He could improve every one of them, boasts Dr. Bederman. Well, almost every one. New Brunswick’s premier, Frank McKenna, 48, is virtually perfect. "Unless he came in saying he really hated his nose or something, I’d leave him alone," says the doctor; who runs the Centre for Cosmetic Surgery in Toronto.

Elm Street provided official photographs of the premiers, pictures chosen to put their best faces forward. Even so, Dr. Philips, whose Toronto practice specializes in smile analysis, believes he could turn up the wattage on the smiles of several of the men. He wouldn’t bother changing Saskatchewan’s Roy Romanow; somebody, he believes, beat him to it.

Using the two experts’ know-how, plus electronic photo- manipulation software, we could have turned back the clock and made the premiers look like their high-school photos. We didn’t. "These days plastic surgery aims for subtle, natural- looking refinements that leave the patient looking refreshed," says Dr. Bederman. The goal is to soften lines, not to pull the skin so tight that the face looks permanently startled.

One word of caution. No matter how gifted the practitioner; cosmetic surgery is a mix of science and art. Computers aren’t bound by the realities of scalpel and sutures. In real life the premiers might not emerge from surgery looking as sleek as they do in our manipulated portraits. "It would be lovely if we could just say, ‘OK, let’s slim the nose by another 10 per cent,’ and have that happen," says Dr. Bederman, "but we can’t."

Still, just look at what a little electronic nip here, a digital tuck there can do to Ralph Klein’s chipmunk cheeks, to Mike Harris’s schnozz, to Brian Tobin’s ears.

Whiter teeth as a biblical imperative? That might be going a bit far, but Toronto-based esthetic dentist Dr. Edward Philips points out humans have seen white teeth as a sign of power and prosperity since at least the time of the Old Testament. In the book of Genesis, for example, the patriarch Jacob blesses his son Judah, noting the beauty of his eyes, "darker than wine," and his teeth, which are "whiter than milk?’

More recently, a slew of products and procedures designed to make teeth white as milk has crowded drugstore shelves and made its way into dentists’ offices. From over-the-counter pastes, gels and strips to dentist-prescribed bleaching kits, lasers and custom-fitted mouth guards, tooth whiteners have taken the market by storm.

According to the American Academy of Cosmetic Dentistry, the number of tooth-whitening procedures has grown by more than 300% since 1996 and sales are expected to more than double to US $400- million in 2004 from US$187-million in 2002. Exact figures are not available for Canada, but the growth is comparable.

Just ask Rob Gray, 33, a writer and program head at the Vancouver Film School. Most of his friends have tried various whitening methods, he says, even making pilgrimages across the U.S. border to buy Crest WhiteStrips before they were available in Canada. He decided to give whitening a whirl after seeing a photograph of himself in which his teeth looked yellow.

"That made me feel self-conscious. I tend to smile widely, and I think I’d always kind of gotten away with murder with my smile. But now my eyes were much whiter than my teeth. I wanted to brighten it up?"

For an hour a day for two weeks, Mr. Gray used the thin, transparent strips, which cost about $45 and are coated with a layer of gel containing peroxide – the same stuff used to bleach hair. The strips adhere to the upper and lower teeth, forming a seal and allowing the peroxide to penetrate the outer enamel to the dentin, which discolours over time as we age. Coffee, tea, red wine and cigarettes – all of which can stain the enamel – also contribute to external tooth discolouration.

Mr. Gray’s teeth did brighten up. Six months and two-plus lattes a day later, however, the yellow has returned and he is contemplating repeating the process – despite the burning sensation in his gums and the tooth sensitivity he experienced during the first few days.

For those considering over-the-counter whiteners, Dr. Philips says strips make more sense than brush-on peroxide gels or kits that offer whitening gel in mass-produced mouthguards or trays that fit around teeth. Researchers at the University of Florida College of Dentistry for example, found the strips are five times as effective as gel, which stays on teeth only a few minutes before saliva washes it away. With generic trays, the gel can also leak out or become contaminated by the surrounding air and saliva.

Dr. Philips also points out so-called "whitening" toothpastes are, in fact, stain removers. While they may be effective at removing those coffee, wine and nicotine stains on the outside enamel, they will not actually change the colour of yellowed teeth. Dr. Philips says strips and other OTC whiteners will take longer to work than dentist-prescribed and supervised whitening, which uses custom-fitted dental trays to hold the peroxide gel – in potentially stronger concentrations – in place against the teeth. Because the guards conform exactly to the teeth, there is less chance of the solution being contaminated or diluted by saliva and air. A well-fitting tray will also help prevent the gel from leaking and from touching the gums, thus helping to prevent gum irritation. Patients wear the trays overnight or for several hours a day, for four or five days to up to two weeks, depending on the strength of the peroxide, their comfort level and their dentist’s recommendations. At-home whitening under a dentist’s supervision can

In-office whitening procedures can take less time, as dentists use lasers (usually on only one or two problem teeth) or bright light, both of which are thought to activate the peroxide and make it work faster. In an office setting a dentist can use higher concentrations of peroxide and monitor the patient, who may also wear gel in mouth-guards for a few nights afterward, just to shore up the effects. Dr. Philips usually recommends patients follow up with one night of whitening every 12 months in order to keep teeth pearly white.

As millions of cases of tooth-whitening in North America suggest, people seem more than comfortable with the idea of putting peroxide in their mouths. Still, some are more cautious. Dr. Laura Tam, an associate professor in the department of restorative dentistry at the University of Toronto’s faculty of dentistry, points out up to two-thirds of whitening patients experience some degree of tooth sensitivity.

"It has been documented as transient and should not persist, but does represent some type of inflammation of the pulp," which is the innermost part of the tooth, where the nerve lies. Peroxide bleaches can also blanch the gums and irritate the mouth’s soft tissues. As for long-term negative effects of bleaching on tooth structure, and peroxide on the human body, Dr. Tam cannot comment because no studies have been conducted.

While hydrogen peroxide has been "adversely associated with carcinogenesis," she noted in a scholarly article on the safety of home bleaching, it is also a substance that the body produces naturally. The bottom line? We need more studies, Dr. Tam says.

In the meantime, she says, clinical studies using a 10% carbamide peroxide gel over two weeks have demonstrated it is safe and effective when used according to directions. Dr. Tam recommends bleaching only with the supervision of a dentist, who can diagnose the source of discolouration and help ensure the method used is appropriate. Children, pregnant or lactating women and anyone with oral tissue problems should avoid whiteners. As for repeated use of bleaching products, she is not comfortable with the practice, although she admits no clinical evidence supports her claim.

Lucas Murnaghan has a pair of custom-made mouthguards sitting in "a neglected drawer" in his bathroom. The 27-year-old surgical resident at the University of British Columbia medical school spent about $250 for a dentist-supervised, at-home whitening kit. He also gave up his daily dose of coffee – switching to caffeine pills to get by. After a few nights of wearing the mouthguards, however, Dr. Murnaghan’s gums begin to hurt and reacted painfully to heat or cold. He gave up on the program – and started drinking coffee again.

"I thought, ‘I’m putting some chemical in my mouth that makes my gums hurt. Maybe that isn’t so good for me. Maybe my teeth are supposed to be this colour and that’s life and I shouldn’t mess with it’."

The Studio for Aesthetic Dentistry is nothing like the typical dentist’s office. But then, Dr. Philips is not a typical dentist. For one thing, he does not clean teeth, fill cavities, or chide patients for not flossing. Those tasks, he says, are the job of a client’s family dentist. He is adamant that clients do not have to worry about alienating their current dentist when they pay a visit to the studio.

"We know the vast majority of Ontarians are happy with their current dentist, and we want them to keep their relationships with their family dentists," Dr. Philips says. "In fact, we insist that they do."

However, when a client wants to enhance the appearance of anal-ready healthy smile, a visit to Dr. Philip’s office maybe in order. Here, clients, many of whom are dentists themselves, learn about smiles and the range of treatments – including whitening, applying veneers and acrylic resins, and untwisting teeth – available to beautify them. In some cases, aesthetic dentistry can be a substitute for braces and orthodontia.

"We have created an environment with a very distinct aesthetic," says Dr. Philips.

"It is a very different emotional space than the place you would normally go to get a root canal."

Looking around, it is easy to see what he means. A bank of interactive television screens commands the information centre at the front of the downtown Toronto office, with educational programming on aesthetic dentistry available at the touch of a button. Consultations take place in the light, airy office belonging to studio director Billie J0 Sabo. Further inside the studio – designed by the internationally renowned firm Yabu Pushelberg – is a patient lounge, private bathroom and dressing room. Soothing scents permeate the air, and soft strains of music play in the background. Kimonos and slippers are provided. There is even a private area for patients to spit and rinse.

The crowning glory is a single dentist’s chair surrounded by every conceivable tool Dr. Philips needs to perform his work. In that chair, a patient can watch television or movies on DVD with the aid of earphones and a headset, listen to music or watch the doctor in action on the television screen. The single chair means the dentist sees only one patient at a time. "We see two patients a day," says Ms. Sabo. "You’re either the morning patient or the afternoon patient. While you’re here, the clinic is yours. It’s your time." When it comes to the aesthetics of the smile, Dr. Philips’ philosophy stems from his early work in the craniofacial department at the Hospital for Sick Children in Toronto. There, he worked with a group of specialists – including speech pathologists, oral surgeons and ear, nose and throat doctors – to treat children with congenital facial abnormalities. The team approach gave Dr. Philips a new perspective on the smile.

"It gave me a new way of looking at the face," he says. "My focus wasn’t simply the teeth or the mouth, but the way they interact with the entire face. That’s the approach I bring to my work now. Cosmetic dentistry triggers a potential change in the overall appearance."

Until recently, however, there were no proper terms to describe the aesthetic properties of the smile. Dismayed by this lack of lingo, Dr. Philips created his own language. He is responsible for classifying smile "types" and for creating a seven-point set of clinical "smile principles" to describe the elements of a perfect smile.

Most people – about 67% – have commissure smiles, where the corners of the mouth first pull- upward and outward. The lips then contract to show the upper teeth. Think Courtney Cox or Elizabeth Taylor. About one-third of smilers have cuspid grins, where the top lip goes up to expose the canine teeth. Drew Barrymore and Tom Cruise are both cuspid smilers. Dr. Philips says that is what gives them a slightly mysterious look. Rarest of all is the complex smile – hello, Julia Roberts and Marilyn Monroe – where the upper and lower lips contract at the same time to reveal a full set of pearly whites.

The smile principles are based on the principle of design known as the golden section, established by the ancient Greeks and found repeatedly in nature’s own perfect proportions: the spiral of a seashell, the whorl of a sunflower’s centre. It comes set of mathematical relationships, says Dr. Philips. For example, we should see no more than three millimetres of gum tissue in a smile. The two front teeth should be symmetrical, and their width should be 80% of their height.

Having the means to accurately describe and classify smiles eliminates guesswork, as well as some of the doubt that can plague new clients. Every consultation at the studio begins, therefore, with a quick crash course in the language of smiles. Ms. Sabo snaps a Polaroid, identifies the client’s smiling style and goes through the seven principles using a series of before and after photographs of other patients. The wall behind her desk is taken up with such photos, organized into dozens of binders with titles such as "Gummy Smiles," "Untwisting Teeth:’ "Inverted Smiles" and "Moving Spaces".

By identifying their own smile types and understanding the smile principles, Dr. Philips says patients better understand why he makes the recommendations he does, and what is possible.

"I can measure your front teeth, do the calculations and tell you by exactly how much I should lengthen or widen them, or how much gum to cut away so that they conform to the golden section:’ Just seeing the before and after pictures was enough to convince Debbie Thornton, 38, that she had come to the right place. "Seeing is believing," says Ms. Thornton, "Going for the consultation was a great education. You get a realistic sense of your smile. You might go in thinking you want to look like this movie star or that one, but it might not work. I can’t say I want Julia Roberts’ teeth when I don’t have her smile type".

Ms. Thornton was unhappy with the "gumminess" of her smile, as well as the heavy veneers that a previous dentist had affixed, making her teeth feel thick and cumbersome. Over a series of visits to the studio, Dr. Philips performed a gingivectomy to trim away excess gum tissue, and replaced the heavier veneers with thinner, more natural-looking porcelain ones. He also whitened Ms. Thornton’s bottom teeth to match the shade of the new veneers.

Her new smile, says Ms. Thornton, was the motivation she needed to make other changes to her body. After having two children, the former professional volleyball player and bodybuilder had abandoned her workout routine and healthy eating habits. The "smile lift" kicked off a three- month diet and exercise program that has dramatically altered her body. Muscles ripple where once there was flab. A bright, toothy smile shines. Most important, Ms. Thornton says, the new smile has given her more confidence.

"I’m happier now," she says. "Just doing it made me feel a lot better. Before I had my teeth fixed, I used to cover my mouth with my hand because I was embarrassed. Now I have a real big smile".

The mere mention of the dentist – or worse, dental surgery – is enough to make most people cringe.

But with all the advancements in cosmetic dentistry in recent years, some adults are actually seeking out the 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 now spending the money and taking the time and trouble to wear them. They even have the option of wearing newer white braces which aren’t as noticeable as the traditional metal wires.

All in all, improving your smile has become less painful and time-consuming.

It’s also become a cutting- edge business. 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-modem "studio for aesthetic dentistry" – complete with a cappuccino maker, stereo, VCR and a separate washroom for spitting. . It’s in the Ontario Hydro build at University Ave. and College St.

He describes his office, which is as white and bright as a smile, quite simply: "It’s 2,000 square feet with one chair."

Instead of dealing with filling and annual cleanings, his new practice is limited strictly to the business of smiles – and it isn’t all laughs either.

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, terribly misshapen or brutally 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 (chief executive officer) 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 clientele is mostly professionals and people in the entertainment industry.

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

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

But he finally faced his fear of the dentist’s chair over the last month to get the kind of grin that was worth opening wide for.

"Of all people, I should be able to smile," he said, adding he was prompted to get his teeth fixed after repeated jabs from friends and fans about how bad they looked.

He found a lot has changed since he was a kid getting fillings at his family dentist, which he recalled as "pure torture."

While he said that the five lengthy visits to the dental surgeon weren’t exactly the most fun he’s ever had, he’s thrilled with the results.

"I’m very, very happy I got it done," he said. Satisfaction did cost him, though; he paid $10,000 to cover his upper teeth with porcelain veneer and get laser whitening for the bottom.

"You can’t put a price tag on your appearance," he said. "It’s like spending money on fitness or buying really nice clothes. It’s really worth it."

The cost is certainly something to chew on. The average price range for smile improvement runs between $200 to $5,000, Philips estimates.

Some of the work – from braces and bridges to caps and crowns – may be partially covered by dental insurance plans if the improvement is deemed a necessity, either due to an accident or a defect in the tooth.

But for dentistry that is strictly cosmetic, such as bleaching and porcelain veneer, you’ll have to get out your chequebook.

The general rule, says Don Mills dentist Lily Lo, is that "anything that goes on your front teeth is cosmetic." Most dentists have monthly instalment plans but they vary from office to office. Some like to have at least half paid up front and stretch the rest out over several months while others will take equal payments over six months. If you need more time to pay, you can apply for special funding at your dentist’s office.

Toronto-based Global Facilities Inc. can provide an interest-free loan over 12 months. After the 12 months, a hefty annual interest rate of 27.9 per cent kicks in, which could replace some smiles with a frown.

The price tag of the myriad cosmetic procedures varies from dentist to dentist.

"It’s not like buying carpets. It’s not easy, from a business perspective, to shop around for prices or to get a second opinion from different dentists," Philips acknowledged.

The Ontario Dental Association has a recommended fee schedule dentists use as a guide to how much to charge for specific procedures.

However, individual dentists are free to charge whatever they want above – and even below – that.

Generally, braces for adults will cost anywhere from $3,000 to $5,000, which includes dental visits over the two- to three-year period. It costs about $500 more for white braces.

Individual crowns can cost $500 to $800 per tooth. Porcelain veneer costs about around $700 a tooth and the average time spent in the chair is about six hours.

For general staining and yellowing, most dentists recommend a home whitening kit which is typically used for about an hour a day over two weeks. The cost is usually about $250, but more intensive bleaching treatments at the dentist’s office could cost up to $800. For deeper staining and discolouration, you could visit a dental surgeon for laser whitening, which costs $800 to $1,200.

Lo, whose office is on Lawrence Ave. E. near the Don Valley Parkway, says she tries to give her patients something to smile about whenever she can through the wave of advancements in her field.

"People are becoming a lot more aware of their appearance, including their smile," she said, adding: "Who wouldn’t want to get something done to improve it.

"If you’re looking for a job, you want to have a good appearance – and bad teeth do not make a very good first impression," Lo said.

Lana Elalfi, one of her patients, is thrilled with the results she has been getting after just one week’s use of a home bleaching kit.

"I drink a lot of coffee and I used to brush and brush and there was never any change," she said.

You see, we find ourselves peering critically into the mirror following every major awards show. All the starlets seem to have such perfect pearly whites. And we want to be just like them, don’t you know. (Well, with the exception of Angelina Jolie, maybe. Even though she does fine in the dental department, she drinks her husband’s blood before dinner. So déclassé.)

We can’t help but notice the proliferation of teeth whitening products at the drugstore, and we have several friends who have forked out a few hundred dollars to their dentists in the name of sparkly incisors. We wouldn’t want our readers to be left behind in the ever-advancing frontier of beauty. We wouldn’t want to be left out of it ourselves either, so we resolved to find out more.

We consulted a Yorkville dentist, Dr. Ed Philips of the Centre for Aesthetic Dentistry and president of the Toronto Dental Society.

He’s been making people more beautiful in the bouche for about 20 years and he’s noticed that, recently, an increasing number of patients are approaching him for the specific purpose of whitening their teeth.

"Right now, it’s the most common procedure that people ask for," says Philips, noting that there’s actually a social reason for the growing interest in aesthetic dentistry.

Baby boomers, he says, are just now becoming concerned about how their teeth look, after having spent much of their lives dealing with the more pressing problem of cavities and decay.

When they were children, cavity- preventing fluoride was not added to Canada’s water, as it is now. Nor was there a variety of brushing education programs in schools. As well, a shortage of dentists following the war meant that kids didn’t visit as often as they should have. So their teeth suffered, and they’ve spent much of their adulthood fixing the problems.

"They’re cleaned up now and they don’t have tonnes of problems anymore," says Philips. "So, they’re taking it one step further."

Some of his clients are referred to him for teeth whitening and other types of aesthetic dentistry by cosmetic surgeons who want to help their clients with their overall appearance.

Tooth whitening is an often-overlooked way to achieve a younger look, says Philips. But it’s not all about vanity. Aesthetic dentistry is part of a natural evolution in people’s expectations of their teeth. While teeth were once weapons used by cavemen to fight off an intruder, as well as functional tools used to shred raw meat, they now have more of a social function.

"In our society," says Philips, "we don’t want to keep people away. We want to get along with people. It makes sense that we want a beautiful smile."

Philips says tooth discolouration is simply part of aging. "It should be called re-whitening, not whitening, because it’s just a process of returning the teeth to their original colour," he says, adding that heredity is also a factor, and can affect the end result.

He says that dentist-dispensed whitening procedures are designed to address intrinsic stains – stains which occur within the pulp of the tooth, underneath the surface enamel.

"As the tooth ages, it leaves behind certain waste products," he says, explaining that most dentists use teeth whitening products containing carbamide peroxide, which goes right inside the tooth to dissolve the by-product of aging.

"People think we’re opening up the tooth and putting a white colour in, but we don’t put artificial colour in. We just dissolve the yellow."

Here’s what to expect when you visit a dentist for tooth whitening:

First, your dentist will examine your teeth and help you decide whether the process will result in the changes you’re looking for.

Philips says that not all tooth discoloration is a result of the aging process, and he doesn’t always advise people to go this route. In cases where the stains are visible – on the enamel of the tooth – a good cleaning at your dentist’s office is the best course.

These stains can result from, frequent consumption of red wine, coffee, tea, tobacco products and other substances, as well as from the glue used to adhere braces to teeth. (Whitening toothpastes are designed to address extrinsic stains, but more on that later.)

After the assessment, your dentist will create a mould of your mouth, which he uses to make custom-fitted trays for you to take home, and gives you a carbamide peroxide gel to put in the tray.

Then, you wear the tray in your mouth for a few hours or overnight for a week or more, depending on the degree of whitening you want.

If you’re looking for a faster solution, some dentists will kick-start the process by doing an in-office treatment with carbamide peroxide and applying a laser to help activate it.

"It’s a good solution if you have a wedding coming up on the weekend," says Philips, but adds it should be supplemented by the at-home program for a longer-lasting whitening effect.

Philips touches up his own smile every three months, but advises his clients to whiten about once a year.

He allows his teenaged daughters to whiten their teeth, but suggests that children younger than age 13 shouldn’t have their teeth whitened.

The only reported side effect is that some people experience tooth sensitivity following the process, but it passes quickly, says Philips.

The process ranges in price from about $250-$700 depending on the dentist and the degree of whitening contemplated, Philips says. Laser treatment can cost between $1,200 and $1,900 and includes a kit for whitening at home.

Philips also notes that whiteners don’t affect caps, fillings and crowns – made to match the colour of the rest of your teeth – so using a kit could trigger the need for replacements. You may have to factor that into the cost.

Counter Culture has decided to forego the dentist-dispensed procedure for now (we can’t bear the thought of wearing those trays around the house), though we’ll keep it in mind for later.

In the meantime, we’re going to switch to toothpaste with whitening qualities, as we came across a clinical study on the Internet, which found that whitening toothpastes reduced extrinsic staining by about 40 per cent.

The array of products available at the drugstores these days is overwhelming. We counted as many as 30 whitening products on the shelf during a recent trip to Shopper’s Drug Mart. But we also found several studies comparing different brands of whitening toothpastes, and Colgate products seemed to fare better than others.

As for the whitening kits that are available for between $14 and $40 and claim to address intrinsic stains, we’re doubtful. The kits available in Canada contain a lower concentration of whitening agent than dentist- dispensed programs. They may also cause irritation to the gums and mouth because the mouth trays aren’t custom fitted and the gel can ooze out.

We don’t like irritation.

Plus, the supervision of a dentist is always a good thing. For example, Philips says quitting a whitening program too soon can create a spotted look because some stains are removed faster than others. And a dentist can help you decide when you’ve reached a natural but sufficiently bright shade of white.

The pictures say it all.

With yellow, worn and chipped teeth, Karen Wilson had nothing to smile about. Three dental appointments later, she had a dazzling designer smile that not only transformed her appearance, but changed her life.

“When I was meeting people for the first time, I used to bring my hand up to my mouth or turn my head,” recalls Wilson, a dog groomer in her 20s. “When it came to meeting men, it was the hardest. They could see I wasn’t happy about myself.”

But now, just over a year since the dental work was done, “I can talk with people; I’m happier. And I smile a lot. People say I’m more confident.”

Wilson’s winning smile is the work of Dr. Edward Philips, a Toronto dental surgeon who’s given hundreds of people more to smile about.

Cosmetic dentistry, in fact, has given Philips something to sink his teeth into, especially when he sees the difference it can make to people’s manner and self-esteem.

“The impact is absolutely incredible. When they come back (after treatment), they just seem to have pulled themselves together. They look better, fashionably, because they’re wearing better colors, hair and makeup.”

Others respond differently, too. Billie Jo Sabo, Philips’s clinic director, tells the story about a CEO with a major bank who was so self-conscious about his poorly spaced teeth he never smiled.

“During meetings, people thought he was unfriendly and intimidating because they perceived this man with a scowl.”

But after his dental makeover, “he came in with this big smile, saying he’d closed a big deal. Because he was smiling all the time, people saw him as being more friendly and approachable.”

Philips often works with hair stylists and makeup artists to help clients maximize their looks.

“With the right combination of work on one’s hair, makeup and teeth, the results can be astounding,” says Santo Della Corte, owner of Yorkville’s La Corte Salon, who gave Wilson a new hairstyle to go with her new smile.

Cosmetic dentistry can involve a number of procedures that vary in cost, complexity and recuperative time. A gingevectomy (cutting back the gums) will “lengthen” small teeth to create a fuller smile. Composite resin or porcelain veneers can be bonded to the teeth to correct shape, spacing and color imperfections. Yellow or discolored teeth can also be bleached.

The cost can range from $100 or $200 to several thousand, depending on how many teeth need work and what procedures are required. Bleaching, for example, costs about $500 and is done by wearing a small gel-filled tray over the teeth at night for a week.

In Karen Wilson’s case, a major dental makeover was required. Weak enamel had caused her teeth to chip and wear down to the point where even eating an egg sandwich caused them to flake, she says. Excess gum tissue covered much of what was left of her teeth.

A gingevectomy and porcelain veneers gave Wilson full, even, white teeth that not only look 100 per cent better but are stronger and more functional, according to Philips.

Wilson’s case was an extreme one, he notes. But often a perceived problem can be corrected simply and quickly. In one case, a woman who complained about her “crooked teeth” and anticipated major dental work, just needed excess gum tissue tnmmed away. A one-hour appointment and about $600 or $700 later, she was all smiles.

A smile, says Philips, is a science. The ‘perfect smile” is one in which the upper edge of the teeth follow the upward curve of the lower lip line. It is also defined by measurements and proportions in relation to the other facial features.

But most people don’t want the “perfect Hollywood Chiclet smile,” says Sabo. “They want some individual characteristics left.”

An initial half-hour consultation, which costs $85 and is covered by most dental plans, is done to identify the problems, determine what can be done and for how much. Later, before-and-after computer images and molds of the mouth might be made to show what the dental makeover would look like.

Philips, who trained at the Hospital for Sick Children’s cranio-facial department, says new techniques have changed the face of cosmetic dentistry.

“Now, many simple defects or problems can be corrected without braces, extraction or surgery that couldn’t be done 15 years ago,” notes Philips, who gives public talks and has appeared on radio and television.

Dr. George Freedman, an author and dental surgeon who runs a “high-tech practice” in Markham, says it’s important to shop around to find a competent dentist who’s trained in the latest techniques.

“Anyone can call themselves a cosmetic dentist,” he says, noting that elective cosmetic dentistry is not taught in dental schools. Only two post-graduate programs exist and they’re in the U.S.

Freedman, who’s the past president of the American Academy of Cosmetic Dentistry, suggests that patients ask a dentist about training over the last two years to see if he or she has kept up with new techniques. The best way to fmd someone, he says, is by personal references from satisfied patients.

Word of mouth, you might say.

“The aged smile,” writes Toronto cosmetic dentist Ed Philips in his new book, Your Guide To The Perfect Smile, is “the most frequent problem reported by patients.”

“They often complain that their teeth no longer have the appearance they did when they were younger – that they seem to be worn and discoloured”

The discoloration from aging and staining is in most cases easily treated with whiteners, either at home or professionally by a dentist.

A bigger problem than discoloration is the tendency of teeth to wear down, and it’s especially noticeable in the two front upper teeth, says Philips.

“When they’re perfect in a 25-year old. they’re 25 per cent longer than they are wide. But at the age of 50, someone will have lost 25 per cent of the length of the two front teeth.”

“When your teeth are wearing down, you lose support between the nose and mouth and it causes creases along the lips and lips start to get thinner.”

His book is a step-by-step guide,to analyzing smiles and the techniques to improve them. ($79.95, ecwpress.com)

Improving the smiles and altering the teeth of aging boomers isn’t just a cosmetic issue. If s a health issue.

“When teeth start to wear down, very often they start hitting in certain spots and grinding in a certain way,” says Philips, “and this heavy loading stresses the roots and gums begin to recede.”

He says that teeth, throughout one’s lifetime, “are shifting and drifting and some of what we thought was gum disease was really a bite that needed to be readjusted.”

Philips says you’re never too old to improve your smile. “I did veneers on an octogenarian,” he boasts.

Aging adults can take extra steps to prevent getting ‘long in the tooth’

sabel Freeman practises diligent dental hygiene. To some people, her five-to-10 minute routine might seem fetishistic.

But Freeman, a retired registered nurse in her mid-60s, worked for decades in hospital dental clinics, including Toronto Western and Mount Sinai. And she knows only too well how negligence can comromise oral health.

So every night she starts her routine by flossing thoroughly.

“I like the unwaxed floss because it squeaks a little when the teeth are clean so you know the shmutz is gone.

Then she uses a manual toothbrush to smear toothpaste all over her teeth. Next, she brushes for several minutes with a good electric toothbrush. “I don’t like to put the toothpaste right onto the electric brush because it clogs it.”

Then she brushes with a Proxabrush, a small tapered bristly brush for the spaces between teeth. She finishes with a rubber-tipped gum stimulator dipped into chlorhexidine, a prescription-strength antibacterial rinse.

In the morning, she’ll brush after breakfast. And twice a year, she’ll keep an appointment with periodontist Howard Tenenbaum, a former colleague at the Mount Sinai Dental Clinic.

People like Freeman who practise good preventive care can keep their teeth and gums healthy as they age, says Dr. Tenenbaum, even though aging does bring new challenges.

“There is an increased risk of gum disease,” he says, “but it doesn’t mean that because you’re getting older, you will have gum disease.”

In the past he says, older people would get “long in the tooth,” a consequence of receding gums, leaving the roots vulnerable. And they’d lose teeth because gum disease went untreated and there were no antibacterial rinses. Now, with prevention and treatment, gum disease is less of an issue.

But because people are keeping their teeth longer into old age, tooth decay has become a big problem again. After 40 or 50 years of being dormant during adulthood, tooth decay can attack seniors the same way it did during childhood and adolescence.

Along with a deterioration of the protective tooth enamel, the chief culprit causing decay and disease in the mouth as we get older is an increased proliferation of bacteria. The sticky plaque that attaches to the bottom of teeth is actually a film of bacteria

That increase occurs because, with aging, we have less of what naturally keeps it under control: saliva. There’s a noticeable decline in the quantity and quality of saliva, says Dr. Marc Goldstein, a family practice dentist and chief of dentistry at Baycrest. “Saliva has antibacterial components and minerals that will harden enamels and it washes away carbohydrates from teeth,” he says. “As we get older, saliva tends to diminish and it has a different consistency!”

Even more importantly, he says, medications have a “huge” impact on the consistency and volume of saliva, including the pills typically prescribed for older people: blood pressure medication, statins, blood thinners, anti-depressants, anti-inflammatories.

“If you’re taking two or three:’ he says, “you can wind up having a real problem.”

TAKE EXTRA CARE

Oral health tips for aging adults from Dr. Howard Tenenbaum.