Various surveys report that when you meet someone for the first time, you notice their smile more than any other feature. This partly explains the huge interest in cosmetic dentistry in the past 10 years. Major advances in technology and techniques are the other side of the picture. With so much information available, deciphering this complex subject can be quite daunting, even for the average dentist. This article will help to clarify the subject by explaining the pros and cons of each option, so you can make an informed and intelligent decision about which option is best for you.

Cosmetic dentistry is often equated with porcelain veneers, perhaps due to the success of the extreme makeover shows. Veneers are a great option, but are by no means the only option. Cosmetic dentistry includes whitening, orthodontics (braces), dental implants, oral surgery, gum lifts, tooth colored fillings, and even a new set of dentures. And depending which type of dentist you go to, you may only be offered one or two of these options.

Let's examine the following analogy: suppose you have a sore joint. If you go to an orthopedic surgeon, most likely surgery will be recommended. A chiropractor might suggest adjustments, a physical therapist would try physical therapy and exercises, a nutritionist might recommend glucosamine, and a pharmacist would recommend Advil or Aleve. All are appropriate treatments for sore joints, but not all would be appropriate for every patient. In fact, the best treatment might be a combination of several different modalities.

Now suppose you have a smile which needs improvement. A general dentist might recommend whitening and/or bonding, a cosmetic dentist will often recommend veneers, an orthodontist would certainly consider braces, and a surgeon or gum specialist may yet offer more solutions. And like the analogy, the best treatment may be a combination of several different approaches.

So let's review the options available in the field of cosmetic dentistry and for each provide an idea of the risks, benefits, cost, and time involved.

WHITENING

Tooth whitening, sometimes referred to as bleaching, has been around for decades. The active ingredient in virtually all systems is some form of hydrogen peroxide, which has been shown to be completely safe for teeth and perhaps even beneficial to the gums. The major drawbacks to whitening are sensitivity and unpredictability. The major advantage is low cost. Various "whitening strips" can be purchased over the counter for around $40. They work well for light staining on otherwise normal, healthy teeth. Stock bleaching trays purchased over the Internet provide about the same level of whitening, but perhaps with more sensitivity.

Custom bleaching trays provided by a dentist provide even better results, if you are willing to wear them every night for a few weeks. One-hour bleaching in a dental office or spa does the same or better job very quickly, but may also result in some short-lived sensitivity. The cost of in-office bleaching ranges from $400-$1,000, but the results are still variable. Some patients experience amazing results from these methods, while others are disappointed. For people with normal healthy teeth that would like predictable results, a system known as "Deep Bleaching" developed by dentist Rod Kurthy will deliver predictable results, even in deeply stained teeth. This system is a combination of in-office sessions and specialized take-home trays that gives amazing results every time.

The cost of deep bleaching ranges from $1,200-$1,800, and there is very little or no sensitivity with this system. However, if your teeth have other issues in addition to color, then you will probably be looking at "permanent whitening", also known as porcelain veneers.