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There could be a reason why boxer Rocky Balboa seldom smiled and when he did, his mouth was closed. Because of his career, he probably had a mouthful of cracked and broken teeth and more than a few were missing. If he smiled with an open mouth, he may have even scared off the love of his life, Adrian. Unfortunately, broken, discoloured and less than ideal teeth can affect just about anybody and for many reasons.
Every month if not every week, we have at least one or two people seek us out to help them with their smile. Often they say they don’t smile or smile conservatively with closed lips. When we take pre-treatment photos, it can be a struggle to see how their teeth actually look when they smile. It usually is not that their lips don’t retract or that they are unable to show their teeth, rather it is that they have trained themselves to hide their teeth. These people are often very self conscious, and sometimes even reclusive and introverted. Others may even sense that they are unfriendly whereas the truth is that “underneath” they are the exact opposite!
While this type of dentistry is not inexpensive, the benefits go way beyond what we see with our eyes. And unlike other things we buy (televisions, cars, computers etc.) that either break, need continual maintenance and repair, become obsolete or require an ongoing expense, a well done and regularly maintained (brushing, flossing, eating reasonably and regular check ups) smile “makeover” will last for many years and give numerable benefits.
I had a patient come up to me last year and thank me for the cosmetic work we had done for her. She showed me a ring on her finger – she had just gotten engaged! She truly felt that the new man in her life was because of the changes that we did for her smile – it changed her life. She has even begun to do some work on a television program in front of the camera, not behind the scenes. That is something she probably would never have considered before.
Cosmetic Dentistry In Recent Years
In the past ten or more years, cosmetic dentistry has become very much in vogue. In my opinion, every dentist is in some ways a cosmetic dentist because no dentist will ever admit that he/she does uncosmetic dentistry! The difference is that some dentists with specialized training, skills, experience and artistic sense are better equipped to determine what needs to be done cosmetically and how to provide that type of service.
Your esthetic needs or desires, the current condition of your teeth and gums and the quality of materials will determine how inexpensive or expensive your cosmetic dental work will be.
Here are six key factors or stages that come into play when it comes to putting a price tag on cosmetic dentistry.
Initial Cosmetic Dentistry Examination
The initial consultation will at least give you some ideas as to options and the approximate costs for the various options. The very first thing that will need to be done is a thorough examination of your mouth and teeth. This is absolutely essential and it will include your gum health and an evaluation of your bite. Some radiographs (x-rays) are usually necessary to assess the teeth, bone and gums in their entirety. Usually photographs of your teeth and smile in repose (relaxed) and when smiling will be important, as well as models of your teeth. This first visit should also include some details of what your expectations are so that we can make sure that your expectations are realistic and achievable.
You should expect an initial consultation and exam to be approximately $100, but depending on the office it could be 2-3 times as much. If radiographs are needed this may add another $75-150.
If a comprehensive change is required the next step is often to do what we call a “cosmetic workup.” I will give more details about this step in a future blog but it is essentially a three-dimension blueprint of what your final teeth will look like….much like building a house and having an architect draw up some plans. In our office we only charge for the laboratory costs associated with this step which is typically $50 per tooth, but it is not unusually to have a “clinic or dental” fee in addition to the lab costs.
How Many Teeth Need Treatment
The consultation above will have determined the current condition of your teeth and gums etc, your expectations and finally what is required to meet those expectations. Sometimes making changes to only a few teeth can make a big difference and is all that is needed. In other cases, the person smiles so widely and wants a dramatic change that we need to treat more teeth. A common mistake I see in cosmetic dentistry is a person will fix or treat the front four to six teeth only, but when they smile you can still see the untreated teeth towards the back. If the front teeth do not match or blend in with the back teeth they will look very unnatural and the cosmetic work will often look “fake”.
The Shape and Condition of Your Teeth
In general the better the condition of your teeth, the less work that will need to be done.
Teeth which have had lots of cavities, fillings and or root canals will often need to be strengthened at the time of the cosmetic changes. This most often necessitates a crown. In some cases the tooth may need to be “rebuilt” first, and it may even be necessary to do a root canal. If the colour, size and shape of the tooth is good it may only require a little contouring.
Of course, all of this will be determined at the consultation phase before treatment is started.
Maybe the only thing wrong with your smile is the colour of your teeth.
Teeth will naturally darken with age. This is due partly to wearing of the enamel and with the tooth forming a thicker layer of dentine underneath, which is the part of the tooth that determines colour. In addition teeth can become discoloured due to stains from food or drink and especially if you smoke.
If your teeth are generally good with respect to size and shape and it is mainly the colour that is a problem, tooth whitening is a very conservative and less expensive approach.
There are many methods of cosmetic teeth bleaching and some are more effective than others.
All tooth whitening products are similar in that they use either a hydrogen peroxide or carbamide peroxide agent to whiten the teeth. The only difference from one product to another is mainly the concentration. Many people (including dentists such as myself!) have been led to believe that you need a special light or contraption to whiten your teeth effective. A study done about 6 years ago showed no difference between many whitening systems…the only variable that seemed to make a difference was the concentration of the whitening agent.
You can buy an over-the-counter bleaching kit from almost any drug or grocery store for about $100 to $200. However over the counter products are generally 10-12%, so anyone with very discoloured or stained teeth will not see much change. In general yellow teeth will whiten the easiest but teeth that are gray, brown or orange in colour will be more challenging.
A more effective way is to have it done professionally by a cosmetic dentist, partly because we can supply the “good stuff”….in other words higher concentrations of whitening products. A home whitening kit (ie do it yourself at home) will involve making and providing custom fitted trays to hold the bleaching agent, and the concentrations are typically 15-18%. These usually cost from $350-400 (our current fees are $375).
Some people want to whiten their teeth immediately…in those cases you can have an in office whitening treatment. This is generally more expensive as it involves chair and personnel time and more expensive products. The concentrations here are from 25-30% and because of the strong concentrations this must be done in a dental office as the gums and tissues must be kept isolated. I have seen prices as much as $1200 to $2000…however our fees are currently $675. This also includes custom fitted trays so that you can do touch ups at home
Note: some people have dark teeth due to tetracycline stains. Tetracycline is an antibiotic that used to be given to children to combat ear infections etc. Unfortunately if given at a young age the tetracycline becomes deposited into the forming teeth and will permanently stain the teeth. Whitening products rarely work for these people.
We’ve all heard of a face lift, but did you know there is such a thing as a gum lift? It’s true! Cosmetically how our teeth or smile looks is partly dependent on the gum height. A lack of symmetry, gums too long or too short-can all affect the look of the teeth and smile. Some people have a very gummy smile and want to have a smile that shows more teeth and less gum.
Many of these changes are possible…in some cases it just requires a minor gum change or modification and other times it may require something called a gum lift. A gum lift is a dental procedure that raises and sculpts the gum line replacing a ‘gummy’ smile with a smile that is far more attractive.
These modifications and gum lifts will cost anywhere between $200 to $1,500, depending on the number of teeth affected and the specific type of work required.
Quality or Type of Materials
Once we know what needs to be done, how many teeth need to be treated, the next thing is to consider what type of material to use. If we need to change the size, shape and colour of a tooth, we need to cover it with something. This is done with either a filling material (composite resin) or porcelain.
In the case of a filling, we sometimes call it a composite veneer to describe covering the entire front of the tooth. These can cost anywhere from $300 to 500 per tooth. If it is porcelain we are placing either a porcelain veneer or crown. Here in Vancouver the costs are typically $1100 to $2000 per tooth, however at the time of this blog our current fees are $1220 per tooth. (Porcelain crowns, veneers etc have a laboratory cost associated with them so you need to ask if the price quoted includes the lab costs. The costs I had just mentioned includes the lab costs.)
My apologies if I have overloaded you with too much information! To put things into perspective, if you are considering cosmetic dental work you will need an initial exam and consultation and you should expect approximately $100-200. From there your costs vary considerably depending on all of the factors mentioned above as well as some other considerations not discussed at this time.
The average cost for the patients we have treated is about $9000-10,000 as most people need 8-10 teeth treated, and I am assuming we are doing porcelain veneers or crowns. However some can be considerably more or even less depending on the number of teeth, type of material etc.
I would suggest that once you decide to move forward, make sure you have a budget in mind in regards to what you are willing and able to spend….and be willing to share that with your dentist. I do not base our fees or treatment plan on a person’s socioeconomic status, but knowing what range the person can afford helps me to find treatment options and solutions that will fit their budget.
About Dr. Balogh
Dr. Peter Balogh (B.Sc. D.D.S. D.A.B.O.I) is a cosmetic dentist at the Vancouver Centre for Cosmetic Implant Dentistry in Burnaby, BC. He is a Fellow at the American Academy of Implant Dentistry and International Congress of Oral Implantologists. Dr. Balogh has been a practicing family dentist for over 25 years and focuses on cosmetic dentistry and implant dentistry. In the past, he was a surgical instructor at the University of Boston School of Dental Medicine.