In search of that dazzling smile

Going to the dentist used to be about getting your cavities fixed. Now it is increasingly about getting your smile improved. TAN SU YEN reports on the growing appeal of cosmetic dentistry.

THE ranks of those looking to improve their smiles through cosmetic dentistry are swelling steadily and not just with tai-tais and celebrities. Regional tycoons and public relations officers, chief executives and yummy mummies alike are waking up to the fact that there seems to be a lot more riding on a dazzling smile these days.

In a recent study by researchers from London's King College, volunteers rated the same individuals less favourably when their photographs revealed visible tooth decay. Those with crowded or rotten teeth were perceived as being less smart, less popular and less well-adjusted. In comparison, those with whitened teeth were rated as more attractive and successful than normal.

Dental surgeon William Chong says perceptions are no different here in Singapore. 'A smile is the first thing you see in a person and right now our outward appearance is very important for our social life, our confidence and our psychological well-being. Many people desire to improve their looks not just for vanity but for a better life.'

Dr Chong, who has a special interest in cosmetic and implant dentistry, is chief executive officer of Pacific Healthcare Holdings, a healthcare group offering a range of services including specialist medical care, health profiling and ancillary services. Doctors in the group practice often work as a team to help patients look their best. As Dr Chong puts it: 'On the one hand there is the skin and the face, that's why patients go to a dermatologist and a plastic surgeon. On the other, there is the smile, which is an important part of the face. We complement the role of the dermatologist and plastic surgeon in creating that beautiful look.'

The first step towards deciding what a patient needs by way of a dental makeover is to identify the problem areas. Says Dr Chong: 'What I normally do is to go down a checklist. Is it a tooth problem, a gum problem or an underlying skeletal issue such as a jawbone problem? It is interlinked and these structures collectively play an important role in the support of the face.'

Teeth darken with age. In fact, most patients who are over 40 years old would have teeth that have darkened after years of absorbing stains. So in terms of basic cosmetic dentistry, tooth bleaching or whitening is one treatment option that would benefit those over 40.

Then there is the question of arrangement. According to Dr Chong, 80 per cent of patients will have some form of tooth irregularity. If it is minor, it can be managed with simple adjustments to the tooth structure.

More severe irregularities may mean exploring the use of braces that are usually worn for two years to be effective. Those who can't spare the time for braces and those with minor alignment issues typically opt for crowns, which are tooth-shaped caps placed over the teeth, or veneers, which are wafer-thin shells made from resin or porcelain that cover the front surface of the teeth.

The best approach combines two or in some cases three forms of treatment. Says Dr Chong: 'Tooth bleaching enhances the colour but it doesn't take care of the shape of the teeth or the alignment. We have to look at each case from a multi-pronged perspective in the sense that even if you wear braces, the braces will straighten your teeth but they won't address tooth colour. So in cases where patients have minor realignment issues and severe discoloration, we would do crowns so as to kill two birds with one stone.'

Dr Chong typically recommends crowns and veneers to better show off the more prominent upper teeth. With lower teeth, which are less noticeable, minor adjustments to alignment and whitening often suffice. While crowns and veneers may be getting more popular, the brave new frontier in cosmetic dentistry is implant dentistry and the related field of bone regeneration. In recent years, advances in implant technology have literally given a new lease of life to those suffering in silence because of the loss of their natural teeth.

Says Dr Chong: 'There are three groups of patients who see us for titanium tooth implants. Many of the older generation grew up with a fear of dentists and did not take care of their teeth when they were younger and lost them to decay or gum disease.

'Then there are those who grew up less privileged. When they become successful later in life they feel they are missing out because they don't have good teeth and they want their teeth back. The third category are those who have had accidents and lost their teeth and do not want to wear dentures or to have their teeth trimmed for a bridge to be fitted.'

In situations where a patient has good bone support, an implant can be done immediately. A more likely scenario, however, would involve bone loss as the jawbone typically recedes when teeth have been lost for years.

'That is nature's way. If there are no teeth, then there is no need for the bone or scaffold to support them and everything collapses,' says Dr Chong. 'In such cases, bone has to be regenerated through a combination of bone graft and the use of a special membrane that functions like a tent above the gum, protecting the site where the cells are producing new bone.'

The development of computer-aided design and computer-aided manufacturing for dental applications means that crowns can now be fabricated in two hours when it used to take seven days. What is even more remarkable is that dental surgeons can now combine CADCAM technology with implant technology to allow people who have damaged or lost their teeth through trauma or natural causes to get a new tooth on the same day. The possibilities are endless but what is it that induces people who have lived with less than perfect teeth for years to consider cosmetic dentistry?

Dr Chong says the impetus for treatment is often an important event in a patient's life like a child's wedding or a promotion to a senior management position. But there are also those who simply want better, more good-looking teeth so that they can live life to the fullest.

Says Dr Chong: 'I had a 70-year-old patient who walked in and asked for implants because she wanted to enjoy her food. And that is understandable because it is miserable to have the money and not be able to enjoy your abalone.'

Source: Business Times, 14 July 2006