A patient and I were having a bit of a laugh the other day (well, he was laughing at me, although he swears it was with me), when I presented a quote for a not-too-sizable amount to offset the effects of years of dental deterioration. That said, the laughter resounded even more when I suggested that no matter what we do, the work envisaged would only have a lifespan of about 10 years.
“Who’d spend X much dollars on something that would only last 10 years, doc?”
“Well, they are called men, Bob (lets call him Bob), and they’ll spend 10X on cars that they replace every 5 years.”
“Oh, come on doc,” spluttered Bob, “I use my car everyday …”
Hmm, okay, so Bob somehow manages not to use his teeth everyday. For the rest of us unluckier souls, there is the problem of how to maintain a dentition that is heavily filled and in a steady state of wear and tear.
The “gold standard” would certainly be the replacement of these worn out restorations with gold fillings or crowns, as these types of restorations last the very longest. However, there is a bit of resistance when you suggest this as most people seem to have an aversion to gold teeth – most say that they remind them of their grandparents. I must say, though that never having known my grandparents, I nearly rushed out to get gold teeth to see if I could inspire any latent childhood memories of the oldies.
There is however, a slightly less costly way to restore both the appearance and function of your teeth, without spending the average GDP of a small tropical country – as long as you are willing to accept slightly weaker restorations that won’t last as long.
Dental composites, or plastics, have been around for a great many years, with light cured composites (when it seems like your dentist is sticking what sounds like a hair-dryer in your mouth) making their first appearance in the 1970s. Although very technique sensitive, composites when placed appropriately in the right places can confer great strength and function to teeth, albeit for a shorter amount of time.
How much shorter? Depends on the studies you read, practically, I expect my composites to last 5-7 years, up to 10 years if my patient has extremely good oral hygiene. As you would expect, if neglect leads to tooth structure loss, it would also lead to loss of restorations. Some composite restorations struggle to last 2-3 years, if care is not taken to keep them clean.
Composites offer a good alternative to the porcelain veneers that you keep hearing harped on about on just about every TV makeover program. Porcelain offers fantastic aesthetics and strength, and last a goodly amount of time. However, should your porcelain veneers fragment, fracture or fall off, there’s no repairing them and replacement is often the only option. Composite veneers do not have the high gloss of porcelain or the translucency but in many cases can look nearly as good as their porcelain cousins. Additionally, you can repair and repolish composite WITHOUT removing the entire restoration.
Composite veneers are often carried out in two steps: an initial preparation, application and shaping of composite to the teeth, and then a follow-up polish appointment. In many cases these types of veneers can be placed without gross preparation of the surface of the teeth. However, they WILL feel thicker than porcelain in some cases.
Cost wise they compare favourably with porcelain, often costing about 50% of the cost of porcelain veneers and restorations. Not every dentist is comfortable placing multi-unit composites as unlike laboratory made restorations, a composite veneer or restoration is to dentistry what live-action theatre is to movies – you get one go at it! So make sure you discuss this with your dentist and are comfortable that HE/SHE is happy to do them.
“So Bob,” I winced, “Let’s talk about your teeth that you don’t use every day.”
The laughter is still ringing in my ears.
Adrian Tan is a general dental practitioner practicing near the water in Auckland’s beautiful Viaduct Harbour! I’m only describing it thus as it’s really cold down here at the moment and this description makes it sound like summer. When it’s warmer. He has two small, grumpy dogs that sometimes greets patients at his reception. He’s a member of the New Zealand Academy of Cosmetic Dentists, and the New Zealand Dental Association. He makes small, regular contributions to the IRD, a New Zealand based charitable organization for the redistribution of dental incomes.