Make Over Your Mouth


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Tooth Whitening

The simplest and most common thing they do, akin to having Botox shots, is tooth whitening. This is nothing new, but it is cheaper and easier today than it used to be.








'Smile Design'



For example, if your gums show too much when you smile, that can be fixed. "We do what's called a gum lift," Bellen says. "The technical term for it is crown lengthening."

This is a surgery that can be done in the dentist's office, whereby the gums are pushed up so that more of the teeth show. "Surprisingly, there isn't much pain," Bellen says. "It's a fairly minor surgery."

You can also have your teeth shaped any way you want them to be. Bellen says that lengthening and rounding the edges of your front teeth can actually make you look younger. A lifetime of chewing (and especially of nail biting) wears down your teeth. Even after a facelift, worn teeth can add years to your appearance.

To shape a tooth, a cosmetic dentist may bond a resin or porcelain veneer or crown to it. Resin bonding is the older method. "It still is good and used a lot today," Malone says, but it doesn't last as long as porcelain, the newer material.

Resin may, in time, wear out or become discolored, whereas porcelain doesn't. The other difference is that resin bonding is done in the dentist's chair. For a porcelain veneer, a mold is sent away to a dental lab to be made, then bonded on later.

In addition to shaping teeth attractively, a cosmetic dentist can give you pouty lips. "We take profile photographs of the lips," Bellen says, "If somebody wants a fuller lip, we can actually increase the bulkiness of the veneer," so that it pushes the lip outward.

Tetracycline stains can also be covered with veneers. "When tetracycline [a commonly used antibiotic] is given as a child, it tends to stain developing teeth," Bellen says. "It happens in bands -- striations across the teeth."

If your molars are a mess of metal fillings, that can be fixed by grinding them down and capping them with new porcelain crowns.


The Architecture of a Smile

Bellen says a cosmetic dentist can do just about anything needed to improve your smile, but he stresses the work must be carefully planned. "I go though a pretty detailed evaluation before I start any work at all," he says.

Your bite -- the way your teeth fit together when your mouth is closed -- is an important consideration. "You can put porcelain on everything and not pay attention to the bite, and have everything break down," Bellen says.

That means that before any veneers or crowns go on, your teeth may need to be realigned, and you may even need jaw surgery. "I, as a cosmetic dentist, will diagnose and plan the treatment," Malone says. Then he may involve other professionals, such as an orthodontist or an oral surgeon.

When teeth need to be realigned, it's usually an orthodontist who takes care of it. And you may not need braces. Many people can have their teeth straightened with the Invisalign system, which uses clear plastic "aligners" to gradually move the teeth around. Although it is widely accepted, "You cannot use Invisalign for every case that you can use braces for," Malone says.

Often the jaw can be repositioned without surgery, but sometimes an oral surgeon may need to join the team. As part of a "whole mouth rehabilitation," as Bellen terms it, some people need to have a severely recessed or protruding jaw corrected.

How much you want done depends on how much time you're willing to commit to it, and how much money you have at your disposal. Strictly cosmetic dental work isn't covered by insurance, and the cost can be steep. Veneers, for example, may cost as little as $250 and as much as $2,000 -- per tooth.

Again, you would be paying for a lot of time in the chair. Bellen says he sometimes works on a single patient for a full eight-hour day. What's more, the end result can take many months to accomplish. "There are cases I have in progress right now that have been going on for a year," he says.

But for some, an elaborate and costly production may be worth it in the end. "People smile more when they have nice-looking teeth," Bellen says. "Your whole face brightens up."

WebMD Feature Reviewed by Brunilda Nazario, MD


SOURCES: Michael Malone, DDS, president, American Academy of Cosmetic Dentistry. Jerry Bellen, DDS. AACD cost estimates.

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