To all my patients, mentors, colleagues and friends who have inspired me and believed in me… they’re the ones who ‘get’ me’!
Tx
INDEX
SmileScription™
Introduction
I still regularly see clients from all walks
Yes unhealthy mouths are my bread
of life arrive at my practice and when
and butter – I could just sit back except,
they open their mouth it’s clear they’re
diagnose & treat the never-ending stream
oblivious to the poor condition of their
of decay and periodontal disease patients
Towards
teeth or gums. Or in search for a solution
bring to my practice. Or I could put into
to their problems and concerns.
words how my practice operates: team
‘A good smile is about how your smile works with the rest of you face’ So why does this happen? ‘Perfecting and maintaining your smile is attainable for everyone – you just need the right information and education.’
work, high quality dentistry using cost effective reliable procedures & crucially
Why do so many individuals have less
educating & informing the consumer at
than the average smile in Great Britain?
ever stage in the process. To you I give you a simple book to educate and inform.
What makes a Beautiful Smile? It is based on experience and its factual &
After 15 years in dentistry and 5 years in aesthetic medicine, having travelled the world and libraries in search of the latest techniques, technologies & advancement. It never ceases to amaze me how few questions you the consumer clients asks of their dentists, doctors or professionals about the maintenance of good dental health and wellbeing.
Good questions & all that many
most of all truthful! The book is dedicated
professionals and consumers
to all the many patients, friends and
could debate all day!
educated professionals I have gathered
The answers – multi-factorial really
over the years. These individuals either educated me or trusted my advice and
4 Lack of availability of service?
will have healthy teeth for years to come.
4 Do we value a smile that
So enjoy the read!
is provided free?
Dr Tracey Bell BDS Hons
4 Are Hollywood smiles really the answer? 4 Education – yes an answer to all life’s problems, Are you the consumer educated? And if so by whom
Dentistry is more than a necessity it is a want.
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SmileScription™
chapter
one
Cosmetic Dentistry today You only need to turn on the TV or pick up a magazine to recognise that Britain is certainly aspiring to the ‘perfect smile’. But what is the ‘perfect smile’?
don’t know what the best solutions are,
problems, trying to salvage what we
where to find these solutions and what
could as quickly as possible. This certainly
questions you should ask of your dentist.
wasn’t how we would want to be treated,
This is where I can help. “A great smile can enhance a person’s physical beauty, but most importantly, it can be life-changing, improve
A question which causes great debate.
TO BE COMPLETED??? TRACEY
Do you the consumer know what choices
–YOU HAVE NOT PROVIDED
you have and what exactly the risks and
WHAT YOU WANT HERE
the long term features and benefits are?
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self-esteem and confidence.” When I started out in 1993 dental services were still provided free or relatively
So in conclusion you the patient certainly
cheaply under the NHS. But 1-8 years
In Britain alone according to the BACD
knows what don’t like about your teeth,
later and thousands of patients later I
(British Association of Cosmetic Dentistry)
which may be chipped, worn, discoloured,
came to realise I was providing a service
missing or crooked. As a practicing
that I wouldn’t want myslef. My team
Dentist I see regularly that you the patient
was merely firefighting decay and gum
so we converted to private practice – and it proved one of the best career moves we as a practice ever made. It meant we could perform treatments that would last and offer the services of specialist dental practitioners to ensure the very best care for our patients. The difference – choice, time and education. Listening to the individual, solving and preventing problems plus providing the consumer with information.
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SmileScription™
The val ue of a beautif ul smile
It’s hardly surprising that given the amount of information – or misinformation – available, there are so many misconceptions and unrealistic expectations surrounding cosmetic dentistry. And with more and more dentists marketing their practices as ‘cosmetic’ it’s difficult to find anyone whose advice you can trust, which is why I’ve written this book.
We don’t rely on
My patients know what they don’t like
I’ve created thousands of smile makeovers
about their teeth – they may be chipped,
using crowns, veneers, whitening and
worn, discoloured or crooked - what they
implants. The aesthetic results can be
don’t know is what the best solutions are,
fabulous for the patient, while for me
where to find those solutions and what
the most satisfying result of all is seeing
Every £1.00 spent
questions they should ask of their dentist.
the life-changing effects a perfect
on Dentistry the
smile can have on an individual.
public spend £630 on
photo shop we rely on Skill, Belief & Truth.
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This is where I can help.
cosmetic products.
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SmileScription™
chapter
two
H e a l t hy teeth: The dental examination
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SmileScription™
R a d i o g ra p h s
I often hear patients say: ‘Oh, it’s only a checkup’, but a dental examination is one of medicine’s most undervalued procedures as it provides the opportunity to diagnose systemic disease and take early preventative measures.
Taking radiographs by digital x-ray minimises radiation levels, images are produced instantaneously and data inputted directly into the patient’s notes.
Ty p e s o f x - rays i n c l u d e : O P G ( o r t h o p a n t o g ra m ) An x-ray that rotates around the head to view the whole mouth. It diagnoses the pathology of bones, presence of any
The practitioner will be examining your
I recommend that each time you go for a
dental caries and provides an indication
mouth for dental decay, periodontal
checkup you ask your dentist to record the
of a patient’s general state of health.
disease and oral cancer, looking at the
condition of your gums by a BPE (basic
condition of your lymph nodes and for
periodontal examination) score. This is
any temporomandibular (jaw joints)
also the ideal time to discuss with your
joint and soft tissue problems – all vital
dentist any concerns you may have about
information to be recorded and used as key
your teeth and ask about any aesthetic or
indicators of your general state of health.
normal work you may be considering.
Every patient should have regular dental
The examination may involve taking
examinations and I believe their frequency
x-rays, particularly in the case of a
should be based on the patient’s
newly registered patient who may
dental and medical history.
not have any recent radiographs.
During the dental examination you can expect a number of different procedures to be performed including, impressions taken of your mouth if extensive work is to be completed. Always ask to see their work / photographs if you are considering Dental treatment, my patients ask me all the time. A basic dental examination should include: 4 Examination for dental decay 4 Diagnosis and recording of periodontal (gum) problems 4 Soft tissue examination – important for the diagnosis of disease
Bitewings Radiographs taken of the posterior
and systemic conditions 4 Temporomandibular joint
premolar and molar teeth as an aid
(TMJ) examination. The TMJ
to diagnosing tooth decay. Should
is a complex joint between the
be repeated every 12 to 36 months
upper and lower jaw. The aging
depending on the history of decay.
process can make the joint more painful, ‘click’ when opening or
Pe r i a p i c a l R a d i o g ra p h s ( PA s )
limit its degree of movement.
Individual radiographs taken of the roots of the teeth to diagnose periodontal bone loss problems.
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SmileScription™
chapter
three
Healthy gums the foundation of a per fect smile Healthy teeth and gums are essential - not only for eating but it aids speech, overall maintaining good health. They also form the internal scaffolding to the face, keeping in place soft tissue and lips and helping you sustain a youthful appearance.
O ra l h e a l t h a n d we l l b e i n g There’s a direct correlation between oral health and overall health. Scientists world wide agree that periodontitis (gum disease such as bleeding gums, excess tartar, unstable teeth, bad taste and bad breath) can be a significant cause of diabetes, heart disease, low birth weight and pneumonia.
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SmileScription™
Gum Disease – periodontitis / gingivitis
Gingivitis Gingivitis is swelling of the gums. The gums become red and swollen, indicating the area has become
‘Regular professional cleaning and proper oral care at home can help prevent gum disease’
inflamed through plaque colonisation (‘excess plaque’ in layman’s terms?) The condition is reversible but if left untreated can lead to periodontal disease.
Gum disease is inflammation or infection
Plaque contains millions of bacteria which,
of the tissue supporting the teeth.
if not removed, will stagnate, causing
Without thorough tooth brushing, regular
inflammation and infection. Other factors
flossing and frequent dental checkups
causing gum disease are poor general
an accumulation of plaque will build up.
health, smoking and stress as well as
‘Myth: If you brush your teeth too hard your gums will bleed.’ Healthy, vital gums should not bleed when brushed. If they do bleed, it’s most likely due to inflammation, plaque build-up or, in some cases, systemic disease.
hereditary and systemic conditions.
Pe r i o d o n t a l d i s e a s e
There are t w o simple stages to gum disease:
Persistent inflammation of the gums (gingivitis) can lead to periodontal disease, which can present in a variety of forms, all of which affect gums and bone. In periodontitis the bone anchoring the teeth in the jaw is lost leading to gaps, loose teeth and shrinking gums, and, if left untreated, the teeth may fall out.
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SmileScription™ Indications of gum disease 4 Bleeding 4 Redness and swelling 4 Bone loss
removal of plaque and tartar, allowing the inflammation to subside and the gums to heal.
4 Sensitivity 4 Bad breath 4 Tooth movement 4 Tooth loss Periodontitis and the destruction of
set up a basic periodontal examination
health and general medical health.
monitor progress of your gum disease.
simple at home regime If you have gum disease or have had it in the past I recommend you visit
1. Use a medium / soft small replace every three months.
Periodontal disease/bone loss is not
gums’ condition. Maintaining a healthy
reversible, but it can be contained
mouth is like building a house - your
through good oral hygiene, regular
teeth need strong foundations – good
maintenance and visits to the dentist.
gums. Without a set of healthy gums
Antibiotics
but the bone will not grow back.
– you cannot maintain a healthy smile. Anaesthesia: local anaesthetic may be prescribed for certain conditions. Number of visits: one
2. When brushing the teeth, you should spend 2-3 minutes, ideally after each meal and before bedtime to remove all cavity-forming bacteria and prevent gum disease. 3. Be careful not to brush hard, as this can cause gums to recede and tooth substance to be lost.
lead to significant improvement. Not all hygienists are the same. As well as
unavoidable consequence of ageing.’ However, where periodontal disease
treating patients, the job of a good dental
With regular visits to the hygienist and
persists you should be offered a referral to
hygienist is to educate and advise patients
good dental care a smile can last for life.
a periodontist - a specialist in gum disease
on their home care regime. A good dental
who can provide options such as gum
hygienist should also record gum condition,
surgery, bone replacement and adjunctive
measuring bone loss using the BPE index.
Early stages of gum disease often
treatment which may include???
cause little or no discomfort, which
x-rays and bone measurement.
Initial treatment normally involves
Proper oral care starts with
enables the hygienist to monitor your
antibiotics may be prescribed, usually
undetected for some time.
P r o t e c t yo u r s m i l e
headed toothbrush and
the bone can be halted and maintained
means the condition may remain
want to keep your teeth for life.
the hygienist every three months. This
Where gum disease persists,
Tr e a t i n g g u m d i s e a s e
polish – you can’t rush things if you
Ca n g u m d i s e a s e r e t u r n ?
for a three-month period, which can
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on a regular basis. The timing of these appointments is dependent on your oral
bone is not reversible. The damage to
‘Myth: Growing ‘long in the tooth’ is an
All patients should see a dentist or hygienist
At this point your dentist or hygienist should (BPE) and pocket charting record to
4 Gum recession
What do I need to know?
4. Instead brush gently in small circular motions at 45o angle. 5. Flossing is so important – do it after every meal sliding up and down the side of the tooth.
You must accept, though, that thorough removal of plaque above, below and
‘Helping patients achieve beautiful
in between teeth (interdental brushes
teeth and healthy gums produces
are excellent for this) takes time.
people who love their smile’
Never accept a 10-minute scale and
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SmileScription™
If you smile needs a
chapter
pick me up – whitening
four
is often the solution.
AgePerfectingPointers To enhance your smile use a cool based (blue based) pink or red lipstick.
AgePerfectingPointers The illusion of white teeth can be as easy as a fashion accessory.
Whiten your smile
tooth whitening
Steer clear of brown / orange clothing, which can make teeth appear more yellow.
The colour of our teeth is influenced by a
There are many different systems on the
number of factors such as tea, coffee, red
market, all of which will achieve some
wine, smoking, anti-biotics and also age.
degree of whiteness, depending on
Now there are many methods of enhancing and whitening the smile for every lifestyle and budget. This ranges from inexpensive home bleaching, whitening trays to professional ‘in office’ laser treatments.
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the concentration of bleach, how the bleach is applied, the length of time the bleach remains on the teeth, as well as on the level of care taken in maintaining the teeth after the procedure.
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SmileScription™ S t r i p s a n d Pe n s
Not all tooth whitening i s t h e s a m e.
Teeth whitening strips and pens are the ‘over the counter’ way to whiten teeth.
H o m e r e s e r vo i r s / t rays There are various methods of home teeth bleaching but trays and bleaching gel is the most popular.
With the exception of proprietary home kits tooth whitening is a dental
The SmileScription™ pen contains 6%
Sensitivity: After all types of tooth whitening
procedure that should only be carried
Carbamide Peroxide that is simply applied
procedures teeth will be temporarily
out by a dental professional.
once or twice a day to the teeth and left.
sensitive, usually due to the teeth hydrating
Strips also typically contain 6% and are thin
then rehydrating during the process.
Many horror stories have appeared in the media about whitening procedures
flexible transparent strip that are applied
Burns: Peroxide burns. It is essential
damaging tooth enamel and soft tissue.
over the teeth for 30 minutes per day.
the soft tissues be completely protected
Always insist your dental practitioner
during the procedure, which should only
explains the type of procedure proposed
I n - s u r g e r y o r p o we r w h i t e n i n g
be carried out by a dental professional.
and the concentration of bleach to be used
Systems such as SmileScription,
In some cases unevenness may result
Zoom and Britesmile offer accelerated
due to the properties in your tooth enamel,
The treatment normally takes two to six
whitening. Procedures normally take
therefore it is important your practitioner
weeks to achieve optimum whiteness
between 45 to 60 minutes, use stronger
examines your teeth before the procedure.
depending on the concentration of
concentrations of bleach and produce
bleach. More difficult cases are those
dramatic results in a short time.
This system uses mouth guards that fit the teeth. Carbamide Peroxide is then applied to the trays which are worn for between 90 minutes and overnight. The Carbamide Peroxide removes stains from tea and coffee.
where the persons teeth are not such stained but inherently darker, whitening can take three to six months. Age perfecting pointer – Yes it is natural for teeth to become darker with age. Enamel ‘the glossy part of the tooth’ becomes thinner and darker, the inner
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Risks:
Deep bleaching Deep bleaching combines reservoirs with power whitening. The process is favoured by clients wanting whiter-than-white teeth, as results are long-lasting and maintenance is easier than with other procedures.
part of the tooth becomes yellower.
Number of visits: Varies according to
Rejuvenate a smile by whitening and
procedure chosen.
great ‘anti-ageing’ smile solution.
Anaesthetic - No
Blotchiness/whitening unevenness:
and make sure you are shown before and after case studies.
B u ye r b e w a r e I often have people come to my practice wanting ‘pearly whites’ – as seen on TV
Some teeth - especially grey-toned teeth
celebrities. It’s important you discuss
- do not take to whitening and clients
your expectations with your practitioner
with teeth of this colouring are advised
and realise that many celebrities such as
to consult their dental practitioner.
Simon Cowell, Catherine Zeta Jones and Katie Price have achieved their Hollywood smile not only through tooth whitening but also major dental work involving the fitting of crowns and veneers. Tip: Using desensitising toothpaste after tooth whitening swiftly reduces sensitivity.
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SmileScription™
Fi l l i n g s chapter
five
A filling replaces part of a tooth that has been lost because of decay or trauma.
There are numerous ways to replace part of a tooth either using amalgam (silver fillings) or composite (white fillings) In some cases where the filling is very large the dentist may choose to produce an inlay either in porcelain, composite or gold. This is produced where the dentist takes an impression and sends the impression to the lab. The dental laboratory then produces an inlay that is filled into the hole in the tooth.
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SmileScription™
Amalgams Mercury is a very powerful Neurotoxin, which has been shown to escape from the fillings and lodge into the surrounding tissue. However the American and English
Are they as good a s S i l ve r f i l l i n g s ? Yes, as long as they are placed correctly and good moisture control is maintained during the placement and the bite is correct.
What happens?
and overall result achieved.
Your dentist will… 1. Numb (place local anaesthetic) around the tooth
governing bodies maintain that it is perfectly safe although many dentists have stopped using it on health and aesthetic reasons. Many men and women report that on removing these amalgam fillings
W h e n c a n’t white fillings b e co m p l e t e d ? missing, an inlay or crown
better. The newer white composites
may be more appropriate.
tooth cracking and fractures.
4 2. If decay is too extensive 4 3. If good moisture isolation
W h i t e f i l l i n g s / I n l ays Unlike silver (amalgam) fillings white filling material sticks to teeth hence giving the tooth strength.
the tooth, isolating it i.e. providing good moisture control.
can’t be obtained Not all white filling material is the same: There are many types of ‘white filling’
3. Remove any decay and /or old filing from the tooth 4. Wash and dry the tooth, prepare the tooth with etch – which is a mild acid in order for the glue or bond to stick the filling in place. 5. Places the composite filling into the
material your dentist may choose to fill
tooth and sets (cures) the filling in
White fillings come in all shades of ‘white’
your tooth with, such as: Glass Ionomer,
small increments with a special light.
and when colour matched correctly can
Compomers and Composites.
appear ‘invisible’ restoring the natural appearance of the tooth. This gives an all white beautiful aesthetic smile.
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– rubber dam will be placed over
4 1. If too much tooth is
that the mouth feels fresher and looks and ceramic inlays can help prevent
2. In most cases a rubber sheet
Composites tend to be longer lasting
6. Trims and carves the filling to produce a life like tooth.
and more aesthetic, but remember there are many variations in composites
Local Anaesthetic: Yes
which will be reflected in the price
Number of Visits: One
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SmileScription™
Porcelain veneers From making teeth whiter, straighter, more proportioned and fitting in with the facial structure. Veneers could be the solution to all your problems
chapter
– ‘the age perfector for the smile’
five
They can be used to close gaps, fix chipped teeth, worn, discoloured or misshapen teeth. Yes they can be expensive, but veneers are definitely stronger, more aesthetic, thinner, whiter and of course more natural.
AgePerfectingPointers
AgePerfectingPointers
The anatomy of beautiful
In some cases
teeth, the colour, shape
veneers or branded
and alignment of teeth
‘Lumineers’ can be
all contribute to the
bonded to teeth,
appearance of the smile.
requiring neither drilling nor local anaesthetic.
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