Cosmetic dentistry

Cosmetic dentistry is generally used to refer to any dental work that improves the appearance (though not necessarily the function) of a person's teeth, gums and/or bite. Many dentists refer to themselves as "cosmetic dentists" regardless of their specific education, specialty, training, and experience in this field. This has been considered unethical with a predominant objective of marketing to patients.^[1] The American Dental Association does not recognize cosmetic dentistry as a formal specialty area of dentistry.^[1][2]<ref name American Association of Public Health Dentistry ">American Association of Public Health Dentistry</ref> However, there are still dentists that promote themselves as cosmetic dentists.

Fields

There are only 2 dental specialties that predominantly focus on dental esthetics/cosmetics. They are:^[3] Prosthodontics^[4] and Orthodontics^[5] and such specialists are called Prosthodontists and Orthodontists respectively.

Common cosmetic dentistry options

Types

Cosmetic dentistry may involve:

1. the addition of a dental material to teeth or gums – examples: bonding, porcelain veneers (laminates), crowns (caps), gum grafts
2. the removal of tooth structure or gums – examples: enameloplasty, gingivectomy
3. neither adding nor removing dental materials, tooth structure, or gums – examples: teeth whitening (bleaching), gum depigmentation
4. straightening of teeth accompanied by improvement in appearance of face – orthodontics

Examples

• Whitening, or "tooth bleaching", is the most common cosmetic dental procedure. While many whitening options are now available, including over the counter products, dentist-supervised treatments remain the recommended procedures for lightening discolored teeth.^[6]

Teeth reshaping (sculpting) and bonding performed in one office visit.^[7]

• Tooth reshaping removes parts of the enamel to improve the appearance of the tooth. It may be used to correct a small chip, or to alter the length, shape or position of teeth; it can be used to correct crooked or excessively long teeth. The removed enamel is irreplaceable, and may sometimes expose dentin. It is also known as enameloplasty, odontoplasty, contouring, recontouring, slenderizing, stripping or sculpting. This procedure offers fast results and can even be a substitute for braces under certain circumstances.
• Bonding is a process in which an enamel-like dental composite material is applied to a tooth's surface, sculpted into shape, hardened and then polished.^[8]
• Dental bridges are false teeth, known as a pontics, which are fused between two porcelain crowns to fill in areas left by missing teeth. Two crowns hold it in place, these are attached to adjacent sides of the false tooth. This is known as a fixed bridge. This procedure is used to replace one or more missing teeth. Fixed bridges cannot be taken out in the same way that partial dentures can. In areas of the mouth that are under less stress, such as the front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space. Bridges can reduce the risk of gum disease, help correct some bite issues and even improve your speech. Bridges require commitment to serious oral hygiene, but may last up to ten years or more.
• Veneers are ultra-thin, custom-made porcelain laminates that are bonded directly to the teeth. They are an option for closing gaps or disguising discolored teeth that do not respond well to whitening procedures. Depending on the procedure, tooth reduction may be necessary.
• Gum lift is a cosmetic dental procedure that raises and sculpts the gum line. The procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or more symmetrical teeth.
• Bite Reclamation: Patients who have had years of excessive wear to their teeth due to grinding or acid reflux can alter their vertical dimension. This gives them a closed or shorter look to their face and smile. By opening up their bite, a qualified professional can reclaim their vertical dimension and sometimes even remove unwanted wrinkles as well.

Materials

In the past, dental fillings and other tooth restorations were made of gold, amalgam and other metals—some of which were veneered with porcelain. Now, dental work can be made entirely of porcelain or composite materials that more closely mimic the appearance of natural tooth structure. These tooth colored materials are bonded to the underlying tooth structure with resin adhesives. Unlike silver fillings (amalgams) they are entirely free of mercury. Many dentists offer procedures to be cosmetic and because their patients prefer natural looking teeth. Cosmetic dentistry has evolved to cover many new procedures and new dental materials are constantly introduced.

Credentialing

In America, formally trained specialists recognized by the American Dental Association undergo a minimum of 2–3 years full-time rigorous education program after dental school graduation. These specialties also lead to board certification approved by the American Dental Association.<ref name American Association of Public Health Dentistry ">American Association of Public Health Dentistry</ref>

• Prosthodontics
• Orthodontics

Non-specialists with supplemental education related to specific interests. The certifications by these groups will not lead to approval by the American Dental Association.

American Academy of Cosmetic Dentistry: The American Academy of Cosmetic Dentistry (AACD) is the largest international dental organization in the world, composed of general dentists, specialists, and lab technicians focused on the art and science of cosmetic dentistry. Founded in 1984, the AACD has over 7,000 members in the United States and more than 70 countries around the globe. Members of the Academy include dentists, dental laboratory technicians, educators, researchers, students, hygienists, corporations and dental auxiliaries. AACD members seek out continuing education through lectures, workshops, and publications in order to keep up-to-date with all of the advancements in cosmetic dental techniques and technology. In 1984, the AACD was formed and has filled the dire need for credentialing in cosmetic dentistry. The purpose of the American Board of Cosmetic Dentistry (ABCD) is the testing, analyzing, and evaluation of the services of dentists and laboratory technicians for the purpose of awarding AACD Accreditation in cosmetic dentistry.^[9] However, this certification is not approved or recognized by the American Dental Association.

American Society For Dental Aesthetics: Conceived in 1976, the American Society for Dental Aesthetics was developed with a single purpose in mind: continuing dental education to teach dental health professionals the most advanced aesthetic and restorative techniques available. To become a member of the ASDA, a dentist must show a minimum of five years in dental practice, or postgraduate training of two years in an approved program; attendance to at least two ASDA sponsored continuing dental education seminars; nomination by a member accompanied by two letters of recommendation by Society members; presentation of five (5) cases illustrating the concepts of aesthetic dentistry.^[10]