Published by Bupa’s health information team, September 2009.
 
This factsheet is for people who are planning to have cosmetic dental treatments, or who would like information about them.
 
Cosmetic dental treatment includes any techniques used to straighten, lighten, reshape and restore teeth.

About cosmetic dental treatments
Cosmetic treatments to restore teeth
Tooth whitening
Veneers
Straightening teeth (orthodontic treatment)

 
About cosmetic dental treatments

 
Cosmetic treatments tend to look better and last longer in people who have healthy teeth and gums. So any tooth decay or gum disease should be treated before cosmetic dentistry begins.
 

Cosmetic treatments to restore teeth

 
Fillings, crowns, onlays, inlays, root fillings and veeners are used to restore decayed, worn or broken teeth or those affected by gum disease.
 

Tooth-coloured fillings

 
Fillings are used to fill holes (cavities) that have formed in your teeth, usually as a result of decay or tooth wear.
 
Tooth-coloured fillings can be used instead of amalgam (silver) fillings, making them a natural-looking alternative. They are often used in teeth that show when you smile or talk. They don’t tend to last as long as amalgam, and so they aren't always recommended for the grinding and chewing surfaces of the back teeth.
 
Before you have your filling, your dentist will remove the decayed and weakened parts of your tooth using small drills, and clean the hole. With tooth-coloured fillings, your dentist may need to build the filling in layers, hardening each layer with a special blue light before placing the next. This technique takes a bit longer than having an amalgam filling done.
 
Tooth-coloured fillings must be kept completely dry while they set, so your dentist will take special precautions to keep saliva away from the area. This may include placing a sheet of rubber over your tooth (called a rubber dam).

 
Crowns, inlays and onlays

 
If a tooth has been broken or weakened by a large filling or a lot of decay, your dentist may recommend fitting a crown (or cap). A crown looks just like a healthy natural tooth. It is made in a laboratory and then glued over the top of the damaged tooth, to disguise it. For teeth near the front of the mouth, crowns are made of ceramic materials. Crowns on back teeth may be made of ceramic, gold or a gold/porcelain combination.
 
Inlays and onlays are similar to fillings (in that they fill a hole in your tooth). However, like crowns, they are made in a laboratory and then cemented to the tooth with special glue. Inlays and onlays are strong and can be an attractive alternative to amalgam fillings. They are suitable for the grinding surfaces of the back teeth and can be made out of gold, porcelain or tooth-coloured filling material.
 
The process of preparing and fitting crowns, inlays and onlays requires two visits to the dentist.
 
For more detailed information on cosmetic treatments to restore teeth, see Related topics.
 

Tooth whitening
 

There are a number of different bleaching methods available to lighten the natural shade of your teeth. Some you can buy and use yourself, while others require a visit to the dentist.
 

Whitening toothpastes

 
This type of toothpaste is slightly abrasive, which may help to remove surface staining, but they don’t alter the natural shade of your teeth. Experts are currently reviewing how effective whitening toothpastes are.
 

Over-the-counter (OTC) kits

OTC kits are sold in most major pharmacies throughout the UK. In general, they contain rubber mouth trays (moulds that are approximately the same shape as your teeth) and tubes of bleaching gel.
 
The bleaching ingredient in the gel is called hydrogen peroxide. OTC kits only contain weak hydrogen peroxide, and tend not to be as effective as stronger products that may be used by your dentist.

 
Home bleaching

This is similar to the OTC kit method, but with two main differences. Firstly, your dentist makes rubber mouth trays so that they fit your teeth precisely, and secondly, the bleaching gel may be stronger and therefore more effective. Your dentist will give you tubes of bleaching gel and detailed instructions. It can take up to four weeks to achieve the colour you want.
 
There is some evidence that OTC home bleaching products work, but some products may be better than others. Possible side-effects of home bleaching include tooth sensitivity and gum irritation. Also, the long-term effects of using these techniques aren’t known. Home bleaching is only recommended when done in consultation with your dentist.

‘Power’ or ‘laser’ bleaching

This is done in the dentist’s surgery. Your dentist will put a rubber seal around your teeth to protect your gums. Then, the bleaching gel is painted onto your teeth and a special, bright light is pointed at them to try to enhance the whitening process. The bleach is much stronger than in a home kit, and so it is much quicker (it takes about an hour). Again, sensitivity is a common side-effect.

Internal bleaching

Internal bleaching involves placing a bleaching product inside a tooth. It can only be done on teeth that have been successfully root-treated. This means that the blood vessels and nerves inside the tooth have been replaced with a rubber filling.
 
To bleach a tooth in this way, your dentist will make a hole in the tooth and put the bleaching product into this hole. The hole will be sealed with a temporary filling, leaving the bleach inside the tooth.
 
For more detailed information on all tooth whitening methods, see Related topics.

 
Veneers

 
If one of your front teeth is chipped, damaged or discoloured, a thin layer (veneer) of porcelain can be made to fit over it. In some cases, if you have one or more teeth that are slightly crooked, veneers of varying thicknesses can be fitted to help them appear straighter.
 
You will need two visits to the dentist – on the first your dentist will take a mould of your tooth, which is then sent to a laboratory to make the veneer. On the second visit, your dentist will cement the veneer onto the front of your tooth.
 
Veneers can last for several years but they can be damaged just like normal teeth due to an accident, break or chip. The edge of a veneer may be fragile, so you should try not to bite your nails or other hard materials, such as ice, or tear sticky tape with your teeth.
 

Straightening teeth (orthodontic treatment)

 
Orthodontics is the branch of dentistry that specialises in straightening teeth. An orthodontist is a dentist who specialises in the prevention or correction of irregularities of the teeth. Orthodontic treatment usually involves wearing a brace (appliance). This puts gentle pressure on specific teeth to move them into the ideal place.
 
Orthodontic treatment is quite slow, and usually takes one to two years, depending on the severity of the problem. There are different kinds of braces. Some can be removed while others are fixed in place.
 
Removable braces are made of plastic and usually have wire clips and springs to move specific teeth. Removable braces may also be made from a clear, see-through plastic, which is nearly invisible. They are mostly used to move upper teeth. A removable brace must be taken out to be cleaned, but it should be worn at all other times, including meal times and at night.
 
Fixed braces (sometimes known as ‘train tracks’) can’t be removed except by your orthodontist. They are made of small brackets that are stuck with filling material to the teeth and joined together with a wire. Fixed braces can be used on upper and lower teeth. Once the treatment is finished, the brackets and filling material are cleaned off the teeth.
 
Orthodontic treatment is not suitable for everyone, so ask your dentist to explain the options available for you.
 
For more detailed information on straightening teeth, see Related topics.

 
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
 

Can I have all my grey fillings replaced with white ones?
Can anything be done about the gap between my front teeth?
I’m getting a veneer fitted. Will my tooth look odd between appointments?
 

Can I have all my grey fillings replaced with white ones?

 

Answer

 
It’s usually possible to replace grey (amalgam) fillings with a tooth-coloured alternative. However, it may not be necessary to do so all at once or at all, particularly if you have good-quality amalgam fillings in teeth that don’t show when you smile.
 

Explanation

 
Tooth-coloured fillings used to be considered too fragile for the chewing and grinding surfaces of back teeth (molars). Therefore, if you have fillings in your molars they are likely to be made of hard-wearing amalgam, which can appear grey or even black. However, advances in technology mean that tooth-coloured fillings are now much stronger than they used to be, although they may not be as durable as amalgam.
 
If you have an amalgam filling that is very noticeable when you talk, laugh or smile, you may wish to ask your dentist about the more attractive options available. He or she may suggest replacing the grey filling with a tooth-coloured one, or disguising the filled tooth with a crown.
 
If you have good-quality amalgam fillings that aren’t usually visible, your dentist may encourage you to wait until they need replacing anyway. It may then be possible to use a tooth-coloured material to fill it instead.
 
If you’re concerned about the mercury in amalgam rather than the appearance, you may actually prefer to keep your grey fillings. This is because drilling into amalgam causes mercury to be released. Dentists use suction and plenty of water spray when removing a filling to minimise the amount of mercury that is produced.
 

Further information

 

 

Sources

 

  • Mitchell DA, Mitchell L. Oxford handbook of clinical dentistry. 2nd ed. Oxford: Oxford University Press, 1995
  • Chestnutt IG, Gibson J. Churchill’s pocketbook of clinical dentistry. 3rd ed. Elsevier, 2007

 

Can anything be done about the gap between my front teeth?

 

Answer

 
Yes – there are a number of options available to disguise or reduce the gap between your front teeth. However, it’s important to talk this through with your dentist because everyone is different. Your dentist will be able to recommend the most appropriate treatment for you.
 

Explanation

 
The technical names for a gap between your front teeth are a midline diastema, median diastema or incisal diastema. A diastema can be disguised by reshaping your front teeth with fillings or veneers, or closed using orthodontic braces.
 
Your dentist probably won’t need to do any drilling of your teeth if you decide to have tooth-coloured fillings. The fillings are glued onto the sides of your teeth to build out the shape and close the gap. Closing up a gap can make a big difference to your overall appearance, so this could be a good option if you just want to see how it would look. If you decide that it doesn’t suit you, tooth-coloured fillings can be removed.
 
Veneers are coverings made of porcelain. They can be made slightly wider than your natural teeth. The ceramic fills the gap when the veneers are cemented onto your teeth. Your teeth may need to be trimmed for the veneers to fit properly. This option involves more dental work and isn’t as easy to reverse.
 
Sometimes it’s possible to use orthodontic braces to push the front teeth together. However, it may be that the gap is caused by an unusually thick piece of gum tissue (fraenum) between your front teeth. If this is the case, your teeth are more likely to return to their original position after the braces have been taken off. To prevent this from happening, your orthodontist (a dentist who specialises in aligning teeth) may recommend removing the fraenum in a small operation (fraenectomy) just before fitting the braces. Once you have had the braces taken off, a wire will usually be cemented along the back of your front teeth, where it can’t be seen, to stop the gap opening up again.
 
It may take months or even years to orthodontically correct the gap between your teeth. For some people it may not be possible. Ask your dentist or orthodontist for more advice.
 

Sources
 

  • Mitchell DA, Mitchell L. Oxford handbook of clinical dentistry. 2nd ed. Oxford: Oxford University Press, 1995
  • Chestnutt IG, Gibson J. Churchill’s pocketbook of clinical dentistry. 3rd ed. Elsevier, 2007

 

I’m getting a veneer fitted. Will my tooth look odd between appointments?

 

Answer

 
Your dentist will try to make sure that your tooth looks as acceptable as possible during the time between your appointments. You can get a temporary veneer stuck on, but often this isn’t necessary because only a very small amount of enamel (the white surface of your teeth) is shaved off to prepare your tooth for a veneer.

Explanation

 
Your dentist will shave off a thin layer of enamel from the surface of your tooth when preparing it for a veneer. The appearance won’t be perfect while you wait for the veneer to be made but it shouldn’t be too obvious. Try to plan with your dentist when you will have the veneer fitted so that you aren’t waiting for it at the time of an important event or special occasion. Your tooth will be more sensitive to hot and cold because the outer layer of protection has been removed. It will also feel a bit rough against your tongue.
 
If your treatment means you need to have a greater thickness of tooth removed at the first appointment, the change in appearance may be more noticeable. It may be possible for your dentist to make a temporary veneer for you to wear until the second appointment.
 
Your dentist will try to make the veneer as lifelike as possible, but a temporary is usually made of acrylic and can be more likely to stain. Also, it will only be stuck on with weak cement because your dentist needs to take it off easily at the second appointment. This means it could come off unexpectedly, for example if you bite something too hard.
 
Talk to your dentist before starting the treatment about any concerns and any important events you have planned.   
 

Further information

 

 

Sources

 

  • Chestnutt IG, Gibson J. Churchill’s pocketbook of clinical dentistry. 3rd ed. Elsevier, 2007

 
 
 

Related topics

 
Dental treatments – fillings and crowns
Straightening crooked teeth
Tooth whitening
 
 
This information was published by Bupa’s health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Related topics

 
Dental treatments – fillings and crowns
Straightening teeth
Tooth whitening
 

Further information

 

 

Sources

 

  • Chestnutt IG, Gibson J. Churchill’s pocketbook of clinical dentistry. 3rd ed. Elsevier 2007
  • Mitchell DA, Mitchell L. Oxford handbook of clinical dentistry. 4th ed. Oxford: Oxford University Press, 2007
  • Rajesh S, Marinho VCC, Croucher R. Home-use whitening toothpastes for removal and prevention of stains in adults (Protocol). Cochrane Database of Systematic Reviews 2008, Issue 4. www.cochrane.org
  • Tooth whitening. British Dental Health Foundation. www.dentalhealth.org.uk, accessed 23 March 2009
  • Hasson H, Ismail A, Neiva G. Home-based chemically-induced whitening of teeth in adults. Cochrane Database of Systematic Reviews 2006, Issue 4. www.cochrane.org
  • Veneers. British Dental Association. www.bdasmile.org, accessed 23 March 2009
  • Veneers. British Dental Health Foundation. www.dentalhealth.org.uk, accessed 23 March 2009
  • Orthodontic treatment. British Dental Health Foundation. www.dentalhealth.org.uk, accessed 23 March 2009

 
 
This information was published by Bupa’s health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
 
Publication date: September 2009.
 

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