You may be very proud of your strong, white teeth, but most people’s dental health becomes increasingly troublesome as they get older. ‘Teeth can shrink back and “drift” with age, leading to a wonky smile,’ says Manchester dentist Dr Ben Atkins, of Revive Dental Care. ‘They also tend to darken and there’s a reduction in saliva that can increase the risk of gum disease, decay and tooth loss.’
Fortunately, these days there’s no need to put up with ugly, discoloured, overcrowded, metal-filled gnashers. So many treatments, from whitening to implants and invisible braces, are now on offer. And with new ‘chairside’ procedures, even serious issues can be fixed in less than a day, with no need for impressions or temporary teeth.
Find out how to cut the cost of a trip to the dentist
What to do about wonky teeth
Braces (orthodontic treatment)
Why? Overcrowded, overlapping or misaligned teeth can mean much more than a crooked smile, according to orthodontist Raman Aulakh, of Bow Lane Dental, East London. ‘They can trap food, making cleaning harder and increasing the risk of gum disease or decay.’
What’s involved? Today’s braces are more comfortable, discreet and smaller than the bulky contraptions of old. There are three options:
• Visible braces. Clear ceramic brackets are placed in front of the teeth and fixed with white wires, so they are less noticeable than the old metal ‘train tracks’.
• Invisible (lingual) braces. Custom-made to each individual tooth, they are attached to the teeth, so they cannot be seen.
• Almost-invisible braces (Invisalign). The newest option, you wear these removable, custom-made, clear plastic ‘aligners’ over your teeth for 22 hours a day, removing them only to eat and brush your teeth.
Expect to pay: £50-£70+ for an initial assessment. From around £3,000 £5,500 for the braces and follow-up appointments
Find out more about orthodontics in adulthood
Why? Simpler than braces, requiring fewer surgery visits, veneers can enhance wonky or chipped teeth, close small gaps, align slightly out of place teeth and cover stains.
What’s involved? The dentist shaves off some of the tooth’s enamel and takes a mould. A veneer, colour-matched to your teeth, is stuck over the tooth like a false fingernail, and polished. You’ll usually need to make up to three visits. Apart from the cost, the disadvantage over braces is that removing enamel can kill the tooth.
What’s new? Instant veneers, such as Lumineers, are like dental contact lenses, made from a special thin-yet-strong porcelain that requires minimal tooth preparation. The procedure is reversible as, unlike traditional veneers, the natural tooth structure is left intact.
Expect to pay: from £350 per tooth to £550-£800 per tooth for porcelain veneers and Lumineers.
What to do about bad teeth
Why? To protect decayed or weak teeth, damaged fillings or large fillings where there isn’t much tooth left. They can also hold together cracked teeth, and restore or cover badly worn, misshapen or discoloured ones.
What’s involved? The dentist takes an impression of the tooth and a crown is created in a lab from porcelain bonded to gold alloy, porcelain alone, ceramic, glass or gold. This process normally takes around four weeks.
What’s new? Same-day crowns are now possible using CEREC, which is an all-ceramic material that conserves more of the natural tooth. The dentist takes a photograph to create a 3D computer model of your tooth. The resulting design is then beamed wirelessly to a milling machine, which creates the crown on the spot.
Expect to pay: from £300-£1,000 per crown
(also known as tooth-coloured fillings, onlays and inlays)
Why? A simpler procedure than most crowns, material made from glass particles or a synthetic resin is used to fill the tooth.
For larger cavities, tooth-coloured inlays, which fit in the tooth, and onlays, which cover several surface cusps, may be required.
What’s involved? The dentist drills out the decay and/or filling and repairs the tooth in a single visit. The fix should last from five to ten years.
Expect to pay: £75-£100 per restored tooth
What to do about missing teeth
Why? To provide a long-term natural-feeling and looking replacement for a lost tooth, which allows you to bite naturally, eat what you want and brush as normal.
What’s involved? The dentist measures the depth of the bone before inserting a titanium screw, around which bone and tissue grow. A crown is then attached to the screw.
What’s new? A complete set of functioning ‘teeth’ in a day. The dentist uses a CT scan to create a 3D image of your jaw and determine the number and placement of implants. Temporary ones are inserted and, after the bone has started to knit to them, replaced by a permanent set.
Expect to pay: around £3,000 per tooth for single implants; £12,000-£18,000 for a full arch
Why? To improve appearance and correct bite issues or speech problems resulting from missing teeth if you don’t want, can’t afford or aren’t suitable for an implant – perhaps because there’s not enough bone in your jaw to support one.
What’s involved? The dentist drills down the adjacent teeth to remove their enamel. A solid false tooth made from porcelain (or porcelain bonded to precious metal) is then suspended between them. A bridge can last from ten to 15 years.
Expect to pay: £300-£900
What to do about worn-down teeth
Why? To protect teeth from further wear. Can be used with other treatment such as tooth-coloured fillings, veneers and crowns.
What’s involved? There are two options. You can use soft night guards, which are available over-the-counter or online, to keep your upper and lower teeth apart and prevent grinding in your sleep. Or you can try occlusal splints, which are hard acrylic guards available from your dentist that fit precisely over your teeth.
Expect to pay: from around £30 for a soft off-the-shelf guard to £450-£1,000 for an occlusal splint
What to do about dingy teeth
Why? Veneers and crowns can be used to hide discoloured teeth, but whitening is less intrusive and there is no need for the enamel to be removed.
What’s involved? Dentist-prescribed home whitening is the gold standard. The dentist makes a mouthpiece, which you fill with a bleaching agent and wear for 30 minutes to an hour over two to four weeks. Newer whitening products can be applied for up to eight hours at a time, producing a result in as little as a week.
What’s new? Instant whitening, aka chairside bleaching, laser whitening or power whitening. The dentist puts a rubber dam over your teeth to protect your gums and applies the whitening agent. A bright light or laser is then used to activate it. The procedure takes around one to two hours.
Expect to pay: from around £500-£800 a session for chairside whitening or £300-£700 for dentist-prescribed home whitening
Whitening should only be done under dentist supervision. Not everyone is suitable for the process and some kits bought online can be too strong.
Foods that whiten teeth naturally
What to do about black triangle teeth
Better dental hygiene
Why? One in three of us suffers the dreaded black triangles at the base of lower teeth caused by receding gums.
According to Elaine Tilling, the head of clinical education at dental-products firm TePe, proper brushing and cleaning between teeth with interdental brushes – plus a regular scale and polish – can slow the gum disease that causes the problem, but it can’t cure it.
A deep clean (root-surface debridement) may be recommended if you have particularly deep spaces around the teeth.
Expect to pay: £25-£200 depending on how much work is needed. TePe interdental brushes start from £3.49. Other products include the Philips Sonicare AirFloss, £75, which fires air between the teeth
Dental hygienist: costs and FAQs
Why? Treats more serious cases of black-triangle teeth.
What’s involved? A periodontist (a dentist specialising in gum disease) grafts tissue taken from elsewhere in the mouth onto the affected area to cover portions of the root exposed by the receding gum. The procedure halts further recession, eases sensitivity and improves appearance.
Expect to pay: £650-£800. Black-triangle teeth can also be combated by opting for either veneers or composite restoration
Dr Ben Atkins Dentist and Press and Parliamentary Representative British Dental Association. Dr Raman Aulakh, Orthodontist and Tutor in Aesthetic Dentistry, Kings College Dental Institute. Dr Niall Hutchinson, Dentist, Cherry Tree Dental Practice, Wantage. Dr Shaun Smith, Dentist, The Dental Surgery, London. Elaine Tilling, Hygienist, British Society Dental Hygiene and Therapy Adviser To NICE.