Healthy aesthetics

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  Posted by: Dental Design      12th May 2024

Patients seeking cosmetic dental treatment may do so simply to improve their appearance, and dental professionals will recommend treatments within an ethical framework. Clinicians prioritise function, and the informed consent and participation of patients in any given treatment. Awareness of possible risk factors is a vital factor in helping patients to understand why a preferred treatment may not be recommended for them.[i]

Cosmetic dentistry is the art of improving the appearance of teeth, and/or gums, while maintaining and protecting oral health. Practitioners employ a number of approaches, depending on the nature of the problem, but these can include peroxide-based whitening, cosmetic bonding, adult orthodontics, veneers, gingival contouring and implants.

Research has shown that poor dental aesthetics can have a severe impact on people’s mental health as well as job prospects.[ii] Abnormalities in tooth colour, or problems like pitting, chipping or malalignment can have a significant effect on oral health-related quality of life (OHRQoL), especially if the anterior teeth are affected.[iii] For these reasons, more and more patients are seeking improvements to the aesthetics of their teeth.[iv]

Starting simple

Offering one of the least invasive cosmetic solutions, tooth whitening has become a popular cosmetic treatment in the UK and can be used to treat both extrinsic and intrinsic defects. Extrinsic dental discolouration results from the accumulation of chromogens – a family of compounds that change colour in response to stimuli – on the outer layer of enamel or the salivary pellicle that covers teeth.[v] Intrinsic discolouration happens when chromogenic material stains the internal structure of either the dentine or enamel.[vi] In the developing tooth, exposure to high levels of fluoride, tetracycline or some other drugs, inherited developmental disorders and trauma may result in pre-eruptive discolouration.[vii] Once teeth have erupted, most intrinsic discolouration can be attributed to factors like pulp necrosis and the effects of medications or illness. [viii]

There are many in-office and over-the-counter products on the market that can treat both intrinsic and extrinsic staining with varying degrees of success, however, due to potential damage that some solutions can pose, home treatment is not recommended.[ix] For mild staining, good oral care with regular brushing and interdental cleaning is recommended, and moderate stains may be treated with a good scale and polish.[x]

The efficacy of light accelerated whitening (LAW) has been debated for decades, but recent studies shows that blue light can accelerate whitening, within the limits of an in-vitro model. The findings show that LAW accelerates the bleaching process, and that it attacks more stain compounds than peroxide alone does.[xi]

Teeth whitening products may not be a suitable treatment for many patients, and any underlying conditions like periodontal disease should be treated before treatment is considered.[xii] Hydrogen peroxide is a key ingredient in bleaching products, which in high concentrations can cause enamel softening, surface roughness, and can lead to demineralisation.[xiii] If patients have any restorations, they may be advised not to seek bleaching treatments due to the greater chance of restored teeth becoming sensitive.[xiv]

Alternative treatment options

A number of treatments with varying degrees of invasiveness may be appropriate for patients seeking improved aesthetics, from aligners to treat mild malocclusion, to implants to treat edentulism.

Porcelain veneers can be offered in the treatment of many conditions affecting dental aesthetics. Minimal-prep veneers are a conservative and effective treatment for diastemas, misaligned teeth, worn dentition, chipped and pitted teeth, as well as excessively discoloured teeth.[xv]

Treatment with veneers can be effective, but clinicians must manage the expectations of patients as it’s not always a quick fix. Patients with a bruxism habit, edge-to-edge relation, insufficient enamel, or with poor oral hygiene may not be suitable, or will require intervention before cosmetic treatment.[xvi]

Dental crowns are an increasingly predictable treatment for the restoration of a smile, and technology around materials has evolved in recent years to better replicate the true colour, translucency and shape of natural teeth. For example, treatments like 5-mol% yttria partially stabilised zirconia (5Y-PSZ) are more robust than porcelain.[xvii] Crowns are a more invasive and expensive treatment that veneers, but may be more appropriate treatment for complex cases.

Visualising treatment

 Three-dimensional simulations allow clinicians to explain more easily how each dental procedure influences further treatments.[xviii] Helping patients to visualise procedures is useful in demonstrating the effects of different treatment approaches, enabling a collaborative strategy.[xix]

 Chairsyde – a state-of-the-art patient consultation platform – enables clinicians to demonstrate different treatment procedures clearly using a comprehensive portfolio of patient-friendly animations. Illustrating the risks and benefits of different treatment options, it enables patients to participate fully in decision-making, improving case-acceptance. In addition, post-consultation summaries can immediately be sent to patients with animations explaining agreed treatments for reference.

Patients can experience a great deal of stress due to conditions affecting the visual appearance of their teeth. Clinicians strive to offer patients solutions that promote the best conditions for oral health as well as improving aesthetics. An approach that helps patients understand and collaborate in recommended treatment is an excellent way of building trust, and helps them achieve a beautiful smile that lasts.


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[i] Hajjaji S, Karray S, Hajjemi H, Boughzela A, Hached F. Ethical Considerations in Cosmetic Dentistry. International Journal of Scientific Engineering and Science. Volume 5, Issue 10, pp. 67-70, 2021

[ii] Campos LA, Costa MA, Bonafé FSS, Marôco J, Campos JADB. Psychosocial impact of dental aesthetics on dental patients. Int Dent J. 2020 Oct;70(5):321-327. English. doi: 10.1111/idj.12574. Epub 2020 May 31. PMID: 32476147; PMCID: PMC9379174.

[iii] Goettems ML, dos Santos Fernandez M, Donassollo TA, Donassollo SH, Demarco FF. Impact of tooth bleaching on oral health-related quality of life in adults: A triple-blind randomised clinical trial. Journal of Dentistry, Volume 105, 2021

[iv] Millennials spend three times national average on dental treatment. Available at:,42%25)%20opting%20for%20it. Accessed March 2024

[v] Alammari ST, Al Rubaie FM, Shukr BS. Chromogenic Black Dental Staining in Children: A Case Report. Cureus. 2024 Jan 9;16(1):e51984. doi: 10.7759/cureus.51984. PMID: 38344489; PMCID: PMC10853677.

[vi] Alyson Wray and Richard Welbury. Treatment Of Intrinsic Discolouration In Permanent Anterior Teeth In Children And Adolescents. Royal College of Surgeons. Available at: Accessed March 2024

[vii] Gbadebo SO, Ajayi DM. Self Reported Tooth Discolourations Among Patients Seen At Dental Center University College Hospital Ibadan. J West Afr Coll Surg. 2015 Jul-Sep;5(3):66-77. PMID: 27830134; PMCID: PMC5036264.

[viii] Ibiyemi O, Taiwo JO. Psychosocial aspect of anterior tooth discolouration among adolescents in igbo-ora, southwestern Nigeria. Ann Ib Postgrad Med. 2011 Dec;9(2):94-9. PMID: 25161491; PMCID: PMC4111029.

[ix] NHS. Teeth Whitening. Available at: Accessed March 2024.

[x] Setien VJ, Roshan S, Nelson PW. Clinical management of discolored teeth. Gen Dent. 2008 May;56(3):294-300; quiz 301-4. PMID: 19288841.

[xi] Gottenbos B, de Witz C, Heintzmann S, Born M, Hötzl S. Insights into blue light accelerated tooth whitening. Heliyon. 2021 Feb 10;7(2):e05913. doi: 10.1016/j.heliyon.2021.e05913. PMID: 33615002; PMCID: PMC7881219.

[xii] NHS. Teeth Whitening. Available at: Accessed March 2024.

[xiii] Carey CM. Tooth whitening: what we now know. J Evid Based Dent Pract. 2014 Jun;14 Suppl:70-6. doi: 10.1016/j.jebdp.2014.02.006. Epub 2014 Feb 13. PMID: 24929591; PMCID: PMC4058574.

[xiv] Carey CM. Tooth whitening: what we now know. J Evid Based Dent Pract. 2014 Jun;14 Suppl:70-6. doi: 10.1016/j.jebdp.2014.02.006. Epub 2014 Feb 13. PMID: 24929591; PMCID: PMC4058574.

[xv] Kamble VD, Parkhedkar RD. Esthetic rehabilitation of discolored anterior teeth with porcelain veneers. Contemp Clin Dent. 2013 Jan;4(1):124-6. doi: 10.4103/0976-237X.111635. PMID: 23853471; PMCID: PMC3703685.

[xvi] Alothman Y, Bamasoud MS. The Success of Dental Veneers According To Preparation Design and Material Type. Open Access Maced J Med Sci. 2018 Dec 14;6(12):2402-2408. doi: 10.3889/oamjms.2018.353. PMID: 30607201; PMCID: PMC6311473.

[xvii] Jung JM, Kim GN, Koh YH, Kim HE. Manufacturing and Characterization of Dental Crowns Made of 5-mol% Yttria Stabilized Zirconia by Digital Light Processing. Materials (Basel). 2023 Feb 9;16(4):1447. doi: 10.3390/ma16041447. PMID: 36837076; PMCID: PMC9963883.

[xviii] Coachman C, Blatz MB, Bohner L, Sesma N. Dental software classification and dento-facial interdisciplinary planning platform. J Esthet Restor Dent. 2021 Jan;33(1):99-106. doi: 10.1111/jerd.12713. Epub 2021 Jan 20. PMID: 33470496.

[xix] Jafri Z, Ahmad N, Sawai M, Sultan N, Bhardwaj A. Digital Smile Design-An innovative tool in aesthetic dentistry. J Oral Biol Craniofac Res. 2020 Apr-Jun;10(2):194-198. doi: 10.1016/j.jobcr.2020.04.010. Epub 2020 Apr 18. PMID: 32373450; PMCID: PMC7193250.

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