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Dr. David Hornbrook, founder of the San Diego Center of Cosmetic Dentistry in La Mesa, says his patients are a varied group - from college students to elderly retirees - with half older than 50. "I think that people today are healthier than they once were at 50. They work out at the gym, perhaps they have had a facelift or other cosmetic surgery. That's when they decide that maybe Mother Nature hasn't treated their teeth as well as the rest of their body."
Although the American Dental Society doesn’t officially recognize cosmetic dentists as specialists, general practitioners are increasingly positioning themselves as such by promoting smile-enhancing services to clients. Some take it a step further, joining the American Academy of Cosmetic Dentists. The AACD's membership is 3,800 "and counting" nationwide, says continuing education coordinator Lisa Phelps. To become an accredited member, dentists complete a three-year program and present five cases to the board for review.
Before: Poor and neglected dentistry.
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After: Porcelain veneers, crowns and a
new cantilevered bridge.
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Hornbrook is an accredited AACD member and one of only 13 fellows worldwide. His La Mesa practice employs some of the most advanced technology available to cosmetic dentists, including digital smile imaging, which lets patients visualize the results of proposed treatments. Hornbrook also uses a particle beam to remove decay without drills or anesthesia; an argon laser to set resin materials; and the miniature Acucam Intraoral Camera to enable patients to print or view tooth fractures, decay and other conditions on a 19-inch color television.
His office is spacious and sunny, with amenities like warmed towels, a color television in each treatment room, a coffee and juice bar and before/after photo albums. "For me, general dentistry didn’t offer much in the way of creativity or artistic value. I realized I was becoming the constant bearer of bad news," says Hornbrook. "Appearance-related dentistry offered me the chance to provide my services to patients who were actually asking me for treatment. And allowed me to be far more creative; I’ve become a smile designer."
One of the quickest and cheapest ways to improve a smile is to whiten the teeth. Patients are usually offered the choice of at-home or in-office whitening. "In the office we put a bleaching solution with a photo activator on the patient's teeth and then use a laser to activate it," says Hornbrook. The laser solution is five times stronger than the one used for at-home bleaching and is a little harder on the gums. In-office treatments also can involve applying heat, but Hornbrook prefers the laser.
Dr. David Smith uses the heat technique in his office, although he says most of his patients choose to whiten their teeth at home. "We make impressions of the teeth and custom trays are created to fit them. The patient is sent home with bleaching gel and they apply it to the teeth via the tray for a few hours a day. Most people do it while they sleep."
Smith says the bleach is harmless and breaks down into oxygen and water. Occasionally, patients feel a little stinging on their gums, but it’s usually because they put too much bleaching gel into the tray. "Eighty percent of our patients get the whitening they want in eight or 10 days," he says.
Smith has been a member of the Academy of General Dentistry - and on the staff of Scripps Memorial Hospital - for 30 years. He was one of 17 dentists in 1995 to be made a fellow of the Academy of General Dentistry and also is a member of the AACD. He says after whitening, the next, least-invasive procedure used to improve a smile is tooth contouring. "That's done to straighten out jagged edges, round the corners, things like that. It’s very minor and it isn’t painful."
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Before and after photos illustrate the dramatic changes cosmetic dentistry can make.
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Both dentists also do extensive work with composite bonding and porcelain veneers, which can change the shape of the teeth or fill in unsightly gaps. A resin is placed on the tooth, and it is hardened with a laser or light, says Hornbrook, and it is then polished. "It allows us to build up teeth in certain areas. We can straighten them, fill in chips, and we have better control over color than with whitening," he says.
Porcelain crowns are back in style too. "My parents' generation used all-porcelain crowns but they used to break a lot, so the industry moved to a porcelain-fused metal crown. Now porcelain is much stronger so we can use that again and it’s very attractive," says Smith.
Both Smith and Hornbrook prefer to use porcelain veneers instead of tooth crowns whenever possible. "We have to remove a certain amount of tooth to fit in the crown," explains Hornbrook. "I'd rather save as much of the tooth as I can. Veneers cover only the front of the tooth, and we take only a fingernail thickness off the tooth," he says.
Another advantage of veneers, says Hornbrook, is "instant orthodontics. We can make the veneers thicker or thinner, maybe removing a little more of a tooth that was too thick, adding a little more to one that was too thin. We can lengthen teeth, straighten them - it’s what I call a smile lift. We can literally cheat Mother Nature."
What does all this cost? Both dentists declined to give amounts for higher-end treatments, citing the uniqueness of each case. But for about $250-$300 you can whiten your teeth at home, and Smith says minor contouring - which usually takes him no more than ten minutes per mouth - costs less than $100.
Is it worth it? An AACD survey reports that nine out of 10 Americans agree that an attractive smile is an important social asset; 74 percent believe an unattractive smile can hurt a person's chances of career success; and only half of those surveyed were satisfied with their smile.
"The public has become more aware of what an appearance-related dentist can do for them to help them feel or look younger. I recently handed one of my patients a mirror after treatment. She was so happy she started crying," says Hornbrook. "That's incredibly gratifying."
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