What everyone should know before getting that smile straightened, whitened or veneered

Cosmetic dentistry procedures — teeth whitening and straightening, veneers, bonding — have become commonplace in the U.S. and, seemingly, mandatory in Southern California, where image enhancement is something akin to religion.

Here are four things to consider before you take the plunge.

1. Success starts with a blueprint

Edmond Hewlett, professor and associate dean for outreach and diversity at the UCLA School of Dentistry, says the best practitioners emphasize planning. "You really need to have a blueprint of what is going to be the best thing for any individual patient and not just what will make them the most attractive. The mouth is not a fashion accessory."

For patients who are getting veneers, for example, that planning should include models, photographs and, Hewlett says, "an extensive interview with the patient to understand what they are looking for, what's going to please them emotionally."

Dr. Jack Ringer, who practices general family and restorative dentistry in Anaheim and is a former president of the American Academy of Cosmetic Dentistry, also stresses extensive planning. For his patients who want veneers, he explains, "We do a computer simulation. We build a 3-D model so a patient can decide. Many dentists don't do that.”

Although the American Dental Assn. does not include cosmetic dentistry on its list of specializations, many dentists participate in training and continuing education in the field of "smile enhancement." In addition, about 5,500 of the 190,000-plus dentists nationwide are members of the AACD, which offers an accreditation process.

2. Take the time to understand the logistics and benefits of various treatments

Whitening is the most popular of the cosmetic dentistry procedures. Although many of us opt to whiten our teeth with over-the-counter products, in-office treatments (which typically involve a bleaching agent that is painted onto the teeth) have proved to be a boon for tens of thousands of practices — and patients. Follow-up treatments, Ringer says, depend, in part, on consumption (coffee, cigarettes, red wine) habits. "Typically, maintenance doesn't need to be done more than every six to 12 months," he adds.

Dental bonding, often used for chipped teeth, involves the use of a resin material that is applied to a tooth and hardened with a special LED light.

Porcelain veneers, the superstars of cosmetic dentistry, offer "the most conservative, long lasting and beautiful cosmetic therapy available — if designed and manufactured correctly," Ringer says. The procedure typically involves a thin piece of porcelain that is bonded to the enamel of a tooth, and many dentists employ professional ceramicists in their quest to achieve just the right look, which should be natural rather than perfect, Dr. Ringer says.

3. Ask about the cost of treatments (and possible follow-up treatments) before you take the plunge

According to Ringer, the average price for in-office bleaching ranges from $200 to $2,500, depending, in part, if the patient uses a take-home system provided by the dentist or has a series of in-office treatments.

The price of a veneer is typically $1,000 to $3,000 per tooth, he says, and the price of bonding "varies dramatically depending on how much a tooth is modified or bonded, but is probably in the range of $100 to $500 per tooth."

4. Don't forget about orthodontics

"One of the most under-discussed things is orthodontics," Hewlett says. "The color is one thing, but there is also the position of the teeth. As dentists we are obliged, when it's appropriate, to tell patients about orthodontics. Even if [the process takes] two years, two years is going to be here quickly."

The price of conventional orthodontics (with bands and wires) can range from about $5,000 to $7,000. Computer-generated trays such as Invisalign typically start at about $5,000. For patients with minor problems some dentists use a tray system that costs from $700 to $2,500.

Health@latimes.com

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