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Dentists Try to Overcome an Old Foe: Fear 

By: Ramin P. Jaleshgari

Kerry Kehoe looks forward to visits to her dentist. That is when she gets to sit back and relax because while the dentist, Linda Golden, works on her mouth, Ms. Kehoe gets a foot massage. Later she gets her neck, shoulders and back rubbed, too.Practices like these, called distraction treatments, that aim to ease the anxiety and worry of dental patients, are turning up increasingly in dental offices on Long Island.

"Anything a dentist can do to make a patient feel more at peace or at ease is beneficial - for both," said Matthew Messina, a dentist who is consumer adviser for the American Dental Association. "It's easier to work on a calm patient and a calm patient feels more comfortable with the work that's being done."

While the association does not have any formal position or statistics on nonmedical stress-reduction practices for dentists, Dr. Messina said that anecdotal research did point to value in these treatments, which vary from massage therapy to musical or visual stimulation. Dr. Messina, who has a practice in the Midwest, also said that not all distraction methods were conducive to practicing the best dentistry.

"I could see how video glasses, for example, could remove a patient from the situation too completely, so they could not participate in their own care such as moving their mouth a certain way" he said.

Dr. Golden is one of a number of Long Island dentists who promote distraction techniques for patients who experience a lot of stress during dental work. "Massage therapy is just one way to help patients with anxiety" she said. "We also offer stress balls for patients to squeeze and provide information on an acupuncturist that will come to the office to treat them during a visit."

Dr. Golden said she was first exposed to distraction treatments when she worked for seven years in a Manhattan dental office that catered to celebrities. Six months ago she introduced the foot massage into her three year old Manhasset practice; she has also arranged her office using the Chinese art of feng shui, the practice of arranging furniture and using color and aromatherapy to create maximum harmony in a physical environment. 

Michelle Engels is one of three massage therapists who collectively work five day a week at Dr. Golden's office. This is the first time Ms. Engels, a licensed massage therapist with a specialization in reflexology, has worked in a medical office. She gives chair massages to patients in the dentist's waiting room and performs foot massage and reflexology while they are in the dental chair. There is no additional charge to patients who use her services. 

"Working in a supporting role, where massage is a pain management technique, rather than the whole purpose of a visit, has been different for me," she said. "It's been a good experience - especially since the patients react so well to the program." 

Other dentists have also reacted well: Ms. Engels said she had been approached by three other dentists who are considering adding the services of a massage therapist.

Dr. Jay Piskin, a dentist in Floral Park, offers headphones to patients and a massage chair. He has also considered, but decided against, having a manicurist doing patients' nails while he is working on their teeth. His next purchase will likely be video glasses.

For dread-filled patients like Carey Wolen, whose dentist is Ira Newman of Old Brookville, anxiety reduction techniques are not a nicety but a necessity. "I'd rather not see what he's doing because that causes me too much anxiety," he said, adding that his tension was relieved when Dr. Newman offered video glasses and a C.D. Player.

"The glasses make me take my mind off what's coming next," he said. "Plus the sound from the headphones drowns out the drill. Before, I would come to the dentist and be heavily Novocained or get nitrous oxide gas - even for a cleaning. Now I don't use the gas, and I don't put off making follow-up appointments."

Distraction techniques are old hat to pediatric dentists and dentists who routinely work with phobic patients. "Years ago it was board games and coloring books," said Lee Weinstein, a Roslyn dentist who has an office filled with video games and pop music on portable C.D. Players. "But the premise was the same: Take the patient's mind off the fear of the unknown. Make the visit a pleasurable experience."

Not everyone agrees with such methods. In fact, Dr. Mark Solvin, the head of the Dental Phobia Clinic at SUNY Stony Brook, said that in truly phobic patients, some of those approaches may make matters worse. "I don't, for example, see a patient with an actual phobia being comfortable in video glasses or a virtual reality viewer because they are so confining" he said. "And as a dentist working with that kind of special needs patient I wouldn't like to use a method that would eliminate my ability to connect with them."

Barry Wilder, a dentist in Selden, also expressed skepticism about distraction procedures. Although he has occasionally used hypnosis and allows patients to bring in their own C.D. Player, he mainly opts for good communication to put patients at ease.

"I think foot massage is a bit extreme." he said. "I'm not very big on using anything out of the mainstream or anything that could prevent me from communicating with a patient. I think they are just a way to draw patients to a practice." 

For Ms Kehoe, however, who became wary of dental work after getting her first migraine following a root canal five years ago, Dr. Golden's offer of a foot massage has made it easier to go to the dentist. Today, the Port Washington resident tries to schedule appointments during times a masseuse will be on staff.

"I think it's a great idea to have the alternative practices involved with medical professions" she said. 

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The Natural of Appeal Holistic Dentistry

By: Estelle Sobel

I have always been afraid of going to the dentist. Something about the drills, the injections, even the gas gave me the chills (and not in a good way). That all changed the day I walked into the office of Linda Golden, DDS, a Manhasset, NY-based dentist who specializes in "distraction dentistry" which can be a comforting part of holistic dental care.

Courtesy of Dr. Golden’s artistry, I sport beautiful porcelain laminates that look entirely natural. But most importantly, I no longer get a sick feeling in the pit of my stomach any-more at the thought of going to the dentist. Perhaps it’s because the minute I walk into Dr. Golden’s office, I can plunk myself down in her deluxe massage chair, or better yet, take advantage of a on-premise masseuse who uses a combination of Swedish and shiatsu techniques to get the kinks out of my neck and back. Later as Dr. Golden works on me, the masseuse works reflexology magic on my feet and hands. Most of the time, I feel like I’m at a spa instead of at the dentist and that’s just fine with me.

"I do try to create a spa-like atmosphere to help my patients relax," says Golden. "While in the chair, patients can relax, watch a movie (on video, complete with headphones), get a massage, listen to music. We also offer them coffee or tea, ad a blanket t rest with before, during and after treatment. An added benefit is that when my patients are relaxed, I can on their teeth with a minimal pressure from them to get it done faster."

What Is Holistic Dentistry?

Holistic dentistry recognizes the relationship between the mouth and overall health and tries to enhance the patient’s health and well being while doing the least amount of harm in any course of treatment, according to the Holistic Dental Association in Durango, CO. Since dentists can’t get specialized training or accreditation in "holistic" forms of dentistry, most, like Dr. Golden, are satisfied to simply apply the principles to their practices in a number of ways.

"We do everything that a regular dentist would do, except we understand the relationship between how the teeth can affect the rest of the body, based on the nutrition and lifestyle habits of the person," says Reid Winick, DDS, a Manhasset, NY-based holistic dentist.

Kristina Saljanin, 30, who admits to having been "petrified by dentists" in the past, is thrilled with her treatment by Dr. Winick. She especially liked that his assistant rubbed an acupuncture pressure point between her index finger and thumb while she got an injection so she wouldn’t feel the needle too much. "He also suggested I get myrrh oil and rub it on my gums after he worked on a cavity, and he gave me a sugar-and fluoride-free toothpaste and oral rinse, and recommended I use an oral irrigator instead of flossing."

Cor Van Huemen, 41 from Kansas City, MO, found a local holistic dentist to replace his amalgams. David Dowling, DDS, tested him for allergies to standard dental products, suggest epoxies, fillings and crown replacements, and tested each tooth for its polarity, to see which he needed to work on first. "He also suggested I take coQ10 and vitamin E in limited amounts. I’ve been thrilled with the results."

CoQ10, available as a dietary supplement, is a natural substance used by every cell in the body to produce energy. Some experts believe it can help reduce blood pressure. It is also frequently used by people suffering congestive heart failure.

Hand On Healing

Simple relaxation techniques can go a long way in dental treatments. A study at Case Western Reserve University in Cleveland showed the use of a warm eye mask and a massaging pillow can reduce pain, according to Dr. Andre K. Mickel, DDS, MSD, an endodontist (root canal specialist) in private practice who headed the study. In his practice, Mickel offers patients herbal tea and soft, classical music.

Restoring Natural Balances
 
Many conventional dentists have adopted at least some form of holistic practices. Stephen Z. Wolner, DDS, a Manhattan-based dentist, uses a non-surgical treatment for bacterial-caused periodontal disease. Bacterial periodontal disease, according to the American Academy of periodontology, strikes more than 75% of American over the age of 35 and is the primary cause of tooth loss in US adults.

The most common method of treating periodontal disease is surgery-a painful, expensive and often ineffective treatment.

"I believe that surgery should be the last resort, not the first," says Wolner, who restores the natural balance of bacteria in the mouththrough a three-month regimen of antibiotics, boasting a 95% success rate.

"I use an ultrasonic cleaning device in conjunction with antiseptics to reduce bacteria to extremely low levels, and when necessary I prescribe an antibiotic for acute infections. I also recommend supplements, such as coenzymeQ10 (120 milligrams), vitamin E (400 IU), calcium (1200 milligrams) and vitamin D (400 IU), which is essential for optimum calcium absorption," says Dr. Wolner , whose home care program also involves the use of an electric power toothbrush, tongue cleaning device and an oral irrigation unit. Other suggestions: limit red meat to no more than once or twice a week, as its high level of phosphorus may lower your calcium absorption, and avoid cola and caffeinated coffee.

Dr. Winick also uses a non-surgical, nutritional approach to gum and periodontal disease, favoring herbal medicines and supplements. "We use a number of natural oil/herb based formulas that are preservative, chemical, and fluoride-free, with which to kill bacteria. We also use a magnetic irrigator, that I tell my patients to add antimicrobial tea tree oil to. Not only is the bacteria killed this way, but the water is polarized, so it repels bacteria from teeth." Dr. Winick recommends his patients supplement with antioxidants, such as vitamin C, vitamin E, garlic (90-100 milligrams), coenzyme Q10, and grapeseed extract.

The Amalgam Conundrum

Although the American Dental Association (ADA) reassures us that the silver/mercury amalgam filling, which have been used to fill cavities for the past 160 years, are perfectly safe, others disagree. Organizations such as The Holistic Dental Association, The Foundation for Toxic Free Dentistry and the International Academy of Oral Medicine & Toxicology oppose the use of silver amalgams, believing that the mercury in amalgam is linked to health problems.

According to Michael F. Ziff, DDS executive director of the International Academy of Oral Medicine and Toxicology, an antimercury organization, several countries, including Sweden, Denmark, Austria, Germany, England and Canada, have issued advisories stating that mercury-containing amalgams can be dangerous in the mouths of children under the age of six, people with kidney problems and pregnant women. A 1997 report by the US Environmental protection Agency says nothing deposits more inorganic mercury into the body than feelings. Silver amalgams have been shown to be responsible for increasing mercury, a problematic substance in the body (Arch Environ Health 1996 May-Jun, 51(3): 234; Schweiz Monatsschr Zahnmed 1994, 104(11): 1336-40; J Dent Res 1998 Mar, 77(3): 461-71).

Newer porcelain, ceramic and resin filling cost about 20% to 100% more than amalgams and many insurance companies won’t cover the difference. Before removing amalessential fatty acids, flaxseed, evening primrose oil, DHAs, plus drink a lot of water and exercise."

Tools of the Trade

Many holistic dentist are using lasers in place of traditional drills along with alternatives to amalgam fillings. Dr. Richard Hansen, DDS, in Fullerton, CA, uses a Hydrokinetic hard tissue laser that uses sterilized water to cut enamel, dentin and carry away decay, without the need for anesthesia, needles or the drill. Because the laser cauterizes nerve ending, expose and infected tissue feels less sensitive.

In other offices, people uncomfortable with the noise and vibration of a drill can opt for air abrasion, where a thin stream of aluminum oxide particles driven by compressed air sprays away tooth decay, on or close to the surface of the teeth. Because the tool used is non invasive, no anesthetic is usually required, making it an ideal treatment for small children of fearful patients …like me.

All of these kinds of measures are changing the face of dentistry to a kinder, gentler profession.

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Self-Help for your Mouth

By Stan Friederich

Dental and oral disease may be the most common (albeit, most preventable) health condition afflicting people in the U.S., according to the U.S. Public Health Service. According to the American Dental Association, nearly 75 percent of adults older than age 35 suffer from gum disease. More than 100 million American suffer from periodontal disease and other oral disease.

The term "periodontal" means "located around a tooth," and periodontal disease infects gums or other teeth-supporting structures.

Gingivitis, inflammation of the gums, describes the early and reversible stage of periodontal disease.

Nearly 20 percent of working Americans between the ages of 55 and 64 suffer advance gum disease. Left untreated, periodontal disease loosens teeth, hampers speaking and chewing and causes tooth loss.

Plaque (colorless, sticky film that constantly forms on the teeth and contains bacteria, mucus and food particles) under the gum line is one of the main causes of gingivitis. When bacteria in plaque contact sugars and starches in our mouths, the bacteria produce an acid that attacks tooth enamel, leading o tooth decay. The gums become infected, causing pockets to form between teeth and gums that trap more plaque. Left untreated, gingivitis (puffy, red, bleeding gums) makes way for advance periodontal disease, destroying bone in the jaw and its supporting tissues.

As we age, gum disease replaces cavities as the greatest tooth-related concern. The good news: just two visits to the dentist each year combined with impeccable oral hygiene can save your teeth by preventing or curing gingivitis. But the key to healthy pearly whites is excellent oral care at home.

Good Home Care

Spend time on your teeth. Allow 15-20 minutes each night before bedtime to floss, brush and use an herbal rinse. Follow flossing by brushing with a soft, small-headed toothbrush. Don’t scrub side to side; doing so destroys tooth enamel. Move the bristles in circular motions over teeth and gums.

When you’re done brushing, use a gum stimulator to apply gentle pressure taps on the gum between your teeth.

An Ounce of Prevention

When you’re through brushing, swish a capful of herbal rinse in your mouth for 30 seconds. Aside from leaving fresh scent and taste, an herbal rinse may help soothe swollen, irritated gums and make your mouth feel better.

Herbs benefit the gums the same way they benefit the skin.

Good-for-the-gums herbal rinses include:

• Echinacea, used by Native Americans to treat abscesses and wounds; fights bacteria and stimulates the immune system.
• Goldenseal, also used by Native Americans, treats wounds and inflammation.
• Grapefruit seed extract, reputed to kill germs.
• Bloodroot, a Native American remedy once used to treat skin ulcers, is now linked to preventing cavities and destroying germs that cause plaque
• Calendula, a natural antiseptic used to treat cuts, sores and burns.
• Aloe, an herb that treats damaged tissue.

You Are What You Eat

A poor diet can contribute to gum disease by causing an imbalance in certain proteins and minerals. This imbalance allows more bacteria to collect on the plaque on the teeth.

Holistic dentist Victor Zeines, DDS, tells his patients "to change their diet. The American diet of today is not fit human consumption, because it’s high in fat and cholesterol from meat. The ideal diet is largely grains, vegetables and fruit." Meat and junk food, he says, are a major cause of dental problems. Dr. Zeines recommends body detoxification, an internal cleansing to rid the body of wastes.

He suggests: Eat a natural diet, high in fruits and vegetables; drink two quarts of distilled water each day; take a high potency vitamin/mineral supplement; take the herb milk thistle (a natural detoxifier); take vitamin C with bioflavonoids (deficiencies of vitamin C are thought to allow toxins, like those from the bacteria in plaque, to permeate, like psyllium seed, nightly; decrease consumption of caffeinated beverages.

The health of your gum tissue depends on fulfilling its nutritional needs. Make sure your diet supplies enough vitamin A as well as Zinc. Zinc acts with vitamin A to reduce healing time.

A deficiency of vitamin A is thought to be a cause of periodontal disease. Coenzyme Q10 is an antioxidant, which, according to Dr. Zeines, can help reverse periodontal disease, Vitamin E and selenium, too, have been shown to have beneficial affects against periodontal disease.

According to Dr. Zeines, "Healing can be enhanced by good diet rich in nutrients and high in fiber with a decrease or absence of caffeine and smoking. By changing the body’s chemistry and enhancing the immune system, periodontal problems can be greatly reduced."

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The Power of a Smile

"Start off every day with a smile and get it over with."

-Anonymous

GLOWING SKIN CAN MAKE YOU LOOK YEARS YOUNGER. CAN YOU GUESS ANOTHER great way to take years off your face? It’s as simple as making cosmetic changes to your teeth. That’s right: Laminate veneering, bonding, or whitening teeth can make a huge difference in the way you look and, ultimately, in the way you feel about yourself.

Because a nice smile has served as an invitation to social and professional success from time immemorial, I wanted to give you the most up-to-date information on what you need to do to get yours in prime working order. For that advice, I went to Dr. Linda Golden, a cosmetic dentist based in Manhasset, New York, whom the New York Times has featured as an expert in her craft. Here, she reveals the secrets to a better smile-and a younger-looking face.

Men and women constantly strive to improve their looks. We work out to improve our muscle tone. We address to flatter our shapes. We get the hippest hair colors. Makeup artists show us how to chisel our cheekbones and to make the most of our facial features. We gladly submit to chemical peels, microdermabrasion, liposuction, and whatever nips and tucks we deem necessary to achieve our own best image of ourselves.

So why not beautify our smiles? After all, people from the beginning of time have responded to a happy, reassuring smile. Why not let them respond to yours?

Your smile is gifts you give to the people you come into contact with every day. When you meet someone for the first time, yours smile instantly communicates your good intentions and lack of hostility. It demonstrates in the most natural way possible that you want your experience with this person to be a pleasant one. If someone is already your friend, your smile communicates warmth, playfulness, good humor, and understanding. To someone you love, a smile can say what words cannot. It says with certainty that you exactly where and with whom you want to be.

Smile for Your Life

Smiling is good for your health and well-being. In fact, psychologists say that smiling not only reduces stress, it also releases endorphin, which give you a feeling of well-being.

Because smiles make every one happy all around, if you feel the need to cover up or hide your smile you are robbing yourself of one of the healthiest, most beneficial drawing (or calling) cards available. If you are uncomfortable with the appearance of your smile because your teeth are crooked or broken or discolored, you may subconsciously use gestures to hide them, such as covering your mouth or lips with your hands as you talk, smiling tightly, or doing something to distract the focus from your face (such as gesturing wildly or twirling your hair). These gestures are self-defeating and don’t really fool anyone. If you are careful about how and when you show your teeth, your guarded smile may make other people feel you are unfriendly or uptight.

The people you encounter daily respond constantly to the subtle clues you give off. If you talk with your lips pursed, for example, people may feel you are hiding secrets from them. Placing your hand over your mouth when your smile or talk may make think you lack confidence in other areas of tour life. It may even make people think you lack confidence in other areas of your life. It may even make people feel you are unapproachable or, worse, nervous or angry with them.

It’s a fact of life: If you want to look your best, but you feel that your teeth are holding your back, you’ve got to make a change.

Get a Smile Makeover

If you look back at older photos of celebrities, you’ll notice that, as most of them achieve fame, they leave behind their old set of teeth in favor of a brand-new (usually whiter and larger) set of chops with star power. But redesigning teeth isn’t just for celebrities.

A good cosmetic dentist can redesign anyone’s teeth and provide a list of options to suit any budget. A good cosmetic dentist will work with patients to help them become their selves and to let their individual personalities shine through their equally individual smiles. The transformation (as you will see) can be dramatic.

Patient profiles

Here is a number of Dr. Golden’s patients and their stories, to show how well cosmetic dentistry works.

Top Treatments for Restoring and Redesigning Your Smile

Today, you can choose from several cosmetic dental procedures to ensure a better, prettier smile. Let’s go over the most common ones, in order of complexity (from least to most complex).

Tooth Whitening Guide

As you age, your teeth tend to yellow and discolor slightly. (Drinking coffee and tea and eating foods like berries certainly don’t help.) You can try whitening toothpaste, but if it doesn’t do the trick, check out what a cosmetic dentist can do for you. One popular method that could boost your smile’s dazzle is bleaching. This technique works best on nicely shape teeth that are not marred by extensive yellow/orange or gray discoloring. In some cases, but not all, teeth that have been stained by tetracycline can also be bleached. Still, most teeth are bleachable to some degree. Three bleaching methods are currently available.

Laser Bleaching

Where it’s done: in the dentist’s office. Specific dental offices have a laser for whitening.

What It Is: First, teeth are isolated for treatment, with a dental dam, to minimize leakage of oxidizing agents into other areas of the mouth. The teeth are then prepare by "painting" them with a special acid, which is combined with a concentrated hydrogen peroxide solution (as high as 50 percent). Your dentist then uses a laser beam to painlessly active the bleach. At-home maintenance treatments are often using to prolong the effects of laser bleaching.

Strengths:

• This is the quickest method of brightening and whitening teeth.
• No at-home trays (although some offices include an at-home kit for touch-ups).

The combination of the pretreatment and laser creates a reaction that eliminates the staining in the pores of the teeth. For the laser bleaching, a chemical oxidizing agent-normally hydrogen peroxide or carbamide peroxide-is introduced into the pores of the teeth to eliminate the stain. Toothpaste uses a much weaker strength and there is no reactive in the toothpaste.

When Do You See Results: Immediately

Weaknesses:

• Relapse; as teeth become stained again over time, rebleaching is required.
• Increased sensitivity (in some patients).
• Result may vary.
• Patients with exposed root structure or generally sensitive teeth usually experience heightened sensitivity during procedure.
• Fillings, crowns, and veneers will not lighten, so they usually need to be replaced to match the rest of the mouth.
• Some darkening may appear in about a year.

Cost: $1,200 to $1,500

Power Bleaching

Where it’s done: In the dentist’s office

What it is: A process similar to laser bleaching, power bleaching uses an acid and hydrogen peroxide solution that is activated by a high-intensity light (rather than by a laser).

Strengths:

• Like laser bleaching, this process works quickly to eliminate staining from the pores of teeth.
• Power bleaching uses high-strength solutions-as much as 50 percent hydrogen peroxide to 44 percent carbamide peroxide.
• Fast results. No at-home trays.

When do you see results: Immediately.

Weaknesses:

• May require several visits and long session.
• Increased sensitivity.
• Must do home bleaching to maintain the effects.
• Results vary.

Cost: $250 to $400 per treatment; usually requires several treatments.

Also requires additional cost of at-home treatment to maintain effects.

Home Bleaching

Where it’s Done: First in the dentist’s office, then primarily at home, with observation visits to the dentist.

What it is: With at-home bleaching the dentist makes a plaster mold in exact shape of patient’s teeth. From this mold, a plastic tray is fabricated that fits over the teeth; a compartment inside the tray holds a solution of carbamide peroxide (in a 10 percent to 22 percent solution). The patient wears this tray, filled with solution, for approximately four to six hours (during the day or while sleeping), depending on the brand of bleaching formula used. (Treatment time varies according to the manufacturer.) A variety of treatment options accommodate different patient’s needs, for example, allowing for day bleaching twice a day for 30 minutes or for bleaching while you sleep. Either of the two other bleaching techniques can be combined with home bleaching.

Strengths:

• The latest research suggests that at-home bleaching is perhaps the safest and most effective of the bleaching methods.
• No rubber dams.
• Minimal chair time.
• Trays can be used over a long span of time.
• Fewer office visits are required.
• Less sensitivity.
• Home bleaching is generally the most affordable method of bleaching. The bulk of initial cost is for the mold, which can be used repeatedly for touch-ups over several years. The cost of refill solution is relatively nominal.

When do you see results? One week to 10 days, sometimes sooner. Results vary greatly, depending on the type of stains and or patient’s compliance with the dentist’s instruction. Yellow and brown stains bleach best. Grays are more difficult, and tetracycline staining can be reducing over a few months.

Weaknesses:

• Requires periodic touch-ups.
• For best results, the bleaching technique must be repeated once every six month to two years.
• If the patient is a smoker or has a penchant for coffee or red wine, the process most likely will need to be prepared more frequently.
• Patients need to be compliant-noncompliance can lead to disappointing results.
• Less rapid results.
• Length of time required is usually two weeks or more.
• You have to wear something on your teeth for hours a day or at night.
• Patients do not like the taste.
• Results vary.

Cost: $500 to $800 a kit; $20 to $30 for each gel refill (touch-ups)

Bonding

Where it’s done: In the Dentist’s office.

What it is: Bonding involves adhering a layer of plastic, called a composite, to the teeth to make them more attractive. It is a good choice for patients who want to change the shape, structure, and/or surface of their teeth. First the dentists perform some minimal drilling directly on the enamel of the tooth to prepare it for the bonding composite material. Next, a mild acid is use to condition the surface of the teeth (which is necessary to adhere the bonding to the enamel), and the composite is place on the tooth. Then, a high-intensity light is direct on the teeth to harden the material to create the desired shape and length.

Strengths:

Bonding is a wonderful technique for repairing chipped or fractured teeth.

• Bonding can also do great things for pitted or spotted teeth.
• Bonding can be used to close unwanted spaces between the teeth or to give crooked teeth the illusion of being straighter.
• In more extreme cases, bonding can completely cover the surface of each tooth to mask discoloration, bad positioning or poor shape.
• A patient’s teeth can also be lightened during the same office visit.
• The procedure is usually painless, and consequently most treatments require no anesthesia (depending, of course, on the patient’s tolerance).
• One advantage of bonding is that this procedure usually requires minimal tooth reduction (read, drilling).
• Bonding is one of the more affordable of the cosmetic procedures.

When do you see results: Immediately

Weaknesses:

• The primary downside of bonding is that is not permanent. The typical bond lasts three to five years.
• You don’t get as good a shine and translucency as you do with porcelain laminates.
• Tents to chip easily.
• Stains require routine maintenance.
• It is difficult to acquire a translucency and luster that properly approximate natural tooth, which limits the aesthetic use of bonding.
• Cost: $300 to $400 per tooth.

Laminate Veneers

Where it’s done? In the dentist’s office.

What it is: If cost is less of a concern and optimal aesthetics are of paramount importance, the top treatment option is most certainly laminate veneers. Laminate veneers Roll-Royce of dentistry: ultra-thin sculpted pieces of tooth-shaped porcelain that fit over the front of your teeth. Veneers are sort of like jewelry for your teeth-perfect, if your teeth are significantly discolored, chipped, pitted, malformed, or crooked, or if you have unwanted spaces.

This two-step process requires anesthesia and usually performed on two separated days: On the first visit, the teeth are prepared; on the second visit, the laminates are applied. The process works as follow:

• In preparing the tooth for the procedure, the dentist frequently removes certain parts of the tooth’s structure to ensure the sculpted piece of porcelain will fit properly. An impression is taken and the porcelain is sculpted directly on the individual’s teeth like a piece of jewelry.
• The teeth receiving the porcelain veneers are chemically treated with the same mild acid used in bonding.
• The tooth-shaped porcelain is then placed on the front of the tooth’s surface.
• A high-intensity light is used to adhere the porcelain to the tooth (as with bonding).

Strengths:

• Provides an effective way to change the color, shape, and structure of teeth.
• Good for treating cracks and ships, unwanted gaps between teeth, and crooked teeth.
• Provides a protective covering, where needed, for teeth that have been chipping or wearing away.
• Offers the best option for reshaping or broadening a smile and for creating a younger appearance, because of the life-like luster of the porcelain veneers, which bonding can never achieve.
• Stronger and more permanent than bonding, lasting 10 to 15 years.
• Considerably more stain-resistant than bonding treatment.

When do you see results? Immediately after the final (second) treatment, when the veneers are applied.

Weaknesses:

Sometimes previous dental treatment makes it impossible to use laminates veneers. If that is the case, a dentist can redo crown and bridgework using all porcelain to make it look like the rest of your teeth, matching shape and color.
Cost: Not cheap. $1,000 to 1,500 (or more) per tooth. But they’ll last form 10 to 15 years and won’t stain.

Porcelain Inlays and Onlays

Where it’s done: In the dentist’s office.

What it is: Old and worn fillings and restorations, such as silver amalgam fillings, which can give teeth a blue tint on the sides, are replaced with porcelain inlays or onlays that closely match the color of your teeth. Porcelain inlays or onlays require isolating teeth, and then drilling out the old fillings under anesthesia. Then an impression is made–like a piece of jewelry in a ceramic studio. On a second visit to the dentist, your teeth are again isolated, you are numbed, and the porcelain is bonded in place, adjusted, and polished. The porcelain onlays are a more conservative procedure than crowning a tooth and can look wonderful used in conjunction with laminate veneers.

Strengths:

• Eliminates the blueish tint from the old silver amalgam fillings.
• Hold up well over time because the bonding provides a strong and strengthening foundation for the teeth.
• Can make a great match to the rest of the teeth.
• When do you see results: Immediately after the second visit, when the inlays/onlays are applied.

Weaknesses:

This is an extensive procedure that requires a lot of time. In removing and old restoration, there is always a chance a patient may need a root canal or crown.
Cost: $800 to $1,500 per tooth

How to Create a Younger-Looking Face

When it comes to creating a youthful smile–and face–just remember this: the lips are the curtains, the gums are the scenery, the two front teeth are the stars, and the surrounding teeth are the supporting actors. So:

• The front teeth should be slightly longer than the teeth next to them.
• The smile should broaden as it sweeps toward the back of the mouth. (When you smile, teeth should follow your lip line.)
• There should be no black space in your mouth, in front or in back.
• Teeth should be bright.
• Fix chips and cracks.

Your teeth can also be customized to fit your face shape. For example:

• Round Face: Teeth should be slightly square to create a more angular look.
• Square Face: Teeth should be more oval-shaped to soften the face.
• Heart Face: The central incisors should be flatter across.
• Long Face: The smile should be as wide as possible.