Cosmetic treatment
What is cosmetic dentistry?
Dentistry is no longer just a case of filling and extracting teeth, as it was for many years. Nowadays, many people turn to cosmetic dentistry, or ‘aesthetic dentistry’, as a way of improving their appearance, much as they would use cosmetic surgery or even a new hairstyle. The treatments can be used to straighten, lighten, reshape and repair teeth. Cosmetic treatments include veneers, crowns, bridges and tooth-coloured fillings.


What is a veneer?
Veneers are thin slices of porcelain. These are precisely made to fit over the visible surface of front teeth, like a false fingernail fits over a nail.


Why might I have a veneer?
Veneers are an ideal way of treating discoloured or unsightly teeth, closing gaps between front teeth, or repairing chips and cracks.


How are veneers made?
They are made by a dental technician, using impressions taken by the dentist. The veneers are made in the laboratory and bonded to the tooth to form a strong and natural-looking repair. Sometimes a natural colour ‘composite’ material is used instead of porcelain. Composite veneers can be completed in one visit and involve bonding tooth-coloured filling material to the front of the tooth. Although these veneers are slightly more prone to staining and have a shorter life, they are easily replaced.


Can I use veneers to close the gaps between my front teeth?
Yes. Again, using tooth-coloured material or porcelain, the dentist can change the shape or size of the tooth very slightly, closing the gap between the teeth.


How much will a veneer cost?
In some cases veneers can be available on the NHS. However, this type of treatment is usually classed as cosmetic and would therefore only be available privately. Costs will vary from practice to practice and from region to region. It is therefore important to discuss treatment options and charges with your dentist and it is always recommended that you get a written estimate before starting treatment.


Can I have white fillings?
For over 150 years standard fillings have been made out of a silvery-grey material called ‘amalgam’. This is still one of the strongest and longest-lasting materials available for fillings. However, many people find it unattractive and some are concerned about possible health risks.

White fillings are now becoming a popular alternative to amalgam fillings. The new dental materials mean it is much easier to find a perfect match for the shade of a particular tooth. In most cases, it is quite impossible to see that the tooth even has a filling.


Are there any other alternatives to silver fillings?
In some cases, the cavity that needs filling is quite large, but the surrounding tooth is healthy. A composite filling may not be strong enough, but it would seem pointless to remove more of the healthy tooth in order to make a crown. In these cases an inlay may be the answer.

The dentist can make an inlay by preparing the cavity in much the same way as they would for a filling. But instead of putting in a filling, the dentist takes an impression of the tooth. The impression is then sent to the laboratory where the technician makes an ‘inlay’ using porcelain, resin-material or gold. The dentist then bonds this into place.


My tooth is badly broken - what can I do?
When a tooth is badly broken or heavily filled, the dentist may need to crown or ‘cap’ it to restore its appearance and strength


How does the dentist make a crown?
The usual procedure for fitting a crown involves shaping the tooth under local anaesthetic and then taking an impression using a rubber-like material. The impression is then sent to the laboratory along with the details of the shade to be used, where the technician makes the crown.


What happens to my teeth while the crown is being made?
While your crown is being made, the prepared tooth can be protected with a temporary crown, which is easily removed just before fitting the permanent one. In most cases, the temporary crown is in place for about two weeks.


What is a crown made of?
Crowns can be made of a variety of different materials, such as porcelain or porcelain bonded to gold. New materials are continually being introduced. There are different crowns for different situations and it is a good idea to discuss with your dentist which crown would be best for you.


How much will a crown cost?
On the NHS, tooth-coloured crowns are available on teeth near the front of the mouth (from the first pre-molar tooth forwards). Many people want to have tooth-coloured or gold crowns for teeth that are further back, but these are only available privately. Costs for these vary from practice to practice and region to region. Always get an estimate of the cost and discuss all possible treatment options with your dentist before starting treatment.


I have a gap – should I have it closed?
If a tooth is missing, or needs extracting, there are several ways to fill the gap that is left. In some cases it is important to try to replace any missing teeth in order to balance the way your jaw bites. If you have several missing teeth, the remaining teeth are under more pressure, which can lead to broken fillings or even jaw problems.


How can my dentist fill the gap?
A partial denture is the simplest way of replacing missing teeth. However, some people find dentures uncomfortable and eventually decide to have a bridge made.


What is a bridge?
Bridges are ideal for people who don’t like dentures or only have one or two teeth missing. Conventional bridges are made by crowning the teeth on either side of the gap and attaching a false tooth in the middle. They are fixed in the same way as crowns. These bridges are usually made of precious metal bonded to porcelain. Sometimes other non-precious metals are used in the base for strength.


What if I don’t want my remaining teeth drilled?
Adhesive bridges are another way of bridging a gap, and less of the tooth needs removing. These bridges are made up of a false tooth with metal ‘wings’ on either side. These wings are made to bond to the teeth on either side, with very little drilling of these teeth. The teeth are roughened and the bridge is fitted using a very strong composite resin.


How much will a bridge cost?
Bridge work is expensive because of the time, materials and expertise involved. Even bridges covered by the NHS cost more than most other treatments. It is important to get a written estimate of the costs involved before starting.


Can I have teeth screwed in?
‘Implants’ are an alternative to dentures or bridgework, but they are more expensive. Implants are titanium rods, which are surgically placed into the jawbone, leaving parts sticking out through the gum. These act as anchors for fastening dentures or crowns onto.


Can I lighten the colour of my teeth?
Tooth whitening can be a highly effective way of lightening the natural colour of your teeth without removing any of the tooth surfaces. It cannot make a complete colour change, but it will lighten the existing shade.


What does tooth whitening involve?
Professional bleaching is the most common form of tooth whitening. Your dentist will apply the whitening product to your teeth, using a specially made tray which fits into your mouth like a gum-shield.

The ‘active ingredient’ in the product is usually hydrogen peroxide or carbamide peroxide. As the active ingredient is broken down, oxygen gets into the enamel on the teeth and the tooth colour is made lighter.

Once your dentist has started this treatment you will need to continue it at home.


How long does tooth whitening take?
The total treatment can usually be done within three to four weeks. This means regularly applying the whitening product at home over two to four weeks, for 30 minutes to one hour at a time.

However, there are some new products which can be applied for up to eight hours at a time. This means a satisfactory result can be achieved in as little as one week.


What other tooth whitening procedures are there?
There is now laser whitening or ‘power whitening’. During this treatment a light or laser is shone on the teeth to activate the chemical. The light speeds up the chemical reaction of the whitening product and the colour change can be achieved more quickly. Laser whitening can make teeth up to five or six shades lighter. This procedure usually takes about one hour.


How much does tooth whitening cost?
You cannot get whitening treatments on the NHS. Private charges will vary from practice to practice and region to region. Laser or power whitening will be more expensive than professional bleaching. Ask for a written estimate of the cost before you start any treatment.


What is an incorrect bite?
This is when the teeth do not fit in the jaw properly, when the teeth are not in the correct relationship with the rest of the face or if teeth are lost and not replaced.


What can happen if an incorrect bite is not treated?
If an incorrect bite is not treated the face can ‘collapse’. This can cause the face to sag, the chin to stick out or the smile to droop. It can even cause headaches, neck pain and other pains in the body.


How can an incorrect bite be treated?
There are a number of treatments, including crowns, bonding and orthodontics ( braces). Ask your dentist which treatment is most suitable for you. Ask for an estimate of the cost and a written treatment plan before you start.


Can my crooked or twisted teeth be straightened?
Teeth can be straightened with orthodontics (braces). This is usually done during the teenage years, when the teeth are going through a period of growth. However, many adults also have treatment to straighten their crooked teeth or to approve their appearance. The procedure can take much longer in adults and is therefore more expensive.


Are there any alternatives to orthodontics?
Cosmetic contouring can be used to improve the appearance of teeth. It is ideal if you have slightly crowded teeth. It takes about one hour and is less expensive than other forms of cosmetic treatment. It is not recommended for young children.


What is tooth jewellery?
Tooth jewellery involves sticking small accessories onto the teeth. They come in many different designs and can be in the form of gems, or gold or silver shapes. They are stuck onto the teeth using a dental cement, although a dentist can easily remove them if necessary.


Is tooth jewellery safe?
We recommend you contact a dentist for advice if you are considering having tooth jewellery. A dentist has the skills and knowledge needed to apply the jewellery safely and will be able to advise you how to care for your teeth afterwards. It is important to keep to a good oral hygiene routine at home as you may find you are more likely to get dental decay if this area is not kept clean.


Is mouth piercing safe?
Piercing the mouth, lips or tongue is not recommended for a number of reasons. When the piercing is first done, there is a high risk of infection, inflammation of the surrounding tissues or even severe blood infections.

Piercing the tongue can cause it to swell. It can also cause damage such as chipping and fracturing to other opposing teeth. It can also affect speech, eating and swallowing and make oral hygiene difficult to maintain.

Piercings, particularly on the tongue, can make dental treatment difficult, especially if x-rays are needed.