Keep Smiling

The days of painful extractions and false teeth on the bedside table are long gone. Frances Webb looks at the latest innovations in cosmetic dentistry

When everything opened up again after the covid pandemic, I went back to the dental practice I had been registered with as an NHS patient since 1971. Everything had changed. Not only was there an entirely new group of staff but it seemed there had been a sea-change in the options for dental treatment.

I grew up in the 1970s, which apparently makes me part of the ‘heavy-metal’ generation. This was news to me because I have never been a fan of heavy metal music (I preferred watching Legs & Co on Top of the Pops). No, heavy-metal in a dental health context refers to the use of lots of amalgam fillings, made of mercury alloyed with other metals. Today, there are plenty of people like me (women over 50) with mouths full of the stuff. And like anything else, they eventually wear out.

I have lost two large molar fillings in the past year, but so far have baulked at doing anything about it, so I jumped at the chance to talk to Dr Hannah Woolnough, a practising dentist in Suffolk. She brought me up to date with the current alternatives for solving all kinds of dental problems.

Mind the gap

It was reassuring to learn how common it is to lose one or more teeth. With the passage of time, wear and tear plus bits breaking off, you can end up with gaps, so what should you do next? Broadly, there are four options.

First, if the gap is at the back and you can’t see it, and it doesn’t affect the functioning of your mouth or cause any discomfort, leave it be.

The second option is removable dentures. These can work fantastically well if you’ve got a large gap where several teeth are missing, but less so if it’s only one or two. Removable dentures are often used as an intermediate measure so there is something to fill the gap before you have any other work done.

Third is a ‘bridge’. This is a false tooth or group of teeth that is attached permanently to those on either side of the gap, depending on the size of the space and where it is. Bridges work very well but can potentially compromise the teeth they are attached to. This is because the anchoring teeth have to be crowned to provide a solid foundation for the bridge, which requires removal of tooth tissue. If they have already been crowned, or are heavily filled and would benefit from one, then that’s fine – but it’s not ideal to crown an otherwise healthy tooth because you’re potentially creating more work
down the line. Nothing lasts forever!

Finally, there are implants. This involves inserting a titanium screw into the jaw under the gap to which a false tooth can be attached. The metal screw will eventually fuse with the bone, making a permanent and secure bond. They are the best thing for filling a space because they don’t impact on the surrounding teeth.

Not all dental surgeries offer implants, but there are plenty that do, and your own dentist will be happy to refer you to another clinic if they don’t offer the service. It’s quite a specialist procedure and can be technically tricky, but surgeries that will do implants are becoming increasingly commonplace.

The main disadvantage of implants is the cost. They are not available on the NHS unless there is a medical reason that means they are the only option for replacing a tooth, such as damage to the face or jaw. The cost varies quite considerably depending on how straightforward fitting the implant will be. The price for a basic single implant starts at about £2,000.

They are also not suitable for everyone. Crucially, there has to be enough bone under the missing tooth to secure the implant. If you’ve had a tooth removed because it’s cracked an implant should be fine. But if you’ve lost it because of gum disease which has resulted in a loss of bone around the tooth, there may not be enough bone to support one.


White stuff

Teeth whitening works really well if it’s done by a qualified dentist with professional kit. There are a lot of products you can buy on the internet that Woolnough is extremely cautious about because you have no idea what you are buying.

In the UK it is illegal to sell products of the same strength as those you get on prescription from a dentist, so anything you buy online is suspect. It’s either a genuine product being sold illegally or it’s whatever some scammer has put in a bottle.

If you follow the instructions and it’s done under supervision of your dentist, tooth whitening will do no harm. How long it lasts depends on your lifestyle, and there will be natural changes in your tooth colour over time. Normally, Woolnough’s practice recommends topping up the treatment every 12-18 months.

Your dentist will take a mould of your teeth and this will be used to make ‘trays’ that fit over them. You fill the trays with a gel containing hydrogen peroxide and wear them each day, usually for two to four hours, for about a week, or as recommended by your dentist.

The cost for an at-home system is about £350-£600, depending on where you are in the country. As it is a cosmetic treatment, it is not available on the NHS.

The key thing to bear in mind with tooth whitening is that it will only whiten natural tooth tissue. If you have any white fillings, veneers on your front teeth (common in patients over the age of 50), crowns or bridges, they will not change colour.

If patients have old crowns or bridges that they want replacing, Woolnough makes sure to do the whitening before any repair work, so she can get any new crowns to match properly.

Brace yourself

Increasingly people are having braces fitted at all stages of life, rather than when they are children, to make their teeth straighter. If they are in reasonably good condition you can even them out with a brace and then whiten them.

Woolnough has seen a massive increase in women over 50 who have been unhappy with their teeth for a long time. It usually only takes from six months to a year to improve their alignment, so you can potentially look forward to another 40-plus years of nicer looking teeth.

Braces are usually fitted by an orthodontist, a dentist who specialises in tooth alignment issues. There are several types, from traditional metal braces that fit on the front of the teeth to less visible ones made of ceramic, or braces that are fixed onto the back of the teeth.

My local practice advertises clear braces made by Invisalign. A 3D scan is taken of your teeth to measure their alignment and make a mould, from which the plastic braces are cast. The first set feels tight, but after two weeks you move on to your next set. They are virtually invisible but slightly annoying because you have  to take them out when you eat or drink.

Premium bonding

Bonding uses an adhesive white filling material – the same that is used for cavities – to alter the shape and finish of the teeth. A lot of people will have whitening and then might have a bit of bonding if some of their teeth have worn edges or the odd chip.

Bonding creates a more even appearance and is less invasive than veneers or crowns because none of the existing tooth has to be drilled away – your dentist is just sticking a little bit of composite onto the teeth.

The main difficulty is that because the material is on the edges of teeth it has a tendency to come unstuck – especially if you tear off sellotape or bite your nails! It’s not as strong as a crown or a veneer.

Like all the other dental treatment, cosmetic bonding is offered on a case-by-case basis. While people often think veneers are the answer, they are not always. Straightening, whitening and cosmetic bonding can potentially achieve the same result as a whole set of veneers. If you can have six months of Invisalign and tooth whitening and get the same result, that’s a better option.

Hello, Hollywood

A crown is a replacement for a whole tooth, but it also possible to improve the front surface of teeth by using veneers. These are pieces of porcelain that are shaped and colour-matched to your existing teeth and fixed on with a hard-wearing dental cement.

They are particularly useful for the front teeth and can give you a real ‘Hollywood smile’ – indeed, they were invented in 1928 by a dentist working for the film studios there.   

Veneers can be used when teeth have become permanently discoloured or to even out the size of them and disguise any small gaps.

They should only be fitted by reputable dentists – there has been a worrying trend over recent years called ‘Turkey teeth’. Because prices for dental work are much lower in Turkey and Eastern Europe, people from the UK have been travelling there to get cut-price veneers and crowns. The results are sometimes disastrous and require extensive remedial dental work back in the UK.

Like implants, veneers are not available on the NHS. Prices start at about £500 per tooth, and they tend to last about ten years before they need to be replaced.

Hygiene is key

In the 1960s and 1970s the influence of diet on dental health wasn’t so widely considered, but there have been huge steps forward in preventative care, such as the fluoridation of water and fluoride toothpastes. Although today fewer people add sugar to their tea, sugary juices and fizzy drinks are more of a problem.   

The key preventative tool for women over 50 is good oral hygiene, particularly if you have any implants. They don’t decay, but you can get gum disease around them in the same way you could with your own teeth. If you do not see a dentist regularly then you might not pick up on any issues.

So minimise sugar, floss twice a day and visit a hygienist regularly. Take it from the heavy-metal generation!

  • Hannah Woolnough is chair of the English Council of the British Dental Association

Pictures: Adobe Stock