Fluoride, flossing and better brushing techniques have emptied dentists' chairs. But Americans' quest for a whiter, more perfect smile is filling them up again.
People are spending large amounts of money on better-looking, but not necessarily healthier teeth. The most sought-after procedure by far is bleaching; dentists are also bonding ultra-thin veneers to teeth to hide stains and chips, replacing silver amalgam fillings with white porcelain ones, and installing porcelain crowns that look more real -- and more perfect -- than the teeth they cover.
"We've been doing cosmetic dentistry for years, but the public is just discovering it," says Dr. Larry Rosenthal, a New York dentist whose high-profile patients include Kathie Lee Gifford, Michael Bolton and Donald Trump.
"People have become tooth- obsessed."
When Baltimorean Christine Glazer turned 50 she decided to give herself a birthday present: four beautiful bottom teeth. At around $400 a tooth, it was extravagant, she admits, but worth every penny.
"I smile again," she says, "And people comment on that."
Glazer's first trip to a cosmetic dentist was to repair chips in two top front teeth that formed an inverted V, the result of an accident. Porcelain laminates -- thin veneers cemented to the teeth -- were a relatively painless and noninvasive solution. The total cost of her dental work was around $3,200.
"I found myself putting my hand in front of my mouth when I smiled," she says. "That's when I decided to have them fixed. The top looked so good I decided to have the work done on the bottom."
Cosmetic dentistry is just one facet of the current interest in personal appearance, fitness and looking young, particularly among aging baby boomers. Whiter, more perfect teeth aren't just beautiful teeth. They are younger-looking teeth.
"It's a youth-driven society," says Dr. Steven Haywood, a Lutherville cosmetic dentist. "Forty to 55 are prime earning years, but teeth can look old then, particularly with outdated dentistry."
When the American Academy of Cosmetic Dentistry was founded 15 years ago, it had 60 members. That number has exploded to more than 4,000. And an increasing number of dentists, even if they aren't members of the AACD, are doing less drilling and more cosmetic work on their patients' teeth. It makes good business sense for dentists to turn to aesthetic work as tooth decay and gum disease become less pervasive, but that isn't the only reason.
"Cosmetic dentistry is very rewarding psychologically," says Dr. Charles Fine of Owings Mills, who describes himself as "a true general dentist who started doing cosmetic dentistry very early on." About 60 percent of his practice is now cosmetic, he estimates, if you count patients who ask for the more costly white porcelain fillings even on back teeth.
"In the past, people hated going to the dentist," Fine says. "Now they leave with something they're happy with, and it's almost painless."
It's not, however, cheap. Dental insurance doesn't cover the cost of dentistry for purely aesthetic reasons. The fact that more Americans have the money these days to spend on the perfect smile is an important reason why cosmetic dentistry has become a booming business.
It cost Chester Stump of York, Pa., almost $10,000 to have 14 teeth beautified with porcelain veneers and crowns. And while he was at it, the 73-year-old went a shade or two whiter.
Stump, a retired plant superintendent, says he isn't wealthy. "Through the years I just wasn't satisfied with the alignment of my teeth."
His porcelain crowns -- caps that fit over teeth that have been ground down by about a third -- are realistically translucent and don't have the tell-tale dark line of metal at the gum line. (Crowns no longer resemble white Chiclets if the work is done by a competent dentist.)
New technology and materials have made possible pearly whites that look remarkably natural. That, too, has fueled the public's interest in aesthetic dentistry. Lasers can be used to activate bleach so that the whitening process takes only one visit to the dentist's office, or they can be used to "sculpt" gum away to create a less gummy smile. New bonding mmaterials, resins and veneers create whiter-looking teeth and fill in gaps, requiring less cutting down of healthy teeth in the process than crowns do.
Behind every successful cosmetic dentist is a great ceramist -- someone who is both a lab technician and an artist. This is the person who creates the veneer or porcelain crown that fits so well and looks so realistic.
Dr. Ronald Goldstein, an Atlanta-based dentist who wrote the first textbook on cosmetic dentistry, has his own lab. "Our chief ceramist makes more money than any dentist in the office," he says.
"When it comes to aesthetic dentistry and brain surgery," he adds. "Don't look for bargains."
Bargains, however, are what many of us are looking for. If all you want is whiter, brighter teeth and are willing to spend time rather than money to achieve them, you probably won't need a specialist. Start with your own dentist. (The American Dental Association doesn't recommend using any over-the-counter whiteners except toothpastes. They could damage gums and tooth enamel.)
"Whitening is the most frequently brought up dental topic in my practice," says Dr. Gordon Shelton, a general dentist in Towson. "Nothing else even comes close."
Bleaching can be done by the dentist in his office, but what's known as "nightguard" bleaching is less expensive. The patient does the whitening himself. Shelton's fees and procedures are fairly typical for dentists in this area: For a flat rate of $328, he provides custom-fitted molds that hold the bleaching gel. The patient wears them for 4 hours at a time. (They can be worn during sleep for convenience, but Shelton says that after 4 hours the gel is no longer effective). Maximum whiteness is reached after 45 to 60 hours. To maintain the shade you want, Shelton recommends rebleaching the teeth once a month.
Whitening, however, is sometimes only what Haywood calls "an entry level concern."
"Patients sometimes don't know what else to ask for," he says. "That starts the discussion. There's so much available now to create an almost perfect smile."
Chew on this awhile
If you're considering cosmetic dental work, here are some tips for ending up with that perfect smile:
* Start with your own dentist, if only to ask for a referral.
* Do your research. If you want to know more about tooth whitening, the American Dental Association has lots of information on its Web site (www.ada.org).
* Call the American Academy of Cosmetic Dentistry at 800-543-9220 or visit the organization's Web site at www.aacd.com for more information about procedures and to find members in this area.
* Keep in mind that good cosmetic work is done by dentists who aren't members of the AACD.
* When you find a dentist, pay for a consultation. Get a second opinion if necessary.
* Ask for before-and-after pictures of procedures similar to the ones you're interested in.
* Many cosmetic dentists have access to computer imaging equipment to show what you'll look like if you have alternate treatments.
* Find out upfront what the cost will be. You may have to pay in advance.