My Smile – What Can I Do?
By Simon W. Rosenberg, D.M.D.
Published on July 20, 2007
It all depends on what is causing your smile to be
If you cover your mouth when you talk, meet new people, or
attempt to smile, then there is help for you. Let’s look at
some of the reasons people hide their smiles, and the modern
dental solutions that can give them more confidence.
Why People Hate Their
People find many reasons to hate their smiles. Here are some
of the major culprits:
- Aging and stains from food and drink, which
darken the teeth.
- Decay that has begun to take its toll between
- Older fillings that have darkened with time or
leaked at the margin, showing a black line between the
tooth and filling.
- Broken, chipped teeth, which can be unsightly
and give people the impression that you don’t take care of
- Twisted, rotated and mal-aligned teeth, which
also compromise the impression you make when you
- Spacing between the teeth, which, while viewed
as “sexy” by some people, is considered unsightly by
Modern Dental Solutions
CEREC 3D for Decay, or
Decay, or “Caries,” can darken and destroy tooth structure.
For small cavities, tooth-colored composite resin can be used
in place of the old silver amalgams (mercury-containing metal
fillings). For larger fillings, porcelain inlays, onlays or
crowns are used to restore the missing tooth structure.
The latest cutting edge technology in this area is Sirona’s
CEREC 3D (Ceramic Reconstruction) system. It is a same-visit
CAD/CAM (computer designed and manufactured) technology that
produces the most life-like, gorgeous restorations available.
Because the porcelain material has been manufactured to
simulate tooth structure in appearance and physical
characteristics, CEREC 3D restorations last longer than other
restorations. If the front teeth are chipped or cracked, we can
restore the teeth with porcelain veneers (also known as
laminates) or all-porcelain crowns – with no black metal line
at the gums to give away that it is a restoration.
The older dental method for making porcelain crowns or
veneers can be unpleasant. First, anesthesia (a shot) is
administered, then the tooth is prepared (the drilling), a
gloppy impression is made of the prepared tooth, and a
temporary crown is made and temporarily cemented. Then you wait
two weeks, during which time the temporary may come off, become
irritating to the tongue or oral tissues, or not look or feel
Traditional methods of placing crowns also take time from
your busy schedule (for travel and the visit). Finally, they
require a second anesthesia shot in order to have the crown or
veneer that the lab fabricated fit and cemented by your
In contrast, CEREC 3-D technology enables dental patients to
receive an all ceramic crown onlay or veneer that fits well and
is highly esthetic and durable – all in one visit. Because
CEREC uses electric dental handpieces, the preparation phase is
40 percent quieter, with less of the vibration and loud,
grating, jet whir sounds that were associated with the
1960s-era air turbine handpiece. And instead of taking a gloppy
impression, the teeth involved are sprayed with a white powder
– the same one used to put the “M” on “M & Ms.” Finally, a
digital 3-D picture is taken with a thin camera attached to a
specially designed computer.
Next, the dentist designs the crown or veneer on the
computer, and a block of porcelain that matches the tooth is
milled right there for cementing about 15 minutes later. The
50-micron (50 thousandths of a millimeter) precision of the
process provides a much closer fit than what you get with
indirect lab processes, which often result in mistakes when
making models and wax copings, casting metal copings, and hand
CEREC porcelain blocks are factory-made, with greater
strength and consistency for less chipping and a more natural
appearance. With twenty years of follow-up research (now using
state-of-the-art Biogenic 3D design software) and the
precision-milled porcelain block technologies, the results look
great and will last and last.
Bleaching, aka Tooth Whitening:
Improvements and New Choices
While we all grow new skin cells and hair on a daily basis,
our teeth have been there chewing and bathed in staining foods
since we were six or seven years old. Over time, many people’s
teeth begin to darken or turn yellow due to stains and/or age.
If it’s only surface stains, a routine or extended dental
cleaning can sometimes make a dramatic improvement. For deep
staining and aging of the enamel and dentin, dental bleaching
or teeth whitening can be helpful.
There are two broad types of bleaching available:
over-the-counter products and professional bleaching supervised
by a dentist. Think of the bleaching choices as similar to the
choice presented when you want to remove stains from clothing:
would you rather buy something at the store or have a dry
cleaner use their professional judgment and stain removal
systems to see if the stain can safely be removed from the
The products available in stores and over the Internet
generally use a much lower dose of the active ingredient,
Carbamide Peroxide. They carry it to the teeth on plastic
strips or a one-size-fits-all tray. The gel cannot be uniformly
applied to the tooth, nor can these systems keep the chemicals
off of the gums and soft tissues of the mouth. Unless you are
very educated on what to look for, you may not notice damage to
the gums and soft tissues.
Professional dentist-supervised bleaching is more
predictable, and the dentist’s staff can modify treatment to
maximize the whitening while decreasing the sensitivity.
Professional dentist-supervised bleaching offers two
- Take-Home Custom Trays, or
- In-Office Procedures that may include light
Your dentist will advise you as to which choice is best for
you after assessing prior bleaching experience, sensitivity,
gum recession, and whether you prefer wearing trays overnight
for several weeks or want single visit power whitening.
The tray treatment is slower but more predictable, and can
be extended for several additional weeks until the desired
lightening is achieved. There is also less sensitivity of the
teeth after tray bleaching than with in-office one-visit
bleaching. In almost all cases, the sensitivity can be
controlled with special gels applied to the teeth and gum
margins after bleaching (but it may take more time with
in-office bleaching.) An advanced tray fabrication technique
that maximizes bleaching gel contact with the tooth and
minimizes seepage of the saliva under the tray was developed
and is in use by offices employing the Deep Bleaching system
developed by Dr Rod Kurthy.
The most popular light-activated in-office bleaching systems
are the Zoom! Advanced Power system and Brite-Smile. For
chemical-only bleaching, Ultradent Boost and a group of other
systems can be used for patients who have medical conditions
that make the use of light activation more complicated. For
take-home custom tray bleaching, there are more than a dozen
dental companies that provide comparable products.
For patients who have tetracycline staining, a more
prolonged three-phase program of in-office bleaching, take home
trays for several weeks, and an in-office deep bleaching
procedure may be needed to get extra decolorizing of the
tetracycline stain as well as whitening the teeth beyond what
single approach bleaching procedures can accomplish.
Orthodontics without Braces – a Good
Technique for Adults
Invisalign offers an alternative to braces that is nearly
invisible. With Invisalign, the dentist gathers the same
information as with any Orthodontic patient, and if the patient
is a candidate for these nearly invisible aligners, the dentist
sends dental impressions for computer analysis. A simulation of
the final result (a “ClinCheck”) showing a proposed result with
all of the steps needed to accomplish the goal is e-mailed back
to the dentist. If the dentist is satisfied, this ClinCheck
visualization of treatment and its results are shown to the
patient for final approval.
Therapy starts two weeks later. The patient wears the first
of a series of thin, comfortable, clear plastic aligners
(similar in thickness to a bleaching tray) 24 hours a day,
except during eating and brushing the teeth. A new aligner is
used every two weeks. This therapy is gentler than traditional
braces and wire orthodontics were. Teeth can be moved 0.2 mm
with little discomfort, and if held in the new position for two
weeks, the body will remodel the bone and periodontal ligament
attachment to the tooth to hold the new position. Then the next
aligner is inserted to move the tooth 0.2mm closer to the
Where to Go from Here?
A comprehensive dental evaluation, complete with dental
X-rays, periodontal pocket charting, photographs, and dental
casts, can help the dentist determine which options your
individual situation warrants. To find out which of these
treatments is best for you, be sure to discuss any of these
areas with your dentist.
Simon W. Rosenberg, D.M.D. is a general and
maxillofacial prosthodontic specialist with a practice in
Manhattan focused on applications of High Technology for
Cosmetic Dentistry. More information on each of the problems
and treatment options discussed in this article can be found on
his website: www.drsimonrosenberg.com