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Hollywood Smile

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Hollywood Smile

Stop reading this now, walk over to the mirror, and smile, go on just smile

Do you confidently show all 32 of your gleaming white teeth? Are your teeth somewhat dull, with a slight yellowish brown tint? Maybe the thought of showing your teeth is about as appealing to you as ‘a visit to the dentist’ and you would rather just grimace as if your lips had been glued together.

The British are famed and ‘ridiculed’ for their crooked and discoloured teeth. l’m sure most of us have laughed at Mike Myers’ goofy teeth as Austin Powers, but in real life bad teeth just aren’t funny. Today's society is becoming more image conscious and we only have one chance to make a good impression. So what does your smile say to others about you?

ln our patient medical questionnaire we ask if patients would like a brighter smile. It may surprise you to know that, young or old, 97% of patients ticked the yes box, so no matter how good their teeth were, they still felt their smile could be better. But how much better, and why do we feel the need for our smiles to be better?

ln this article we discuss some of the whitening treatments that are available and describe the pros and cons associated with each.

Tooth whitening is rapidly becoming one of the most commonly prescribed dental procedures. There are three main methods of whitening:- in surgery; at home trays, or over-the- counter products.

There are strict rules and regulations controlling the prescription and provision of whitening products. With the exception of over-the- counter products the General Dental Council (GDC) and Trading Standards have decided that it is illegal for anyone other than a registered dental surgeon to whiten teeth.

Dr Bill Dorfman with Dr Mark Hepworth

Dr Bill Dorfman of 'Extreme Makeover' and Dr Mark Hepworth from Abbey Dental.

Over-the-counter whitening products

Currently, on the lsle of Man, the only over-the-counter whitening products available are toothpastes, gels in trays and paint on liquids. Toothpastes range from £1.99 to £5.99 and while they should clean your teeth, freshen your breath and remove some tea, coffee and tobacco staining, no toothpaste can change the colour of tooth enamel.

Smokers’ toothpastes are not recommended either because they contain abrasive agents that can damage tooth enamel and remember - smoking really does affect your teeth.

Gels cost around £30 and come with a set of trays that you soften in hot water, then form around your teeth. The problem with these systems are that the trays never really tit closely enough to adequately hold the gel against your teeth. There have also been reports that these gels are too acidic which can increase tooth sensitivity and damage the surface of the teeth.

Paint-on liquids are normally available for around £10 and resemble a bottle of nail polish, they probably taste a bit like nail polish, too! They are applied to the dry surface of the teeth and after that all you have to do is keep your mouth open and your teeth dry for the next 30 minutes. In reality the liquid stays in contact with the teeth for about a minute and gets washed away almost as soon as you close your mouth.

Over-the-counter products:

Pros — Inexpensive and can be easily purchased from the chemist.

Cons — Ineffective, no guarantee of result or safety, not selected for the individual and no professional advice or guidance with them.

Surgery based treatments

lf dentists don't rate the over- the-counter products, how do they rate the professional ones? The professional systems currently available have no permanent effects or complications, but as with any medical procedure there can be some short term adverse effects. Before any whitening procedure is prescribed a dentist should perform an examination of your oral health, not just your teeth, to decide not only which system will work best for you, but if you are suitable for whitening. Remember any dental restorations you currently have will not whiten and you may have to factor in the additional cost of replacing these into the total cost of your treatment.

At home tray systems

Current research carried out at Belfast University has found that there is only a small difference between at home or in surgery systems. lf used correctly the take home systems are believed to whiten the teeth better and the results are thought to last slightly longer. On the first visit to the dentist, impressions of your teeth are taken so that custom fitted trays can be made. On your next visit your trays are fitted and a current shade of your teeth is taken. At home the trays, loaded with whitening gel, are worn overnight for up to 14 nights, although results are usually seen after the first few days.

At home trays:

Pros — whiter teeth, convenient and discreet, when supervised by a dentist are safe and effective.

Cons — Temporary sensitivity and white spots on enamel, can take 14 days to see effects, previous restorations may require replacement, patient compliance is very important.

In-surgery systems

In todays fast moving world some people cannot wait 14 days. So if you can spare an hour you could chose one of the in- surgery systems. The procedure begins with a special barrier material being placed over the lips and gums leaving only the teeth exposed. The whitening gel is applied and a high intensity LED light is used to activate the ingredients, usually carbamide or hydrogen peroxide. Fleactive oxygen enters the enamel and bleaches coloured substances without altering the overall structure of the tooth.

As with take home trays, patients can experience some sensitivity, white spots and the gel can cause some irritation of the gums, but these side effects are again only temporary. Once finished, patients leave with instantly whiter smiles, although the results will vary for each individual and the shade will usually ‘drop back’ slightly over the next two weeks. Some patients find a combination of at home and in-surgery systems give the best results.

The cost for both in-surgery and at home systems is about the same. At home systems involve a laboratory cost, while in-surgery systems involve a chairside time factor that your dentist will have to recoup. Costs for either system range from £99 to £499.

In-surgery

Pros — whiter teeth in about an hour, patient compliance is not involved as the dentist controls the procedure. About the same cost as at home trays. Cons — Temporary tooth sensitivity, white spots and gum irritation, less control of the level of whitening during the procedure, may have to replace previous restorations.

For some patients just having a whiter smile is not enough and in-order to obtain their ‘Hollywood smile’ they must have perfectly straight teeth too. One quick way to make teeth look good is to provide crowns and veneers, but this involves removing large amounts of natural tooth tissue. The majority of dentists today, myself included, have issues about taking a high speed dental drill to perfectly healthy teeth just to make then look straight.

Once you place crowns or veneers on teeth they require regular maintenance and hygiene visits, something many patients may not have realised.You are effectively married to your dentist. Extreme makeover’s ‘dentist to the stars’ Dr Bill Dorfman once told me that he considers veneering teeth to be “like instant orthodontics", but where possible he would rather use real orthodontics to straighten teeth as the long term effects are much better for the patient.

Orthodontics

Orthodontics involves the placement of metal braces on the teeth by a specialist and gradually straightening them over the next one to three years. Some patients don’t fancy the prospect of metal wires fixed to their teeth for a long period and many are now looking at newer invisible orthodontic systems. These can involve using clear braces, braces fixed to the inside of the teeth or nearly invisible custom made polymer trays called ‘lnvisalign’.

lnvisalign is becoming more popular because unlike conventional treatments it is very aesthetic, removable and only a few visits to the orthodontist are required to fit and adjust them. lnvisalign trays can be easily removed to keep your teeth clean and if you wish you can even use the trays to whiten your teeth. However, because lnvisalign uses a high number o‘ laboratory manufactured custom trays it is more expensive than conventional orthodontic treatment, and unfortunately not everyone is suitable, as sometimes the movement of very misaligned teeth requires more force than lnvisalign can provide.

lnvisalign straightening system

Pros — almost invisible, easy to remove for cleaning, no gum irritation, can be used for at home teeth whitening

Cons — unsuitable for severe orthodontic problems, not suitable for children because adult teeth must be present, more expensive than other types of braces.

Remember a great smile can be achieved simply and sometimes ‘less really is more’.

You don’t have to have cosmetic dentistry or plastic surgery to look good, but if you are unhappy with your smile, at least there is now something you can do about it! Consult your dentist.