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Dr. Philips in the News...



EXPLORING BEAUTY: Say Cheese

Hankering after a whiter, brighter or shapelier smile? RONDI ADAMSON considers the latest cosmetic dentistry options.

IF, AFTER THOSE COLLAGEN injections, the nose job and the multiple glycolic peels, you still feel less than perfect, maybe you should look into improving your smile. (Or maybe you should look into therapy and figuring out why you're so fixated on your appearance, but I guess some of us fear analysis more than the drill). In any case, having sped far beyond the Pearl Drops and braces of yore, we '90s folk have the brave new world of aesthetic, or cosmetic, dentistry open to us. Enter into it and gaps can be closed, gums modified and teeth dramatically whitened and reshaped. But you must be willing and able to pay, and while it isn't beyond the realm of the possible for many, you can be sure it's more costly than Pearl Drops or even that Shopping Channel favourite, The Sonic Toothbrush.

First among the popular aesthetic services your dentist may now offer is, undoubtedly, whitening. Even people relatively happy with their teeth-middle-class girls like myself, for example, who were lucky enough to have had Dad pay for braces-usually feel that their teeth could stand to be whiter. It's that movie star thing, that Marilyn Monroe or Tom Cruise thing. And as we age, coffee, red wine, tea, cigarettes and even some antibiotics leave their marks on our teeth.

Apart from the new generation of whitening toothpastes available at your pharmacy, remedies for stained teeth include laser whitening and tray whitening. Laser whitening takes two to three hours and is more or less painless, depending on the sensitivity of one's teeth to begin with. The gums are protected with a wax strip, hydrogen peroxide gels are applied to the surface of the teeth, and then laser energy is applied to activate the whiteners. There is increased sensitivity of the teeth for about two hours afterward, a small price to pay for results that are, by all accounts, remarkable. How white your teeth become "depends on where you start out," says Dr. Ron Golden, who runs Toronto's The Perfect Smile clinic. "If your teeth are terribly stained, then we may not be able to get them to a sparkling white, but we will certainly be able to drastically improve them." (Golden sees clients aged 25 to 75 and says that men especially seem to appreciate being able to do something about their looks without having to resort to girly things like spas or facials.)

Sandra Gneo, 27, was one of Golden's first customers when The Perfect Smile opened earlier this year. A dental hygienist (not with Golden), Gneo says she heard about the laser treatment through the dental grapevine and decided to try it out. "I am very happy with the results," she says. "I will have to do tray whitening to maintain them, but [two applications] are included in the cost." Twice-a-year maintenance with the tray method is recommended because as soon as people start living again-i.e., smoking and drinking- new stains can appear. Laser whitening runs anywhere from $800 to $2,000.

Tray whitening costs $250 to $800, takes one to three weeks and, because it's done at home, requires diligence on the part of the whitenee. It is, however, every bit as effective as laser whitening. Trays-in which the whitening gel is placed-are fashioned to fit the client's teeth, and he or she must wear the trays, usually overnight, for about two weeks.

"If you're getting married tomorrow, then I'd recommend the laser treatment," says Dr. Edward Philips of The Studio for Aesthetic Dentistry whose clients have included Yuk Yuk's owner Mark Breslin and renowned architects George Yabu and Glenn Pushelberg (designers of Toronto's Canoe and Monsoon restaurants, just for starters). "But if you're not rushed, stick with the trays. They're cheaper." Once you have the trays, you can buy the whitening gel to maintain results-two tubes cost $50 and last for two years, or four applications. Philips also speaks highly of "spot lasering," whereby if you've done the trays or you have veneers and there's one stubborn tooth that won't part with its stain, it's "the perfect time to blast it with the laser." Spot lasering costs $250 to $500 per tooth.

If coffee stains aren't your biggest smile problems, but you want the shape of your teeth changed, consider bonding, veneers and crowns. What lay people call "bonding" is the process of applying acrylic resin (though bonding technically refers to the method of attachment for both resin and veneers), curing it with a bright blue light and then, as the client wishes, altering the shape, size and colour of the tooth. It costs about $350 per tooth.

Veneers are similar to false nails. They are made with a porcelain laminate veneer and placed on top of the tooth-effectively changing its shape, size and colour. Veneers run about $650 to $1,000 per tooth but are generally considered more durable than bonding. And, where bonding can sometimes result in the Chiclet look of cosmeticized teeth, veneers tend to look more natural. This is because, with fewer layers involved, veneers are more translucent than bonding finishes and more closely mimic the natural enamel of our teeth which allows light to pass through and refract.

Crowns (known to the lay population as "caps") require the shaving away of a good deal of the tooth and, unlike veneers, wrap around the entire tooth. Crowns, made from Procera, a high-grade porcelain, cost approximately the same as, or a little more than veneers and are recommended when significantly more restoration of the tooth is required.

If your teeth are white and straight and even, but you feel your smile is a little too "gummy," a procedure called gingivectomy might be just what the dentist ordered. Gingivectomy, or gum modification, involves the removal of gum tissue with a laser and is, according to Philips, desirable when "more than three millimetres of gum shows in a smile. People don't like gummy smiles." Gingivectomy takes about 30 minutes to an hour and requires no stitching. Philips likens it to cauterizing and says it is painless, though he admits that he freezes clients first, "because otherwise, they get nervous." For every "site," or every four to eight teeth affected, the cost is $500.

Finally, jaw alignment works on a person's bite-known in dentistry as "occlusion-rather than on the damage to or flaws in individual teeth. "If the front end of your car is not properly aligned, you find your tires wear unevenly," says Dr. Brian Friedman, who studied occlusion at the (famous among dentists) L.D. Pankey Institute in Florida. "And similarly, if your jaw joint and teeth are not aligned, your teeth wear unevenly." This uneven wearing can lead to damage not only on your untreated smile, but also on a smile filled with crowns, veneers or bonding. So fixing your bite can make all that money you've spent go a little further Jaw alignment is usually achieved with the help of a "nightguard," which according to Friedman, can range in price anywhere from $750 to $1,400. A night-guard is an orthodontic appliance, sort of a cross between a retainer and a mouth guard, and must be worn overnight by the client. It has the added advantage of limiting the damage caused to teeth by the stress-related "bruxism," or tooth grinding, something done by approximately 80 to 90 per cent of the adult population while they sleep. "The nightguard permits the jaw to easily skate around without any resistance," says Friedman.

Before you make any of these investments it would, of course, only be normal to want some idea of what you will look like after a given treatment is over. To this end, most dentists who offer aesthetic services also offer computer imaging. A "before" picture is taken with a digital intra-oral camera and brought up on the computer screen, then adjustments are made to show you what a difference those crowns will make. The imaging is usually part of an overall consultation costing about $75 to $100.

And if you go through with it and don't like the results? Well, you could always sue-and you could probably find a lawyer right in Philips' office, where attorneys, he says, constitute the largest group of professional clients.


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