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Million-Dollar Smiles

From the incessantly airbrushed images of glamour magazines to gigantic pearly whites beaming at us from cinema screens, perfect smiles bombard us from all directions. Be honest: Who hasn't stared down actress Julia Roberts' throat and wondered where all her fillings went?

In the past, acquiring a movie-star grin required painful and complicated orthodontic work, including metal wires, messy brackets and bottles of over-the-counter pain relievers. If you were lucky, the entire process lasted between six months and two years. But today's busy professionals and active retirees, as the old Carly Simon song goes, "haven't got time for the pain." Instead, they're turning to revolutionary cosmetic and reconstructive dentistry procedures that can guarantee results in as little as two weeks or less.

Compared to other major cosmetic procedures, dentistry may be the fastest, most pain-free way to immediately enhance your appearance. The American Academy of Cosmetic Dentistry (AACD) boasts that cosmetic and reconstructive dentistry can cure virtually any aesthetic malady, from stains, chips, cracks and old fillings to missing teeth, a bad bite and an uneven gum line.

So many people are clamoring for cosmetic services that 84 percent of dentists now offer some type of cosmetic procedure. A survey conducted by the AACD found that 92 percent of respondents cited an attractive smile as an important social asset, but only half were happy with their own dental appearance. Another survey found that 74 percent of the respondents believed an unattractive smile could harm a person's chances for career success.

But cosmetic dentistry is not just about looking good. It also serves victims of automobile accidents, sports injuries and those who suffer the ill effects of cancer and antibiotic treatment. Reconstructive dentistry can also correct bite problems caused by temporomandibular joint disease, or TMJ, in seniors who often can't handle extended orthodontic treatment for this problem. For these people, cosmetic and reconstructive dentistry can be a godsend.

It comes with a price, of course, and that price rises with the amount and complexity of the procedures.

Like all Naples dentists Helmut Richardt says preparing and treating a single tooth can cost from $800 to $1,500. Since the average treatment is for at least 10 teeth, he says, it's not unusual to pay $10,000 for an entirely new smile.

Costs are rising because of innovations in bonding and porcelain veneer technology. Bonding involves applying a material similar to enamel to the tooth's surface and sculpting it to a desired shape. After the material hardens, it is polished to blend with the rest of the tooth. Since the treatment can usually be completed in a single visit, it's considered a minor miracle for repairing small cracks and chips. It can even be used to replace large, conventional metal fillings. The AACD says advances in tooth-colored materials can render fillings virtually invisible. And they are often more durable than traditional silver or gold fillings.

Veneers are ultra-thin laminates that bond directly to the surface of the tooth. They are especially useful for repairing large cracks or severely worn teeth. Made from either porcelain or composite resin, they can improve crooked gum lines and change the shape of teeth. form. Veneers are stronger than bonding and last longer, and they usually require no more than two visits.

The AACD reports that over the past five years, the use of bonding and veneers has increased by 100 percent and 250 percent respectively. They have distinct advantages over traditional crowns. "Because they cover only the front and side edges, veneers are much more conservative than a full crown," says Richardt. Because crowns cover the entire tooth, he explains, they require 75 percent more of the tooth than a veneer. "Once a tooth is crowned, it must always be crowned," says Richardt. "With a veneer, you still have the option later on of crowning the tooth should that become necessary."

Another innovation is laser technology. Lasers have been used in general dentistry for more than a decade, and tissue-cutting lasers (electrosurgical scalpels) have been around for 30 years. But according to Sarasota dentist Dr. Jay Suverkrup, the most popular new laser treatments are cosmetic bonding procedures that are vastly improving the way crowns and porcelain veneers are applied.

"In the past," he says, "we made crowns with metal underneath the porcelain, because we needed the metal for strength." A major drawback to this method was that the underlying metal sometimes gave the tooth an unnatural appearance.

By comparison, lasers emit a precise beam of concentrated light that penetrates a thin veneer and fuses it directly onto the existing tooth. The process, called "curing," produces a much more natural look than traditional metallic crowns.

Suverkrup estimates that 98 percent of dentists today are using high-intensity light lasers for just this purpose. In his own practice, he uses a smaller, pen-shaped device called a plasma arc. "I call it a laser because that's what people relate to. Actually, it is something between a laser and a high-intensity light."

He says that while many high-intensity lights take 40 seconds to cure a bond, the plasma arc cures four to five millimeters deep in only 10 seconds. That's nearly four times as fast as most lasers, and with little or no heat. Not bad for a machine the size of a toaster.

Lasers have also found their way into gum sculpting, a procedure that removes excess tissue from the gum line to make teeth look longer, correct receding gums, or bring symmetry to the entire smile. Occasionally, some bone must be removed to accomplish the desired effect, but Richardt says that when no bone is involved, tissue heals within a week. In many instances, these "gum lifts" do not even require anesthesia, he says.

The most popular procedure to emerge is teeth whitening, with such treatments jumping more than 300 percent over the past five years, according to the AACD. Most patients are middle-aged men and women who've overdone the coffee, tea or soda drinks, but Dr. Johnn Griffith of Cosmetic and Family Dental Care in Naples says he's also seeing an increase in young female patients, especially before large social events like proms.

Dr. George Whiteside of Fort Myers has whitened the teeth of nearly 600 patients over the last 10 years. He attributes the surge mainly to new bleaching techniques that patients can use at home over the course of only two weeks. New lasers that can brighten teeth in seconds also have added to the appeal of teeth whitening, he adds.

Like most cosmetic procedures, reconstructive dentistry requires maintenance. Whitening should be repeated about every six months. Veneers can last 10 to 20 years depending on the nutritional and hygienic habits of the wearer, Richardt says. But because of innovations in bonding technology, he adds, "if we have to go back and redo them (before 10 years), they're very hard to get off."

Patients accept the inevitability of maintenance because they are so thrilled with the results, according to Richardt. "We can bring back 20 years on the teeth," he says. And unlike other more complicated cosmetic surgeries, dentistry comes with almost immediate satisfaction, nary a bruise and considerably fewer Tylenols to down. Even at one thousand dollars a tooth, most cosmetic dental patients consider that a bargain.

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