A cosmetic dentistry smile makeover simulation illustrating the use of dental bonding and porcelain veneers.

Dental History: If you'll notice, all of the cosmetic deficiencies associated with this person's smile are located at the gum line. For example, the front upper teeth have darkened areas along the gum line. Different in color but similar in location, other teeth have a white discoloration (especially the teeth on the lower left).

All of these cosmetic defects are most likely the result of the same set of events: dental plaque accumulation and the subsequent formation of tooth decay. And in fact, this picture actually illustrates different stages of tooth decay formation:

• Early tooth decay formation: The white areas found along the gum line.
• Active and arrested tooth decay: The dark areas on the teeth.

Treatment Plan Comments: An important part of this treatment plan is to help this person understand why tooth decay is forming. (For more information about cavities check out our topic about tooth decay and how cavities form.) In most cases high decay rates are associated with either inadequate brushing technique or else a diet high in sugar content, or both. Any and all future dental work will be at risk for failing if this person's decay rate is not brought under control.

The Cosmetic Dentistry: The cosmetic changes we've illustrated in our "after" picture could probably be accomplished by simply placing white fillings (dental bonding). Certainly this would be the treatment of choice for some of the smaller blemishes. The upper teeth that have the greatest amount of discoloration might instead be restored using porcelain veneers. Doing so would give the dentist an opportunity to idealize the shape of the biting edge of these teeth (as illustrated in our "after" picture).