Are You Happy With Your Smile?

Tooth colour, like hair colour, varies from person to person. Unlike hair, teeth tend to darken naturally with age. Surface staining from smoking or drinking tea, coffee, red wine etc. can make teeth look darker still.

Teeth may be discoloured from the time they first come through. This "intrinsic" discolouration can occur as a result of illnesses or the use of certain medications at the time teeth are forming. Sometimes teeth become discoloured when the nerve dies inside the tooth. Old fillings, whether metal or tooth coloured, can become stained and discoloured, particularly at their edges; old metal fillings can also discolour the surrounding tooth.

Old crowns can appear the wrong colour if the shade of the natural teeth has changed, the edges of old crowns can look unsightly if the gums have receded. Recession of the gums can also lead to unsightly amounts of yellow root surface becoming visible. 

Your smile is also affected by how straight your teeth are.

Modern dental techniques give you new options to change the way your teeth look, improving their colour, shape or alignment.

Veneers are thin layers of porcelain that can be attached to the front surface of teeth to change their appearance. Veneers can help to improve the appearance of discoloured teeth.

They can also be used to slightly modify the shape or alignment of teeth.

To prepare a tooth for a veneer a thin layer of enamel is removed from the front surface and biting edge of the tooth. Impressions are then made and a shade chosen. The veneer is made in the laboratory. At a subsequent appointment the veneer is bonded onto the prepared tooth surface with a special adhesive. 

It normally takes two weeks to make the veneer, though in special circumstances it is possible to arrange for the veneer to be made in just one working day in the laboratory. The completed veneer can then be ready for fitting two days after the preparation appointment.

A crown or "cap" completely covers a natural tooth. Crowns can be used to change the appearance of discoloured teeth. They can also be used to effect changes in the shape or alignment of teeth. Crowns are particularly useful for teeth that are heavily filled or markedly discoloured. 

Preparation of a tooth to receive a crown involves reduction of all the tooth surfaces. Impressions are made of the prepared tooth, a shade is chosen and the stump of the remaining tooth is protected by fitting a plastic temporary crown. The crown is made in the laboratory and returned for fitting at the practice about two weeks later.

Where the final appearance is critical (e.g.: front teeth) it is often helpful for the technician who makes the crown to be involved in matching the shade and shape of the crown to those of the adjacent teeth. The finished crown can then be "tried in", both at the practice and the laboratory to verify an exact match before it is finally cemented into place.

Crowns on front teeth can be made of porcelain alone or from porcelain reinforced by a metal substructure.

By building up porcelain in layers of different shades and different degrees of translucency it is possible to make very lifelike crowns. However porcelain is a brittle material and conventional porcelain crowns are prone to fracture.

New developments of high strength porcelains have resulted in all-ceramic crowns, which are now almost as strong as the metal-reinforced versions. The system we favour is "ProCera" which uses a computerised manufacturing process based in Scandinavia.

Porcelain fused to an underlying layer of metal produces the strongest tooth coloured crowns. These crowns are the best choice for crowning teeth likely to be subjected to very heavy loads. This would include back teeth and canines in general, the teeth of people who have a marked habit of grinding their teeth heavily and teeth which are already heavily broken down. It can be more difficult to produce a completely lifelike and translucent crown using porcelain fused to metal.

Bleaching is a way of altering the appearance of teeth by using chemicals to lighten discoloured tooth structure. The main advantage of bleaching is that it avoids the need for the destructive preparation of teeth that would be required if using veneers or crowns. 

Bleaching lightens the existing shade of the teeth. The exact shade at the end of treatment is difficult to predict. Bleaching tends to be most effective at reducing yellow discolouration. Brown discolouration will take longer to lighten and grey discolouration may be resistant to bleaching.  

It is important to bear in mind the following points:

There are two methods of bleaching live teeth:

NIGHTGUARD BLEACHING and POWER BLEACHING

NIGHTGUARD BLEACHING
 

Nightguard bleaching is a well-accepted technique for tooth whitening. It uses lower concentrations of chemicals than power bleaching and is therefore less prone to cause unwanted side effects.

The dentist makes trays from impressions made of the teeth. The trays are shaped to hold bleaching gel very precisely against the teeth needing treatment without touching the gums.

The bleaching gel contains carbamide peroxide, which releases hydrogen peroxide. A small amount of gel is placed in the bleaching trays, which are then worn overnight. The time taken for treatment depends on the colour of the teeth being treated but is typically two to three weeks.

Bleaching can cause soreness of the gums and sensitivity of the teeth to hot and cold. For these reasons it is important to have your teeth checked regularly whilst undergoing bleaching treatment.
 

POWER BLEACHING
 

Power bleaching involves the application of higher concentrations of carbamide peroxide to the teeth; applying heat or light to the gel further activates the peroxide. These higher strengths of peroxide are more caustic and great care is needed to avoid contact with the gums.

Power bleaching is a newer technique and there is currently less long-term data as to how effective it is.

INTERNAL BLEACHING
 

Internal bleaching can be carried out where a root filled tooth has discoloured. A mixture of bleaching agents can be sealed inside a root filled tooth under a temporary filling. The bleaching agent is sealed in place for a week, during which time the tooth will lighten to more closely match the colour of the surrounding teeth.

LEGAL ISSUES
 

The use of nightguard bleaching has been widely practised in both Europe and North America for a number of years. In the past few years EU cosmetics legislation has given rise to legal questions over the supply of proprietary tooth whitening products releasing hydrogen peroxide.

Tooth whitening by dentists, where appropriate, is legal. Manufacturers supply the gels required without instructions, for use as directed by a dentist.

Sometimes minor modifications to the shape or length of certain teeth can dramatically improve the overall appearance of a smile. For example uneven edges can be brought into line, small chips can be smoothed away and angular, masculine looking teeth can be made to look softer and more feminine, or vice versa.

Obviously removing sound tooth substance has its limitations and needs to be planned carefully using photographs and models of the teeth to gauge the effect of proposed modifications.

Metallic amalgam fillings have been used successfully to restore teeth for more than 100 years.

Over the past 40 years there have been rapid developments in more aesthetic tooth coloured “composite” filling materials.

There is now a range of different tooth coloured filling materials that are acceptable for use on front teeth. Newer tooth coloured fillings are more colour stable than they used to be. Replacing yellowed and discoloured “white fillings” with newer materials can make fillings look much less noticeable.

Tooth coloured filling materials can be used as an alternative to porcelain for veneering teeth. It is harder to get a truly lifelike result than with porcelain but such composite veneers are often a good interim option. They also have the advantage of being less fragile and more easily repaired than porcelain and can be useful in situations where there is a big risk of blows to the teeth (e.g.: players of contact sports).

There are still limitations on using tooth coloured fillings to restore cavities in back teeth. Tooth coloured materials perform best in smaller cavities. Very extensive cavities that include most of the biting surface or which extend between the teeth and close to, or below the gum line are difficult to restore reliably with tooth coloured fillings. Amalgam still fulfils an important role as a filling material in these deeper cavities. Alternatives to amalgam in large cavities include using cast gold inlays or crowns.

Orthodontists can use appliances (“Braces”) to straighten crooked or malpositioned teeth. Straightening crooked teeth can improve your smile as well as making it easier to keep your teeth clean. If teeth are very crooked then straightening them can make chewing and biting easier too.

The ideal time for orthodontic treatment to be carried out is when children are growing rapidly, in their early teens. Occasionally earlier treatment is required after just a few adult teeth have come through.

It is perfectly possible to have orthodontic treatment carried out as an adult, though treatment can take longer. Whatever your age the most important thing is to make sure your mouth is healthy before and during orthodontic treatment. Your dentist can refer you to the orthodontist as and when necessary and your hygienist can help you keep everything nice and clean – it can be more difficult to clean your teeth when wearing a brace.

Orthodontists use appliances (braces) to move teeth and sometimes to modify the growth of the jaws. Sometimes teeth need to be extracted to allow space for the others to be straightened.

Appliances can be either fixed or removable:

Modern developments in orthodontics now allow braces to be fitted that are much less visible. Tooth coloured brackets can be used. In some cases Brackets can even be fitted to the inner surfaces of the teeth rather than the outside. (Lingual appliances)

A lingual appliance

Good oral hygiene habits are important to keep your teeth and gums attractive and healthy and your breath fresh.

Brushing twice a day with a small amount of fluoride toothpaste on a medium texture toothbrush is good start. It is important to use the correct brushing technique as over enthusiastic brushing can cause damage to the teeth and gums. Your dentist and hygienist can help check how you are doing with your brushing.

Cleaning between the teeth is important to reach those areas your toothbrush doesn’t. Floss, tape, inter-dental brushes or wood points can all be used to clean between your teeth. Again your dentist and hygienist can advise you which option is best for you. 

Good oral hygiene is vitally important in keeping your teeth and gums healthy. Despite brushing and cleaning between our teeth, most of us find that stains and tartar gradually build up on our teeth.

In order to keep things healthy and looking good periodic professional scaling and polishing is needed. Removing built up stains and tartar helps reduce the inflammation that causes gum disease and makes gums bleed. Healthy gums keep your mouth and breath feeling fresh.

Our hygienists will work with you to help get your mouth as clean as possible and point you in the right direction to keep things as clean as possible on a day-to-day basis.

It is worth remembering that untreated gum problems can result in loose teeth, swollen and tender gums and even the loss of teeth. 

As well as removing stains, regular brushing with a medium texture toothbrush and fluoride toothpaste is important in maintaining healthy teeth and gums.

Some tooth whitening toothpastes may be slightly better at removing surface stains than others, however any change in the underlying tooth colour is likely to be very slight.

Some toothpastes for smokers are very abrasive. They are not recommended as they can lead to permanent damage to the teeth if used regularly.