Michael Apa, DDS
Michael Apa, DDS, restorative and aesthetic dentist, the Rosenthal/Apa Group, New York City. Dr. Apa teaches aesthetic dentistry at the New York University College of Dentistry.
One of the funniest bits in the long-running TV show Friends was when the Ross character had his teeth bleached. Much to his horror he discovered his newly whitened teeth glowed in the dark. Of course it was a TV trick, but the joke was real, a comment on people’s excessive attempts to get blindingly bright smiles. Teeth whitening is now common, and today bright, natural-looking white smiles are available even for the mature mouth — but that is only one of the wonders of cosmetic dentistry. Techniques have become so sophisticated that properly trained dentists can transform the most difficult teeth into beautiful, healthy ones.
Michael Apa, DDS, does restorative and aesthetic dentistry in the Rosenthal/Apa Group practice in New York City and also teaches aesthetic dentistry at the New York University College of Dentistry. I asked him for an update on the field, starting with teeth bleaching. Though many people think bleaching makes teeth brittle, Dr. Apa says bleaching is completely safe — it works by breaking apart large-chained cellular molecules in enamel and dentin so that light is reflected rather than absorbed. This in turn gives an appearance of whiter teeth. “Bleaching doesn’t really whiten,” he explains. “It simply works with the physics of light.” To achieve the most effective whitening… that is, brightening… it is best to have bleaching done by a dentist, but drug-store strips can be quite effective. Dr. Apa likes Crest Whitestrips, saying they may make a difference after a few days of use. You can continue use as long as you wish without damaging your teeth. Though some people report sensitivity from bleaching, it varies patient-to-patient. If it’s a problem, Dr. Apa suggests using fluoride or sodium bicarbonate products — for example, Sensodyne toothpaste or any fluoride-based mouthwash.
At one time the gold standard for beautiful teeth was bonding, in which a plastic material gets applied to imperfections to correct chips, grooves and even discoloration of teeth. But Dr. Apa says that is yesterday’s news and material. He says problems can develop when the material shrinks or pulls away from teeth, allowing leaks and decay to set in. He does not advise bonding other than perhaps to repair a tiny chip in the tooth.
Veneers are porcelain laminates, attached with bonding agents, that serve to permanently sheath teeth to mask a host of imperfections such as teeth that are stained, too small or crooked, teeth that should have had orthodontia but didn’t, or teeth that relapsed after previous braces. Though veneers have been maligned in the past and with some reason, since they often required cutting down healthy teeth in order to fit properly, Dr. Apa says new techniques are much better. Skilled cosmetic dentists work with extremely thin veneers and, if the tooth is healthy, may not even have to drill at all to fit them on. Also, veneers used to result in perfectly symmetrical teeth, which looked fake. This, too, has been refined says Dr. Apa. Good cosmetic dentists today are trained to use trial and error, working like an artist, to create a natural look.
Veneers are not without a downside — or several. For one thing, the work may call for what is called a “gum lift,” where lasers are used to remove gum tissue to make the veneers fit properly. Veneers can be complex to apply, making it crucial to have them done by a highly qualified dentist. And they are quite expensive (running from $10,000 or more for several teeth). Once finished, though, Dr. Apa says veneers can be a “fountain of youth” for an older smile. They require two visits, typically, and will last 20 years on average.
Another major surge in cosmetic dentistry has been dental implants — these use titanium screws implanted into the bone under the gum to which a crown is attached. Dental implants are used to replace lost teeth or in cases where a crown won’t work because of bone loss or decay. An implant can take the place of one tooth, so there’s seldom any need today for multiple-tooth bridges — which is a distinct advantage, since these often require cutting down adjoining healthy teeth. Implants cost about the same as what you’d pay for a bridge and, if the bone is healthy, can sometimes be done in a single day (with a temporary crown) — though if bone needs to be packed around the implant, several months may need to elapse before the work gets finalized.
Braces are also part of the world of cosmetic dentistry. With modern orthodontic developments, these can be unobtrusive enough that even adults are comfortable wearing them. The first kind, called Invisalign, is a clear aligner that fits on the front and back of the teeth like a retainer. Best for minor corrections, such as overcrowded teeth, widely spaced teeth and crossbites, overbites and underbites, this device gets adjusted every two weeks by the dentist until the teeth are straight. Another new alternative is braces made of ceramic, rather than the metal brackets we wore back in the day. These can be perfectly shaded to match the color of your teeth so they’re barely noticeable. Also, it’s possible to have braces on the back of the teeth only (lingual braces), which can’t easily be seen either. However, this last is a tricky technique and requires the services of a specially trained orthodontist, with experience placing them.
Ads for cosmetic dental services are everywhere, but don’t be fooled into thinking that one is as good as another. Pardon the pun, but when it comes to perfecting your smile — word of mouth is the best place to start. For cosmetic dentistry, it’s also important to first review a doctor’s “before and after” photos. To find a cosmetic dentist, go to the American Academy of Cosmetic Dentistry’s Web site, www.aacd.com.