Veneers … as an alternative to whitening with bleach

Article by Christopher Pescatore, DMD

As a cosmetic dentist who has spent years crafting smiles, I am rarely surprised when patients are disappointed with their bleaching. It’s not that bleach doesn’t work; properly applied, high-quality bleaching agents such as Opalescence by Ultradent can produce a bright and natural whiteness, at least for a while.

People don’t realize they want more. They want movie star smiles, and they tend to focus on color rather than their complete smile. Perhaps this is because color is the most conspicuous component of a beautiful smile. It is hard for patients to identify the role of shape, contour, harmony, and the teeth’s relationship to the lips and face. However, these elements are also significant, and the totality produces an esthetic effect greater than the sum of the parts.

One masters the “art” of cosmetic dentistry when one grasps holism. But most patients don’t understand this point initially, and their focus on color is usually wishful thinking. They see bleaching as less radical than the alternatives, and hope to obtain a movie star smile while saving money, time, and hassle.

Dentists have three options to whiten teeth: bleach, composite resin, or porcelain veneers. Unfortunately, patients tend to overrate bleach because it is the option they are most familiar with, and they have either incomplete or incorrect information about composite resin and veneers. Consider the treatment’s impact on:

• Color - Short-term effects are roughly comparable, and all three treatments can produce lovely white teeth. Over the long term, however, composite resin is superior to bleach, and porcelain is superior to both. Since bleached teeth are otherwise normal, they stain at the normal rate. Hence, patients may need to repeat bleaching several times a year, especially if they smoke, drink coffee, etc., 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, and 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, which is 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 their teeth bleached in a dentist’s office or at home. The first method involves an office visit, while the latter requires wearing bleach trays about two hours a day for at least two weeks. In contrast, veneers require a certain amount of preparation - tooth reduction, impressions, temporaries - so the short-term impact on time and convenience may be more substantial. However, since teeth must be re-bleached regularly, 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 - In-office bleaching costs about $600, while home treatment is less. The investment in veneers is much more. But this discrepancy is offset at least somewhat by the expense of repeated bleaching over the approximate 15-year lifetime of a ceramic veneer, especially considering the lost work time, the cost of gas, and more.

Given the pros and cons, all three are viable options for whitening alone, but most people are interested in a beautiful smile, not simply whiter teeth. The problem is they tend to confuse whiteness with beauty until they see the results of bleaching. Bleach generally works best on young people with straight “virgin” teeth that show little wear and tear. But if white teeth are crooked, too long or too short, chipped, etc., they can still be unattractive. Patients tend to notice imperfections more after they have their teeth bleached, and feel disappointed. It is at this point that they often begin to seriously consider veneers.

One of the common misconceptions I hear from new patients is their concern about veneers. They have heard veneers are painful to put in, or that much of their original tooth structure will be removed. I inform them that it is not only a painless procedure, but the amount of tooth structure removed is minimal compared to traditional full-coverage preparations. Also, the result is a beautiful, long-lasting new smile, not simply whiter teeth.

Before I bleach someone’s teeth, I try to figure out 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 I also don’t want to disappoint them if they have certain expectations. One helpful step is to ask a good laboratory, such as MicroDental, to put together a wax-up of the prospective veneer-treated smile and compare it with a computer-whitened photograph of the existing teeth. Patients can then objectively compare each treatment’s probable results and decide between whitening their teeth and receiving a beautiful new smile.

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 former 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, and is also on the Editorial Board of REALITY - the information source for esthetic dentistry. Contact him at (925) 362-9330, or at [email protected].