After an initial article introducing our practice to South Shore Magazine readers, Dr Leland has been providing this quarterly publication with timely articles about dental procedures and trends.

Here are a few of his recent articles:

Smile and the world smiles with you
By Claudia Dolphin

Someone once said that joy is the source of your smile, but sometimes your smile can be the source of your joy. For Jane Crowley, a woman in her mid-fifties, the excitement of her daughter's upcoming wedding was dimmed with the realization that her smile wasn't what it used to be.

Her almost thirty year old dental work was rapidly degrading and the financial prospects of having it repaired seemed out of reach. After working with Dr. Rob Leland, a partner of Dr. Barry Brodil in the Hanover based Creating Ultimate Smiles dental practice, not only did she achieve the cosmetic results that she hoped for, she did so within her budget. Jane Crowley is now smiling from ear to ear.

Listening to Crowley talk, one gets the impression that she can't say enough good things about her experience with Dr. Leland and his team. As someone with extensive oral health issues, she is no stranger to the dental chair. Crowley's woes go back to her childhood and the manner in which her permanent teeth came in. She was missing a set of eye teeth that created uneven spacing and a significant gap between the top two front teeth. When she was in her early twenties, she had major restorative work done, involving bridges, crowns, reshaping, and orthodontics. As time took its toll, however, the bridge work began to crumble and her teeth were beginning to discolor. Crowley needed help and looked to Dr. Leland to find it.

During her initial visit, Crowley was immediately impressed with the attentiveness and professionalism of Dr. Leland's staff. "The office atmosphere is wonderful. Everyone bends over backwards to make you feel comfortable and welcome. It is the real personal touch that makes you want to come back," she says.

Crowley's case was complex and involved many different materials and techniques. Going in, she had a fear that the cost would be prohibitively expensive. But after hearing the details, a plan was implemented that allowed her to go forward with the needed work. Crowley's case was difficult because there were challenging spacing issues to deal with. Dr. Leland explains that a procedure was done to replace old bridge work, using new bridges and crowns. Adjacent teeth were then resurfaced and reshaped using some veneers, which are thin, custom made moldings that cover the fronts of the teeth. They are made from state of the art materials that are natural looking, with the strength and durability to stand the test of time. Finally, whitening of non-involved teeth was employed so that all teeth blended together nicely. The treatment took place over the course of six weeks. The results are astounding and, according to Crowley, are "far superior to what was previously done."

As an example of how gifted Dr. Leland is in his craft, Crowley attended a party the weekend after receiving the temporary crowns and bridge. Temporary work is implemented to cover the time between tooth surface preparation and the receipt of the permanent materials from the lab. At this gathering, she was introduced to a man that turned out to be a dentist. "When I told him about my treatment, he was stunned to learn that my dental work was just temporary. He was quite impressed and totally fooled," says a beaming Crowley.

When asked about the explosion in the popularity of cosmetic options, Dr. Leland attributes some of it to the wonderful advances of materials now available. "In the last ten years, there has been extraordinary progress in the durability and realism in the final product for both restorative as well as cosmetic denristry. Ceramic materials now can provide a look that is basically indistinguishable from natural teeth, with a strength that matches or exceeds that of the previous generations of dental materials," comments Dr. Leland. This can all be provided while maintaining maximum oral health.

The expense of cosmetic work is very individual, with some options being covered by insurance. One of the simplest and most effective tools is tooth whitening, with products available for as little as $40. For more extensive work, like Crowley's, Creating Ultimate Smiles has ways of making it affordable. The professionals at Creating Ultimate Smiles develop a treatment plan and set the proper financial expectations along with each patient, producing a happy outcome. By developing a plan ahead of time, patients know what to expect at each visit and can feel comfortable in achieving pre-set goals for treatment. It is a part­nership that often leads to a long term relationship.

There's a real artistry in their cosmetic work, but both Dr. Leland and Dr. Brodil are also concerned about their patient's overall oral health. Their practice offers regular, comprehensive dental care services in addition to their cosmetic expertise. Their staff includes several hygienists and support professionals who are committed to making the dental care experience of you and your family superb. Their patients mean a lot to them. When Jane Crowley cracked a tooth unrelated to the restoration work, Dr. Leland offered to see her in the office on a day when they were closed. She was so impressed by this, she not only became a regular patient, but convinced her daughter to follow suit as well.

Watching her daughter walk down the aisle, Jane Crowley was filled with tremendous joy. She was happy to share it openly. On this wonderful day, it was written all over her face.

A majority of the people I encounter note that there is at least one facet of their smile that they are not pleased with and very often it is more than one aspect that makes them dissatisfied. Many indicate a desire to have teeth that are whiter or brighter. Others express displeasure with the worn appearance or chipping of their front teeth.  Some people are bothered by discolored fillings in their teeth. In virtually all cases, those who are unhappy with their smiles acknowledged that these concerns affect their confidence in their day-to-day lives.

Dental technology and practice techniques have made significant advances over the past decade, particularly over the past several years. As a result of these advances, we are able to help individuals achieve the more beautiful, natural looking smile they desire. With the effectiveness of the whitening treatments, and with the proper use of implants and veneers, there is an increasing likelihood that an individual can possess a full, healthy attractive smile.

I am often asked, “How can I get a beautiful smile?” Depending on the particular circumstances, many smiles can be rejuvenated or enhanced with whitening, bonding, veneers, and/or crowns. Missing teeth can be replaced with implants, crowns, bridges or a combination of these types of restorations. Each person’s mouth is unique; therefore, esthetic and functional needs must be assessed and tailored to suit the individual’s particular oral health.

As dentists, we consider a number of esthetic principles to enhance smiles that harmonize with a person’s age, lifestyle, ambition, and physical appearance. For example, a “too-white” smile where the teeth are too large or bright can look out of place for an individual who is at the age when teeth tend to discolor and get shorter with wear. Esthetic principles are the criteria we use to assess the harmony and attractiveness of the teeth, smile, and face.

Dental esthetic principles are based on size, shape, color, proportion, and alignment. Teeth must not only have a pleasing shape, color, and size, but also a correct proportion of width to height. They should also match the surrounding teeth in size, shape, color, and be in proper alignment with them. The proportion of tooth-to-gum that is evident when a person smiles is also an important component of the esthetic quality of the mouth and face.

Dental esthetic principles are not strict rules imposed by one body of authority. There are no hard and fast rules. It is easy to recognize when a tooth is too long or if it doesn’t “fit-in” in some way or another. Surprisingly, a smile that is imperfect in symmetry and shape is often the perfect, beautiful smile for an individual. Dentists utilize all of the principles and their experience when considering and determining a course of treatment to achieve the smile that is correct and pleasing for their patients. Currently, there are a number of effective methods that we employ to significantly improve individual smiles. Whitening processes can be used to lighten stained or discolored teeth. Bonding and conservative re-contouring of tooth surfaces and edges may be useful to give a more youthful look for some patients. The treatment which we have found makes the most flattering and stunning impact to a person’s smile, and to his or her self confidence, is a treatment plan using all-porcelain restorations such as veneers, crowns, and crowns on implants.

Patients that need to achieve significant changes of color, shape, and alignment of teeth can do so with porcelain restorations. Using porcelain restorations, we can restore length and balance to worn-down teeth, rejuvenate discolored teeth, and conceal chips or gaps in teeth. These restorations are hand-sculpted layer by layer to a tooth’s exact dimensions. Well-constructed porcelain reflects inner light and shows the fine detail of natural tooth enamel so that it appears completely natural when bonded to a tooth. Esthetic dentistry properly done should not make your teeth look “fake” but rather the teeth and smile should look and feel natural.

Porcelain restorations, like veneers, are beautiful restorations that, similar to normal tooth structure, will maintain their natural, bright appearance with proper oral hygiene. Because these are all-porcelain restorations and have no metal beneath the porcelain, there is no black or gray discoloration at the gum line.

Depending upon the processes required to rejuvenate your smile, the entire treatment plan may be completed within a relatively short period of time. A patient’s periodontal health must be good before rejuvenating processes can be undertaken. With good periodontal health, much of the work can be completed in just a few visits. Some of the procedures require reshaping of existing tooth structure and a local anesthetic may be necessary. We strive to make certain that all of the visits are comfortable and painless.

Just like today’s reality television make-over shows, a new smile often changes and improves individual’s confidence and outlook on life. One of our patients, Maria M., recently made changes to some of her discolored, aged dental work. She said that she has experienced a dramatic improvement in her self-confidence.

She has more confidence smiling and she speaks more often and freely because people are commenting on how beautiful her smile is. Her smile was brightened with new porcelain bridges that did not have a gray line near the gums and were a lighter brighter shade than the previous color. What a difference in her smile! She is pleased with the result and we share her excitement.

The goal in rejuvenating a smile is to create a smile that doesn’t look like the patient has undergone an esthetic procedure. The highest compliment that you can receive for a new smile is that your family and friends tell you that they notice that “something is different.” They cannot pinpoint the difference, but whatever it is” you look great.” A natural, beautiful smile should not stand out as “new teeth.” A rejuvenated smile should look as though you have refreshed your natural smile. Current techniques and materials in dentistry allow us to achieve these wonderful results for our patients every day. We care about our patients’ total health and take pride in our work. We also love the changes we can make for our patients by enhancing and rejuvenating their smiles.

New Dental Office Technologies

Dental offices have come a long way since the days of barbers moonlighting as dentists. Even in the last few decades, dental materials and office equipment have changed immensely.

The following are a few of the many technologies that have evolved over recent years, that not only enhance the quality of dental care, but also make dental visits more comfortable and pleasant.

Digital Radiography

Digital radiography (x-ray technology) has been around for a number of years but now is more ubiquitous than ever in the dental office. Patients will still have to “open wide” and “bite down,” but in place of dental film, they will be closing their mouths around electronic sensors. With the new technology, instead of the trip to the film processor and several minutes of developing time, dentist and patient will watch images come up on a computer screen seconds after the device is inserted into the patient’s mouth. The images will be higher resolution than film images and will be stored in computer memory, from which they can be easily retrieved, combined, and manipulated to supply more information. The digital x-rays allow for instant or real time image production and display, image enhancement, and are very useful in patient education. The chemical waste associated with film processing is eliminated as well. Most significantly, patients may be exposed to one-tenth the x-ray dosage typically delivered with conventional films.

The Dental Porcelain Revolution

For many decades the only way to fabricate tooth-colored crowns and bridges was to place porcelain over a metal substructure. These are fantastic restorations and may last for years and years. However, particularly in more cosmetic areas such as front teeth, the natural appearance of these restorations may fade. With changing gum-tissue and chipping porcelain, the metal underneath can appear and give the teeth a grayish look. It is the source of the “black lines” that my patients report to me with some of their older crowns and bridges.

Until fairly recently, however, the materials used in these types of restorations were the only ones that would provide long-lasting results in areas of particular cosmetic concern. Now, with the evolution of very strong dental ceramics, the underlying structure of these same crowns and bridges may be fabricated in a tooth-colored material that rivals the metal in long-term strength and eliminates the future emergence of “black lines.”

The porcelain that is added atop these non-metal substrates can then be layered and crafted in such a way that they mimic natural teeth in every way possible. The quality of the porcelain used now by dental laboratories still amazes me, as does the exceptional quality of today’s crowns, bridges, and veneers.

Lasers

Dental lasers are a “family” of dental instruments. Some lasers are used for surgery, some to harden tooth-filling materials and enhance tooth bleaching, and others to remove tooth structure for elimination of decay.

Depending on your treatment needs, your dentist may use the laser for a long period of time or only for a few brief moments. With laser surgery, there is a reduced need for local anesthesia, bleeding is minimized, swelling is controlled, and there is usually little, if any, postoperative discomfort. Lasers that remove tooth decay are fast and seldom require anesthesia.

Because laser techniques cause less pain than traditional methods, they are also likely to reduce the fear that many people have of the dentist. At the very least, lasers in some dental applications would eliminate the noise of the instruments that to some patients are nearly as disturbing as the physical discomfort. Patients should be able to relax and be comfortable while the dental laser is in use.

The major drawback of lasers so far has been the high cost compared to the conventional therapies and equipment. Additionally, the technology is changing and improving in leaps and bounds, so many practitioners are wary of early investment in lasers. For these reasons, lasers are not common in general dental offices.

Office Technologies

Many dental offices have made the leap into the 21^st century with state-of-the-art electronics. Dental offices often use computerized scheduling and billing systems, employ intra-oral video cameras in addition to digital films, and install screens in each room for entertainment and patient education.

A lot of the new technologies in dentistry are developed to make the jobs of the dental team easier and more efficient. This, of course, passes increased comfort and ease onto patients.

Oral Health, General Health and Quality of Life

Over the past fifty years, the oral health of Americans has improved. However, oral diseases are a major health concern that affects many of us. Oral health and general health are inseparable. Diseases and conditions of the moth have a direct impact on the health of the entire body.

The Impact of Oral Disease

In recent years, scientific reports have linked poor oral health to poor general health. Dental decay (cavities) is one of the most common chronic illnesses among children. Although most dental diseases are preventable, many children unnecessarily suffer from dental disease because of inadequate home care and lack of access to dental services.

Oral diseases, even in adults, can affect one’s overall health and one’s ability to eat healthy food. Recent reports link low-grade infections in the mouth (periodontal disease) to systemic illness such as cardiovascular diseases (heart disease), respiratory ailments (pulmonary or lung disease), and poor pregnancy outcomes (babies born too small and too soon). People with diabetes are also at increased risk for periodontal infections. In fact, it is the dental team that can often recognize the first signs of diabetes.

Americans lose more than 164 million hours of work each year as a result of oral health problems or dental visits. About 30 percent of adults 65 years old and older have lost all of their natural teeth. Oral diseases are the most common of the chronic diseases and are important public health problems because of their prevalence, their impact on individuals and society, and the expense of their treatment. The determinants of oral diseases are known – they are the risk factors common to a number of chronic diseases: diet and dirt (hygiene), smoking, alcohol, risky behaviors causing injuries, and stress.

Oral health affects people physically and psychologically and influences how they grow, enjoy life, look, speak, chew, taste food, and socialize, as well as their feelings of social well-being. Severe decay detracts from children’s quality of life: they experience pain, discomfort, disfigurement, acute and chronic infections, and eating and sleep disruption, as well as higher risk of hospitalization, high treatment costs, and loss of school days with consequently diminished ability to learn. Decay and subsequent discomfort in anyone affects nutrition and well-being.

Prenatal Oral Health

Pregnancy is a time of many changes, including changes in the mouth and oral health. It is important for pregnant women to get their teeth cleaned, examined, and have any needed dental work done before their baby is born.

Preliminary studies show that there may be an association between periodontal disease – a chronic infection of the gums – and premature birth (delivery before 37 weeks) and low-birth weight (baby weighing less than 4 pounds). Improving oral health during pregnancy can also help prevent early cavities in children. Dental decay is an infectious transmissible disease. Mothers can pass on decay-causing germs to their babies. Good oral health for moms can mean good oral health for their babies.

Children’s Oral Health

It is important for children to develop good oral health habits at an early age. Practicing health habits can prevent or reduce tooth decay in infants and children. This is a practice carried into adulthood as well. Children with good oral health and home-care practices tend to be the patients that have the best oral health as adult. Children’s oral health is certainly reflective of their parents’ level of oral health. This correlation should encourage parents to be quality examples for their children.

The American Academy of Pediatric Dentistry (AAPD) recommends that infants see the dentist for their first dental exam within 6 months of getting their first tooth or by their first birthday. It is generally best to have parents bring children with them on one of their visits for an informal “first” visit. This allows the child to become familiar and comfortable with the dental office and personnel. It allows the parent to be an example to the child as well, showing the child that dental visits are positive experiences.

Adult and Senior Oral Health

Over the past 50 years, there has been great progress and improvement in the nation’s oral health. Most middle-aged and younger Americans expect to keep their natural teeth over their lifetime.

Adult oral care is important. Brush your teeth and gums with a soft bristle toothbrush at least twice a day with a fluoridated toothpaste. Replace your toothbrush every 3-4 months. Floss daily to clean between your teeth; brush bristles only get so far between teeth. If you are not flossing, you are not completely cleaning all surfaces of your teeth.

Oral health is certainly stimulated by eating a balanced diet and limiting between meal snacks. Avoid sugars and starches when snacking and limit the number of snacks eaten throughout the day. Visit your dentist regularly. Regular professional care is important even if you do not have natural teeth. An exam of the mouth can provide early detection of pre-cancerous or cancerous lesions.

Taking good care of dentures is also an essential for good oral health. Dentures should be kept clean and well-fitting. Ill-fitting dentures can cause irritations on the inside of the cheeks, gums, or tongue. It is recommended that dentures be removed while sleeping.

Certainly optimum oral health is achieved by avoiding tobacco products (smokeless too!) and by limiting alcohol consumption.

Talk to your doctor and dentist if medications you take give you dry mouth. Certain medications may cause changes in amounts and consistency of saliva that can adversely affect oral health.

The bottom line is that oral health and general health are inseparable. There is a reason the moth is often called the gateway to the body. What we put into our mouths as well as how we treat our mouths affects our entire bodies.

Whitening - An Easy Way to Brighten Your Smile

In today's society, a healthy, attractive smile is increasingly important to just about everyone. A bright smile can improve self-confidence and make us look younger. So much so that the wildly popular television make-over shows invariably involve a dental make-over. Modern dentistry has much to
offer in order to improve aesthetics of a smile. One of the most effective, least invasive, and successful ways to brighten most smiles is tooth whitening.

There are many reasons teeth can discolor or darken. The most common cause is surface staining from the consumption of coffee, teas, red wine, cola, and tobacco. These types of stains are the easiest to remove. Trauma, tetracycline (an antibiotic) excessive fluoride, and degeneration of the nerve inside the tooth, can also darken the teeth. Discoloration caused by these factors may be more complicated and tougher to brighten.

Many people are satisfied with the sparkle they get from brushing twice daily with a fluoride-containing toothpaste, cleaning between their teeth once a day with dental floss, and the regular cleanings at their dentist's office. However, if you decide to go beyond standard oral hygiene techniques to obtain a brighter smile, there are a variety of products and procedures available. These options include in-office whitening, at-home whitening, or whitening toothpastes. You may want to start by speaking with your dentist. He or she can tell you whether whitening procedures would be effective for you.

Whiteners may not correct all types of discoloration. For example, yellow-hued teeth will probably whiten well, brownish-colored teeth may whiten less well, and grayish-hued teeth may not whiten well at all. Anyone interested in brighter teeth should also be aware that whitening may not enhance your smile if you have had bonding or fillings in your front teeth. The whitening applications available today will not affect the color of these materials, and they will stand out in your newly whitened smile. In these cases, you may want to investigate other options, like porcelain veneers or dental bonding.

If you are a candidate for bleaching, your dentist may suggest a procedure called "power" or in-office whitening. During this procedure, the dentist will first apply either a protective gel to your gums or a rubber shield to protect the oral soft tissues. A whitening gel is then applied to the teeth, and a xenon plasma light may be used to enhance the action of the whitening agent. The "active ingredient" in the whitening product is usually hydrogen peroxide or carbamide peroxide. As the active ingredient is broken down, oxygen enters the tooth enamel, staining can be extracted, and the tooth color is lightened.

There are several types of whitening products available for use at home, which can either be dispensed by your dentist or purchased over-the-counter. At-home or take-home whitening is accomplished by wearing custom-made dental trays filled with prescription whitening gel for several hours at a time for a period of one to three weeks.

With "take-home" procedures, patients must first visit their dentist to have impressions or molds made of their upper and lower teeth. From these impressions, custom trays for the teeth are formed. The trays are extremely thin, virtually invisible and can be worn during the day or at night. At the next appointment, the dentist then shows the patient how to dispense the prescription-quality whitening gel into the trays. The results of this procedure are long lasting, and teeth are noticeably brightened within days.

There are many over-the-counter whitening products available at local stores that are not necessarily dispensed by your dentist. Some of these products are effective, while others may not offer any long-term results. The over-the-counter products that are effective often show results within days of initial use. The major drawback to these treatments is that they are not customized for each user. The "one-size fits all" nature of these products may contribute to uneven whitening or unnecessary application of the whitening material to gum tissue. It is best to ask your dentist about which products will be most effective for you.

There are several whitening toothpastes on the market. Although they do not affect the natural color of your teeth, they may effectively remove stains, thereby improving the overall appearance of your teeth. In addition, once teeth have been professionally whitened, the use of whitening toothpaste may keep a smile brighter longer.

"Whitening" toothpastes approved by the ADA have special chemical or polishing agents that provide additional stain removal effectiveness. Unlike whitening gels, these toothpastes will not change the intrinsic color of teeth. Rather they simply help remove some surface staining.

All patients should discuss the possibility of side effects from whitening procedures with a dentist. Teeth can become sensitive, particularly to cold foods or beverages, during any type of whitening process. This sensitivity is not a result of any damage to the teeth. The sensitivity is temporary and should lessen once the treatment is completed. Some patients may also experience soft tissue irritation, either from a tray that does not fit properly or from whitening solution that may come in contact with the tissues. As with any treatment, you should speak with your dentist about bothersome side effects so that they might be lessened or alleviated completely.

Tooth whitening is a very effective way to enhance your smile. Consult your dentist to find out which method would not just improve your smile, but keep you smiling while you're whitening!

Prime Time Smiles

As I have noted in this column in the past, "make-over" shows are unbelievably popular today in America. We love to see homes, cars, motorcycles, and especially people, dramatically transformed, seemingly overnight. Americans love instant gratification and immediate results.

As a dental practitioner, I frequently receive inquiries regarding new dental technologies and particularly whether the extreme make-over phenomenon is real and something that would apply to them. While I cannot speak to the work of the plastic surgeons, fashion consultants and personal trainers in the world of "personal transformations," I can confidently say that the dental technology available today can allow for a nearly immediate smile make-over.

I perform the techniques featured on make-over shows on a daily basis with excellent results. There are many relatively straightforward, minimally invasive restorative treatments highlighted on the shows that produce dramatic results in a matter of hours or a few days. Current restorative dentistry involves a myriad of procedures that use a wide variety of materials that can produce amazing results. The following are several of the techniques and applications I use that are readily available today to enhance a patient's smile.

Tooth whitening in most cases can be the simplest, least invasive "cosmetic" dental procedure. After speaking with a number of patients, as well as friends and family, I have discovered that the first aspect of their smile that they mention is the color of their teeth. Almost everyone desires whiter teeth.

The three most common methods used to whiten teeth are: over-the counter products, some of which are effective, some not; take-home trays and whitening gel that are fabricated and fitted by a dental professional; and in-office "power" whitening. There are positive and negative aspects to each of these whitening modalities. While over-the-counter treatments may be the least expensive option, the products themselves may not be effective on all types of stain or be suitable for all shapes and positions of teeth. The other options prescribed by dental professionals are more predictable in achieving positive results as each is tailored to a specific patient.

Another popular make-over treatment to enhance the shade of teeth or to repair fractured teeth is dental bonding. Simply stated, the tooth's surface is prepared and a tooth-colored dental filling material is bonded to the tooth. Dental bonding is utilized to improve the appearance of cosmetic imperfections found on the surface of a tooth, to replace tooth structure that has chipped away or broken, or to repair damage caused by tooth decay. In some situations, the technique can be used to resurface the entire front side of a tooth to improve its cosmetic appearance.

Compared to some cosmetic dentistry techniques, such as veneers, dental bonding can be less expensive and is usually a one-visit dental procedure. A tooth treated by dental bonding that happens to chip or break can usually be patched or repaired easily. It should be noted that dental bonding material has a tendency to stain over time and may not be as long-term or durable a treatment as other cosmetic dental procedures.

All-porcelain restorations are the latest, most natural looking application of the art and science of cosmetic dentistry. Porcelain veneers or full porcelain crowns are generally the esthetic restorations crafted for patients on make-over shows. The process enables the dentist to close spaces, visually rotate teeth, and give the appearance and function of a natural smile.

For decades dentists have had materials available that create a durable bond to tooth enamel. Porcelain veneer techniques utilize these bonding capabilities to securely affix a thin sheet of porcelain (the porcelain veneer) to the front of a tooth or to bond a full-coverage porcelain crown into place. The most effective and appropriate type of porcelain restoration can only be determined after clinical examination.

Although porcelain itself is inherently brittle, when it is firmly bonded to a sturdy substructure (a tooth) it becomes very strong and durable. One property of the tooth's enamel covering is that it is translucent in its undamaged natural state. The translucent property is an important component that gives teeth their characteristic appearance. Porcelain veneers and crowns, because of their glass-like translucency, are esthetically superior to other types of cosmetic dental bonding. When bonded onto a tooth's surface the porcelain mimics the characteristics of natural, unadulterated enamel. This translucency provides a sense of depth and thus a very natural appearance.

Porcelain is a ceramic, and therefore glass-like; it is extremely smooth and basically impervious to stain. Porcelain restorations are often effective in changing tooth color or making cosmetic changes to teeth that are chipped, worn, stained or misaligned. An examination by a dentist can determine whether porcelain restorations are the most appropriate method to attain the desired results as there are some limitations to the use of all-porcelain veneers and crowns and they may not be appropriate for some patients.

In a majority of the make-over shows, the participants have teeth missing or have dark spaces to fill. In these cases, the practitioner often uses dental bridges or removable appliances to replace missing teeth and restore the appearance of a natural smile.

Fixed bridges are applied by placing crowns on the teeth adjacent to the spaces-to provide support for artificial teeth-or by bonding the artificial teeth directly to the abutment teeth. The ability to utilize a fixed bridge depends upon the number of teeth being replaced and the condition of the teeth on either side of the space. In some instances, dental implants may be placed to use as abutments or anchors for the replacement teeth.

Removable partial dentures consist of replacement teeth attached to pink or gum-colored plastic bases, often connected by metal framework. These attach to remaining natural teeth with precision attachments, such as metal or plastic clasps.

As a clinician in the improving and evolving world of dentistry, I am enthused and pleased that shows such as ABC's Extreme Makeover highlight the possibilities of dentistry and the technologies that enable dentists to enhance and improve nearly any smile. I encourage anyone interested in improving or changing their smile to consult with a dental professional who will be able to tailor treatment options for their individual case in a way that also promotes optimal oral health.

New Developments in Smile Enhancement Technology

You may have seen or heard reports about new types of dental veneers that permanently repair stained, chipped, discolored, and misaligned teeth, or even revitalize old crown and bridgework. These advertisements highlight a relatively new dental technology called Lumineers™. This product utilizes a material that can be made ultra-thin and is placed over existing teeth to achieve the results listed above. In most cases where this treatment is used, there is minimal or no removal of tooth structure (compared to traditional veneers that require removal of a certain amount of tooth structure). In just two or three visits to the dentist, Lumineers™ can provide a custom-made smile that can last for many years.

Everyone is not a candidate for the new technology, but for those who are, the process can be an excellent way to achieve a revitalized, more attractive smile. In some cases, however, traditional veneers may still be necessary. An examination by a dentist can help to determine whether Lumineers or more traditional veneers would be the preferred treatment for you. The decision as to which type of restoration should be used is made during the diagnostic process. Which process and restoration is employed depends upon the health and positioning of the existing teeth, as well as any previous dentistry that has been performed on the teeth to be treated.

There are instances where traditional whitening processes will not lighten and brighten teeth sufficiently. When teeth have staining or discoloration that will not lighten, Lumineers™ may be used as a means to lighten and brighten teeth. Teeth that are stained or discolored as a result of tetracycline or other medications taken while the teeth were developing may have a discoloration that is intrinsic in the teeth themselves. This discoloration can be improved with the use of Lumineers™. The technology allows the dentist to block out the traces of any stains or discoloration. The procedure leaves a patient with permanent "whitening."

Bothersome or unattractive chipping or cracking of front teeth may also be remedied by the use of Lumineers™. While bonding in some instances may be a short-term solution to repair chips and cracks, application of Lumineers™ may offer a more natural looking, long-term solution.

Similar to traditional veneers and crowns, Lumineers™ may be used in some cases to close spaces (diastemas) between front teeth or to "correct" misaligned teeth. (If orthodontics is not an option, the Lumineers™ may be a viable alternative.) These contact lens-thin "smile-shapers" can eliminate the spaces, while keeping your original tooth-structure intact. Your dentist will be able to evaluate your teeth and mouth to determine whether orthodontics is necessary. There are many factors that cause spacing or crowding of teeth over time. These factors should be evaluated by a dentist before determining whether orthodontic treatment or Lumineers™ can close the spaces or eliminate the appearance of crowded teeth. In cases where there is not a severe orthodontic problem that has caused the changes, Lumineers™ can modify the shape and alignment of teeth, making them appear straighter and more uniformly positioned.

The company that makes Lumineers™ reports that the new technology may even be used over existing crowns and bridges. This can be useful in instances where a bridge or crown is clinically intact and solid but may have chipped or worn porcelain. Lumineers™ may be bonded directly to the existing restorations to correct their appearance.

In my experience, the most positive attribute of the Lumineers™ is that the process requires minimal or no change to natural tooth structure. This means that there is no need for temporary restorations between visits and in most cases there is no need for local anesthetic. Once the procedure is completed, there is little or no post-placement discomfort or sensitivity. The treated teeth will look natural and feel very comfortable from the time of treatment.

It is projected that the integrity of the Lumineers™ will last up to or beyond 20 years, similar to what I would expect from traditional veneers. The cementation process for the Lumineers™ is akin to that of traditional veneers as well. Care and maintenance of the Lumineers™ is the same as for your natural, untreated teeth.

Lumineers™ may not be appropriate for all cases. There are many instances where traditional veneers or crowns may be required to address the esthetic needs of some patients. A clinical exam by a dentist as well as diagnostic models can be used to determine which course of treatment would be most appropriate for the patient.

In our practice, I have seen Lumineers™ as most effective in cases where there are minor to moderate changes in alignment and chipping to be repaired, as well as in cases treating any type of discoloration. While traditional veneers and crowns are often required for more dramatic changes in alignment and more severe fractures, in some cases, a combination of both traditional veneers and Lumineers™ can provide very positive results with little or no elimination of natural tooth structure.

A dentist's goal in treatment of any kind is to retain and protect as much natural tooth structure as possible. Lumineers™ afford the dentist another type of restoration to maintain tooth structure while enhancing the esthetics of a smile.

Please be certain to consult with your dentist to determine if Lumineers™ may be right for you and your smile.

Note: The author is not paid or supported in any way by Cerinate© or the Den-Mat Corporation (the makers of Lumineers™). The article is strictly informative in nature, and based upon personal experience using the product.