A History of Trends In Cosmetic Dentistry
People care about their appearance and oral health, which is why trends in cosmetic dentistry are ever-evolving with more advanced tools and better technology. The aim is to help enhance your smile.
During the 1990s that the cosmetic component of dentistry started to become a trend. That was because baby boomers were starting to show their age and looking for different ways to maintain their youthful appearance. The ever-evolving trends in cosmetic dentistry produce better options for you and your family.
A History of Trends In Cosmetic Dentistry
There were other cosmetic trends that emerged first like skin care. Baby boomers had been famous for worshiping the sun to gain the beautiful, golden tan. Over time all that exposure to the sun and the harmful effect of its rays had caused wrinkling and aging of the skin. In conjunction with wrinkling skin people were noticing lumps and sags in areas they had never seen before. The baby boomers were ready and willing to invest in creams, health clubs and cosmetic surgery to turn back the hands of time to regain their youthful appearance.
Not too far behind the skin care and body cosmetic trends, the boomers noticed that their teeth had worn, chipped and yellowed over the years, mostly due to coffee, wine or smoking. That led to questions for their dentist to see if anything could be done to regain that youthful, white smile design. Thus began the start of dentists incorporating cosmetic dentistry into their practice. I think one of the biggest single factors in creating awareness about cosmetic dentistry was the TV show “Extreme Makeover.”
Extreme Makeover, was on from 2002-2007 and really helped to propel cosmetic dentistry as people saw and became aware that creating a beautiful smile could take years off their appearance. In the show, people would have various cosmetic procedures done to enhance their image. The numerous dental procedures provided greatly increases public awareness about the options available to enhance a smile. It is now projected that in the next three years, the persistent quest for dental perfection and beauty is expected to raise the industry of cosmetic dentistry to a new high of $22,362.4 million per HOME by 2020, says a market research firm.
Since patients’ first request was for whiter teeth companies began to produce products that could quickly and effectively whiten teeth. Again- “Extreme Makeover” with Dr. Bill Dorfman developed Nightwhite bleaching solutions. Nightwhite was on the leading edge of a wave of teeth whitening products that hit the market. Since the bleaching agent used in many of these products was strong enough to burn gum tissue it needed to be administered under the supervision of a dentist.
A patient would stop into their dental office and have custom molds made to fit their teeth. They were then provided with bleaching solution that would be put into the molds and worn overnight for a period of usually 2 weeks. At the end of the two weeks, the patient would stop back to the office to check how white the teeth were compared to before the bleaching. Usually, the results were quite dramatic and people were very pleased with the results.
Initially, the costs for this could range up to $750 for the treatment. As people flooded in for the care costs decreased dramatically. Even to the point where a dentist would offer the care at no charge as an incentive to prospective patients. Today the average price has settled in at around $150-$300 for the service. While not usually free anymore, it is still very effective at whitening teeth at a reasonable cost.
* Bleaching Teeth for a Pearly White Smile
Over the years teeth bleaching has evolved.
We live in a world that loves instant gratification. Two weeks was longer than some people’s patients would allow for a pearly, white smile. Same day whitening was developed for those individuals. A patient would come into an office and a bleaching agent that had the highest concentration of bleaching ingredients allowed was applied. Due to the high concentration of whitening agents, it needed to be applied by a trained dental assistant and supervised by a doctor.
A dental assistant would first apply protection to the gums as the bleaching agent could damage the tissues if not protected. Sometimes these were used along with a special light to activate the bleaching agents. These were usually done in increments as sensitivity could develop. After a period of 2-3 hours, a patient’s teeth would come out dramatically whiter. Obtaining results in a couple of hours that used to take two weeks.
As you can imagine patients loved it!
Like everything else in-office whitening has evolved over time. Now new methods are used to reduce sensitivity and the possibility of gums being burned and today often do not require a light. Sometimes a combination of in-office and take-home whitening is used. These are for teeth with the most difficult stains. While more involved than a simple office visit for the whitening it is nice to know that there are options for people with all types of stain.
Today we not only use bleaching in cases where a patient wants to whiten teeth after years of yellowing but also as a way to enhance our final esthetics prior to bonding or other cosmetic dentistry. If a patient has chipped or wear on their front teeth that need repair and veneers are not an option the patient should consider that it may be a good time to whiten their teeth. Since the chip needs to be repaired and the composite material placed can be made whiter than the teeth currently are why not whiten your teeth first then repair the tooth with a composite that matches the new color of your teeth? Whitening does not change the color of composite or porcelain so now would be the time to consider a color change since it won’t be an option after the dentistry is done.
* Natural Tooth-Colored Fillings
After teeth whitening through bleaching methods the next wave to hit dentistry and beautiful, white teeth were tooth-colored fillings. These are made of a composite material that can be made any shade of white to match your natural teeth. Again, it was the baby boomers leading this wave. When a baby boomer got a cavity as a child the standard of care was to use an amalgam or silver colored filling. The dentist would remove decay from the tooth then place the silver filling to repair the tooth. While amalgam is an effective treatment for tooth decay one of the side effects was that, over time, many of these baby boomers ended up with a mouth filled with blotches of silver that were very unattractive when they opened their mouths.
Since dentists were now able to use a material for fillings that looked like a tooth and was effective for treating tooth decay, baby boomers requested their dentist to remove the old silver fillings and replace them with the white fillings in droves. One of the big advantages to composite fillings over amalgam fillings is that the tooth is drilled minimally to remove as little natural tooth as possible thereby preserving a greater amount of your natural tooth.
Dentists became so adept at placing the white fillings that the only person who could tell that the tooth had a filling was another dentist.
People loved it. Corey Jensen DDS, MAGD was quoted as saying, “It pains me to think back to the beginning of my career when I would be forced to create an unsightly track of silver fillings to restore a young person’s mouth. Today, with our technological advances I can restore a mouth using minimally invasive techniques and beautiful esthetic materials to create a more durable, healthy, dazzling white smile. It is a rewarding time to be a dentist!”.
Today, while silver fillings can still be placed as an effective treatment for tooth decay, you will see more and more people opt to have a tooth-colored filling because of the cosmetic component. Since cost can still be a factor in the decision process some patients still choose amalgam (silver) fillings as a less costly option for their dental health.
* Dental Crowns made of a Porcelain Material
Shortly after dentists began using tooth-colored fillings for patients it was noticed that people not only wanted white teeth but many were not getting their desired outcome with bleaching alone. While it was effective, the results showed some relapse and, over time teeth would stain as people drank coffee, wine or smoked. They further wanted not only white teeth but teeth that were straight, symmetrical and beautifully shaped, just like the smiles of the stars they saw on TV or at the movies. The initial solution for this demand was to “crown” a tooth.
In this process, a dentist will grind down a natural tooth and then place a crown over it. The crown was usually made of a porcelain material over a metal. The porcelain could be made any color. Usually, due to costs, the patient would limit the teeth being crowned to a few in the front. That would mean normally 2-6 teeth on top and bottom. This process gave the immediate gratification of a white natural smile and since porcelain does not stain, additional bleaching was no longer needed!
Sounds like a great permanent solution… but not so fast.
One thing that sometimes happened is the metal that the porcelain is laid over could give a gray appearance to the tooth or create a black margin by the gum. Probably more concerning for dentists was the aspect of “grinding” down otherwise healthy teeth for a crown. This excessive grinding done to create instantly straight teeth had the potential to create damage to the tooth. This damage could ultimately result in the need for root canal therapy. The general rule of thumb in dentistry is to try and not remove healthy natural tooth structure.
While dental materials are good they can’t beat Mother Nature in making teeth. Since removing healthy tooth structure went against that principal and can potentially do harm, dentists searched for other methods to provide the beautiful smile their patients demanded while clinically preserving the tooth.
* Porcelain Veneers for a Flawless Smile
From this quest, dental veneers were born. A veneer is a covering, either composite or porcelain, that goes over the front of a tooth. Since it only goes over the front the whole tooth does not need to be “ground” down as it is when doing a full crown. This is commonly termed “minimally invasive dentistry”. In other words, a minimal amount of healthy tooth structure is removed for the veneer to be placed. Veneers were also all porcelain, meaning that they could be made any shade of white the patient desired and there was no metal to potentially show through or creating a black shadow at the gumline.
Another advantage that made veneers attractive was the fact that they could be shaped. If the patient did not like the shape of their natural teeth or their smile the skies the limit in what can be created with veneers. Teeth can be made bigger, small, shorter, longer, squarer or rounder. Often when a smile design is being done the patient will look at a smile book, select what they like and then the new smile can be created either on a stone model of their teeth or on the computer with photographic images before work is ever started on them.
Once they have approved this smile it can be transferred to their mouth and they can try it out for a period of time before the final porcelain smile is completed. Patients love this control when making such a big cosmetic change.
* New Materials for Dental Crowns
Around the same time, the materials that were used for crowns changed. Labs who made crowns listened to dentists’ request for a crown that did not have metal. As porcelain material became stronger and more esthetic labs were able to make crowns that did not need metal.
According to Brett Moore DDS, “The ceramics that are used today have remarkable adaptability to patient-specific needs. Whether we are trying to match the subtleties of one tooth or designing all the front teeth in a smile, the custom staining, shaping, cutbacks, and layering can make beautiful teeth that look natural for that individual smile.”
These all porcelain crowns were great for situations where a tooth already had large fillings or fractures and a full coverage crown was already indicated to aid in protecting the tooth. The crown will serve a dual function of restoring the tooth to a healthy state while cosmetically creating a beautiful and transformed tooth.
Since veneers and crowns can be somewhat cost prohibitive for some patients many skilled dentists have gotten very good at placing composite veneers. As the name indicates these are veneers that are made, not of porcelain but of the same material that is used for fillings. They can be made the shade of white a patient wishes and some shaping can be done for the tooth’s appearance. The fact that composite bonding is less costly that porcelain veneers are attractive to some people but the downside is that the material is not as strong as porcelain and it may chip or break, which rarely happens to porcelain veneers.
* Advances in Implant Dentistry
As the demand from patients for a beautiful smile has increased, so did the advances that cosmetic dentistry provided. In cases where teeth were missing, dental implants were developed. A dental implant is a screw that is placed in your jaw in the area where the natural tooth is missing. This screw will bond to your jaw bone making a very strong replacement for your natural tooth. It is then covered with an all-porcelain crown that will look beautiful and natural. As stated above these are used in cases where natural teeth are missing or not able to be saved with more conventional dentistry. The big advantage of replacing a missing tooth with an implant is the neighboring teeth do not need to be ground down to make a bridge.
Also, the implant replaces the root of the missing tooth and does not add stress the neighboring teeth which occur when a bridge is made. This is never considered as a purely cosmetic option as I don’t know of a dentist who would consider removing a healthy tooth. However, if you do have a tooth missing an implant can serve a dual function of replacing the missing tooth while looking beautiful.
* Invisalign clear retainers
Braces have also grown up with cosmetic dentistry. As children, baby boomers were used to having one option, metal braces, which were placed to help straighten teeth. Now as adults baby boomers wanted straight teeth but did not want the “brace face” look of metal braces.
Invisalign clear retainers were born out of this demand. These are a series of clear retainers that a patient will wear. Each set of retainers slowly move the teeth so at the end of the series teeth are positioned nice and straight, the same result as traditional metal braces provide. Since the retainers are clear someone you are conversing with will hardly know you have them on.
I’ve personally had Invisalign braces and even when speaking with dentists many could not see I had them in during normal conversation. What’s more, they can be removed for eating. If any of you reading this have had traditional wire braces you know the challenges of removing food after eating. You can now go out for dinner without the annoyance or embarrassment of food getting stuck between teeth like with metal braces. It is easy to see why these have become a favorite for adults wanting straight teeth. Invisalign has also not stood still in regards to advancing the clear braces product. In the spirit of immediate gratification, the process of straightening teeth has been reduced in many cases from 12-18 months to 6 to 12 months. While still not an instant gratification, the process to a straight smile has become much quicker.
* Gum Contouring Surgery
Another art (procedure) that dentists employ to make teeth seem longer or more shapely is called gum contouring. A dentist can take a laser and actually reshape a patient’s gums. It is a perfect procedure for people who have a “gummier” smile. Not merely a cosmetic procedure gum contouring can actually improve the health of your teeth and gums.
The Demand for Cosmetic Dentistry Treatments is Growing
While I have been describing various options in cosmetic dentistry, in many of the more complicated cosmetic cases a combination of the above cosmetic treatments may be used. The patient may have crooked teeth and missing teeth and discolored teeth and poorly shaped teeth.
In cases like these, a dentist will need to use a combination of the treatments listed above to provide a great smile. For instance, if a patient is considering veneers and it is determined by your dentist that the positioning of the teeth requires more than veneers are capable of your dentist may recommend a combination of orthodontics to make the teeth straight then veneers for final shaping after the orthodontics is completed. Or, as I described earlier combining bleaching to whiten before putting composite bonding on the front teeth.
The Real Advancement is Dentists That Become More Skilled
When dentists invest in skill improvement, you gain more than current trends in cosmetic dentistry alone can ever offer.
While procedures have evolved and improved over the years in cosmetic dentistry, I believe that the greatest advances have come in the skill level of the dentists who are performing the procedure. Any dentist can call themselves a cosmetic dentist, but what has really evolved is the understanding by the dentist on how to make the cosmetic dentistry beautiful and be able to function like a natural tooth, working in conjunction with the other teeth in one’s mouth.
There are many examples of what can happen if a dentist has not had the training necessary to deliver comprehensive cosmetic care. When tooth colored fillings were first developed, many people experienced sensitivity in the tooth. Training and education taught dentists the correct way to place them, and avoid these sensitivity issues.
When veneers first started being placed if the tooth was not prepared properly the result may be the tooth needing a root canal. When new dentistry is placed it can change the way you bite, chew and speak. A dentist needs to know the relationship between the dentistry being delivered and the effect it will have on the way the rest of the mouth will function. Not understanding this relationship can negatively impact the way you eat and speak and was not readily understood early on in cosmetic dentistry.
Advances in training and education have taught dentists how to create the beautiful smile while maintaining function.
If you are considering cosmetic care be sure to do some research. Many dentists will proudly display their work on their website. Notice how long the dentist has been providing care and look for their online reviews. Also, notice the continuing education or credentials the dentist has. Does the dentist proudly display that they are trained in multiple disciplines like implants or orthodontics or advanced cosmetic care?
It is important for dentists to have a life-long continuing education to stay current on the advances that continually happen in dentistry. If you do some of this basic homework I feel confident that you will end up with the smile you have always wanted!
Contact Smile Design Dentistry today to schedule an initial cosmetic consultation. You can meet with any of our skilled dentists. (763) 537-1238
Brian Denn is the Clinic Manager at Smile Design Dentistry in Plymouth, Minnesota. Brian has over 25 years of dental practice management involving making practices run smoother and patient experiences better. He also leads a dental practice managers group staying abreast of the latest dental practice management trends.