Staying sparkly white

  • Published
  • By Col. (Dr.) Joel Knutson
  • 51st Dental Squadron commander
February is National Children's Dental Health Month. The dental profession traditionally takes this opportunity to promote the benefits of healthy eating habits and prevention of tooth decay and periodontal disease. 

However, this year I would like to review two popular cosmetic dental procedures and their long-term benefits and potential negative effects. Much of the cosmetic dentistry consumer marketing information presented on television, newspapers and magazines appears great, but the success of these procedures and associated long-term maintenance cost is rarely discussed accurately.

Bleaching is the most common cosmetic dental procedure. The active ingredient in nearly all dental bleaching systems is hydrogen peroxide or carbamide peroxide. The main difference between bleaching systems is the concentration of the active ingredient.

Typical home bleaching kits use 8-12 percent carbamide peroxide. Although this concentration may cause temporary sensitivity if applied to exposed root surfaces, the procedure has not been shown to cause other long-term negative effects. 

In-office bleaching solutions, including laser bleaching, may have peroxide concentrations of 45 percent or more. Studies of laser bleaching systems indicate the laser provides no benefit whatsoever. It is the high concentration of peroxide that is responsible for the rapid color change for all in-office bleaching procedures. However, as the concentration of the active ingredient increases, so does the risk of severe post-treatment sensitivity. 

Veneers are another common cosmetic procedure. These are very thin pieces of porcelain or composite resin that are fastened (bonded) to the exterior of teeth using a resin-based bonding agent. 

Porcelain veneers are promoted as being more permanent than composite resin veneers as porcelain does not stain or discolor over time. Although porcelain veneers are very fragile, they may last as long as 10 years if bonded to enamel, the hard outer layer of tooth structure. 

However, porcelain veneers require reduction of tooth structure to make space for the porcelain veneer. The greater the desired change in tooth shape or position, the greater the reduction of tooth required, often resulting in partial or complete exposure of dentin, the porous inner layer of tooth structure. 

Unlike the bond to enamel, the porcelain to dentin bond decreases significantly over a relatively short time; up to a 50 percent decrease in bond strength in as little as two to five years. When a porcelain veneer breaks or fails, it may be possible to repair or replace the veneer once or twice. Over time, it is very likely a full coverage crown will be required. 

Patients should be active participants in their healthcare decisions and fully understand the long-term consequences of treatment options. Cosmetic dentistry is largely driven by patient demand. However, it is questionable whether patients understand the long-term maintenance costs before consenting to treatment. Informed consent will protect the dentist from consumer lawsuits, but it provides little benefit to a patient incurring large expenses to maintain their elective cosmetic dental treatment. 

If you have questions regarding these or other dental issues, please feel free to discuss them with any of the dentists in our clinic.