Reprinted from Today’s Chicago Woman, 2/97.

Q. For as long as I can remember, the appearance of my teeth has bothered me. I don’t have any pictures with me smiling, The tooth surface is blotchy, stained and discolored, and my teeth are crooked. What can I do to improve the appearance?

A. When I have a consultation appointment with a patient concerning cosmetic improvements, we first discuss the overall expectations that patient has regarding the final outcome of the treatment. Some patients desire dramatic whitening, others prefer more subtle changes. The techniques involved vary with the degree of improvement desired.

When a patient has mal-aligned teeth, I stress orthodontics, the ideal way to straighten teeth. However, since orthodontic treatment can take anywhere from three to 24 months, some patients desire faster treatment. To solve minor overlapping and staining problems involving the front teeth, bonding, porcelain veneers and bleaching are the answers.

Without actually examining your mouth, it’s hard to provide a specific solution. I have, however, assembled three basic case types.

Case I-A patient has severely stained and deeply pitted enamel. First, we’d start with bleaching to improve the general color of all the teeth. The bleaching procedure would be followed by porcelain veneers applied over the front teeth, improving the surface texture of the enamel and tooth alignment. This procedure takes approximately two months.

Case II-A patient may be happy with the color of all of her teeth. However, the six front teeth have a darkened appearance due to a grayish border caused by extreme thinness and translucency of the enamel. In this case, veneers are ideal. They I create a smooth creamy color and lifelike enamel appearance using the patient’s same tooth color.

Case III-When a patient has satisfactory tooth alignment and surface texture, but has a slightly yellowish or grayish tooth color, bleaching is the treatment of choice. Patients can whiten their teeth at home using a new product. The procedure is safe and relatively inexpensive. Length of treatment depends on, the original tooth color along with how diligently the patient adheres to the instructions given.

It’s clear that there isn’t always one answer. Other situations may affect the treatment plan. These include the health of the gum tissue and existing fillings or crowns. If existing crowns are darker and the patient doesn’t want to change them, the final desired color might need to be altered. If the patient’s home care (brushing and flossing) is very poor, it’s necessary to hold off on all cosmetic treatment until her hygiene improves, as dental health takes precedence over all cosmetic procedures.

Reprinted from Today’s Chicago Woman, 6/97.

Q: I recently had tooth colored fillings placed next to a porcelain to metal crown on my front tooth. At first they matched but now there is a black line along the gum of the crown and the bonding has become darker what can be done – I’m so frustrated!

A. Years ago matching restorations of porcelain to metal crowns, and bonding was a problem. Each material reflects light differently, metal crowns would always leave a black line at the gumline and bonding over time would wear away, allowing the discoloration of the existing tooth to show through. Now we can replace these fillings with long-lasting cosmetic restorations, like all- porcelain crowns and veneers side by side completely revitalizing one’s smile, not only in shape but in color. No longer will teeth have a dead, lifeless appearance, without metal under the crowns light can be reflected as naturally as enamel.

-Benjamin S. Fiss, DDS Dr. Fiss is a general dentist practicing in Chicago, who maintains an interest in cosmetic dentistry.

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