That perfect smile

Part of a healthy lifestyle that we have been discussing all along in this column the past two decades is the maintenance of proper dental care. Today, more than ever, people who are cosmetic-conscious are taking advantage of the “miracles” of dental veneers.

What are dental veneers?
Dental veneers are very thin pieces of custom designed porcelain, or plastic teeth laminates or “jackets or shells” (very precisely tailored to match individual patient’s needs) that are glued over “honed-down and prepared” teeth, often an alternative to crowns. Sometimes, only the front of the tooth needs porcelain laminates for a cosmetic look. The resultant naturally looking, well-aligned, whiter, more evenly-spaced teeth provide for that much sought-after cosmetically perfect smile. Dental veneers are most popular among people of all walks of life and profession who are aesthetic-conscious, and not only among actors and actresses and other public performers. Dental veneers are made of either very thin porcelain (more expensive but has greater longevity, 10-15 years or more) or plastic or composite (cheaper and lasts 5-7 years).

Who are candidates for dental veneers?
Dental veneers are cure for crooked, odd, or misshapen (too big or too small) teeth, chipped teeth or those with pits or holes, severely discolored enamels, or for uneven or unwanted spaces. Not everyone is a candidate for dental veneer. If confused, get a second opinion, to avoid regrets later for not having it done or for having it done.

What causes dental discoloration?
The discoloration of the teeth enamel can be due to chemical damage, staining or aging. Common causes are medications (tetracycline, etc.), cigarettes, coffee, tea, cola drinks, red wine, and “dark” foods. Genetics also plays a role. Some people are born with darker enamel and others with brighter teeth.

How are the teeth prepared?
After detailed inspection and evaluation, the cosmetic dentist will discuss the plan and the actual procedure with the patient. Whether only one tooth or two, or both the upper and lower front sets, are involved, it usually takes about 2 to 3 visits to complete the office procedure. After the patient understands and agrees, a dental mould (an impression of the patient’s teeth) is taken.  This will create a 3-dimentional replica of the patient’s complete upper and lower sets of teeth and gums, representing the status of the teeth pre-veneer implants.

Topical anesthesia is then applied with a cotton swab over the areas of the gums to be anesthetized. This numbs those areas in a minute or two. Injection with lidocaine anesthetic agent into the appropriate gum area involved is subsequently performed using a very skinny 30-gauge needle to properly render the teeth involved totally pain-free when manipulated or drilled, or even extracted (if necessary).  The problem teeth are buffed, honed down, and reduced in size to accommodate the veneer jacket over the teeth, maintaining the original over-all size and natural bite of the original teeth. After the reduction/preparation of the teeth, another impression mold is taken, which will be used in custom designing and creation of the permanent veneer.

What are temporary veneers and metal casings?
After the preparation and the second mold (which is the impression of the honed-down teeth), a temporary set of veneers made of plastic is made and available in about 4-6 hours. The patient comes back that same afternoon for the temporary veneers, which is to be worn over the prepared teeth while waiting for the creation of the permanent veneers. The subsequent implantation many times includes a Talladium metal casing that is placed and glued over each honed-down tooth. Over this metal shell, the wafer-thin porcelain veneer (which will have the appearance of the final tooth) is glued (using glass ionnmerluting cement) and capped onto it like a deep hat, completely hiding the metal. This Talladium component provides added strength and durability to the veneered tooth. The perfect fit will maintain the normal bite and normal dental comfort of the individual.

How long do veneers last?
The veneers are strong and durable, and if properly cared for, they could last up to 10 to 15 years. They cost less than crowns, won’t stain, and come in various shades of colors that will brighten dark teeth and will not change or fade. Porcelain veneers cannot stand excessive forces or sharp impacts. Biting on hard objects, like hair pins, fingernails, battle caps, bones, or any other hard items, are to be avoided because this could crack or dislodge veneers. Those into sports must wear a protective mouth guard. Those who clench and grind their teeth (termed “brux”) must control this habit of bruxism. A plastic night guard for the teeth can be worn to protect the porcelain veneer from breaking during sleep.

What are the color choices?
The usual goal is to have whiter teeth, if discoloration is the reason for the veneer. If only one or two teeth are involved, the color of the veneer should obviously match the color of the other teeth. If both the front upper and lower sets are to have veneers, the choice depends on the complexion of the person, hair color, eye color and the color of your natural teeth. The idea is to have the brightest and yet naturally-looking teeth, and not fake or artificial looking super white teeth. The orthodontist has a shade chart (Vita Shade Guide) for patients to choose from. The veneer will be made to the final color of choice. Your orthodontist can help guide you in making the right choice to enhance your personality.

How are they attached to the natural teeth?
The permanent veneers are tried on, usually with water or glycerin on the teeth to ascertain a perfect fit and shade and color. If they feel comfortable and right, the teeth are then cleansed with chemicals to achieve a durable bond. The glue is applied and the veneers placed over, and glued to, the teeth. A light beam is used to harden the glue cement. This permanently bonds the veneers to the teeth.

What are the pros and cons of veneers?
The veneers are the easiest way to a perfect smile and a friendlier appearance. They don’t stain or change color. They could be implanted within 2 to 3 office visits, usually about an hour and a half each. They durable and could last from 10-15 years. Except for the usual dental care (brushing, flossing), they do not need additional maintenance. The downside is that although veneers are impressive facsimiles of natural teeth, they are not perfect replacement for natural teeth.   A portion has to be “shaved off.”  The cost per tooth is not cheap, especially the porcelain veneers. It takes about two weeks or so to adjust and get used to teeth which have been changed in size, shape, spacing and color. The porcelain veneers can break when subjected to excessive force or impact. The advantages and disadvantages of dental veneer, and whether one is a good candidate for it, are important matters that the person should discuss in detail with his/her orthodontist.
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: scalpelpen@gmail.com

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Dr. Philip S. Chua
Dr. Philip S. Chua

Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States.

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