Form and Function

A down economy and elective dentistry isn’t the best mix. But Cleveland-area doctors are reporting both structural fixes and affordable, aesthetic upgrades among their top picks for what's popular now.
It’s a tale told over and over again by local dentists. Dr. Scott L. Rose recounts the story of a woman in her 50s. The patient, a housewife who was living comfortably on her executive husband’s salary, had come in early last winter for a consultation and immediately scheduled $10,000 worth of work.

But in the month between that consultation and her first appointment, her husband lost his job.

“She called and canceled,” Rose recalls. “She just said that they really couldn’t justify going ahead with the work. They weren’t sure about when he would be getting another job. And if they had to delve into their savings, they didn’t want to delve in for dental work. They wanted the money for the mortgage, utilities, gas — the daily essentials.”

He says he’s seeing a gradual increase in demand for cosmetic dentistry procedures as the nation’s economy recovers, but Rose is quick to add that many patients are still too worried about their own financial futures to invest in an elective smile overhaul. Dr. Benjamin Hornstein, of the Center for Advanced Dentistry in Beachwood, agrees.

“Most people are doing what is necessary from a structural and functional perspective,” he says. “But something structural and functional can also look good.”

Still, when we asked other doctors to name their most-requested procedures, some aesthetic options made the top of the list, too.

Neuromuscular Dentistry

Headaches, tempomandibular joint problems and neck or shoulder discomfort drive a large number patients to Rose’s office, because many of these problems are caused by bite anomalies.

“These people are in pain,” he says. “That’s a driving factor.”

Using sophisticated computer equipment that tracks how nerves communicate to muscles in the jaw, Rose diagnoses what is causing the pain and then corrects the problem by way of orthotics, crowns or other dental remedies. Fortunately, Rose says, many insurance companies cover treatment of these sorts of problems.

Porcelain or Composite Restorations

Dr. Alia Kalaf, of Solon Dental Excellence in Solon, says she’s seeing plenty of people replacing mouthfuls of unsightly mercury-amalgam fillings with natural-looking counterparts. But they are often motivated by more than just a desire to improve their looks. She says many cite concerns about having mercury in their teeth, in some cases since early childhood.

Kalaf notes that she mills the porcelain inlays and onlays, which are applied to the biting surfaces of the teeth, right in the office, using computer technology to provide an excellent fit. She explains that the ability to make replacements in-house also saves patients the time and aggravation of coming back to the office to have temporary fillings replaced.

“They can last 20 or 25 years, even a lifetime if patients take care of them,” Kalaf says.

Fillings can also be made from a composite resin material that is matched to the color of the surrounding tooth. Like Kalaf, Dr. Steve Marsh, of Art in Dentistry in Lyndhurst, uses this process, called composite bonding, in lieu of more costly veneers or crowns to reshape and resurface teeth. In some cases, it can even be used to repair cracks, chips and breaks.

“It’s not quite as stable, and it doesn’t last quite as long,” he says. “But it will give you a wonderful result.”

In-office Whitening

Though processes can vary, office tooth-whitening typically involves applying a carbamine peroxide gel to the teeth, then enhancing the gel’s bleaching action by exposing it to a special light.

Most patients see good results in one session, and the prices are relatively affordable. Marsh puts the current price at anywhere from $350 to $550 dollars — a figure that has actually decreased over the years.

“It’s sort of like Botox is to a face-lift,” Marsh says. “In an hour and a half, they can make their teeth a lot brighter.”

Invisible Braces

Beachwood dentist Dr. Stuart B. Katz acknowledges that vanity is at least partly responsible for the continuing popularity of invisible braces, the clear, paper-thin plastic forms that fit over the upper and/or lower teeth.

“They sort of snap on — they look more like a mouth guard,” he says. “When they’re on, people can’t see them.”

Mild to moderate malocclusions are corrected by wearing a series of computer-designed “aligners,” which are swapped out every two weeks for a new one — a process that gradually straightens the teeth.

But as Kalaf points out, straight, evenly spaced teeth are important for more than just looking good.

“Crowded teeth can lead to plaque accumulation and the development of gingivitis, periodontitis and gum disease,” she explains. “And there is a link between periodontitis and heart disease and diabetes. People are becoming more aware of it, and they’re trying to prevent any complications that can affect or jeopardize their general health.”
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