Cosmetic Dentistry

My teeth are yellow or stained

The cause of the discolouration is assessed first. Surface stains can often be removed with a professional clean; darkening of a single tooth may be linked to decay or to the tooth's nerve. In suitable cases, whitening is considered. According to reviews, whitening at home with a low-concentration gel over a longer period gives a colour change similar to whitening in the clinic¹. For home whitening, your dentist decides the product and how long to use it. Whitening lightens the colour of natural tooth tissue. Existing fillings, crowns and veneers do not whiten; if a colour difference remains, they may need replacing. The effect is not permanent and needs topping up. A single root-filled tooth can be considered for whitening from the inside; in rare cases, this method has been linked to hard tissue being gradually lost from the outer surface of the root near the gum line (external cervical resorption). For discolouration that does not respond to whitening: bonding or laminate veneers.

One of my teeth is chipped, worn or small

Bonding can often be done in a single appointment, usually without drilling tooth tissue away; the surface is treated so that the material bonds to it. If the fracture is large or extends towards the root or the nerve, or if the tooth has a large filling, a crown or a partial-coverage restoration may be considered; if the nerve is affected, it may need treatment first. The choice depends on how much sound tooth remains.

My teeth are crowded, rotated or stick out

Orthodontics: braces or clear aligners straighten the teeth without reducing them for crowns or veneers. Some plans may need limited reduction of enamel between the teeth, or extractions. Treatment takes months, and keeping the result needs retention. Hiding crowding with crowns or veneers means removing a great deal of tissue from the teeth, so orthodontics is assessed first.

There is a gap between my teeth

Depending on the cause and width of the gap: bonding, laminate veneers or orthodontics; sometimes leaving it alone is the right choice. These options are compared side by side on the gap teeth (diastema) page.

Colour and shape together on several front teeth

Laminate veneers, if there is enough enamel and the teeth are healthy. They cannot be undone. How they differ from crowns is covered on the "Crown or veneer?" page.

My gums show a lot when I smile, or the gum levels are uneven

Treatment depends on the cause. Too much visible gum can come from the gum level, the position of the supporting bone, the position of the teeth, the structure of the jaw or the movement of the lip. In suitable cases the gum, and where needed the supporting bone, is reshaped; in others, orthodontics or other treatments are considered. Unevenness caused by gum recession may need tissue to be added. The decision is made after an examination and any imaging needed.

My old fillings or crowns do not match

Depending on the cause of the mismatch, polishing, reshaping, repair or replacement is considered; where possible, the existing restoration is kept. If replacement is needed, whether more tissue will be removed from the tooth is discussed beforehand.

I want to change my whole smile

This is a matter of planning, not a single procedure: smile design. A trial stage gives an idea of the planned look before any permanent work; the final colour, shape and appearance of the gums may differ.

When other treatment is needed first

Active decay, gum disease and uncontrolled clenching are dealt with first; in teeth that are still developing, permanent restorations are postponed.

If more than one procedure is needed, the order changes the result and the cost to the teeth:

1. Health first. Decay, gum disease and bite problems are resolved before cosmetic procedures; a restoration placed while disease continues is at higher risk of failing early.
2. Then procedures that can be reversed or do not cut the tooth. Orthodontics corrects the alignment; whitening lightens the colour. Because the colour of ceramic does not change later, whitening is done before crowns or veneers.
3. Restorative procedures last. Once the alignment and colour are settled, any remaining flaws in shape are corrected with bonding, laminate veneers or crowns, according to what the tooth needs; these are not consecutive steps but alternatives chosen for each tooth. Laminate veneers and crowns are made only on the teeth that need them, after the result has been seen at the trial stage.

When this order is skipped, more teeth may be treated than needed, with more tissue removed.

Risks

• Irreversible loss of tissue. Preparing a tooth for a full crown removes enamel from every surface, and often some of the dentine beneath. For a laminate veneer, a more limited layer of enamel is usually removed. Removed tissue does not grow back; the tooth will depend on a restoration for life.
• The tooth's nerve. In teeth that were alive at the start and received indirect restorations (crowns, partial restorations or bridge supports), the nerve can lose its vitality; root canal treatment is then needed to keep the tooth. In the pooled results of 37 studies with different follow-up periods, this happened in about 5 in every 100 teeth². The certainty of this evidence is low; the figure is pooled over the studies' different follow-up periods and is not a personal risk or a yearly rate.
• Sensitivity. Temporary sensitivity is the most common side effect of whitening. A network meta-analysis of 77 studies found the risk higher with 20–22% carbamide peroxide and 14–16% hydrogen peroxide gels than with 2–4% hydrogen peroxide³; the risk varies with the product, how long it is applied and the person. Temporary sensitivity can also follow preparation for crowns or veneers. Whitening is not done while the teeth or gums are unhealthy, and is not recommended during pregnancy or breastfeeding, or under the age of 18.
• Fracture, coming loose, staining. Over time, ceramics can fracture or come loose and their edges can discolour, and composite can stain and roughen; repair or replacement is then needed.
• Risks specific to orthodontics. Shortening of the root tips, white spots and decay on the enamel where brushing is difficult, and gum recession can occur. Keeping the result needs long-term, sometimes lifelong, retention and regular check-ups.
• Gums. Restorations with poorly fitting edges can lead to gum inflammation and recession.
• Expectations. Visual designs are not a promise; the result depends on the real condition of the teeth.

Benefits

• The option that fits the concern often gives a result without cutting the tooth, or by cutting it very little.
• A plan in the right order can avoid unnecessary restorations and help keep tooth tissue.
• Ceramic surfaces stain less than composite and keep their shape longer. In a review combining 29 studies, about 94 to 97 in every 100⁴ feldspathic, leucite-reinforced and lithium disilicate veneers were still in place after an average of 10 years. Staying in place does not mean staying free of complications; there are no long-term data for zirconia veneers.

Contact your dentist if any of the following happens after a cosmetic procedure:

• Sensitivity that lasts more than a week or gets worse
• Pain when biting, or a feeling that the bite is high
• A fracture, crack, movement or loss of a restoration (keep the piece)
• Bleeding, recession or a dark line at the gum along the edge of a restoration
• White patches or burning on the gums after whitening (stop home whitening until you have spoken to your dentist)

Emergencies. Throbbing pain, facial swelling or a fever are not an expected result; see a dentist without waiting. If you have difficulty breathing or swallowing, swelling in the mouth or neck that spreads quickly, or swelling around the eye, go to an emergency department or call 112.

Fees are not given on this page. The main factors that shape the plan are which treatments are included, how many teeth are treated, the material and how it is made, any treatment needed first, and review appointments. Conservative procedures (whitening, orthodontics) often involve the whole set of teeth; for restorative procedures (bonding, veneers, crowns), the cost rises with the number of teeth treated. Ask for the plan in writing, showing which procedure is recommended for which tooth, and why.