 oz)

Carbamide Peroxide Gels (trays needed): These products are very common and very popular.  They provide simple whitening without exorbitant prices with the use of an ingredient called carbamide peroxide.  The gel is placed within the tray and the carbamide peroxide is placed all around the teeth.  After the carbamide peroxide begins breaking down it introduces oxygen into the enamel of your teeth - thereby literally bleaching any staining element present.  Only natural or enamel can be whitened, veneers, crowns and fillings cannot be lightened.  Many of these were generally available only to dentists, the Internet has brought these  professional strength formulations to your door without a dentist's prices. Such products are:

BriteWhite®

Finally White® by IGIA: (I got it for $36.90 (29.95 + shipping/handling); it seems to bounce around from $36.90 to $39.95 to $59.95, If you find it for over $40.00 - NOT WORTH IT! But if you can catch it on sale, go for it! The prices go up and down.  I tried it right after the Crest strips and obtained very white teeth with both systems combined and I didn't even have to use all the syringes nor use it for the suggested amount of time.  The photo to the left is very misleading because the little syringes do NOT look like this.  In the photo it looks like the professional syringes when in fact it looks more like some Cracker Jack toy syringes (like in the photo of the IGIA FinallyWhite PRO kit photo.. The IGIA Finally White Plus kit came with:

  •  3 "Custom Moldable Trays" which had to be further customized by trimming excess silicone rubber off
  • 1 Blue "Tray Storage Case" That honestly had a hard time fitting BOTH upper and lower trays, together.
  • "1 oz. Whitening Gel"
  • "Instruction Booklet with Step by Step Directions"

Their before and after photo on the website is a joke!!  It looks like a lady with a very nice, white smile with a yellow filter over the teeth.  I guarantee you my photos below are real and not some touched up computer generated graphic.  Remember, I smoked for a very long time (but quit several years ago) and Kahlua coffee liqueur was my cocktail of choice in my twenties.  This isn't the best photo, in fact the improvement is much better than what shows in the photo.  I will get the new photos up soon as soon as I can locate them on my poor hard drive.  The after pic on the right is NOT my natural bite -- I have my teeth apart so you can see them all since I have a slight overbite.  I am getting my teeth fixed especially those vampire incisors - eek! My incisors are turned out and back so you can see the backside of the tooth a little from the front.

before after

I did experience tissue sensitivity and tooth sensitivity as well and had to skip a few days and resume after the sensitivity went away, IT HURT!

Update: 9/9/01: I checked tonight and there was a Pro version -- same as what I bought for $46.90 but with an extra syringe, a robe, a magnifying mirror, an extra tray and a neutralizing mouth rinse!!  What the??  Actually, I saw the deal and well, I couldn't resist.  I admit it, I bought it. I needed some more gel anyway -- who was I to pass up the freebies?


Finally White® PRO by IGIA: I received my kit with the promised lighted magnifying mirror, the extra tray, the extra gel and mouth rinse plus the official IGIA robe !  Well, the mirror is something I will never use hahaha!  The robe I use when I apply my sunless tanning lotion and the gel is the same good gel as in the other kit.  I really like it and it doesn't cost a fortune. Although I HATE wearing those huge trays longer than the minimum amount of time (3 hours). If I had custom trays that are very thin plastic I'd be a happy camper.  The IGIA Finally White PRO kit came with:

  • 7 Syringes of Carbamide Peroxide Gel
  • 3 "boil and mold" customizable trays
  • mouth rise (what's the point?)
  • a carrying tray
  • plus the other freebies:
    • the lighted magnifying mirror
    • the IGIA robe

It works though, I'd try it before spending the big bucks on professional treatments if you don't have the cash to spend.  It doesn't really taste too nasty and if you place the gel in the tray correctly you shouldn't have over spilling of the gel on to the gum line.   Makes me salivate like Pavlov's dog though. 


Other Over The Counter Brands

  • PowerWhite® Professional Tooth Whitening System with SofTray™ (patent pending) ($124.95)
  • Nite-White®
  • Nupro Gold®
  • Opalescence®
  • Perfecta®
  • Rembrandt® Gel
  • UltraWhite®


Professional (Dentist-Supplied) Whitening Systems & Procedures

Many times the same Carbamide Peroxide that are available on the internet are also what your dentist will provide you.  Check around and compare strengths.  Many of the over the counter brands are actually one level below the professionally available strengths.  Usually the difference is less wear time, custom trays and decreased tooth sensitivity.

Carbamide Peroxide Gels (trays needed): These products are inexpensive in comparison to laser whitening but are sufficient in whitening usually all levels of staining.   The gel is placed within a custom tray and the carbamide peroxide is placed all around the teeth.  Just as with the over the counter brands the carbamide peroxide begins breaking down it introduces oxygen into the enamel of your teeth -- thereby literally bleaching any staining element present.  Only natural enamel can be whitened, veneers, crowns and fillings cannot be lightened.  Such products are:

  • Nite-White®
  • Nupro Gold®
  • Opalescence®
  • Perfecta®
  • Rembrandt XTRA-Comfort® ($250. - $350. for product)
  • There are more Whitening Systems, please check with your dentist for other options.

Laser Tooth Whitening Systems
These systems generally require an application of gel which is activated by either light, a single or even two different types of lasers. Such systems are:

  • LaserSmile™ Laser Whitening System (Biolase): A purple gel is applied to one to several teeth at a time, then the dental damn gel which will protect your gums is applied.  After these applications are complete, laser light is then applied to the teeth for as little as 2 minutes collectively for the average whitening cases.  Most visits require 2 hours of treatment time.
  • PEARLINBRITE™ Laser Whitening System: This system utilizes Energy Transfer Crystals , or ETC's.  ETC's actually absorb the laser's energy and transfers the energy to the hydrogen peroxide molecules of the gel.  This whitens the stains in your teeth with oxygen on a much higher level that typical carbamide peroxide gels.  Usually several applications, lasting up to 30 seconds, per each tooth is needed per session.  However, only one session is usually sufficient in most whitening cases.  Most visits require 30 minutes of treatment time.
  • BriteSmile™ 3000 Laser Whitening System: This system uses a 15% hydrogen peroxide gel application in conjunction with gel plasma light technology.   Application may take up to 20 minutes on average, the gel is then exposed to the light which speeds the whitening process by exciting the hydrogen peroxide molecules.   After the light exposure, the gel is left on the teeth for a little over an hour.
  • There are more Laser Whitening Systems, please check with your dentist for other options.

How long does whitening last?  Well, that depends upon you and your habits.  It also depends upon which option you chose.  Typically carbamide peroxide gels can last anywhere from 6 - 12 months whereas professional laser whitening can last up to a year and a half.  

Porcelain (or Composite) Veneers
A very popular procedure for restoring chipped, worn and discolored teeth is by the use of Cosmetic Porcelain (or Composite) Veneers.  Even teeth which are crooked and spaced too far apart (these spaces are called called a diastemas) or too close together may benefit from veneers.  They can also help those who may have permanently stained or discolored teeth which cannot be helped with professional whitening systems.

Porcelain (or Composite) Veneers are approximately 0.3mm to 0.5mm in thickness but once bonded to your natural teeth become very strong and instantly change your smile from drab to fabulous.  They require removal (usually .5mm/grinding down) of the surface of the natural tooth which is why this procedure is not reversible.   Take this into consideration before choosing to undergo cosmetic porcelain (or composite) veneers. You may need anesthetic so request it if you find the grinding intolerable.  Although .5mm does not normally necessitate a temporary cap to wear for a week until your veneer is delivered by the dental lab, you can request one if you have sensitive teeth or find that your teeth look "odd".

When you return a week later for your veneer insertion you will not usually need any anesthetic -- although you may request it.  After your fit is ascertained and your veneer verified for color-match, your teeth are cleaned, the pellicle removed and the veneer laminate is applied to your teeth with a light-activated binding agent.  After your veneer is exposed to the white light, your veneer should be permanently adhered.  Your veneers should last you many, many years as they are very strong.  Just be sure to watch what you eat - opening things with your teeth or eating very chewy candies like cold caramels or toffee is not recommended.

Porcelain Crowns
Also known as "caps" Cosmetic Porcelain Crowns are very attractive looking and provide a more natural look as compared to amalgam or gold crowns.   Although there are of course the metal crowns as previously said, there are porcelain-covered metal crowns and full porcelain crowns.  There are several reasons for which you may need or benefit from a crown:

  • excessive decay
  • excessive decay which has been repeatedly filled
  • root canal, which will of course need a crown or cap of some sort
  • permanently stained or discolored teeth which cannot be helped with professional whitening systems
  • fractures or large breaks (crumbling)

Your initial appointment requires tooth preparation which will involve and removal of decay and grinding down of the tooth. You will then have an impression made of your teeth.   A temporary crown will also be made which will somewhat resemble your tooth.  Your impression and requirements are sent to the lab where they will construct your porcelain crown.  

Within 2 weeks or more it is sent back to your dentist's office.  When you return your dentist will remove your temporary crown and ascertain your permanent crown fits well.  Any adjustments are made to either your teeth or the crown and your crown is then permanently cemented over your natural tooth.  Your dentist will then have you bite down on what looks like thick carbon paper to check your bite.  If proper contacts are made you will need no further tooth surface adjustment.  If contacts are not being made correctly or your  bite is uncomfortable your dentists will lightly drill or sand parts of your crown until the correct contacts are made.

I have 2 crowns, one which is a porcelain-covered metal crown with a portion of the metal showing through on one corner and the other is a standard cosmetic porcelain-covered metal crown.  The metal cornered crown was from a place I call "Western Teefus" which is a ghetto place that reminds me of a dental assembly line.  It is really named Western Dental and anyone who has gone there knows what I mean.  I kid you not it took me 6.5 hours for a root canal (and many shots later) because the dentist would work on me, then on someone else, then someone else, then yet another patients THEN on me again.  This repeated aaaalllll day.  That was just the root canal procedure -- I still had to go back for the post placement and then the fitting and final placement of the crown.  Thankfully those didn't take too incredibly long.  Anyway! I was told that the metal cornered one was the only type of crown there was because the fully porcelain-covered crowns would break if you chewed something hard.  Well me not knowing any better, accepted that. When I went in for the fitting (after the post placement), he put my new crown on with petroleum to check the fit and told me to bite down, I did and the bite wasn't right.  So he proceeded to drill it down a bit with the electric drill to fix the bite instead of ordering me a knew crown and it cracked!  Do you know he had the absolute nerve to write in my file that my biting down cracked it!! 

Two years later I go to a REAL dentist (with real exorbitant prices, joy.) and he tells me that the dentist at Western Teefus lied to me about the metal cornered crown and preceded to show me his on full porcelain-covered crown!  He also pointed out the dark metal under the porcelain showed through at my gum line, ugh! I knew that already, thanks for noticing.

He then further inspected my crown and said, "they even have "WD" stamped in the metal! Look!"  Well I turned WHITE and grabbed the mirror to see for myself.  Well, he started laughing so hard! I finally realized he was kidding.  That certainly broke the ice for us.   Well that same "high-priced" dentist gave me a 45 minute root canal (woo hoo!) and I was gonna get a full porcelain covered crown!   Which I did and it is SO much better looking.

Cosmetic Dental Bonding
Cosmetic Dental Bonding (also known as composite or composite fillings) is the act of using a natural-colored light-sensitive composite resin filling to fill in cavities, gaps (diastemas), cracks and general flaws.  Teeth can be reshaped, repaired (filled), straightened, made whiter, made brighter, made simply more attractive with a few thin coats of composite resin.  It is less invasive and less expensive than crowns or veneers and more attractive than typical amalgam (silver) fillings.  Unfortunately Cosmetic Dental Bonding doesn't last as long as Porcelain Veneers or Crowns and will need to be replaced within 10 years.  However, it is better for your teeth than amalgam fillings as it will expand and act like natural enamel as opposed to the unyielding metal fillings.

You may wish to have your teeth whitened before your bonding to color-match the composite to a nicer, whiter shade.  After your teeth have been bonded  Your teeth must first be marred or abraded to create a surface which the composite can adhere to easily.  After a thin coat of color-matched resin is applied, your dentists will cure (harden) it with a special light.  You will have several layers applied as needed and then your new teeth will be sculpted into an aesthetically pleasing form.  You can significantly build up several layers to sculpt an entirely different-looking tooth.  Filling in gaps and enlarging teeth which are too-small is very effective with Cosmetic Dental Bonding.

I have this in/on several teeth -- instead of keeping the silver fillings, I had them all removed and had them filled with composite -- more expensive but worth it!!  I am thinking of having this done on a few cracks in my front, lower teeth rather than having veneers.  The veneers will go on my uppers (canines) but the lowers I want to just straighten and fill in by bonding.

Cosmetic Gum Surgery & Upper Lip Retraction
Many of you may have heard of a gummy smile.  This can either be from literally excess gum (and teeth which appear too short) or retraction of the columella (segment of skin which divides the nostrils) and upper lip. And also may need excision for placement of veneers and crowns.

Gum surgery itself involves the removal of this excess gum either manually, or more commonly, with a lasing device (laser). It is actually a very simple surgery but can cause discomfort due to the rawness of the gums post-laser treatment.

Upper Lip Retraction
When the upper lip is too short it does not adequately cover the upper gums of the maxilla and can be literally released for more gum coverage.  This can be done by releasing some muscle fibers above the upper lip which will lower the upper lip to lessen gum show.  Be careful when choosing a surgeon to perform this as too much of  release can severely elongate the upper lip and increase your subnasale to lip ratio.  This area naturally elongates in average individuals with age and muscle laxity.

Average Prices of Cosmetic Dental Procedures

Product Or Procedure Price
Orthodontics: (braces) $1,200. - $10,000.
Invisalign $2,000+
Over The Counter Tooth Whitening Pastes $6. - $40.
Over The Counter (OTC) Whitening Systems (gels, liquids, etc.) $14.95 - $150.
Porcelain Crown:  (w/o root canal: $600. - $800.; w/ root canal: $750. - $1,200.)
Veneer:  $400. - $1,800. per veneer
Bonding:  $175. - $750. per tooth
Bleaching:  $10. - 250. for the trays; $35 - $200. for the bleach
Laser Whitening:  $500. - $2,500.
Cosmetic Gum Surgery:  $500. - $2,000.
Lip Retraction Surgery:  $2,000. - $4,000.


Related Links
American Association of Orthodontics 
Invisalign - Removable, Clear & Effective 
American Dental Association 
International Association for Dental Research
IGIA Finally White $29.95 (with trays & 6 syringes of gel)
Ultra-White
BriteWhite.com
SuperSmile - Pellicle Remover in a Tube ($15. for 4.2 oz, $10. for 1.75 oz)
BriteSmile Professional Teeth Whitening Treatment  
Dr. David Rich - Madera Dental
ASK DR. RICH A QUESTION ON OUR FORUM! 
Cosmetic Dentistry Network Discussion Forum RECOMMENDED!

References 
30th Annual Meeting of the AADR, March 7-10, 2001" 922 Impact of Prior Tooth Brushing on Whitening Strip Clinical Response