The price of perfect teeth

Suddenly, everybody wants a movie-star smile and cosmetic dentistry is booming. But rushing into treatment could do lasting damage to your looks - and your wallet, warns Jane Corrigan

Back in 1995, the chattering classes were outraged at reports that Martin Amis had spent £20,000 having his teeth fixed. Today, such news would raise barely an eyebrow - not least because the chattering today more than likely emanates from a mouth sparkling with thousands of pounds worth of braces, veneers, crowns or bleaching.

Back in 1995, the chattering classes were outraged at reports that Martin Amis had spent £20,000 having his teeth fixed. Today, such news would raise barely an eyebrow - not least because the chattering today more than likely emanates from a mouth sparkling with thousands of pounds worth of braces, veneers, crowns or bleaching.

It's a paradigm shift, says Dr Ian McIntyre, the ex- president of the British Dental Association. "People are suddenly very conscious of their mouths because having a good smile affects their lives. You can't get a job in Woolworths with gaps in your teeth."

Despite this new obsession, few people go as far as the model Jodie Marsh in their quest for dental beauty. Earlier this month, she endured five hours and £15,000-worth of surgery on Channel Five's All New Cosmetic Surgery Live to acquire a set of perfectly symmetrical, toilet-white veneers on her front teeth - giving a smile, according to a leading cosmetic dentist, "that bears little resemblance to what is human and natural".

But, according to Dr Nigel Saynor, president of the British Academy of Aesthetic Dentistry (BAAD), it's only a matter of time before we're all doing it. "The growing trend, according to our members, is for a Hollywood smile with big, film-star, teeth with the central incisors increased in size by a significant two millimetres that mean you suddenly see a huge smile coming towards you," he says.

It's a trend that is promoted by the popularity of extreme makeover shows featuring celebrities such as Marsh - as well as the arrival of American-style "dental spas" in UK department stores, including Selfridges, which give the subtle message that having cosmetic dentistry is rather like having a massage or getting your hair done. And if you're not sure where to go, there are pages of cosmetic dentistry practitioners in Yellow Pages and on the internet.

But it's worth listening to some leaders in the profession. They warn that dental work is never like having your hair done. "A dentist should never simply do a cosmetic job. They should be taking into consideration the health of the patient's mouth as a whole," says Dr Saynor.

Many dentists who offer cosmetic work have had no training in the field and sometimes precious little experience. Even membership of BAAD means little more than that the dentist has paid - as well as having lectured or published on the subject.

"There are no qualifications for cosmetic dentistry recognised by the General Dental Council simply because it doesn't exist as a specialist field," says Paddy McCullagh, a consultant in restorative dentistry for Hammersmith and Fulham Primary Care Trust.

Dentists who advertise themselves as providing cosmetic dentistry services may have done no more than a weekend course by a team of visiting dentists with an interest in heavily marketing their own technology.

The Harley Street dentist, Dr Myles Dakin, one of a handful of UK dentists who have completed postgraduate training in restorative dentistry in the United States and are members of the prestigious American Dental Society of London, says that any dentist can do anything they want. "There's a feeling that, with cosmetic dentistry, one size fits all," he explains. "But the essence of quality dentistry is that it is a bespoke service." Most people, he says, do not realise that dentistry is a team effort, with the quality of the work dependent on the input of laboratory technicians.

Underpinning all this is the question of cost. Dr Dakin's laboratory fee for a crown, for instance, is £250, at least double the cheapest fees. "For that, you get a lot," he says, "including technicians working at 250-times magnification, digital photography and qualified ceramicists who interview patients. The result is work that looks natural, mimics a normal healthy appearance and lasts a lifetime."

Cheap isn't always unsatisfactory, says Alan Petrie, a deputy laboratory manager at Edinburgh Dental Institute. "But, with cosmetic dentistry, it's largely a matter of getting what you pay for, because the price relates to the amount of time that is spent on the work. "

There are simple checks that anyone contemplating cosmetic dentistry can follow. Experienced practitioners will have a portfolio of before and after pictures demonstrating their work, and will be happy to show it to patients. Before you embark on a course of treatment, says Mr McCullagh, you should make sure that the rest of your mouth is healthy.

You should also obtain a written treatment plan that is fully costed before treatment starts, and have a clear statement from the dentist on exactly how long the work is expected to last and what will happen if something goes wrong.

It is also worth checking on the laboratory service. Top-level laboratories will be DAMAS (Dental Appliance Manufacturers Audit Scheme) accredited. A further guide is that the laboratory has an MDA (Medical Devices Act) number - only half of UK dental laboratories have the number.

McCullagh says the trick is to get the maximum effect with the most conservative treatment. The result, says Dr Dakin, "should be the restoration of healthy, normal-looking teeth that may be crooked and irregular but still look beautiful - and that doesn't necessarily include the Jodie Marsh look.

Need to know

Crowns

Pros: One of the most popular forms of cosmetic dentistry (shown before and after, with veneers, above). A cap, usually made of porcelain, is placed over the filed-down existing tooth.

Cons: Irreversible. Also highly invasive. Around 15 per cent of teeth prepared for a crown require root canal work.

Veneers

Pros: Relatively simple. Most of the original tooth remains in place, with the addition of a surface covering.

Cons: If you've got one grotty tooth, it's very easy to be persuaded to have more veneers so that they all look the same.

Whitening or bleaching

Pros: A non-invasive procedure, relatively inexpensive and which can have a dramatic impact.

Cons: Can create sensitivity. The most successful and tried and tested method is the home-bleaching kit - though it takes up to three months of fairly hard work. "There is little evidence that power-whitening, using a strong bleaching agent and a light or laser, is any more effective," says McCullagh.

Braces

Pros: Conservative and almost entirely non-invasive. Invisible braces are available - though not as powerful. In some US schools, not to have a brace is a seen as a sign of parental unemployment.

Cons: Have to be fitted by an orthodontist, and are therefore relatively expensive. Tooth-straightening takes a long time to work.