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Make Over Your Smile

The best cosmetic fixes to freshen up teeth and gums — and what you get for your money

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Wrinkles aren’t the thing that give away our age. Decades of downing stain-causing food and drink, stress-induced grinding and, yes, less-than-stellar dental hygiene habits can really make themselves visible at a certain point. If you’ve been tossing around the idea of (finally) tinkering with those lackluster ivories, consider this: A study reported in the British Dental Journal revealed that people with nice teeth are viewed as being more friendly or trustworthy, happy and self-confident than those with subpar choppers. Another study, this one conducted by Kelton Research — involving simulated job interviews, before and after whitening treatments — found that people were more likely to be hired when they had whiter teeth. And yes, there’s the superficial: Research conducted by the American Academy of Cosmetic Dentistry showed that people are most likely to underestimate the age of a person if he or she is smiling. (Let’s face it, we’re a lot more likely to beam when our teeth look good, right?) Read on and learn just how easy it is to get your own million-dollar grin and all the good stuff that comes with it. 

Bleaching Options

Our hair may get whiter as we age, but our teeth are a different story. Over time, the outer layer of enamel thins, allowing the yellowy dentin (the tissue that comprises the inner structure of the tooth) to show through. Certain foods and drinks can also stain the surface of your teeth (coffee, tea, wine, cola, blueberries are common culprits), as can smoking. Here’s how to get the bright back.

Whitening strips

Tooth-whitening strips are small pieces of flexible plastic coated with a thin layer of gel that contains peroxide. Each strip is pressed against the surface of the teeth, allowing the bleach to seep into the enamel to lighten the color and lift stains.

Pros: Though whitening strips don’t employ as high a concentration of peroxide as other whitening methods (read: trays, lights and lasers), they can deliver decent results (figure on a shade or two lighter) for people whose teeth aren’t too badly stained for a fraction of the cost of in-office treatments. They’re also no fuss, no muss — since you just press the strips on your choppers and go — and convenient: You wear them daily, for about 30 minutes to an hour, over a period of two to three weeks. Results last for up to four months. “Crest Whitestrips, which are easily found at the drugstore, have been found to be safe and effective,” says Kimberly Wright, a dentist at Advance Dental Arts Center in West Linn, Ore. But before bleaching, have your dentist clear you for the procedure. “Cavities or broken teeth may be extremely sensitive to bleach,” says Wright. “They would need to be repaired before starting.”

Cons: “Unless your teeth are perfectly straight, it can be difficult to get the strip to lay close enough to make contact with the entire tooth surface — particularly in between the teeth — which can lead to uneven results,” says Wright. And keep in mind: Whitening products will work only on “natural” teeth; they won’t change the color of crowns, bridges, or veneers. What’s more, whitening can’t work miracles. If you’ve lost a significant amount of surface enamel, veneers may be a better choice. Other types of discoloration that are difficult to tackle with whitening alone: grayish teeth, caused by the antibiotic tetracycline (sometimes given to children whose teeth are still developing) and some antihistamines, or high levels of fluoride in drinking water.

Cost: Kits can cost $25–$65.

Tip: “The best time to use any over-the-counter (OTC) product, strips included, is right after you’ve had a professional cleaning,” says Wright. “The less residue on the surface of your teeth applying the whitening strip, the better the results.”

Whitening trays

Whitening (or bleaching) trays are made of flexible material that fits around your teeth to whiten on the surface and in between your teeth. They’re usually prefilled with a peroxide-based whitening gel, or come with syringes of whitening gel that can be dispensed as needed. You can purchase dispensable trays over the counter or be fit with a customized take-home tray at your dentist’s office. They'll also supply refills of bleach to take home; when you come in for a cleaning, you can get a few more tubes for touch-ups.

Pros: Bottom line is that either type of tray will do the job. But a customized “tray and gel” treatment from your dentist will probably contain higher percentages of bleach than over-the-counter kits, delivering faster results. As with strips, it’s all about getting good contact with the teeth, says Wright: “Custom-made trays fit snugly, so the gel seeps into every nook and cranny, for the most even results possible.” A close fit also minimizes the amount of bleach that can dribble onto (and potentially irritate) your gums, while preventing saliva from coming into contact with the bleaching agent, which can dilute its strength.

Basically, though, “It all comes down to what fits into your lifestyle,” notes Betsy Bakeman, a Grand Rapids, Mich.-based dentist and president-elect of the American Academy of Cosmetic Dentistry, who’s a fan of prefilled disposable OTC trays for traveling. She suggests Opalescence Go, which has whitening gel in prefilled trays, worn for about 15-20 minutes a day for five to 10 days. It contains potassium nitrate to reduce sensitivity, plus fluoride to help strengthen enamel. (Ten trays cost about $63.)

Cons: “The gel is sticky and gooey, which can be a turnoff for some people,” says Wright. Store-bought trays come with a few caveats. There’s a limit to the percentage of peroxide that’s sold over the counter, so you’ll probably need to bleach longer than you would if you had a professionally made tray with a higher percentage of bleach. (Figure on about an hour or two a day, for five to 10 days, depending on the degree of whiteness you’re aiming for.) What’s more, with a one-size-fits-all tray there’s more of a chance that gel will get on your gums and possibly irritate the tissue, though it typically heals over a few days. “A dentist can trim the trays that she or he dispenses,” says Wright, “so there’s less of a chance the bleach will come in contact with the gums.”

Cost: OTC kits can range from $100 and up; in-office kits about $200–$600.

Tip: If you prefer to wear a tray overnight, as you doze, try a product that contains lower-strength carbamide peroxide (10 percent to 16 percent). “Carbamide peroxide, which gradually breaks down into hydrogen peroxide, releases about half of its whitening power in the first two hours, then remains active for up to six additional hours,” says Wright. “Some people experience less sensitivity, because it’s a slower process.”  

Bleaching lasers

With this high-tech in-office procedure, a peroxide-based gel is brushed onto each tooth, then it’s hit with light from a laser, which activates the bleach.

Pros: Most dentists use a gel with higher concentrations of peroxide (about 35 to 40 percent), which delivers dramatic results in a faster time (a single two-hour visit to a couple 30- to 60-minute visits spaced one to two weeks apart). The dazzle lasts about as long as a dentist-dispensed tray, from six months to a few years.

Cons: This is not for the financially faint-of-heart, and, frankly, some dentists question whether the hefty price tag is worth it. The fact is, it’s not the high-tech gizmos that deliver the amazing results. The whitening is simply the result of using a much stronger concentration of hydrogen peroxide, which bleaches teeth more intensely, more quickly. “The results won’t last longer than those of an at-home bleach — you’ll just get there faster,” says Wright: “If you think you can be compliant and put forth the time and effort to bleach with a tray at home, you’ll get the same great results.” What’s more, using a bleach in such high concentrations increases the chance of sensitivity. “As we age, the nerves in our teeth actually recede, making teeth less sensitive, so people over 55 can probably tolerate a high concentration of bleach with little or no tooth sensitivity,” says Wright. But, she notes, if the bleach gets on your gums it will burn the tissue (this typically heals after a few days).

Cost: $1,000 and up

Tip: If you're prone to sensitivity, rub a dab of sensitivity toothpaste, such as Sensodyne, over teeth and gums afterward to dim the temporary discomfort, says Bakeman.


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Dentist comparing tooth shade to patient's teeth

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Cosmetic Cover-Ups for Teeth

These in-office procedures can fix a laundry list of complaints: chipped or crooked choppers, spaces between teeth — and, in the case of veneers, an all-over lackluster smile.

Bonding

How it works: A dense tooth-colored resin, matched to the color of your teeth, is applied to the teeth, molded into shape, and then hardened with a special light.

Pros: Sound easy? It is. Bonding can be done in just one appointment, requires minimal preparation of the teeth, and is painless. And though it corrects the same imperfections as porcelain veneers, bonding is easier on your wallet.  

Cons: Bonding may last up to 10 years before it needs to be repaired, but typically has a shorter lifespan, depending on the patient. The resin material isn’t as sturdy as your natural teeth (or veneers, for that matter), which can be bad news if you’re a grinder, or like to chomp on ice or nibble on pencils. “Though bonding material holds its color well, it can become discolored and lose its sheen over time,” says Bakeman. What’s more, the resin used in bonding is nonporous and won’t whiten as easily as natural enamel does, so get your teeth whitened before the procedure.

Cost: $300 to $1,200 per tooth                                                                                                                         

Tip: Try to avoid the same foods and beverages that caused discoloration before the treatment (common culprits: coffee, tea, berries, soy sauce), or be diligent about brushing after indulging.

Veneers

Porcelain veneers (or laminates) are super-thin shells of tooth-colored porcelain that are attached and cemented over the surface of the front teeth, changing their color, shape, size, or length. “Unlike bonding, which is put directly onto the tooth, porcelain is fabricated outside of the mouth,” says Bakeman.

Pros: Veneers can be made as white as you’d like, making them a permanent alternative to bleaching, and they won’t lose their color or luster, or stain over time. They’re also durable and hold up with normal wear and tear, which is good news for habitual grinders. Once they’re in place, they’ll be there for many years down the road.

Cons: The process is more labor-intensive than bonding and usually takes at least two trips to the dentist. A small amount of enamel may be removed from the surface of your teeth to make room for the veneer. After an impression is made, it’s sent to a dental lab, which will construct the veneers, usually in a few weeks (temporary veneers can be worn while you’re waiting). Hopefully, you’ll love your veneers, because the process is usually irreversible. If the porcelain chips for cracks, the veneer will most likely have to be replaced. And then there’s the cost (read on). Lastly, not everyone is a good candidate for veneers. “If you don’t have sound structure, crowns may be a better alternative,” says Bakeman.

Cost: Generally, they range from $1,000 to $3,000 per tooth, but they usually last a good long time (10 to 15 years and often longer).

Tip: Your choppers may look perfect afterward, but don’t be deceived — you can still get cavities and decay. So don’t skip those checkups.

And Don't Forget: Gums

Nice teeth aren’t the only way to transform your smile. “The gums are the framework for our teeth,” says Bakeman. “And when the gum tissue is exactly where it should be, it makes everything so much more beautiful.”

Gum reshaping 

When your gum tissue comes down too far (can you say “gummy smile”?), it can make teeth look short, square and squat. Gum reshaping or sculpting, also called crown lengthening, is the most commonly done procedure to trim away excess gum tissue. Another possible option: Would you believe, Botox? “Some people simply have what we call a ‘hypermobile lip,’ ” says Wright. “We inject a small amount of Botox into the tiny muscles on either side of the nose, near the nostrils, that lift your lip way up when you smile. You’ll still be able to grin — you’ll just show less gum.”

Pros: Gum sculpting can be done in just one visit, taking anywhere from 30 minutes to a couple hours, depending on how many teeth are involved. A local anesthesia will be administered to keep pain to a minimum. The benefits of Botox: It’s minimally invasive, not to mention convenient (a few quick pricks and you’re done), with a somewhat reasonable price.

Cons: “In many cases, you’re not only removing the gum tissue, but underlying bone as well, to prevent the tissue from growing back,” says Wright. “This is a more complicated procedure that may require incisions, and sutures.” You’ll experience some tenderness — similar to the sting you feel after brushing your teeth too hard — for a few days. Numbing the area with an icepack or popping an ibuprofen can help manage the pain. The gum tissue will look reasonably pink and healthy in a week, but it will take up to three months for the gums to fully heal. Botox injections are easier-going, but need to be repeated every four to six months.

Cost: Reshaping costs range from about $600 to $1,200 per tooth, though some dentists may lower the price per tooth if multiple teeth are being treated. (Since it’s a cosmetic procedure, your insurance is unlikely to cover it.) Botox? Between $300 and $500 a treatment.

Tip: Until your gums have healed, stick to friendly foods — such as eggs, yogurt and pasta — that won’t irritate.  

Grafting

A receding gumline is pretty common as we age (thus the phrase “long in the tooth”). It can happen for a variety of reasons, including heredity, smoking, years of aggressive brushing, and poor hygiene. Grafting can help restore missing gum tissue. How it works: Your dentist takes a piece of tissue from the roof of your mouth, or uses regenerated donor material from a tissue bank, and sutures it over to the gum tissue that surrounds the exposed root.

Pros: Along with a nicer smile and reduced tooth sensitivity, there’ll be less of a chance of decay at the roots of teeth.  

Cons: The amount of pain or discomfort, both during the procedure and during the recovery, depends on the type of tissue used (if your dentist takes it from the roof of the mouth, you’ll have two surgical sites that need to heal) and how much of the gumline is involved. Healing may take up to a few weeks, though you should be able to resume your normal activities within a few days. Also, while gum grafts can last a good long time, recession may come back a bit over the years. And not everyone is a candidate for the procedure. “If someone has lost bone between the teeth, for example, there are limitations as to how much root coverage we can achieve,” says Bakeman.

Cost: A gum-tissue graft can cost about $1,200 to $1,800 per tooth, depending on the extent of the gum recession and the type of tissue used.

Tip: Grafting isn’t a cure for gum disease. Once your gums heal, you’ll still need to whip out the toothbrush — along with dental floss and those little between-the-teeth brushes— twice a day. Since brushing too aggressively can cause gum recession, consider switching to a soft-bristle toothbrush (working in a circular motion) or an electric toothbrush. 

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