The brave new world of cosmetic dentistry

THOSE DAZZLING white, perfectly even smiles that movie stars and top models flash seem too flawless. They may have been born with beauty, talent and ambition; but perfect teeth, too? Well, in some cases, those pearly whites may have come with the original blueprints (unlike many noses, chins, bosoms and backsides), but more often than not, they’ve had a little help-from a dentist.

Look closely at a perfect smile. Where is that telltale sign of unevenness that Mother Nature gave most of us? If it’s absent, it’s likely missing by design. A pretty smile means more than a pleasantry to a struggling model or ambitious politician; it can produce lucrative modeling assignments or help win an election. But for some, the price for such an asset-in cash as well as comfort-has been steep.

For many years, the most that dentists could do for bad or imperfect teeth was to cap them-covering up the stained, diseased and misshapen ones. But this procedure requires that teeth-sometimes those still healthy-be ground-down (a millimeter or more on all sides) in order for the caps to be fitted. Patients can expect to spend several hours in the dentist’s chair, undergoing extensive drill work and an anesthetic. The price tag for conventional crowns runs between $300 to $800 each.

“For a long time, dental concern was mainly on trying to get the decay out, not on cosmetics,” Carrollton dentist Phil Kozlow says. Now, he says, that has changed. There has been a great deal of interest in making cosmetic dentistry accessible and affordable.

A new process called “veneer capping” may just be the answer to traditional capping and bonding (a technique developed about 10 years ago that affixes a resinlike material to the front of teeth, giving the appearance of capping, but only lasting a short time).

Until recently, veneer capping was available in only a few pockets of the country. The University of Michigan School of Dentistry developed the process in 1973. Dr. Mardy Doyle, a Los Angeles-based dentist who has promoted the process since 1978, now has a wide clientele-including many show-business personalities. Doyle has improved the smiles of Joyce DeWitt, George Segal, Gene Rodden-berry and the late Natalie Wood, among others.

Last March, Doyle invited several dentists from around the country, including Kozlow, to learn this process. Kozlow says that he became convinced of Doyle’s method at the three-day seminar: “It’s a humanistic approach that treats the whole patient, not just the tooth. We aren’t as dogmatic about dentistry as before. Dentists must be concerned about a patient’s psyche.”

Although cosmetic dentistry is a new trend, it’s one that Kozlow believes will catch on, especially in the Dallas area. “Dentistry in general is as high a quality in the Southwest as you’ll find anywhere. A few years back, during what what was decribed as the recession, you could hear tales of woe [from dentists] all around the country, but not here.

“There is an optimistic attitude in the Dallas area that you don’t find in other parts of the country. People are concerned about how other people see them.

“I treat an increasing number of executives-many of them women-and they are very conscious of their appearance. When we think of success, we think of someone who’s attractive, well-dressed and happy. You can’t give that impression if your mouth is closed.”

Annette Groves, a secretary at Mostek-United Technologies, an electronics company in Carrollton, had been self-conscious about smiling for most of her life. Her front teeth had wide spaces between them and she rarely smiled. When she did, she discreetly covered her mouth with her hand. She assumed that there was nothing she could do about her teeth.

“If you go through the family albums, you’ll see that I wouldn’t smile,” Groves says. “Now, I smile all the time. My self-confidence has greatly improved.”

Randy Young, a 13-year-old boy, fell while playing at school and chipped his left front tooth, leaving a jagged edge. Kozlow fitted Young with a veneer cap matching his right tooth in color and size. After two sessions with Kozlow (one for making the tooth impression and one to apply the cap), Young is back on the playground as if nothing ever happened. “I got a big grin from Randy when he inspected his new smile,” Kozlow says.

The popularity of this technique has garnered national attention. From talk shows to newspapers to magazines and dental journals, there have been reports on the advantages of this technique.

Veneer caps, which are available for 20 of the 32 teeth, are made out of an acrylic material and are composed of tooth-colored resin. The caps are thin, translucent and resemble an oblong contact lens. The material’s main ingredient is “high-load” glass filler, which contains far less resin than traditional bonding material. Although the laminated veneer is not as shiny as bonding resin, it looks more like natural teeth once it has been applied. And unlike capping, no teeth need to be ground-down; the veneer caps are applied directly over a patient’s teeth by the use of an adhesive and ultraviolet light. If necessary, the process can be reversed; traditional caps are permanent.

This flexibility, Kozlow says, is ideal for those patients who really need capping because their decay area is extensive, but they can’t pay for it right away. The veneer caps can be applied to correct the problem immediately, then can be removed when the permanent capping takes place. The acrylic caps will last up to nine years. This process is also beneficial for children who-like Young-have teeth that have not come in fully. The caps can be removed when the permanent teeth have grown in, and, if the decay area is extensive or the teeth are badly chipped, traditional caps can be put on.

In addition to the veneer applications, tooth-colored restorations are also available. Restorations can take the place of traditional fillings. Metal fillings, Kozlow says, contain 45 to 50 percent mercury, which may be harmful to patients over a long period of time. Tests recently performed in Sweden indicate that the mercury deposits in traditional fillings may cause mercury contamination. Among other side effects, Kozlow says that depression and chronic malaise have been detected. Kozlow says that restorations may actually be stronger than metal fillings. “Tooth-colored restorations are not for everybody,” he says. “They are not a substitute for a crown if there is a lot of decay. But for small fillings, where the teeth are still healthy, they [veener caps and restorations] are so much better than what dentists could previously do.”

The advantage of tooth restorations, Kozlow says, is purely cosmetic. “When a person smiles, these tooth-colored restorations are undetectable.” Kozlow shows “before and after” pictures of Frank Large, a model who initially sought out Kozlow because of a problem wisdom tooth. But Large wanted to know if anything could be done about his mouthful of fillings; they were being picked up by the camera when he smiled. The “before” picture depicts a mouth full of metal. After the tooth-colored restorations were applied, the fillings were invisible.

The benefits of veneer capping are many: No anesthetic is required (“The procedure is completely painless,” Kozlow says); the time in the dentist’s chair is greatly reduced (the first visit, in which an impression of a patient’s teeth is made, usually takes less than half an hour; the second visit, in which the caps are applied, can take up to two hours); healthy teeth don’t have to be ground-down for capping; and the cost is one-third to one-fourth that of traditional capping or bonding (veneer caps run about $150 per tooth). Before patients undergo the process, Kozlow talks with them about their lifestyles. “I want to find out what they’re looking for and what they don’t like about their teeth. The most common responses I hear are: ’I want white teeth. My teeth are too dark’ or ’How can I lighten my teeth?’ ’What can you do about these spaces?’ and ’I don’t like the shape of my teeth.’ ” These comments, Kozlow says, come equally from both men and women.

New work has also been done in the area of orthodontics. Removable orthopedic and orthodontic devices are becoming popular as an alternative to traditional braces. In the past, to correct a malformation of teeth that were crooked, teeth were sometimes removed and braces were put in place. (This is a common practice for children who were habitual thumb-suckers.) Now a new appliance can be inserted that is adjusted every two weeks. This eliminates the need for retainers.

Dr. Frank Faunce, a professor of pedodon-tics at the University of Mississippi Dental School who is credited with pioneering the veneer capping technique, writes that the effect of a smile is most attractive when the contour of the line of the teeth follows the line of the smile. The contour is determined by the line of the lower lip.

And, Kozlow says, the line of the lower lip is determined by bone structure. In his office, Kozlow picks up an impression of a mouth and points to the deep cleft in the middle. “This is one of the most common reasons for uneven teeth, caused by a child sucking his thumb. The bone actually forms around the thumb. The teeth develop at abnormal angles because of it. This destroys the natural contour of the mouth.”

Most problems with teeth develop during childhood and continue through adulthood if corrective measures are not taken. The Saturday Evening Post reports there are several reasons for disfigured teeth:

● Heredity. Some people simply inherit misshapen or tinted teet.

● Injury. Teeth may darken abnormally as result of being hit during sports or play.

Fluorosis. Fluorosis-staining results fromexposure to excessive fluoride conditions foundin places such as West Texas and Colorado.(Women who are pregnant and who drink suchwater are likely to pass this condition on totheir children.)

Illness. High fever and tetracycline drugs arealso enemies of teeth. A prolonged high feverwhen a child is between the ages of 6 monthsto 5 years can interfere with the developmentof the child’s teeth, often causing pitting anddiscoloration. Common prescriptions for highfevers are tetracyclines (Declomycin, Sumycinand Achromycin), all harmful to teeth.

Dental students and other interested dentists have watched Kozlow perform the veneer capping process and the responses have been enthusiastic. This month Kozlow will teach aseminar for fellow dentists in Waco. Kozlowpredicts that in time dental schools will beteaching veneer capping, but for now it’s aprocess that’s being passed on among dentists.

Kozlow does not advertise this new technique, and the business he receives is a resultof word of mouth. Or smile. At present, he hassent more than a dozen patients off with a newsmile-so far, there have been no complaints.Mary McKinnell, his receptionist-one of thefirst to take the dentist’s chair when he returnedfrom L.A.-had exposed roots and avoidedsmiling whenever possible. “Now,” she sayswith a wide grin, “I’m likely to marry amillionaire.”


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