"Armchair" diagnosis and cosmetic dentistry treatment plan.

• History: If you'll notice, all of the cosmetic deficiencies associated with this person's smile are located at the gum line. The front upper teeth have dark areas. In this person's case these are likely staining of, or new decay formation around, existing white fillings (dental bonding). Different in color but similar in location, other teeth have whitened areas at their gum line (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. This picture actually illustrates different stages of tooth decay formation:

  • The initial stages of tooth decay formation: The white areas found along the gum line.
  • Active and arrested tooth decay: The dark areas on the teeth.
    
    
• Cosmetic dentistry treatment plan: 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. Just as the white fillings that currently exist on this person's teeth have failed, any and all future dental work will fail too if their decay rate is not brought under control.

  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 having the greatest amount of discoloration might alternatively 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).