Cosmetic Dentictry

COSMETIC DENTISTRY

By Rukoma A.M

During the past decade the demand for esthetic teeth enhancement has improved markedly, this has been ignited by rapid development of new restorative materials and instruments together with improvement or modification of the old ones.

Cosmetic dentistry is a special branch of dentistry dealing with improving the appearance of teeth, especially visible ones when smiling. It includes a variety of dental treatment such as bleaching (teeth whitening), veneer, orthodontic treatment and implants.

Bleaching (teeth whitening)

This is whitening of discolored teeth or even improving the whiteness of the normal colored teeth to meet patient/client desire. A normal color of teeth is milky white; anything out of this is abnormal color (discoloration).

Discoloration of teeth especially the anterior teeth, may become a serious esthetic problem thus, embarrassment to the patient. Bleaching (teeth whitening) is aiming at solving this problem, although its success is dependent to the type of discoloration. Bleaching can whiten mild to moderate discoloration.

Bleaching involve the use of chemicals which oxides the stains. These chemicals include; different concentrations of hydrogen peroxide e.g. superoxol and shofu Hi Lite (30%-35% hydrogen peroxide) and carbamide peroxide 10% such as opalescence (ultradent) and femmiles (Fem). These chemical can removal all general stains caused by foods and drinks, mild tetracycline staining, mild fluorosis and age yellowing or graying. However smokers are contra-indicated because there is concern of about a mixture of hydrogen peroxide with having a potentiating effect on tissue damage already known to be caused by smoking. Pregnant and breast feeding mothers are contra-indicated.

Note: Bleaching can be done in the dentist office or at home.

Causes of discoloration

Teeth discoloration may be caused by one or combination of the following: - 1. Food and drinks such as coffee, tea, red whine and tobacco. 2. High fluoride intake from water or food, thus people in areas with high fluoride in water and those using fluoride salt to soften food are at risk of developing discoloration known as fluorosis. Study done in Tanzania show fluorosis is mainly due to the habit of people using fluoride salt (magadi) to speedup the cooking process of hard food such as dry beans and maize (makande). 3. Any developmental defect which lead to abnormally soft enamel and or dentine. Soft enamel easily absorbs stains. Systemic drugs such as tetracycline when taken during pregnancy or early child may be absorbed developing teeth buds which are not yet or less mineralized. 4. Dental pulp death (pulp necrosis), when the pulp dies the blood clots in the pulp are digested to release bilirubin which penetrates the dentinal tubules and shows up as purple, brown or blackish discoloration. 5. Other causes include secondary mineralization, age yellowing or graying and some restorative materials such as amalgam.

Veneering

This is the removal of a thin layer (about 0.5mm) of a tooth followed by bonding materials on the prepared surface. It used to cover discolored tooth facial surface (outer surface) with the color acceptable/desired by the patient/client.

Types

There mainly two types of veneer; direct and indirect veneer.

1.      Direct veneer, the tooth is prepared and a material of choice bonded to tooth directly in the office at the same sitting. Material of choice in this case is composite.

2.      Indirect veneer, the discolored teeth are prepared, measurements (impression) are taken, and the veneer is fabricated in the laboratory to be bonded on the teeth at a later date.

Under indirect veneer also there is lumineer, an already prepared shell like structures of different sizes, shapes and color; they are like artificial nails. The chosen structure is adjusted to match the intended tooth and then bonded over with or without reduction of the enamel layer.

Note: Apart from changing teeth color, veneer may also be used to correct malformed and fractured tooth to a normal or desired shape.

Orthodontics

Some individuals have improper teeth alignment (mal-occlusion). Their teeth are either abnormally protruded, detruded, overlapping or rotated. This condition leads to improper tooth to tooth relationship or occlusion, thus sometimes known as mal-occlusion. This mal-alignment may be severe enough to embarrass the patient. Treatment needed to correct this imperfection is what is known as orthodontic treatment. The usually involves the wearing of braces (removable or fixed) often the extraction of some teeth, and very occasionally jaw surgery. The braces apply forces which moves and or rotates the mal-aligned teeth to acceptable positions.

The main aim of orthodontic treatment is to improve; the appearance of the teeth and face, the health of the teeth and gums and function i.e. mastication.

The pictures below show the teeth of a patient before and after orthodontic treatment:

Artificial teeth

Missing teeth are linked to a poorer diet. Quality of life clearly suffers when individuals are forced to limit food choices, and the foods chosen do not provide optimal nutrition. Apart from impaired nutrition missing teeth can seriously affect speech (articulation) and facial appearance.

Types of artificial teeth

Acrylic dentures                                                                                   

Dentures (also known as false teeth) are prosthetic devices constructed to replace missing teeth, and which are supported by surrounding soft and hard tissues of the oral cavity. Teeth are embedded in oral acrylic base which resembles the gum. Dentures are either partial (replacing missing teeth in partially dentate patient) of full denture (replacing all necessary teeth in edentulous patient).

They are relatively cheap, but have limited function especially mastication. Their retention depends on surface of oral mucosa and remaining ridge. Though they resemble natural dentition, they are not as good as bridge and implants.

 Bridge

A bridge is a structure, supported by teeth on either side of a space, which replaces a missing tooth or teeth. It is called a "bridge" because it spans the gap between two teeth. It is not removable by the wearer. A bridge is a natural-looking replacement for missing teeth. It matches the adjacent teeth. Teeth on either side of the gap are prepared so that they can allow fixation of the caped part of the bridge. The disadvantage of the bridge is that, it entails reduction of sound tooth substances.

Dental implant

A dental implant is an artificial tooth root that is submerged into the jawbone. It is a screw-shaped threaded cylinders normally made from a very strong material that is biocompatible with the jaw bones. The material of choice is titanium. Implants are more secure and natural looking than dentures and bridges but much more expensive.

Conclusion

With decreasing prevalent of dental caries in developed world, dentists have turned their attention in cosmetic dentistry. Cosmetic dental treatment is relatively expensive; however, despite this fact that its demand is on the increase both in developed and developing countries. In order to cope with the increased demand, dentists should be prepared with necessary knowledge, equipments, instruments and materials.