With all the recent advancements in cosmetic dentistry, some adults are seeking out the once-dreaded dentist’s chair to get their teeth whitened, straightened and brightened.

For the most part, there’s no tooth fairy to pick up the bill. Yet, some whose parents couldn’t afford braces when they were younger are spending the money and taking the trouble to wear them. They even have the option of wearing newer white braces that aren’t as noticeable as the traditional metal wires.

All in all, improving your smile has become less painful and time-consuming. Just ask Dr. Ed Philips, whose office credo is: "Will that be fluoride or a Cappuccino?"

Philips, a dental surgeon in Toronto for 20 years, has just opened an ultra-modern "studio for aesthetic dentistry" near the Ontario legislature, complete with a cappuccino maker, stereo and VCR.

Instead of dealing with fillings and cleanings, his new practice is limited strictly to the business of smiles.

Like every dentist, Philips sees his share of patients who for years have covered their mouths when they laugh or smile because of teeth that are horribly crooked, misshapen or stained.

In fact, problem teeth have held some of his patients back from going for a promotion, public speaking or just meeting new people because of the fear of rejection or ridicule.

"One CEO came in to get some work done because whenever he smiled he looked mean and nasty and it was really affecting his image at work, but he was actually the nicest man," said Philips, whose clients are mostly professionals and people in the entertainment industry.

The CEO acquired a softer smile after a few visits to Philips’s office, where his sharp teeth were filed down and covered with a natural-looking white porcelain veneer, fused on to teeth to improve both color and shape.

Mark Breslin, founder of the Yuk Thk’s comedy chain, used to smile with his mouth closed because of teeth he described as chipped, thin, uneven and badly discolored.

"Of all people, I should be able to smile," he said.

He found a lot has changed since he was a kid enduring "pure torture" while getting fillings at his family dentist.

"I’m very, very happy I got it done," he said after five long dental sessions. He paid $10,000 to cover his upper teeth with porcelain veneer and to get laser whitening for the bottom.

The price range for smile improvement runs between $200 and $5,000.

Eye lid surgery is particularly popular with men, he said. Other forms of facial rejuvenation, he said, are facelift, brow lift (the least popular) neck lift, chemical peel and collagen inserts, or a combination.

Miles said his rule of thumb is that facial cosmetic surgery should not be done more than three times in a lifetime and a second operation should not be done until five years have passed.

The trend is for younger and younger people to come in for cosmetic surgery and he now operates frequently on patients in their 40s, he said.

Cosmetic surgery is becoming more and more popular, he said. "Recently, I was at a cocktail party in Rosedale with about 30 people and when I was cornered and asked questions I said, ‘Six people at this party have had plastic surgery,’ That really set the cat among the pigeons."

He said it is not necessary to have a second consultation but if a patient is not comfortable, he or she should have one.

"The brow lift is the most underestimated and under-performed operation in cosmetic surgery," Miles said.

Breast augmentation, following a masectomy is the operation he does the most. "Our goal is a nice feminine form, not a big bust," Miles stated.

He advises patients who have had cosmetic surgery to wait three weeks before going public and six weeks before attending a major social event.

"Mark my words, within a few years you’ll be getting a call from your dentist to come in every few months for bleaching," said Dr. Edward S. Philips who practices dental cosmetics.

Bleaching, to whiten teeth, is one of the main changes coming in the practice of dentistry, he said. The process will involve patients letting a solution soak their teeth.

The day is not far off when computers will fashion the fillings patients need for cavities or other reasons, Philips said. And on the horizon as well are lasers to fuse fillings into place.

Unfortunately, 90 per cent of dental insurance does not cover cosmetic work, he said. One reason for the increase in dental cosmetics is that people are living longer and want their teeth to look good. Most dental bridges worn by patients are out of date in new-age dentistry, he said.

Dr. Shia B. Wolgelernter described sclerotherapy which he uses for patients with varicose and spider veins. It involves the injection of a solution, takes only 10 or 15 minutes, and has an 80 per cent success rate.

Patients don’t complain of any pain from the needles, but some do report pain from the solutions, he said.

"It is painless and safe and requires no hospitalization," he said. The larger veins are likely to recur, he added. He asks patients to wear support hose for two weeks after the procedure.

-B.R.

Faced with rising costs, competition from an increasing number of dentists and fewer patients needing fillings and restorative work, dentists are turning to a new frontier in search of business: cosmetic dentistry.

“Prevention has been so successful that restorative work isn’t there,” says Dr. George Sweetman, a Lindsay dentist who heads the Ontario Dental Association.

He says the focus is still on prevention but acknowledges the elective or cosmetic side is growing.

“Now that people are keeping their teeth for a lifetime, they’re very concerned about their appearance,” says Sweetman.

And dentists say they’re finding many who want to improve what their genes gave them.

Costs put bite on dentists

These days, dentists can use bleach to whiten teeth, adhesives to lengthen them, fill in gaps, or realign a bite, then finish with a few coats of porcelain veneer.

Patients can even choose from a variety of veneers, deciding just how dazzling they want their smile to be.

“Where we’re heading with dentistry is as new to dentists as it is to the public,” says Dr. Ed Philips, who operates a dental practice at Hydro Place doing regular and cosmetic work.

“We can make teeth look younger, we can make teeth look more elegant, we can make teeth look more corporate.”

The Ontario Dental Association is launching a $700,000 billboard and TV campaign this spring that focuses on the new techniques.

One billboard shows the word “gap,” with a large space between the G and A. “Fixing it is easier than you think,” the copy says, “ask your dentist.”

Recent technological improvements mean much of the work can be done in one or two visits, without resorting to orthodontic wires and tracks, or expensive caps.

The cost of these procedures range from a few hundred dollars for bleaching that can be done at home, to $5,000 for major work.

Most dental programs don’t cover cosmetic services, which means dentists are forced to compete with a myriad other products to capture a chunk of their patient’s disposable income.

Even if you don’t have a dentist, or yours hasn’t mentioned these services, you’ve probably seen others advertising these options on the back of K mart cash slips, or on flyers in other junk mail.

“I’ve always had healthy teeth, but somehow I’ve never had a great smile,” says clothing store owner Pepe Appugliese, who recently decided to alter his smile.

Philips changed Appugliese’s smile by filling in a gap at the front and reshaping a few teeth. Most cosmetic work involves these relatively subtle changes.

There are more than 5,700 dentists Ontario and that number has been growing, despite a cut in enrolment at dental schools, because dentists trained elsewhere have been coming here to work.

A survey found 63 per cent of dentists who had been practising for fewer than 10 years would like more work and 46 per cent of all dentists would like to be busier.

Dentists who rank near the top of the income scale, with average earnings of $99,280 in 1991, are touchy about suggestions they are turning to new services in an effort to bolster declining incomes.

Philips argues that if they are properly informed, patients won’t be talked into something they don’t want.

The high cost of setting up an office is one factor driving dentists into uncharted areas.

A new dentist will shell out $160,000 to $200,000 to set up a one-chair office, says John Caise, operations and equipment manager for dental supplier Ash Temple Ltd.

New graduates usually can’t afford the latest laser machines and video-imaging equipment that could add another $60.000 to their start-up costs.

As part of his approach, Philips uses separate rooms to discuss cosmetic procedures, realizing patients can’t feel comfortable deciding whether to spend several thousand dollars on improving their smile if they are lying in a dental chair with their feet tipped up.

Patients get a plaster model they can take away to show other dentists and before and after pictures that use video-imaging techniques.

Sometimes patients take the proposal away and come back a year or two later when they are financially, or psychologically, ready.

Dr. Allan Jeffries and his traditional practice Scarborough’s Cliffcrest Plaza illustrates the trend.

A few months ago, Jeffuies sent out his first flyer, promoting new cosmetic dental techniques and touting ways to improve smiles.

The response was not great, but many of his patients asked about the methods and directed a few new patients his way.

This fits with Philips’ advice in his lectures. Start your marketing internally with your own patients, then branch out.

“Most of my patients just want teeth that stand the test of time and look decent,” Jeffries says. “They don’t want to look like movie stars.”

Philips offers his patients a written guarantee that the work will last from two to five years, depending on the procedure.