Right after graduation, he went to The Hospital for Sick Children to practice dentistry. Working as part of the reconstructive team in the Cranial-Facial Department of Dentistry, he saw first hand how cruel nature and circumstance can be. He also realized what a difference improving the teeth made to a patient’s self image. Today, Dr. Philips is one of the few dentists in Ontario who only does esthetic work in his practice.

"Our teeth shift and drift as we age; they discolour and wear down," he says, "But patients often underestimate just how much their appearance can be changed with cosmetic work." For example, just lengthening short teeth results in more convex and curvaceous lips. "I call this a smile lift" he says humorously, and recommends that patients contemplating plastic surgery should have their teeth seen to first.

At The Studio for Aesthetic Dentistry, Dr. Philips begins a consultation by looking at the structure of a patient’s face and analyzing the smile. There is no one ideal smile, he explains, adding that "cookie cutter solutions are great, only if you’re a cookie."

But there is an ideal smile for your face. When you smile, the corners of your mouth should line up with your pupils. And your two front teeth should not only work as a unit, but their width should be 80 per cent of their height. He is quick to add, though, this is not a matter of his own personal taste; his esthetic analysis is firmly rooted in established mathematical principle. And we see this proportional beauty reflected everywhere in nature, from the architecture of a nautilus shell – which Dr. Philips has chosen as his logo – to the spiraling strands of our DNA.

The two procedures patients ask for most are the re-whitening of their teeth and the application of porcelain veneers. Dr. Philips explains the reason for the popularity of veneers is obvious – they simulate the play of light on natural teeth. When a patient needs crowns, or what we laypeople commonly refer to as ‘caps’, these are also veneered to eliminate the tombstone look so often associated with the process. Some of the other procedures he performs are composite bonding, dental implants and perio plastic surgery where the gum line is digitally tailored to achieve a more attractive smile.

However, it’s not all high tech at Dr Philips. Patients are really pampered in his spa-like facility by world-renowned designer Yabu Pushelberg. In this serene environment that reflects the flowing lines of a nautilus shell, Dr Philips works on only two clients a day. They have their own private washroom and changing area, and some people even bring their dogs!

Beyond his own practice, Dr. Philips thrives in his role as an educator He reports that a recent survey by the World Health Organization reveals 75 per cent of Ontario’s population sees a dentist at least once a year. "That’s one of the highest rates of preventative care in the world,’ he says, "But we have one of the lowest when it comes to cosmetic dentistry." And Dr. Philips aims to change that.

At his studio, he has incorporated an interactive educational center. Members of the public are welcome to come by any time to access information on the technical and esthetic wizardry that can transform their appearance. And as Dr. Philips views it, this newly emerging field of dentistry is a living example of science driving art, and benefiting all.

The peaceful vibes at The Studio for Aesthetic Dentistry in Toronto are a far cry from the cold sterility usually associated with the dentist’s chair. Glass, metal and porcelain fixtures sit in beautiful contrast to pottery work and wood countertops embodying the studio’s philosophy of harmony.

For the duration of time you spend in the studio’s spa-like facilities, you are the only patient present, indicated by the lone dentist chair. "One doctor, one dentist, one great smile," says Dr. Ed Philips, the studio’s founder and sole practitioner. He explains the purpose of his practice: "We are genetically programmed to look at a smile when gauging someone."

The Studio for Aesthetic Dentistry was not designed to replace a family dentist, but was meant to offer a unique experience to those seeking esthetic procedures. "We are an alternative for special jobs," from fillings and porcelain veneers to full mouth reconstructions, Philips says. "You can’t put the same set of teeth in every mouth and expect them to look good," which is why he offers patient-tailored care.

The studio itself is shaped like the spiral of a shell, with crevices and hidden private spaces – a washroom, dressing room with kimonos, postop rest area and a private rinse room – that provide comfort and calm. "We offer little things to help people get through the entire experience."

Panoramic radiography is invaluable for examining unerupted teeth in children and investigating suspected cysts or bone abnormalities in adults. But when detail is necessary, such as in detecting cavities or gingival problems, the conventional X ray is still necessary.

Fillings and flaws. Thanks to fluoridation and growing awareness of nutrition and oral hygiene, severe dental problems are decreasing. Observes Winnipeg dentist Ralph Crawford, editor of the Journal of the Canadian Dental Association, "Today’s average 17-year-old may have only one filling in his mouth; a person his age a generation ago would have had a dozen."

Nevertheless, due to accident or inheritance, many of us have teeth that are discoloured, chipped, crooked or badly spaced. And a new emphasis in dental practice is being placed on repairing these flaws. "An attractive smile is a personal asset," says Toronto dentist Edward Philips. "We can now create that smile."

Resin bonding is a painless and inexpensive method of correcting minor problems in a single office visit. The dentist paints your tooth with a weak solution of phosphoric acid, which etches a network of tiny crevices on the enamel surface and on the underlying tissue, dentin. This provides an effective clinging surface for the pastelike bonding material that he then brushes on. The bonding material – a tough composite of resin, glass and plastic – is hardened on the tooth by exposing it to intense light for 20 to 30 seconds. The process of applying thin layers of the resin and then hardening them by light exposure is repeated until the tooth is built up to the desired shape and size. After the last coat, the dentist applies finishing touches and polishes the tooth. For more serious defects, a thin, porcelain laminate veneer can be bonded over the entire tooth.

If you are considering cosmetic work, a cosmetic imager can show you the potential results. In only a few minutes, Vancouver dentist Ken Neuman can produce an edited picture of his patient’s smile, simulating possible cosmetic changes – from reshaping the teeth to closing gaps between teeth. Armed with "before and after" views, the patient can decide whether to go ahead with the changes.

Fillings nowadays are commonly made of porcelain or a durable plastic composite. They require smaller holes than amalgam, the traditional silver-coloured material, because they’re cemented in with resin bonding, which also seals out bacteria. Dentists may still use amalgam in back teeth because it’s cheaper than porcelain and stronger than plastic.

Amalgam has several drawbacks. Because it is held in mechanically, the dentist has to drill a hole larger at the bottom than at the top, and the fit is never precise enough to seal the filling completely. As the amalgam suffers wear and tear, decay-causing bacteria seep in.

Implants and replants. Synthetic implants now provide an alternative to cumbersome bridgework or dentures, once the only means of replacing lost teeth. At the site of the missing tooth, the dentist freezes the gum and bone, drills a conical hole into the bone and fits into it a cylinder made of titanium, a material that resists erosion and co-exists happily with oral tissue. The gum is sewn up, and, within three to six months, the cylinder becomes so firmly embedded by the growth of fresh bone around it that, says one dentist, "it’s stronger than natural teeth."

At this point the gum is cut open over the cylinder, and a porcelain tooth is cemented into it. A complete upper or lower plate can similarly be anchored with three or four titanium cylinders. Follow-up studies indicate a success rate of 75 to 90 percent for the implants, which cost about $2000 per tooth.

When an otherwise sound tooth is knocked out as a result of accident or injury, in many cases it can be replanted if tended to promptly. The dentist seals off the small hole at the end of the tooth where the nerve emerged, fits the tooth into its original socket and, with resin bonding, joins it to the adjacent teeth for support. In four or five months, new bone grows around the base of the tooth, and it becomes firmly attached.

Pain reduction. Along with new methods and devices, your dentist also has access to drugs that can make almost any treatment painless while you are in his chair. Some are so powerful they can be administered only by dentists certified in anesthesia. For example, midazolam, a potent intravenous sedative used in cases where the patient prefers being asleep, puts the patient into a trancelike state in which he can respond to directions. Upon awakening he may not remember anything about the treatment.

For the many patients who request a general anesthetic during stressful procedures, propofol is one of several drugs of choice. Administered by injection at ten-minute intervals and in very small quantities, this drug will keep a patient asleep, allowing the dentist to complete in one appointment extensive treatment that would otherwise have required many appointments. When the drug is stopped, consciousness returns quickly, and the side effects are minimal. Its use requires that an additional trained person also be present to monitor the patient.

Bone and tissue treatment. An early-warning test for periodontal disease, the leading cause of adult tooth loss, has been devised by biochemist Jaro Sodek and periodontist Christopher A. G. McCulloch of the University of Toronto. The patient rinses his mouth, and the rinse water is then analyzed. An above-normal enzyme count indicates trouble in the tissues around the teeth.

Another new technique actually restores bone loss caused by periodontal disease, a condition previously thought irreparable. At the site of a bone deficiency, a small, gauze- like package made of filaments of human bone is sewn inside the gum. In time the implant fuses with the existing bone and enhances it. "It’s incredible," says Edward Philips. "In most cases we are now able to halt the advance of periodontal disease and lessen the chances of patients ever losing their teeth."

Indeed, so many dental problems are now preventable that today’s children can look forward to a lifetime with healthy teeth. And for those of us who grew up without the advantages of fluoride and flossing, thankfully the new dentistry is there to keep our teeth in better shape than we ever expected.

Whitening toothpastes
One of the most popular whitening products on the market is the American-made Rembrandt Whitening Toothpaste (available in most drugstores for about $10), which uses Citroxain to whiten teeth and reduce plaque and tartar. Some of the more recent products are Aquafresh Whitening with Triclene ($2) and White Step ($6), endorsed until recently by actress Heather Locklear. Because neither contains peroxides or bleaches, they’re safe for daily use.

Three-step procedures
Similar to a method performed by dentists (see box), over-the-counter three-step procedures are growing in popularity. Natural White, available at your drugstore for about $20, includes the material to create your own bleaching tray, a horseshoe-shaped piece of malleable plastic that retains your teeth’s impression. You fill the tray with the specified amount of bleach gel and hold it in your mouth for two to three minutes, once a day for a maximum of three weeks, depending on the severity of the staining. Then, you cleanse your mouth with the oral rinse. However, Dr. Ed Philips, a cosmetic dentist in Toronto, warns that this tray, unlike the tray a dentist creates, can distribute the bleach to your gum line as well. "Depending on the sensitivity of the tissue, it may cause irritation." Natural White also has another product that includes a pre-rinse to clean your mouth, bleach gel (which you apply directly to the teeth with a cotton swab) and a final polishing step. It costs about $10.

The percentage of the active ingredient in over-the-counter versions of whitening products may not be as high as your dentist’s products, however, and therefore you may not get the expected results. Unlike the gel distributed by dentists, many products may only contain about six percent carbamide peroxide-too small an amount to provide lasting results, says Dr. Philips. Regardless of which type of whitener you intend to use, the Canadian Dental Association advises that, because few tests have been done with over-the- counter products, anyone who is thinking of using a teeth whitener should consult a dentist before making any decisions. Your dentist will be able to discuss with you what product is best for your situation and inform you of any risks.

Dentist-assisted teeth whitening
Cosmetic dentists Ed Philips and Sol Weiss of Toronto practise one of the most common tooth-bleaching methods, called Opalescence or Nite Whites. After taking an impression of your teeth, the dentist makes a specially fitted mouth tray for you to take home. You’ll also receive a gel containing approximately 10 to 16 percent carbamide peroxide which you squeeze into the tray and apply directly to your teeth. The product only needs to be used for up to a few weeks, before you go to bed. According to Dr. Weiss, "Sixty percent of the bleaching occurs within the first week, the other 40 percent in the next week or two." Opalescence will only work on natural tooth enamel so if you’ve had veneers or bonding done on your teeth, it may not be as effective. Patients with active gum disease may not be good candidates because the tissues may be sensitive to the peroxide in the gel. Expect to pay about $500 for the treatment.

Both dentists agree that take-home bleaching doesn’t work on some patients whose stains require a stronger percentage of carbamide peroxide. These patients usually have naturally dark pigments in their teeth or tetracycline stains, both of which require in-office bleaching. Tetracycline stains-permanent yellow or gray bands across the teeth-occur in people whose mothers took tetracycline during pregnancy and in people who were given tetracycline as babies less than 1 year old. In this case, dentists "power bleach" your teeth, painting them with 15 percent carbamide peroxide and then using a light to activate the bleaching process. Prices start at about $400, depending on the extent of your stains and on the number of teeth you want whitened.

With the dentist’s method, teeth will eventually return to their original pearly lustre. This doesn’t imply that touch-ups aren’t necessary, though, say Drs. Philips and Weiss. They recommend patients use a whitening toothpaste to maintain their brightened teeth. As stains begin to redevelop, patients may return for more of the gel treatment every one or two years. Because they have already paid for the tray, the price is substantially lower at about $50.

Not surprisingly, dentists almost everywhere have become really nice to patients. Gone are the days when they’d ask a question, then jam instruments into your mouth before you could reply. Now some take the Sistine Chapel approach to customer relations.

In British Columbia, Dr. Anderson offers 20-channel cable television, installed in the ceiling. In Ottawa, Dr. Sam Lewinshtein plasters his ceiling with a vast collection of funny buttons.

Children in Toronto awaiting Dr. Henry Ross get Polaroid snapshots and play Nintendo. Nervous types, adults included, are tucked into dental chairs with hand-crocheted blankets. And patients are welcome to toss their jewelry into the ultrasonic sterilizer, normally used to prerinse dental instruments. "People are just thrilled," said Helane Fischburg, his office administrator. "It polishes diamonds."

To be sure, it’s still great to be a dentist in, say, North Sydney, N.S., where there are only three dentists for 10,000 people. Dr. Colleen LaPierre laughed when asked whether she does anything special. "You don’t even have to be polite," she joked. "We just open up. People come."

That was standard fare 20 years ago, when patients everywhere might wait six months for an appointment. Children invariably had seven or eight cavities. "Even with emergencies, patients had to wait two weeks," recalled Dr. Edward Sonley, director of clinics at the University of Toronto’s faculty of dentistry.

To cope with the crush, provinces founded their own dental schools. Enrolment expanded. Burned-out dentists backed fluoridation, with few envisioning how this simple measure would end the golden age of dentistry.

A decade ago, dental schools began trimming enrolment, but the impact was neutralized by the influx of foreign dentists and by Canadians who, failing to get in, attended U.S. schools and returned home to set up practice.

Now, in these hard economic times, companies have drilled away at dental plans and some workers have lost their benefits entirely. "It’s funny," Dr. Gordan Markic said, sardonically. "People would rather put food on the table than see a dentist."

Banks, which once automatically gave dentists a loan, now demand business plans. And while dental fees have tracked inflation over the past 15 years, overhead has jumped to 64 per cent of gross billing from 45, according to the Ontario Dental Association. Said the U of T’s Dr. Sonley, 64: "I was taught that business was a dirty word. But God help you today if you don’t run it as a business."

Make no mistake, the pain is relative. Dentists enjoy the second-highest incomes in Canada, after medical doctors. In 1992, the most recent year for which information is available, they averaged $103,000, according to Statistics Canada.

The ineluctable law of supply and demand and a 1990 Supreme Court decision permitting dentists to advertise have sparked an unseemly scramble for market share. The Toronto Yellow Pages is filled with dental ads that blare "New Patients Welcome," announce payment by Visa and offer service in Italian, Hebrew, Cantonese, Tamil, Macedonian or Croatian. Many ads openly tout "senior citizen discounts." While dentists are reluctant to discuss discounting because two-tiered pricing – higher for insured customers and lower for uninsured – is considered unethical, many confirm the practice exists.

Dental advertising remains regulated, but now the restrictions aren’t much different from, say, those governing used-car salesmen. "Most of the complaints we get with respect to advertising come from other dentists," said Dr. Roger Ellis, registrar of the Royal college of Dental Surgeons of Ontario, which regulates advertising. "They keep sending us stuff and saying, ‘Is this legal?’ And, most of the time, it is."

As dentistry has gone from boom to bust, dentists have tried to cope. In Toronto, Dr. Donald Chong, who once stopped accepting new patients during the fat years, spent $20,000 (U.S.) on a dental-management course in Portland, Ore., when times turned lean.

Some dentists have fired their hygienists and clean teeth themselves. Others perform root canals, instead of passing the work to a specialist. "If our regular dentist isn’t as busy, he’s less likely to refer as quickly," said Dr. Douglas Pettigrew, an Edmonton periodontist. "There’s a ripple effect. It’s hurt all of us."

A normally morose bunch – U.S. studies indicate dentists have the highest suicide rate of any profession – some are trying to lighten up. Many wear designer dental garb by, say, Simon Chang. Others eschew whites entirely, especially those touting cosmetic dentistry. Many have spruced up once drab waiting rooms with waterfalls, juice bars and two-metre- long fish tanks. Cosmopolitan and Gourmet have replaced dog-eared copies of Reader’s Digest.

A once proud profession has been humbled. "I know patients don’t like to be kept waiting," Dr. Pettigrew said. "Their time is valuable." Indeed, waiting times at many offices have shrunk to five minutes or less, so short that some patients complain they don’t have a chance to peruse the latest issue of Vanity Fair.

Nowadays, you don’t call them; they call you to set an appointment and even send reminder postcards with cavorting toothbrushes. Same-day appointments are possible. And many dentists are also stocking up on the latest toys to soothe patients. –

In Toronto, Dr. Edward Philips, dressed in a collarless dark print shirt, black pants and lace-up leather boots, offers a choice of music, laughing gas or something called Relax Man, in which patients close their eyes and strap on goggles that flash tiny white lights and supposedly cause the kind of rapid-eye movement that induces relaxation. For those who would still rather be somewhere else, he offers virtual-reality goggles with scenes of Hawaiian beaches.

Some offer acupuncture. Others supply Walkmans or compact discs to drown out the whine of the drill. Across town, Dr. Allan Reiss uses needle-free electronic anesthesia. He also throws in free subway tokens or reimburses parking chits. "I figured: Make it that much easier for them."

Unlike medical doctors, pinched by a dwindling government treasury, dentists work as long as they want. A 7 a.m. start isn’t uncommon. Others open at night and on weekends to accommodate patients who can no longer take time off work. In their office in a strip mall in Mississauga, Dr. Gordan Markic and his wife, Dr. Susan Belavich-Markic, work until 7 p.m. every weeknight and all day on Saturday.

Like a number of competitors, they bought an intraoral camera so patients can see their teeth magnified on a television screen. They also promote services on laser discs and mail newsletters, supplied by a company that lets them customize part of the text. Called Word of Mouth, their latest issue includes flossing jokes, crossword puzzles with a dental theme and a snapshot of their infant son clutching a toothbrush.

Referrals merit thank-you notes and lottery tickets. At least two customers have won several thousand dollars. "It’s a thoughtful gesture for a thoughtful gesture," said Dr. Markic, 35.

Since taking the management course, Dr. Chong, 60, tracks referrals on a computer. When he notices a patient has sent him five or six new customers, he sends flowers. "Always to the office," he said, "because when it gets there, it generates more word-of-mouth business."

Some dentists target niches, such as children, seniors, even welfare recipients, who, until recent government cutbacks, had adequate dental plans. Dr. Kenneth Montague, who practices in Toronto’s hip Annex neighbourhood, goes after the Generation X crowd. He plays Alanis Morissette recordings and has furbished his waiting room in "Caribbean style" colors of sea green and terra cotta. "My personal view is that people equate techno-cyber stuff with the drill."

Other dentists try to lure customers with new services. Dr. Philips, of the virtual-reality goggles, offers "breath disorder" treatment. Patients who fear they have halitosis blow into a Halimeter, which measures volatile sulphur compounds. Dr. Philips then sells topical creams and mouthwash of chlorine dioxide to neutralize the sulphur dioxide chemically. But he and many other dentists see a lucrative future in cosmetics – whitening, bonding, implants and glued-on fakes called veneers.

Dr. Sol Weiss, who looks vaguely like Michael Douglas, recently posed in a magazine ad wearing a wool blazer, tie-less black shirt and khaki pants. He never wears dentist whites and has named his cosmetic practice Art of Dentistry.

"I see my dentistry as art work," said Dr. Weiss, who deemed his native Winnipeg too conservative for cosmetic dentistry and moved to Toronto in 1988. Dr. Weiss, who has his own World Wide Web site, offers his predominantly female clientele a choice of orange blossom, lilac, peppermint or bergamot aroma therapy. He also uses computer imaging to show them how beautiful they will look if they spend, say, $10,000 on a set of veneers.

In these uncertain economic times, will consumers make the switch from insured non-elective care to elective cosmetic dentistry? Some dentists fear not. But they console themselves with the thought that as baby boomers age, there is always gum disease. And the controversy lingers over replacing old fillings with new, mercury-free ones.

"Now dentists are all dying for someone to prove that silver amalgam fillings are bad for you," Dr. Chong said. "Then we’ll all be in business again."

Fluoride works
Three decades of fluoridated water and toothpaste, a glut of graduates and a nineties erosion of welfare and corporate benefits have taken a big bite out of the dental profession.

Dentists lose
Two decades ago, a dentist could survive with 1,000 patients. But these days, with nearly half of all youngsters growing into cavity-free adulthood, a dentist with fewer than 2,000 low-maintenance patients is in trouble. Only half the population normally sees a dentist regularly. In Alberta, there is roughly one dentist for every 1,800 residents, in Ontario one for 1,700 and in B.C. one for 1,600.

Patients get popcorn
Not surprisingly, dentists almost everywhere have become really nice to patients. They call you for an appointment. Waiting times are down to five minutes or less. And they ply you with free popcorn, coffee, hot finger towels and Polaroids of your children. To distract you in the chair, there’s Mozart or Morissette, virtual-reality goggles and aroma therapy.

Whitening
You don’t have to go to a cosmetic dentist for this one. As demand for a more glistening grin continues to grow, more and more regular dentists are providing home whitening kits for their patients. With this simple procedure, the dentist takes a mould of your teeth, and constructs a form-fitting plastic mouth guard – something like Mike Tyson might wear – to fit over them. You just take the guard home, apply whitening gel to your teeth, and fit the guard on top for two to eight hours every day for up to two weeks. You can have this procedure done at the dentist’s office, but it will cost you more in time – the trips back and forth each day – and money. Tooth whitening won’t take as well or last as long on people who are fond of coffee, tea, red wine or cigarettes. Also, if you have a mouthful of fillings and crowns, you’re not the best candidate: the whitening agent relies on a biological reaction, and doesn’t work on unnatural teeth. The procedure will cost between $600 and $1,000 for the full mouth, and you can expect to pay between $30 and $50 for annual touchups.

Porcelain veneer
This thin shell of porcelain laminate can fill teeth that are crooked, stained or chipped. The dentist grinds the tooth down a little, removes about a millimetre from its surface, and then attaches – with very strong cement a perfectly fitting veneer to match the surrounding teeth. It’s the same as gluing on an artificial fingernail, but it lasts much longer – an average of 10 years. Prices can range between $350 and $1,000 a tooth, so shop around.

Bonding
The bonding procedure is similar to veneers, but instead of gluing on a panel, imperfections are smoothed out by applying a soft composite material. Bonding doesn’t look as good as a veneer and won’t last as long either – only five years. But it is much cheaper. The range is between $60 and $350 a tooth, depending on how much of the tooth is covered.

Implants
Implants have been around for 20 years, but they’ve only caught on in the past five years. Say you lose a tooth in a company hockey game. In the past, you’d be fitted with a bridge denture and would join the league of people who pay special attention to Martha Raye television commercials. Today, bridges are reserved for people who can’t withstand minor surgery, or whose jaws are too weak to support an artificial tooth anchor. The minor surgery for implants involves the dentist making a small incision into the gum and bone and inserting a titanium anchor. After a healing time of four to six months, an artificial porcelain tooth is fitted on top. You now have a permanent tooth, instead of a removable denture. The cost? Implants are expensive at $2,500 a tooth, compared with bridges, which run between $1,600 and $2,000. And if you’re a smoker, an implant may not be worth it; the nicotine and tar affects the ability of the implant to integrate into the bone.

Cosmetic contouring
So you want straight teeth but don’t want to get braces? You can have your teeth cosmetically altered so that they just look straight. The dentist uses a high-speed diamond-bit drill to judiciously shave and shape your teeth. It won’t hurt them; there’s about 1½ millimetres of enamel on each tooth that can stand to be filed down. The final touch is repolishing and reglazing the tooth. Not every case is amenable to cosmetic contouring – just minor to moderate problems. But if you qualify, Toronto dentist Dr. Arthur Rubinoff calls this procedure "the biggest bang for the buck. It’s almost like instant orthodontics." And for between $75 and $200 a tooth, it’s definitely cheaper.

Orthodontics
Forget those old metal train tracks. Technology has opened wide to make room for more discrete, clear plastic, ceramic or porcelain braces. And older patients are biting for several reasons – vanity, health and an ability to pay that was absent during childhood. A mouthful of braces costs as much as $8,000 (the general price for metal braces, top and bottom, is $4,500 to $5,000. Ceramic or plastic brackets cost about $200 extra and lingual braces – which are placed on the inside of teeth – will run you 60 to 70 per cent more). Some insurance plans pay up to half of treatment costs, with ceilings of up to $2,000. And part of the costs can also be deducted on your taxes as a medical expense. Now that’s something to smile about. Recent technological advances have given cosmetic dentists such as Dr. Ed Philips the tools to perfect imperfect smiles.

The Complex Smile
The top lip, bottom lip and corners of the mouth pull back simultaneously. Only 2 per cent of the population are characterized by this rare smile: Marilyn Monroe, Julia Roberts, Will Smith and Oprah Winfrey.

The Cuspid Smile
First the top lip goes up, exposing the canine teeth, then the corners of the mouth contract, pulling the lips up and out. A third of smiles (31 per cent) are this type, including those of Elvis Presley, Tom Cruise, Linda Evangelista, Sharon Stone and Tiger Woods.

The Commisure Smile
First the corners of the mouth pull up and outward, and then the top lip pulls up to show the upper teeth. Two-thirds (67 per cent) of the population has this smile. Look for it on Elizabeth Taylor, Calista Flockhart (TV’s Ally McBeal), Jerry Seinfeld, Brooke Shields and Frank Sinatra.

By the time you notice the drill, it seems like an afterthought.

First, a gorgeously appointed waiting room, with amber velvet chairs and frosted glass walls. The cozy change room, with kimono and fuzzy slippers waiting. One sole dentist chair, where the patient lounges, lulled by soothing music on wireless headphones, or perhaps engrossed in a movie on the screen at her feet. A discreet little room where she can rinse and spit through numbed lips in seclusion. And no trace of that sharp, antiseptic smell; instead, only a light floral scent, with traces of vanilla.

This is not dentistry as we know it: This is the science of smiles. It is being pioneered by Dr. Edward Philips, a Toronto dentist who in July opened at Hydro Place on University Avenue what he says is the first studio purely for esthetic dentistry in North America.

Philips, a man of such enthusiasm that his words often backlog in his mouth and spill out in a jumble, boldly claims to have identified the seven principles of the perfect smile. And he is set to bring them to the public from this cool ecru studio, so that no one need smile an embarrassed, close-lipped smile any longer (at least, not if they have some spare cash).

Philips said he had the luxurious surroundings designed by Yabu Pushelberg to soothe patients who must override their natural distaste for the dentist’s office to voluntarily climb into the chair. Presumably the coddling also makes patients feel better about the $5,000 they spend on average for Philips’ services.

These patients’ teeth do not hurt, and probably function just fine. But the people who seek Philips out (men and women in crowds large enough to prompt him to renounce a profitable downtown practice in favour of the sleek studio) want their teeth to look better. So, using new dental techniques such as the fusion of porcelain veneer to the teeth, gingivectomy (removal of gum tissue) and laser whitening, Philips has remade "thousands" of smiles for them, from a litigating lawyer who wanted a charming, persuasive grin, to a union leader who came in and requested "socialist teeth" (nothing too flashy).

"They don’t know what’s wrong exactly, but the people who come in here know that something could be better about their smile," said studio director Billy Jo Sabo. She is there to greet them, and introduce them to the world of the scientifically perfect smile, with the aid of videos, charts, a nifty little mouth camera, and computer morphing. "If you took a focus group of 100 people and showed them a series of smiles, they would all agree on what looks good, but they couldn’t say why," said Philips. "We didn’t have a language for that."

Until, that is, he invented one: He has defined seven principles for the perfect smile, among them the idea that when smiling, the corners of the lips should reach to a vertical line drawn straight down from the pupils, and that the convex curve of the upper top teeth should mirror the curve of the lower lip. Philips bases his smile science on the Golden Proportion, a concept of shape found in nature (such as the sphere of a dandelion, or curve of the nautilus shell) which is, in its symmetry, inherently pleasing and intrinsic to the human perception of beauty. From this, he has calculated an exact length for teeth, amount of visible gum, and degree of space between teeth to give a smile the symmetry that silently soothes the brain.

In the image-drive 90s, the perfect smile packs power: Philips noted that the smile is the first thing, along with the eyes, that a person notices about another. Subconsciously, he suggested, people are put off by flawed mouths. "We think of dental anomalies in connection with congenital defects, which are also associated with low intelligence."

For Mary Anne Dunlop, it was nothing that dramatic; she just didn’t like her teeth, which were slightly uneven and discoloured. "We’re living in a world where it’s important to look your best, from the standpoint of business and competing, and also personally," said Dunlop, 49, a Kingston, Ont., insurance broker who had her smile "improved" in March. "We’ve moved on from the time when you just accepted whatever came your way as you aged." Dunlop described herself as a 50s kid with teeth that did not benefit from the kind of preventative treatment that is now standard; as she got older, it gnawed at her. "I could put on the nicest dress, colour grey hair, run and work out, but with my old smile, it just wasn’t as effective. Not wasted, but not as effective."

Dunlop was so impressed with her scientifically aligned smile that she took her husband Allan to Philips. When he received totally different advice about his smile than she had on hers, she said, it confirmed for her that there was a science to Philips’ work.

There are, of course, questions to be asked about entirely elective surgery that plays with perfectly functional teeth. "Esthetics are important and patients should be informed of the possibilities when they themselves see a problem," said Dr. Dorothy McComb, head of the restorative dentistry department at the University of Toronto dental school. But she is worried that the hype around new technologies in esthetic dentistry may overshadow the real disadvantages and limitations of the treatment. "Nothing is better than an untouched, sound dentician, in terms of function and longevity. Once a dentist starts to drill and change things, [the remade teeth] will need maintenance and it may even need renewing, and that could lead to further loss of tooth structure."

McComb was quick to point out that she herself teaches esthetic dentistry, and she praised veneers as a sound and largely successful product. But to apply them, she noted, at least half the enamel is taken off the front of the tooth. "This is a medical procedure and it shouldn’t be done frivolously."

Philips countered that in virtually all of the cases he treats, there is some medical benefit to the reshaping of the mouth. Beyond that, he argued, it is impossible to quantify the value of improved self-image.

"These are people with relatively healthy teeth and a darn good smile," he acknowledged. "But they want to look better. And I can do that."

If not, you’re missing out. To stay competitive, dentists now pamper patients with everything from aroma therapy and popcorn to hot finger towels and piped-hi reggae music, not to mention extended hours and hefty discounts.

"It’s such a serious profession, said Dr. Kenneth Montague, 32, recently named "best dentist" In Toronto’s Now magazine (along with "best place to meet a straight man" – Canadian Tire), Dentists didn’t even think of marketing as a business tool until quite recently.

Dentists are bleeding, after three decades of fluoridated water and toothpaste, a glut of graduates and a nineties erosion of welfare and corporate benefits.

‘Two decades ago, a dentist could survive with 1,000 patients.

But these days, with nearly half of all youngsters growing into cavity- free adulthood, a dentist with fewer than 2,000 low-maintenance patients is in trouble.

Only half the population sees a dentist regularly. But in Alberta, there is roughly one dentist for every 1,800 residents, in Ontario one for 1,700 and In British Columbia one for 1,600, according to the Canadian Institute for Health Information.

First among the popular aesthetic services your dentist may now offer is, undoubtedly, whitening. Even people relatively happy with their teeth-middle-class girls like myself, for example, who were lucky enough to have had Dad pay for braces-usually feel that their teeth could stand to be whiter. It’s that movie star thing, that Marilyn Monroe or Tom Cruise thing. And as we age, coffee, red wine, tea, cigarettes and even some antibiotics leave their marks on our teeth.

Apart from the new generation of whitening toothpastes available at your pharmacy, remedies for stained teeth include laser whitening and tray whitening. Laser whitening takes two to three hours and is more or less painless, depending on the sensitivity of one’s teeth to begin with. The gums are protected with a wax strip, hydrogen peroxide gels are applied to the surface of the teeth, and then laser energy is applied to activate the whiteners. There is increased sensitivity of the teeth for about two hours afterward, a small price to pay for results that are, by all accounts, remarkable. How white your teeth become "depends on where you start out," says Dr. Ron Golden, who runs Toronto’s The Perfect Smile clinic. "If your teeth are terribly stained, then we may not be able to get them to a sparkling white, but we will certainly be able to drastically improve them." (Golden sees clients aged 25 to 75 and says that men especially seem to appreciate being able to do something about their looks without having to resort to girly things like spas or facials.)

Sandra Gneo, 27, was one of Golden’s first customers when The Perfect Smile opened earlier this year. A dental hygienist (not with Golden), Gneo says she heard about the laser treatment through the dental grapevine and decided to try it out. "I am very happy with the results," she says. "I will have to do tray whitening to maintain them, but [two applications] are included in the cost." Twice-a-year maintenance with the tray method is recommended because as soon as people start living again-i.e., smoking and drinking- new stains can appear. Laser whitening runs anywhere from $800 to $2,000.

Tray whitening costs $250 to $800, takes one to three weeks and, because it’s done at home, requires diligence on the part of the whitenee. It is, however, every bit as effective as laser whitening. Trays-in which the whitening gel is placed-are fashioned to fit the client’s teeth, and he or she must wear the trays, usually overnight, for about two weeks.

"If you’re getting married tomorrow, then I’d recommend the laser treatment," says Dr. Edward Philips of The Studio for Aesthetic Dentistry whose clients have included Yuk Yuk’s owner Mark Breslin and renowned architects George Yabu and Glenn Pushelberg (designers of Toronto’s Canoe and Monsoon restaurants, just for starters). "But if you’re not rushed, stick with the trays. They’re cheaper." Once you have the trays, you can buy the whitening gel to maintain results-two tubes cost $50 and last for two years, or four applications. Philips also speaks highly of "spot lasering," whereby if you’ve done the trays or you have veneers and there’s one stubborn tooth that won’t part with its stain, it’s "the perfect time to blast it with the laser." Spot lasering costs $250 to $500 per tooth.

If coffee stains aren’t your biggest smile problems, but you want the shape of your teeth changed, consider bonding, veneers and crowns. What lay people call "bonding" is the process of applying acrylic resin (though bonding technically refers to the method of attachment for both resin and veneers), curing it with a bright blue light and then, as the client wishes, altering the shape, size and colour of the tooth. It costs about $350 per tooth.

Veneers are similar to false nails. They are made with a porcelain laminate veneer and placed on top of the tooth-effectively changing its shape, size and colour. Veneers run about $650 to $1,000 per tooth but are generally considered more durable than bonding. And, where bonding can sometimes result in the Chiclet look of cosmeticized teeth, veneers tend to look more natural. This is because, with fewer layers involved, veneers are more translucent than bonding finishes and more closely mimic the natural enamel of our teeth which allows light to pass through and refract.

Crowns (known to the lay population as "caps") require the shaving away of a good deal of the tooth and, unlike veneers, wrap around the entire tooth. Crowns, made from Procera, a high-grade porcelain, cost approximately the same as, or a little more than veneers and are recommended when significantly more restoration of the tooth is required.

If your teeth are white and straight and even, but you feel your smile is a little too "gummy," a procedure called gingivectomy might be just what the dentist ordered. Gingivectomy, or gum modification, involves the removal of gum tissue with a laser and is, according to Philips, desirable when "more than three millimetres of gum shows in a smile. People don’t like gummy smiles." Gingivectomy takes about 30 minutes to an hour and requires no stitching. Philips likens it to cauterizing and says it is painless, though he admits that he freezes clients first, "because otherwise, they get nervous." For every "site," or every four to eight teeth affected, the cost is $500.

Finally, jaw alignment works on a person’s bite-known in dentistry as "occlusion-rather than on the damage to or flaws in individual teeth. "If the front end of your car is not properly aligned, you find your tires wear unevenly," says Dr. Brian Friedman, who studied occlusion at the (famous among dentists) L.D. Pankey Institute in Florida. "And similarly, if your jaw joint and teeth are not aligned, your teeth wear unevenly." This uneven wearing can lead to damage not only on your untreated smile, but also on a smile filled with crowns, veneers or bonding. So fixing your bite can make all that money you’ve spent go a little further Jaw alignment is usually achieved with the help of a "nightguard," which according to Friedman, can range in price anywhere from $750 to $1,400. A night-guard is an orthodontic appliance, sort of a cross between a retainer and a mouth guard, and must be worn overnight by the client. It has the added advantage of limiting the damage caused to teeth by the stress-related "bruxism," or tooth grinding, something done by approximately 80 to 90 per cent of the adult population while they sleep. "The nightguard permits the jaw to easily skate around without any resistance," says Friedman.

Before you make any of these investments it would, of course, only be normal to want some idea of what you will look like after a given treatment is over. To this end, most dentists who offer aesthetic services also offer computer imaging. A "before" picture is taken with a digital intra-oral camera and brought up on the computer screen, then adjustments are made to show you what a difference those crowns will make. The imaging is usually part of an overall consultation costing about $75 to $100.

And if you go through with it and don’t like the results? Well, you could always sue-and you could probably find a lawyer right in Philips’ office, where attorneys, he says, constitute the largest group of professional clients.

Now that your cavities are under control, your incisors are straightened and your root canal crisis has passed, just how stained and yellow are those teeth? In a recent North American poll, queries about teeth whitening topped the list of questions asked of dentists by their patients.

"I prefer to call it re-whitening," says Dr. Ed Philips who, right off the top, wants to correct the perception that stained or yellow teeth are somehow whitened by the addition of white colouring in the process that many dentists now offer.

They’re not.

In the dental office whitening process and in the home-whitening kits which proliferate on drugstore shelves, teeth are only "de-stained" and "un-yellowed." In other words, their colour is only brought back to what the colour of the teeth might have been, say, 20 years ago.

Whiter teeth are part of the social evolution of the mouth, says Philips, who runs Toronto’s Studio for Aesthetic Dentistry.

"Historically, during caveman times, teeth were weapons used to eat and to chase someone away. Strong teeth and a scary, gap- toothed, awful smile were good things."

Today, Philips adds, we ask exactly the opposite of the smile.

"Today, it means ‘I’m friendly. Come closer to me.’ Whiter teeth appear healthier and cleaner and that’s more socially acceptable."

It’s true that some people have almost pure white teeth, but when you look at a porcelain palette (the array of colours the dentist holds against your tooth to match the filling to the right natural shade) there’s a wide range of natural colours and many of them have a slight yellowish tinge.

The "Chiclets" smile? False, jarring and not the goal in the whitening process, experts say.

Like crow’s feet and morning stiffness, darker teeth are a product of aging but are accelerated by coffee, tea, red wine, tobacco – even eating lots of curry or beets.

"These are outside stains," says Dr Kenneth Montague, a Toronto dentist. "They enter the tooth enamel on a surface level only."

Montague explains that the tooth’s outer enamel is composed of little pores and that these stains go into the micro pores.

"These stains are hard to get out with a toothbrush but respond well to the tooth-whitening products," Montague adds.

But what exactly are these products? How much do they cost? And how safe are they to use?

Dentist-supervised bleaching is the method most preferred by the Ontario Dental Association. With it, an impression is made of your upper and lower teeth. Then customized trays that fit around the teeth are made. You take the trays home, squeeze in some bleaching material that your dentist has dispensed, then stick the tray to either your upper or lower teeth in much the same way kids make orange- peel teeth or put in a hockey mouthguard.

Because it sticks on pretty snugly, you can sleep on it and speed up the whitening process. It generally works after doing it about 10 nights, but not necessarily 10 nights in a row.

Montague says the process costs under $500.

Many people prefer the daytime method. Also under a dentist’s care, you wear your trays while you’re awake 30 minutes each day. The only setback is you can’t talk, eat or smoke during that time, which is why some people still choose the overnight versions. The price is the same.

Montague says the bleaching process uses an agent like a peroxide that leeches into the teeth. It lightens up, not unlike Javex, but using it effectively is a control issue.

"We don’t condone people using chemicals on their teeth," Montague says.

The chemicals contained in these products have to be powerful enough to do the job but not powerful enough to harm.

Philips explains that the whitening pumps oxygen molecules into the natural pores of the tooth. In doing so, it binds to the artificial colouring that has built up over the years in these pores. The combined oxygen and the yellow pigment join and break down the colour to lighten the teeth a shade or two.

In a survey done of 8,000 dentists in the U.S., 66% of patients reported varying degrees of irritation with bleaching kits although several studies show that tooth whitening is safe when performed properly.

"We are very concerned about the misuse of home-bleaching kits," Montague says.

By home-bleaching kits, he’s referring to the growing number of products available over-the-counter from drug stores. I bought the Natural White 5-Minute tooth whitening system. At less than $15, it was a deal – but dentists say these home whitening kits don’t have the strength that their systems do.

"If you insist on using these, bring them into your dentist and discuss the process. You don’t want it to be harmful," Montague says, adding that some unsupervised home bleaching can burn or irritate gums.

He adds that no whitening treatment can make teeth whiter than their original colour and the process won’t work on crowns or teeth that are darkened as a result of illness or drugs. (Some antibiotics, taken in childhood, can darken teeth right through, and not just on the surface.)

Tooth whitening isn’t a quick answer. Stains return and the process has to be repeated.

Nonetheless, Montague says, "I’m a believer. Twenty years ago, nobody talked about it. A decade ago it was a mumble. Today, it’s a roar."