Full Mouth Makeover

It wasn't that nobody was unhappy with their mouth before "Extreme Makeover."

But in the past, consumers didn't have much of an idea what could be done about a little bit of crookedness or gumminess. Now they've seen their problems fixed on TV. Snaggle smile to gorgeous grin in just a few minutes.

The actual process — going from flawed teeth to perfect veneers — is slightly more intense, but faster than braces. And customers are ready to pay big bucks for what can be a dramatic change in appearance.

In the past five years, the industry has changed consumer awareness of cosmetic dentistry options, boosting whitening and bleaching by 300 percent and increasing veneer sales by more than 250 percent. MicroDental Laboratories, which manufactures MAC Veneers, has had double-digit percentage growth annually. Bleaching is still the most popular treatment in most dental offices.

"Baby boomers have more expendable income," said Robert Margeas, a dentist in private practice in Des Moines and adjunct professor at the University of Iowa. About 70 percent of his practice is aesthetic dentistry.

"They're coming in and they want whiter teeth. They want their dentistry redone. . . . They're more informed," he said.

It's not just TV driving our fixation on smiles. The number of whitening products at the drugstore has multiplied from a few tubes of Rembrandt toothpaste to nearly an aisle of bleaching trays and pastes.

Laboratories manufacturing veneers have ratcheted up advertising budgets and branded their products.

Even in Iowa, a few dentists offer plush practices specializing in cosmetic dentistry.

Some customers who make appointments with dentist Jay Jensen have already diagnosed themselves with temporomandibular disorder (TMD), an affliction of the joint in front of the ear, caused by jaw misalignment, which can result in teeth grinding and pain. Hardly a household ailment 20 years ago.

"People come to me for smile makeover or if they have a lot of different things that need to be done," said Jensen, who calls himself an "aesthetic restorative dentist" and is in private practice at Restoration Dental.

"There's a huge trend in baby boomers having this done. They reach retirement, have discretionary income, and they want to 'take care of me.' . . . We're a beautiful society and looks-driven."

New stuff to smile about

Rather than going to a dentist to ask about fixing their teeth, many people now call the veneer companies to find a dentist who works with the brand of veneers they want.

"New veneers are three times as strong and look better," said Heather Martin, vice president of Consumer Relations at MicroDental Laboratories

"Before, they were monochromatic. Now, they don't look like veneers. They blend.

"Before they looked like they were laying on the teeth. Now, they're homogenous," Martin said.

Improved products are driving demand:

Fix your teeth and you'll get better, stronger, more realistic-looking material in your mouth than you would have been outfitted with 20 years ago.

Installed over filed-down teeth, composite veneers are durable and stain-resistant. Customers should expect to get about 20 years of chomping and smiling out of their new look.

"New porcelains are much more lifelike," said Kathy Elsner, a dentist at University Dental Group. "We don't have to use metal in the mouth any more."

Implants are more natural-looking than removables and bridges.

Bonding, applying a thin layer of material over the tooth to mask and protect it, is also still a viable option, at about half the cost of veneers.

Jensen has focused on such work for four years, since attending the Las Vegas Institute for Advanced Dental Studies, a school that specializes in teaching dentists advanced cosmetic skills. He was inspired after watching a lecture by a famous cosmetic dentist.

Even without inspiration, the move makes sense. Dentists who specialize in cosmetics benefit in several ways. Their practices tend to be less harried - they take fewer cases and work at a more relaxed pace with more patient interaction. And the before-and-after makeover effect can be as satisfying to the dentist as to the happy patient.

"It's very dramatic," Jensen said.

And dentists say cosmetic dentistry is satisfying in creating such noticeable improvements.

"Porcelain veneers are the most beautiful restoration in existence," said Bob McNurlen, a dentist in private practice in West Des Moines and past president of the Des Moines District Dental Society.

"A lot of the work we do doesn't show, so it's nice to do something with a real visual difference.

"They smile more. It affects their whole outlook, like a significant weight loss or plastic surgery or a hair color change.

What brand are your teeth?

Jason Goldstein, director of sales for da vinci Studios, probably the best-known veneer brand, said his company has always advertised to dentists, but only started to advertise directly to consumers when it realized how much interest was being generated by TV shows such as "The Swan."

"We've taken a very generic product that can be made by most dental laboratories and, by giving it a brand name, it's created something that consumers never knew about," he said. "We're not that big of a company, but we have people across the world asking for da vinci veneers. That's pretty powerful."

A little knowledge can be an expensive thing.

Most of the cosmetic procedures dentists performed are at least partially, if not fully, paid for out-of-pocket. The cost can range from a few hundred dollars for whitening to $40,000 for a full-mouth reconstruction.

Veneers vary dramatically in cost, depending on the lab used by the dentist. Labs on the East and West coasts tend to be more expensive, and may offer brand-name veneers. The cost can be $1,000 to $1,500 per tooth.

Bonding, a cheaper, less-invasive option, runs customers about $400 a tooth.

The patients willing and able to spend money at Restoration Dental are typically in their 40s and 50s. National numbers show more women than men make over their mouth, by a 3:2 ratio.

"The majority of patients aren't from around here," Jensen said. "They're from all over Iowa.

"In the past, it was looked at as bad to advertise. But I can do in Ankeny the stuff you see on 'Extreme Makeover.' "

Such shows often discuss jaw alignment and issues with TMD, which has brought educated patients into Jensen's practice.

Dentists may vary drastically in how they treat such issues.

Jensen has the latest high-tech equipment to deal with patients who complain of TMD, including a machine that reads muscle effort to test for a problem and a machine that relaxes the area to relieve pain.

Others may use more conservative approaches. Elsner said the vast majority of cases can be treated with a bite guard and physical therapy.

To know the best route, do your research, Margeas recommends.

"There's no specialty in cosmetic dentistry," he said. "There's no ADA-certified program on cosmetic dentistry."

That puts the burden on consumers to figure out the best route to a perfect smile.