As an experienced cosmetic dentist, I’m rarely surprised when patients express disappointment with the results of bleaching. It’s not that bleach doesn’t work. When properly applied, high-quality bleaching agents, such as Opalescence by Ultradent, can produce a bright and natural whiteness - at least during the short term. But often people don’t realize they want much more. They want the smiles of movie stars, and tend to focus solely on color rather than looking at the complete smile. Perhaps this is because color is the most conspicuous component of a beautiful smile. It is harder to identify the role of shape, contour, and the harmony of teeth, in relationship to the lips and face. However, these elements are just as significant, and the totality produces an esthetic effect greater than the sum of the parts. Patients’ focus on color usually includes wishful thinking. They see bleaching as a less radical treatment than the alternatives.
To whiten teeth, dentists have three options: bleach, composite resin, or porcelain veneers. Unfortunately, patients tend to overrate bleach because it is the option with which they are most familiar. Also, much of the information they have on composite resin and veneers is either incomplete or incorrect. However, consider these treatments’ different impact on:
➡Color: Short-term effects are roughly comparable, and all three treatments can produce white teeth. For the long term, however, composite resin is superior to bleach, and porcelain is far superior to both. Since bleached teeth are otherwise normal, they stain at a normal rate. Hence, patients may need to repeat the treatment several times a year - or more - especially if they smoke, drink coffee, or if their teeth are predisposed to staining. Composite veneers, if properly finished and polished, can be more stain resistant than ordinary teeth but less so than porcelain. They tend to dull after a few years of brushing and wear. Porcelain will remain virtually stain-free and bright for the life of a veneer, about 15 years. Composites last three to five years. Note that pressed porcelain retains its color longer than the less dense feldspathic porcelain, which can shift in shade as the underlying tooth darkens with age.
➡Time and convenience: People can have dentists bleach their teeth, or use home treatments. The first method entails an office visit; the latter requires wearing bleach trays about two hours a day for at least two weeks, and sometimes even for months. In contrast, veneers require a certain amount of preparation - tooth reduction, impressions, temporaries, etc. Thus, the short-term impact on time and convenience may be more substantial. However, since teeth must be re-bleached on a regular basis, long-term bleaching may entail more hassle than the three- to five-year replacement period for composites - and certainly more than the 15 years for porcelain.
➡Cost: An in-office bleaching treatment costs about $600; a home treatment is less. The initial investment in veneers is much more. But this discrepancy is offset, at least somewhat, by the expenses (lost work time, cost of gas, etc.) associated with repeated bleaching during the approximate 15-year lifetime of a ceramic veneer.
Given the pros and cons, all three are viable options for whitening alone. But most patients are interested in a beautiful smile, not just whiter teeth. The problem is they confuse whiteness with beauty until they see the results of bleaching. Bleach generally works best on younger people with straight, “virgin” teeth that show little wear and tear. But if white teeth are crooked, too long or short, or chipped, they still can be unattractive. Patients tend to notice imperfections more after having their teeth bleached, and feel disappointed. Then they often seriously consider veneers.
A common misconception among new patients is they think veneers will be painful to put in, or that much of their original tooth structure will be removed. I tell patients that it is not only a painless procedure, but the amount of tooth structure removed is minimal compared to traditional full-coverage preparations. The end result is a beautiful, long-lasting, new smile, and not simply whiter teeth.
Before bleaching a patient’s teeth, I try to determine what he or she really wants. If bleach isn’t a viable option, I explain why. This can be tricky because I don’t want to pressure patients. But it’s just as important not to disappoint them if they have certain expectations. One helpful approach is to get a good laboratory, such as MicroDental, to design a wax-up of the prospective veneer-treated smile. This can be compared with a computer-whitened photograph of the existing teeth. Patients can then objectively compare each treatment’s probable results.
Dr. Christopher Pescatore lectures worldwide on topics such as state-of-the-art esthetic procedures, techniques, and materials. He holds a U.S. patent for a nonmetallic post system to restore endodontically treated teeth. He is the former clinical co-director and current featured speaker at the Las Vegas Institute for Advanced Dental Studies. He has a full-time practice in Danville, Calif., dedicated exclusively to esthetic dentistry. He can be reached at (925) 362-9330 or at [email protected].
