Essay
Extended Essay- cosmetic dentistry
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This is an extended essay for EPQ on whether cosmetic dentistry is a need or desire.
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The Morality of Cosmetic Dentistry- A Need orDesire?
There are many ethical issues concerning cosmetic dentistry. Is it a necessary need or just a desire? Many
dentists today have been using a wide range of treatments such as teeth whitening, veneers, lumineers, gum
contouring, dentures, crowns, cosmetic bonding, cerec, dental implants, smile makeovers, however the
concern is that are these necessary to live a healthy life or has dentistry changed into a business market
instead of a health care profession? These procedures have been designed to treat dental conditions in a
relaxed atmosphere.
Orthodontic treatments (braces), contouring and reshaping teeth, are the most common form cosmetic
treatments done in today’s society [6]1. Many today use braces to gain an attractive smile, this is an aesthetic
reason. In today’s society our appearance plays a vital part, many think it is important to have perfect set of
teeth, but this is just vanity, pure vanity. People are ready to spend thousands and thousands on trying to
have a perfect smile, but this is just a desire. Invisible braces commonly known as Invisalign are preferred
the most as they are known to be working very well with malocclusion problems nevertheless there are
orthodontic cases involving teeth extraction and movements where this apparatus is not recommended [3]. It
can just be a nuisance taking them on and off when wanting to eat and costs a fortune. This shows that this is
just a cosmetic not necessary to lead a normal healthy life [4].
On the other hand having invisible braces boosts your level of confidence in public and makes one feel
better about them. European Journal of Orthodontics is one of the leading publications in the dental field
targeted at all orthodontists. One of their researches published under the name “Factors influencing the
desire for orthodontic treatment” by W.C.Shaw, one of the top ten most cited articles, allows us to see the
attitude of different people about their teeth. The research was conducted with 100 boys and 100 girls, all
their thoughts on dental appearance were noted. Results show that girls with increasing age were more
concerned about their dental appearance [1]. The reflections here are that females are more concerned about
their looks, but are orthodontic treatments necessary? In reality the top front teeth spreads out over the
bottom set of teeth and the molar teeth meets, but this ideal arrangement is not always met by all. The only
times you should be wearing braces are: Class I malocclusion is when the teeth are twisted, close together,
this is the most common situation. Sometimes, the upper set may be frontward from the bottom set far too
backwards; this is known as Class II malocclusion. There is also the underbite, Class III malocclusion which
is the opposite of Class II. Also, crossbites and open bites may need braces [2]. According to Dr. Ron
Markey, a Vancouver orthodontist, “I see adults in their late 40s who, because of a neglected overbite, have
nothing left of their lower front teeth. And they’ve also worn their upper front teeth so thin, they’ll chip and
disintegrate” [3]. This shows the importance of sorting out malocclusion problems at a young age to avoid
disappointments in the future. This shows the necessity of dental braces but is it necessary to pay a fortune
and get clear braces.
Source 1: This clearly shows the difference between braces and invisible braces
http://www.alexanderdentistry.com/services/invisalign/
1
http://www.knowyourteeth.com/infobites/abc/article/?abc=C&iid=300&aid=1196 – January 2012
,The next most common cosmetic treatment is teeth whitening, also known as bleaching [6]. Teeth whitening
have been introduced into the dental field to give all that wants a perfect smile to illuminate millions of heart
for a long-lasting lifetime which could also display one’s confidence. This generates an optimistic
appearance of you as today’s world is very image conscious and this treatment makes you look further
attractive. In addition, it is also believed by many that once you get this done, all the concentration goes to
your teeth rather than your appearance, it is like a mask to hide one’s age as it can make age wrinkles be
overlooked. There is also a fake perception that individuals with white teeth are pleasanter than the general
public with stained teeth [9]. Before starting this treatment, a dentist will complete a full examination to
prevent this latest method troubling any of the other teeth. There are several methods of teeth whitening.
These procedures are used by appreciated besides celebrated dentists all over the sphere. The frequently used
ways of teeth whitening are over-the-counter bleaching methods that can be suitably used out of clinical
area. Other extremely recommendable ways and means of tooth whitening methods such as laser tooth
whitening method, in-office whitening methods, and loaded tray teeth whitening method. Throughout the
practice of tooth cleaning peroxide chemical is castoff by decreasing the debris and stain [11].This procedure
is an obsession amongst Hollywood performers as the flawless smile is a fundamental part of their
profession. They believe that home tooth whitening kits re-establishes the original tooth colour in a harmless
and effective manner, due to the fact that the substance can be worn while sleeping making the whole
technique much more tranquil. Correspondingly, it is said that no unpleasant taste will be given off [10].
Dental appearance alone cannot examine whether the teeth are healthy or not. There are two types of stains;
Intrinsic and Extrinsic. Extrinsic is the outer layer of the teeth stained due to bad oral hygiene or simply food
and drinks. Intrinsic is the inner layer stained, which is harder to remove, this can be caused by smoking and
tooth decay [5]. The greatest way to stop teeth from staining is by having a very good oral hygiene. A good
oral hygiene pattern is brushing your teeth after every meal with soft bristled brush and fluoride toothpaste
and to eliminate any pigment producing products between the teeth by flossing once a day. In addition,
visiting your dentist every six months and getting a cleaning done by either your dentist or hygienist
improves your oral hygiene [6]. This shows that tooth whitening is not needed as a good oral hygiene is
enough, but some dentist still recommends whitening. Discolouration of the tooth can also occur as your
aging, tooth whitening is the bleaching of teeth in a clinic or at home. Many prefer home bleaching as it is
more convenient, but this just shows the inessential of the dentist presence, showing it is not required to be
handled by professionals, therefore it is just a by-product, a desire by many, not a proper treatment. The only
need for a dentist here is to make a mouth guard to ensure that the bleach is exposed correctly. The
whitening at home takes place over several weeks until a preferred shade is achieved. There are few
circumstances where teeth whitening should not be done, these are: age, pregnancy, sensitivity, gum disease,
worn enamel, exposed roots, dental cavity, restorations such as crowns and filling. Restorations are vital in
dentistry as it repairs damaged teeth, the fact that bleaching cannot be done if restorations are present shows
it is a very avoidable treatment. This is definitely not a need but just a desire. The bleach consists of
hydrogen peroxide and carbamide peroxide. A research done by the Institute of Odontology, Faculty of
Health Sciences, University of Copenhagen, Denmark, shows that the direct contact of hydrogen peroxide
and carbamide peroxide shows 90% immediate success but the consequences are loss of appetite, loss of
weight and blood chemistry change [7].In addition, to support this research another research was done by
Michael g. Jorgensen, D.D.S. and William B. Carroll, D.D.S showing the possible side effects of home
whitening. This was carried out by using double-blind method amongst 50 adults using a substance holding
15% carbamide peroxide and 0.11% fluoride ion and another 50 adults using placebo gel every day for a
month. The independent variables in this experiment were plaque index score, gingival recessive status,
caries status, current dentifrice and smoking history. The sensitivity was evaluated across the four weeks via
interviews every week. Results showed that 54% in both group had mild sensitivity, 10% of the users and
2% of the placebo users informed of feeling moderate sensitivity and finally 4% of the gel testers and 0% of
the placebo testers claimed to have severe sensitivity. It is also analysed that as the time increases the
sensitivity decreased rapidly, as by the second week none of the users had severe sensitivity. The author also
claimed that there is a positive correlation between sensitivity and gingival recession, however no relation
was found between sensitivity and other independent variables. This concludes that patients undergoing
tooth sensitivity are more expected to have gingival recession[8].This just shows that this treatment is full of
risk, therefore it would never be a necessity, only a desire and at the one’s own risk.
, Another cosmetic treatment is cosmetic crowns (all porcelain) which are mostly used for casing leaking and
old silver fillings also known as restorations. There are different types of material used to make dental
crowns such as porcelain, ceramic or even gold, sometimes they are an alloy and all of them offer really
good improved aesthetic results, but porcelain is used mostly as it gives a natural tooth colour. As time goes
by dental filling turn out to be noticeable, with crowns you can avoid this state because porcelain and
ceramic crowns give a natural look and merge in with the appearance of your teeth, giving better optical
properties. Likewise crowns aid to secrete fragmented and cracked teeth as an outcome of injury and hides
bruxism commonly known as teeth grinding. These crowns also provide with additional guard over larger
cavities and thwart further spread [12]. Crowns can be made fully porcelain without any metal in the core this
is an amazing substitute to substitute or cover the six front teeth in the upper and the lower jaw.
However, they are involuntarily weaker and need to be used in
combination with resin bonding cements. Both these parts lead to
augmented clinical and technical burdens and as such there are
strict guidelines concerning tooth preparation and bonding
techniques that need to be monitored while using ceramic crowns.
The article from the British Dental Journal describes these
Source 2: shows a crown failure preparation, impression and bonding guidelines [13]. They are never
http://www.askthedentist.info/Crow a good choice as crown doesn't have enough strength resist forces
nandBridge.htm of biting and will breaks without problems. Occasionally, the tooth
covered by the crown might undergo decaying due to the lack of
tightness of the crown around the tooth. Other times, they may be poorly fitted as well as being the wrong
bite or shape for the tooth, which means replacements needs to be done which will cost more, and take up a
lot of time due to appointments considering the fact that it is very hard to get dentist appointments nowadays
[14]
.
Source 3: implanted metal posts
http://www.miamiperio.com/pro/si
ngletooth.html
The next treatment widely used is dental implants, these are metallic posts implanted into the jawbone and
used to replace missing teeth. Implants needs very detailed planning using x-rays and measurements as it
needs to create a stable additional tooth to fit the missing teeth. It is believed they last a lifetime as it binds
with the neighbouring tooth. A study done by Porter JA, von Fraunhofer JA, tells us that the main factors
making dental implant a success are the quantity and quality of bone, the age of the patient, the experience of
the dentist, position of implant, and a good maintenance of oral hygiene[15]. Dental implants are made by
titanium as it is strong as it has secure bonds which means it will not move preserving the bone and does not
corrode in addition to preventing further corrosion of gum showing that this is a necessity for those who
have lost healthy teeth and bone making it a low maintenance too and functions just like a normal tooth, it is
poor conductor of electricity and non- magnetic so it will not set any alarm off. It is also known to be non-
toxic [16].
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