Holy Molars

Putting your best foot forward may start quite a bit higher up-with your face, according to the American Academy of Cosmetic Dentistry (AACD). In a recent study conducted by the AACD, 74 percent of adults who responded believed that an unattractive smile could lower a person's chances for career success. A related study showed that only 50 percent of adults are satisfied with their own smile.

But advances in cosmetic dentistry techniques and materials, and an ever-increasing knowledge of teeth, nerves, and tissue, have allowed dentists and prosthodontists to "design" smiles, as many of them put it, and allow patients to put their best face forward.

Brighter Pearly Whites

The craze began a few years back, and now everyone wants a dazzling, bright-white smile.

"Hollywood has created smiles whiter than what nature can provide," says Naples prosthodontist Robert C. Hedgepath. "Everyone wants the Julia Roberts smile. God was not that nice to most of us."

But with techniques that range from at-home bleaching strips and kits to laser whitening, nearly everyone can now get lighter teeth-many times to whatever shade they desire, if they use a professional system provided by their dentist. In chemical whitening techniques, the dentist takes an impression of the teeth and makes trays conforming to the patient's bite pattern. Then, using a professional-strength solution in the trays, patients wear them at home as little as an hour or two a day.

But the newest whitening craze seems to be laser whitening, which can be done in the dentist's office in just one visit, and lightens all teeth at once to a custom-selected shade. A halogen "laser" light is used to activate a whitening solution that is absorbed into the tooth, reaching deep-seated stains under the clear enamel. "It doesn't just provide a superficial change," says Dr. Helmut Richardt of the International Institute for Cosmetic Surgery in Naples. He likens the process of his Zoom brand laser to cleaning a carpet: "Oxygen liberates the stain."

In about 90 minutes, laser whitening can provide a permanent change. Stains may redevelop with the intake of red wine, coffee and cigarette smoke, but the original stains, having been removed from the inside out, essentially, are gone.

"Everybody should have white teeth," says Dr. Thomas P. Hale in Naples, who also uses the Zoom system. "Lots of times we can make people look about 10 years younger just by giving them a prettier smile."

For those who desire a truly permanent change, porcelain and resin-laminate veneers can now be attached using adhesives that allow for a chemical bond with the tooth, creating a stronger, more protected surface that Richardt says is "virtually indistinguishable from the natural tooth."

A lab creates the veneer to match perfectly, "very much like a jigsaw puzzle," says Richardt. It's later bonded onto the tooth. Like a porcelain sink, these nonporous veneers won't change color or stain if properly maintained, which means they provide a permanent solution to teeth that darken from substances or simply from age.

Instant Orthodontics

The veneers can also be used in what many dentists refer to as smile makeovers: reshaping and redesigning teeth to create the smile of a patient's dreams. This is the specialty of the prosthodontist, explains Dr. David Clary of Naples. "The prosthodontist serves as the architect of the dental treatment plan, working as a team with other professionals to provide the best care," Clary says.

Rather than putting patients through the long, arduous process of wearing braces, cosmetic dentists can, in as little as a single visit, create the effect of straighter, longer, shorter or whiter teeth, repair gaps or chipped teeth, and even alter the gum line. "It's like plastic surgery for the teeth," says Hedgepath.

The makeovers involve techniques that include veneers, tooth-colored crowns, lasers to recontour tissue and dental implants. Effects can be dramatic. "It's like a noninvasive face-lift," says Tina Cirou, a dental assistant and a patient of Hedgepath's.

Another benefit to this sort of work goes beyond aesthetics. Hale cites occlusion-how your teeth come together-as one of the three leading causes of tooth loss. An improper bite can significantly wear teeth, ruin enamel and in severe cases even damage nerves or cause infections.

"All these things destroy teeth. This is a way of putting them back into position," Hale says.

Most dentists will design a smile using digital imaging or even wax impressions before beginning work, allowing the patient to see and approve the final result before any procedures are undertaken, as well as providing a template of sorts for the dentist.

"Dentistry's a very detail-oriented profession," says Richardt, but the procedures themselves don't have to be painstakingly drawn out. Once the preliminary work is done, the actual repairs many times can take place over a relatively short period in the dentist's chair. Gum resculpting can correct a receding gum line, make the gum line symmetrical, or even reduce the appearance of a "gummy" smile. Porcelain "jacket" crowns can replace old fillings with an undetectable tooth-colored covering. It's even more effective than traditional fillings, according to Hedgepath, because it protects the entire tooth to slightly below the gum line.

With dental implants, a titanium post is placed in the bone, and bone cells grow to it, forming an anchor of sorts. Then the dentist can create a crown, bridge, or clip-on teeth to attach to it and correct gaps. The process eliminates the need for removable or partial dentures, and keeps materials from resting on the gums. The correction is permanent, and being more secure and attractive than older methods of correction.

New advances in diagnostic tools can catch potential problems sooner, minimizing the need for corrective measures. Hale, for example, uses a device called Diagnodent, a laser cavity-detection system he employs after a cleaning. The Diagnodent can pinpoint cavities earlier than the traditional metal-hook method, thus allowing for smaller fillings and more conservative treatment.

The Perfect Smile

"It really goes back to what patients want," says Hale of the possibilities in current cosmetic dentistry. "Most people don't even know what can be done."

If you've always dreamed of correcting elements of your smile that bother you, but haven't been willing to commit to orthodontia, there's never been a better time to schedule an appointment with a professional. Hedgepath moved from Boston to start his Naples practice in 1991. When he left, he says, Boston "had fewer prosthodontists than are [currently] in my office."

The field is growing in tandem with advances in procedures and ever-greater knowledge of how best to create a desirable smile.

"In today's society, people want things yesterday," says Richardt. Thanks to many of the new dental techniques, they can practically have that-a corrected smile without years of orthodontics.