SAN FRANCISCO (CBS.MW) -- Long gone are the days when brushing twice a day was enough: Now the drive is on for the perfect smile.
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The problem is, unless a television network targets you for a complimentary makeover, perfect teeth can be perfectly expensive. Still, there is a range of methods that will improve your pearly whites without sending you deeply into the red. The perfect smile is an ideal to which more are aspiring: Teeth-whitening procedures now represent almost 10 percent of cosmetic dentists' practice, up from about 3 percent five years ago, according to a poll of dentists by the American Association of Cosmetic Dentistry. Veneers, which can make teeth look whiter, more uniform and straighter, represent more than 14 percent of dentists' practice, up from about 5 percent, and bondings, which have a similar effect, are at 23 percent, up from 17 percent. "With ABC's 'Extreme Makeover' and the awareness that people have of all these cosmetic procedures, in particular dental makeovers, there's an increased demand for this type of stuff," said Mitchell Pohl, a cosmetic dentist based in Boca Raton, Fla. A whiter smile Probably the cheapest, fastest way to a better smile is to bleach your teeth. These days, as cosmetic dentist Dr. Lawrence Addleson, of Art of Dentistry in San Diego, said: "Refrigerator-white is a little too dark sometimes." Over-the-counter products are available for $15 to $30, compared with the $300 to $800 you'll pay a dentist, but cheaper may not be better. Over-the-counter whiteners "did not give you as much whitening as you could get from a dentist," said Ed Miller, a chemist and program leader at Consumer Reports, which studied five over-the-counter products. "The dentist has available much stronger tooth whitening chemicals and has techniques for applying them," he said. Still, even over-the-counter products will make your teeth whiter. "You do get a positive result," Miller said. "And if you buy the retail package, you'll be spending a fraction of the cost" of going to a professional. Your best bet is a product that stays on overnight. Colgate's Simply White Night made teeth the whitest in the Consumer Reports study, followed by Crest Night Effects, Colgate Simply White, Crest Whitestrips and Rembrandt 2-Hour White. Still, even Rembrandt's product, the lowest scorer, was rated "fair." A downside to bleaching is its impermanence. If you like the effect, you'll have to shell out again later to maintain it. Dentists' take-home bleaching kits offer a mouth guard made for your teeth, into which you put bleaching agent, for about $300 to $500 -- or you can spend up to $800 to have your teeth whitened in the office. Take-home kits that are used overnight are best, because the longer the bleach is on your teeth, the longer the effect lasts, said Dr. Steven Andreaus, a cosmetic dentist based in Raleigh, N.C. Next-best are kits used during the day "because if you can't tolerate this thing overnight, but you've got a couple of 30-minute sessions during the day, it'll do the job," Andreaus said. His least favorite method is the in-office whitening. "It gives you great results when you walk out the door, (but) 24 or 48 hours later your teeth kind of tone down. Six months later you're like, 'gee, I paid $600 or $700 dollars for this. I want them to be a bit whiter.'" Still, those in a hurry might be willing to pay. "The in-office whitening is for people who have an exaggerated sense of urgency. 'Oh my God, I'm getting married this Saturday and I don't have time to bleach my teeth.' Some people just don't have the patience to put trays in their mouth and do it for two weeks," Pohl said. Getting bonded With bonding, a dentist adheres a composite material directly on the tooth. It's one of the lowest-cost ways to straighter teeth, but given that you're paying $400 to $1,000 per tooth, it doesn't make sense to bond an entire mouthful of crooked teeth. With bonding, "we can lengthen teeth, we can fix a tooth that's partially fractured (and) we can close spaces between the teeth," Addleson said. The disadvantages: Bonding lasts only about three to six years, and it tends to discolor. Still, for teenagers and young adults, whose gum tissue is still moving, bonding makes more sense than the longer-lasting, pricier porcelain veneers. Even those in their mid-thirties should consider bonding rather than porcelain veneers, Andreaus argued. Given their lifespan, "it's going to have to be done again whether it's porcelain or bonding. "But if you're 55, 60 years old and you really want something that you don't have to play with again, go with veneers that are well placed," he said. Bonding vs. porcelain But some dentists warn that a dentist's bonding work is only as good as the dentist: The entire procedure is done right in the dentist's chair. Ensure your dentist is experienced by requesting photos of previous work. A badly bonded tooth may not match your normal tooth color, and may not be well-aligned with other teeth. "There are some clinicians who are really good at (it), but it requires a lot of layering of the colors, the different shades and translucencies of the composite, to make it look lifelike," Pohl said. With porcelain veneers, a model is made and then sent to a lab to fabricate the porcelain piece. Patients can first make sure they like what they see. "You should get to see the model and you should get to see your own temporaries" on the teeth, Andreaus said. "Then the chance of a great result is almost a slam-dunk." Still, porcelain veneers aren't exactly cheap: They cost from $700 to $2,000 per tooth. They last about 10 years or more, but "nothing in the mouth is very permanent," said Dr. Matt Messina, a Cleveland-area dentist and a consumer adviser for the American Dental Association. See the ADA Web site. Cosmetic? It's on you With dentistry, you don't necessarily want the cheapest practitioner, but consumers should realize that many cosmetic procedures aren't covered by dental insurance. While structural improvements are often covered, most whitening and veneer work is "is candidly cosmetic," said Royce Charney, president of Trust Administrators, a health-benefits firm based in Oakland, Calif. Still, "a lot of times we're doing procedures for structural reasons, but while we're doing it we make it look good," Messina said. Bonding is often covered, he said, but "the one procedure that has the greatest difficulty with coverage are the veneers. It may or may not be covered. It depends on the insurance company." Investigate your dentist Americans' rush to cosmetic procedures also means more inexperienced dentists are jumping into the business. "With the increased demand for it, dentists are going to be jumping in to do it that don't have as much experience," Pohl said. "I'm getting a lot more cases that I have to redo that other dentists have done that patients are unsatisfied with." Given the potential for problems, consider the following:
- Ask for photos of previous work. Confirm that the photos are the dentist's work, not that of another dentist, Andreaus said, and if the procedure is expensive, ask to speak to patients who've had the procedure done.
- Make sure the dentist offers options. "There's rarely an occasion when the consumer knows exactly what they want," Andreaus said. "More often than not I talk to patients about not doing $40,000 worth of veneers, just doing a handful of veneers and doing Invisalign (braces) so they can straighten their teeth."
- Research the dentist. "With everybody jumping on the bandwagon, it's just a caution. They need to hold off and make sure they do the research. Don't go to the cheapest guy. I've had to redo a lot of cases because of it," Pohl said.
The American Academy of Cosmetic Dentistry offers tips on selecting a dentist. See their site. |
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