Smiles in the 21st Century

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In follow up to his previous express interview found here: http://108.174.155.130/~gayexpress/2015/01/achieving-perfect-smile/

We asked Ponsonby Road dental expert Matt Sumner some more indepth questions about the modern era of cosmetic dentistry.

 

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How much can you expect to pay for whitening?

Costs can vary enormously for whitening but will be somewhere between $200-$500 depending on what is being done and the type of whitening requested.

 

What creates the issues around certain teeth being different colours or shades?

This can be any number of things but internal or external factors are two good categories to use. Staining is the most common external factor and whitening is great for sorting this out. Internal factors are more complicated and range from thicker teeth being naturally more yellow as they contain more dentine, through to a tooth that is dead or dying which can look significantly darker. Tooth position can also affect appearance as being set back will shadow a tooth making it appear darker.

 

Once whitened how long can you expect the teeth to remain white? Do you recommend customer’s pop back in (say) 6 months for a whitening touch up?

Results from whitening will vary between people but in most cases will lighten between 6-8 shades. The time this lasts also varies, depending on lifestyle and dietary intake (for example coloured foods) however, 6-12 months is not an unreasonable expectation and yes, touch ups are often a good idea. However at Accent, we provide our patients with the capacity to do this procedure themselves without significantly more cost.

 

What are we doing in our day-to-day lives that is causing the most damage to our teeth?

Our western diets have many products that are incredibly sweet and acidic. This is an extremely destructive combination for tooth structures. We also don’t do enough to maintain the 40% of our teeth that tooth brushes don’t clean. Flossing is one way, but doesn’t always work for everyone. There are other solutions which work. Ask about these when you next see your dentist if you are tired of hearing that you should floss more!

 

Can you take us through a bit about the scenarios where you would recommend orthodontics (braces)?

Braces are the perfect solution for someone who has crowded/crooked teeth with few fillings and little wear, which is why they are so common in teenagers these days. This also applies to adults and we will often use braces in adult patients before doing anything reconstructive with ceramics. Especially if this means we can achieve a better result and have to do less tooth reduction.

 

How long on average do adults have to wear the braces for?

This depends on the severity of the case, however 2-3 years is not uncommon and it’s sometimes more. We have to move things a little more slowly in adults as the bone the teeth are in is often denser and skeletal changes happen more gradually.

 

Are there options where the braces are (basically) invisible?

Yes Invisalign is one option for this; also ceramic brackets rather than the metal ones look better and some orthodontists place brackets on the inside of teeth so they don’t show as much. As you would expect there are drawbacks to all of these solutions, one of which is that these are all more expensive than the traditional approach, however they certainly make the process less obvious.

 

Do you have to get them tightened? How often? Is this process painful?

Tightening braces is an integral part of the process. It’s this pressure that provides the steady forces which ultimately move crooked teeth. The timing depends on how quickly things are moving but usually between every 6-8 weeks. There is a sensation of “tightness” which can make the teeth ache, but this usually only lasts a day or so following the appointment.

 

How much does an average procedure involving braces cost from start to finish? (i.e.: from when they go on to when they come off?)

Again prices vary depending on severity and the complicated nature of the case, as well as the processes used. Regular braces are around $5,000-6,000, however optional ceramic brackets add more cost to this. Invisalign is generally $8,000-9,000, and lingual (on the inside) braces up to $14,000.

How long can you expect plastic fillings to last?

I hate to answer questions about durability as I don’t have a crystal ball (how long until someone dings my car in a carpark?) however, small plastic fillings done well should last many years, considering the bigger these fillings get the less time they tend to last. As a material it isn’t really designed to rebuild a whole tooth, which isn’t to say that it can’t be done…only a warning on the longevity.

 

Why do you think the evolution of fillings has led to ‘plastic’? (ie what are the benefits of plastic/ what were the issues with fillings of the past)

We can bond or stick plastic fillings to teeth, so this often means the hole in the tooth doesn’t need to be as big as it would have been in the past. Of course, the older amalgam fillings tended to last longer but would often end up cracking the surrounding tooth, especially big amalgam fillings as the amalgam will “thermocycle” (expanding and contracting under different temperatures). Plastic fillings are also tooth coloured so look way better!

 

How much can you expect to pay for a single plastic filling?

This ranges from $150 up to $500 depending on the size and level of complexity.

 

In your experience, why do people opt for a solution that isn’t permanent and will require further procedures in future?

Let me start by saying that none of these cosmetic solutions are completely permanent. They will all usually require some form of attention at some stage later on. The timing of this is determined by the materials and processes used. Less permanent solutions are less expensive and this is certainly a driver for some people, however there are some situations where people want to “get a feel” for what they are getting into. Also, sometimes in purely “additive cases”, for example closing a gap, a well-placed pair of plastic fillings can do a great job without needing to sacrifice any healthy tooth structure.

 

Veneers, Crowns and Implants – what are the differences between these three and please can you give an example for each of a procedure where it would be recommended?

These are all ceramic solutions and so are variations on a theme. However, technology is definitely changing the processes. At Accent we will do 90% of our ceramic work in a single visit using our on-site computer aided design and manufacture system – which all of our patients love! It’s convenient, quick, and saves messy impressions, temporaries and follow up visits.

A veneer is a way to resurface the front of any tooth which shows in a smile. It leaves the bulk of the tooth intact.

A crown is often called a “cap” and goes all over the outside layer of the tooth and so surrounds the remaining tooth. These sometimes stay in better as they have more tooth surface to hold onto. However they require more tooth structure to be taken away.

An implant is the best way possible to fill a missing tooth space, they are the most permanent solution of any restorative dental process. The technology involved here is amazing!

 

The concept of having tooth structure removed is a scary thought for some. In reality is this a complicated process? And is it something you often recommend?

Having tooth structure removed should never, ever be taken lightly! It is sometimes necessary however, and this is the only time I recommend it. It is not complicated, especially these days with modern hand pieces and electric motors that make the process much quicker and smoother, if not much less noisy!

 

Can you give us an idea of the cost of a: 1) crown 2) Veneer and 3) implant?

Again prices vary in this area enormously, especially as it depends on the experience of the dentist as well as the processes, materials and technicians used. However, crowns and veneers will range from approx. $1,000-$2,000/per tooth and implants from $4,000-$6,500 and these prices are purely indicative. It’s a good idea to ask what you are getting for your money when choosing based solely on price.

 

What are your top tips for express readers wanting to take good care of their teeth?

Do whatever home care your dentist has recommended and see him or her regularly. Small regular visits usually avoid the need for larger more complicated and more expensive treatment! “Little and regular, often”.

 

Article | Oliver Hall.

Photo | Evan Donnelly.

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