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Esthetic dentistry becomes treatment of choice (12-27-99)

The field of esthetic dentistry has exploded in the last few years. Some 15 years ago, esthetic dentistry accounted for less than 20 percent of the money spent on dental care, now it exceeds 60 percent. "There has been a major drift from pain-driven dentistry to elective dentistry. It is a quality of life issueópeople are happy and willing to pay to look good," said Nasser Barghi, D.D.S., head of the division of esthetic dentistry, Department of Restorative Dentistry, The University of Texas Health Science Center at San Antonio.

The technique of bonding, for example, has made huge advances since the 80s. New adhesives that bond to the dentin of the tooth, the living material underlying the enamel, have largely been responsible for the revolution. Dentists once bonded teeth by attaching porcelain to enamel; if a patientís enamel was damaged, there was little a dentist could do, short of filing down the tooth and capping it.

With old bonding methods, the surface of the tooth could look unnatural or uneven, and the color seldom matched the rest of the teeth. Now, Dr. Barghi said, dentists can accomplish more "dynamic" restorations, called veneers. With veneers, tooth color and appearance is much more even, because the color is determined by the color of the tooth itself. The teeth surfaces are lightly prepared, then porcelain is applied directly to the dentin. The tooth structure is reduced minimally, and the color comes from the inside, so color matching is less of a problem.

"Literally, within a matter of hours, in as little as three visits, a patient can get a more attractive smile," Dr. Barghi said.

If a patientís teeth are discolored or yellowed, then they should be bleached first, Dr. Barghi said. "If the color is not ideal, then it will be more difficult to change it with veneers," he added.

Bleaching has been another major development in esthetic dentistry and has created the most public awareness of the field. In fact, bleaching is the treatment of choice for patients who visit their dentists for cosmetic reasons.

The safest bleaching method, Dr. Barghi said, is the treatment prescribed by a dentist for application at home, which is approved by the American Dental Association (ADA). Contrary to popular opinion, bleaching wonít soften or weaken teeth. Some people can notice a difference within one week, others within three or four, depending on age or discoloration. After the initial treatment, dentists recommend a maintenance program, in which teeth are re-treated in one or two sessions at home every six months.

Patients may sometimes need a combination of treatments to improve the smile line. These may include measures to correct malocclusion (bad bite), orthodontics, jaw surgery, and gum surgery to lengthen the teeth. People with a "gummy" smile can have their gums cut back and the bone moved up to improve their appearance.

"Teeth are a picture in the frame of the lip line," Dr. Barghi says, "We create harmony."

The Dental School has been a front-runner in the field of esthetic dentistry. It was one of the first schools to offer a complete curriculum in this area. Dr. Barghi founded the division in the early 90s, and now speaks nationally and internationally on the subject. "It has been very exciting," he said.

Contact: Will Sansom or Jennifer Lorenzo