How to improve your smile

Media item: article

Date published: 1 September 2014

This page records the media item. The original article is the property of its publisher and is not reproduced here.

The only ordering that matters: least invasive first

Almost every problem with cosmetic dentistry comes from doing things in the wrong order.

The principle underneath is called minimally invasive dentistry, and it exists because of one fact: enamel does not grow back. Every irreversible step is permanent, and each one commits you to maintaining it for the rest of your life. A reversible option that gets 80% of the result is usually a better decision than an irreversible one that gets 100%.

So the honest sequence runs — and where to start is a question worth asking before any of it:

1. Health first — always

Untreated decay, active gum disease and failing restorations are treated before anything cosmetic. This is not a delaying tactic. Cosmetic work built on an unhealthy foundation fails, and veneers placed on inflamed gums have visible margins within a year or two as the tissue recedes.

It is also, bluntly, the biggest single visual improvement available to most people: healthy pink gums that do not bleed change how a smile looks more than any restoration.

2. Cleaning

A professional clean removes surface stain and calculus. Cheapest step, most commonly skipped, and it establishes what colour your teeth actually are before you spend money changing it.

3. Whitening — reversible, and the last fully reversible step

Whitening changes nothing structurally. If you don't like it, it fades. It is the last point at which you can change your mind for free.

Everything after this is permanent.

4. Orthodontics — moves teeth, doesn't remove them

This is the step people skip, and it is often the one that would have solved the problem.

Aligning teeth does not remove tooth structure. Braces or aligners move the teeth you have into a better position. It takes months to years rather than weeks, which is exactly why it is skipped in favour of veneers — and why the veneer alternative costs more tooth, permanently.

‘Instant orthodontics’ — using veneers or crowns to make crooked teeth look straight — is a real technique with legitimate uses, and it is also the single most over-sold procedure in cosmetic dentistry. Straightening eight teeth with veneers means preparing eight healthy teeth, some of them substantially. Straightening them orthodontically means preparing none.

5. Bonding and edge recontouring — minimally invasive, often enough

Composite bonding adds material to close a small gap, repair a chip or reshape an edge. It removes little or no tooth. It stains and chips over years and needs replacing — but replacing composite is far less costly than replacing a veneer, and the underlying tooth is still there.

Enamel recontouring — gently reshaping uneven incisal edges — removes a fraction of a millimetre and can transform how even a smile looks. Small procedure, disproportionate effect.

6. Veneers and crowns — irreversible, and the point of no return

Porcelain veneers can produce excellent results. They are also the treatment that generates the most regret, and the reasons are structural rather than aesthetic.

They require removing enamel. How much depends on the case, and modern minimal-preparation techniques remove very little — but conventional veneer preparation removes a meaningful proportion of the enamel from the front of the tooth, and it is gone permanently.

They do not last forever. Published survival figures are good but finite. A systematic review published in 2021, pooling 25 studies and 6,500 porcelain laminate veneers, found a 10-year estimated cumulative survival rate of 95.5% when fracture, debonding, secondary caries and the need for root canal treatment were all counted together as failure — 433 of the 6,500 failed on that definition. The review is explicit that survival is not the same thing as still looking good; the figure counts restorations still in place, not restorations that never needed repolishing or repair. Fracture was the commonest complication, followed by debonding, with both most likely in the first years after cementation. Longer series are thinner and less flattering: one Innsbruck cohort followed to 20 years reported Kaplan–Meier survival of 93.5% at 10 years, 85.74% at 15 and 82.93% at 20, while a separate prospective series reported 73% at 15 to 16 years. Expect replacement at some point, and expect each replacement to remove a little more.

Preparation can devitalise a tooth. A proportion of heavily prepared teeth eventually need root canal treatment, which is a cost and a complication that belongs in the original conversation. In the pooled review above, counting the need for endodontic treatment on its own as failure gave a 10-year cumulative survival of 99.0% across 2,773 veneers — a small number, but not zero, and a heavily prepared tooth is not the same as an average one.

Crowns remove more than veneers — substantially more, because the whole circumference is prepared. The most quoted measurement of that difference is Edelhoff and Sorensen's gravimetric study in The Journal of Prosthetic Dentistry: a partial porcelain laminate veneer preparation removed about 8.2% of the coronal tooth structure by weight, the most extensive complete-veneer design about 30%, and full crown designs 64% to 71.9% — the crown removing roughly four times as much as even the heaviest veneer preparation. That study is in vitro, gravimetric, on resin typodont teeth, and on anterior teeth only, so read it as the order of magnitude of the trade-off rather than a figure for a particular molar in a particular mouth. A crown is appropriate for a heavily broken-down or root-filled tooth. Crowning a sound tooth for appearance is a large trade.

The commitment is lifelong. Once eight upper teeth are veneered, they are veneered for life, and so is the maintenance, the replacement cycle and the cost.

7. Gum contouring, and surgical options

A ‘gummy smile’ is sometimes treated by reshaping the gingival margin, and sometimes it is skeletal, in which case the honest answer involves orthognathic surgery or accepting it. Distinguishing the two is a diagnosis, not a preference.

Questions that separate good cosmetic dentistry from bad

‘How much tooth structure will be removed, in millimetres, and from which teeth?’ A practitioner who cannot answer this precisely has not planned it precisely.
‘What is the least invasive option that would achieve most of this?’ Then ask why it is not being recommended.
‘What does this look like in fifteen years, and what is the replacement cost?’
‘Can I see it before it is irreversible?’ A diagnostic wax-up and a trial smile — a temporary mock-up bonded over the unprepared teeth — lets you see and live with the proposed shape before any enamel is touched. Asking for this is entirely reasonable and a well-run practice offers it.
‘Is any of this treating a health problem, or is all of it cosmetic?’ The treatment discussion should make that clear.
‘What happens if I do nothing?’
‘Who is doing it, and what is their registration?’ — verifiable free at ahpra.gov.au.

Two things worth saying plainly

‘Cosmetic dentist’ is not a registration category. There is no specialist registration in cosmetic dentistry in Australia; it is not one of the recognised specialties. The Dental Board of Australia records that ‘there are 13 dental specialties in Australia which are approved by the Australian Health Workforce Ministerial Council’, and cosmetic dentistry is not among them. Anyone using the phrase is describing an interest, not a qualification, and that is lawful provided it is not presented in a way that implies specialist registration. The recognised specialty closest to complex aesthetic rehabilitation is prosthodontics, and cosmetic work under specialist care is described separately.

Under the National Law, before-and-after images and testimonials about clinical care are restricted in Australian dental advertising, and no practice may promise a specific result. Section 133 bars advertising that uses testimonials, that creates an unreasonable expectation of beneficial treatment, or that offers ‘a gift, discount or other inducement’ without also stating the terms and conditions of the offer. AHPRA's guidelines are specific about urgency too, naming ‘don't delay’, ‘act now before it's too late’, ‘don't miss out’, ‘time is running out’ and ‘for a limited time only’ as wording that may be unlawful where it is tied to unsubstantiated claims that a person's health will suffer. If a cosmetic offer is presented with a guaranteed outcome, a countdown, or a discount that expires, those are the features regulators warn about — because irreversible treatment should not be sold under time pressure.

And on dental tourism

Overseas cosmetic packages are heavily marketed to Australians, usually as full-arch crowns or veneers completed in a week.

The ADA has a policy squarely on this. Policy Statement 2.2.6, Elective Overseas Dental Treatment, states that ‘overseas elective dental treatment carries the risk of adverse oral and general health outcomes with long term problems which may be difficult to resolve on return to Australia’, and that treatment may be delivered ‘without full informed consent and at a different professional and regulatory standard than provided in Australia’. It also makes the point the compressed timetable raises: ‘optimal ongoing oral health cannot be achieved in a single episode or short course of treatment and requires regular maintenance.’

The issues are practical rather than nationalistic: treatment that fast usually means crowns rather than veneers, and therefore much more tooth removed; complications appear after you are home; the practitioner is outside AHPRA's jurisdiction, so the Australian complaint and notification pathways do not apply; and remedial work in Australia on failed overseas full-arch treatment is expensive, sometimes very expensive, and occasionally not possible. The ADA adds two more that people do not anticipate: complications from elective treatment obtained overseas ‘are not always covered by travel insurance and the treatments may not be covered by Australian health funds’, and overseas clinics may not carry professional indemnity insurance, which Australian practitioners are required to hold.

If you go, get full records, radiographs and the materials used, in writing, before you leave. Whoever manages it afterwards will need them — and this is the ADA's own stated concern, that ‘ongoing and corrective treatment may be compromised, as the records and complete details of treatment obtained overseas are unlikely to be available to those providing subsequent treatment in Australia’.

Common questions

I grind my teeth. Can I still have veneers?

Often not, and this is the most frequently omitted contraindication in cosmetic marketing. Healthdirect — the Australian Government-funded consumer health service, page last reviewed February 2025 — states it plainly: ‘Veneers may not be suitable if you grind or clench your teeth or if you have gum disease.’ Both halves matter. Grinding loads a thin ceramic laminate in the way most likely to fracture or debond it; active gum disease moves the margin the veneer was designed to sit against.

There is a second screening question that nobody thinks to ask, and it is about how much enamel you have left. The bonding that holds a veneer on works far better to enamel than to dentine. Burke's review in the Journal of Esthetic and Restorative Dentistry (2012) puts it as ‘there is reasonable evidence indicating that a veneer preparation into dentin adversely affects survival’, and concludes that ‘the ideal preparation for porcelain veneers remains within enamel’. The long Australian series most often cited for veneer longevity set that as an entry criterion rather than an aspiration: Layton and Walton's 21-year cohort veneered only teeth with at least 80% enamel remaining.

So if your teeth are already worn from grinding or erosion, the two facts compound — more force on the restoration, and less of the substrate it bonds best to. Ask specifically how much enamel is left on the teeth being prepared, and what the plan is for the grinding itself, because a veneer does not treat it. Bruxism and night guards.

Can veneers be taken off again if I do not like them?

No, and Australian sources are not consistent about how clearly they say so — which is worth knowing when you read promotional material.

Healthdirect is unambiguous: ‘Your dental professional fixes veneers to the surface of your teeth. You can't take veneers off.’ It also gives the reason the tooth is changed for good: among the risks it lists, ‘your teeth could become more sensitive because some enamel is removed’.

The ADA's consumer site describes veneer treatment as requiring not much or no tooth structure to be cut away. That is accurate for minimal-preparation and no-preparation veneers, which genuinely exist and are the right answer for some cases. It is not a description of conventional preparation, and it should not be read as one. The measured trade-off is in the body of this page: the most extensive complete-veneer design in Edelhoff and Sorensen's study removed about 30% of the coronal tooth structure by weight.

The practical consequence: ‘reversible’ and ‘minimally invasive’ are not synonyms, and which one you are being offered depends entirely on the preparation design. Ask for it in millimetres, and ask to see the proposed shape first — a trial smile bonded over unprepared teeth is the one point at which you can still change your mind for nothing.

Will veneers straighten my teeth or fix my bite?

No. Healthdirect states it in one line: ‘Veneers don't straighten your teeth or fix your bite.’ It adds that ‘They're not used to repair damage’, though it accepts they ‘can help restore worn teeth’.

What they change is how the front surface looks. A veneered tooth that was rotated is still rotated underneath; the porcelain has been shaped to read as straight from the front. That is the ‘instant orthodontics’ described above, and it is a legitimate technique — but it treats the appearance and leaves the position, which matters if the crowding was also a cleaning problem or a wear problem.

Healthdirect's own list of what veneers are useful for is narrower than the marketing: teeth that are ‘discoloured or stained’, ‘a bit crooked’, ‘oddly shaped compared to your other teeth’, ‘chipped or slightly broken’, or ‘widely spaced and leave a gap’. Note ‘a bit’ and ‘slightly’. If the honest description of your teeth needs a stronger adverb than that, orthodontics is the question to ask about first.

Composite or porcelain — how do I actually choose?

They are different trades rather than better and worse, and the appointment count is the clearest signal of the difference.

Composite resin veneers are ‘applied directly to the front surface of the tooth and shaped by the dentist’, and the ADA's consumer site notes this ‘is usually completed in one appointment’, with the veneers ‘created by the dentist while you are in the dental chair’. Less tooth removed, lower cost, repairable, and adjustable on the spot — against a material that stains and chips sooner. Composite bonding.

Porcelain veneers are made by a technician from an impression or a 3D scan, and ‘usually needs at least two appointments’. Healthdirect adds a caveat worth asking about: the number of appointments ‘will depend on whether your dental professional has the right scanning and production equipment’, since a chairside milling machine can compress it. Better colour stability and surface, at the cost of more preparation and a laboratory stage. Porcelain veneers.

Neither is permanent. Healthdirect's key-facts list includes the sentence most consultations skip: ‘Veneers may need to be replaced due to chips, fractures or changes in colour over time.’ So the choice is partly about which replacement cycle you would rather be on — a cheaper, more frequent one with more tooth left, or a longer, dearer one with less.

Once a tooth is veneered, is it safe from decay?

No, and this is the single most expensive misunderstanding in cosmetic dentistry. The ADA's consumer site says it directly: ‘Having a crown, bridge or veneer does not mean no treatment will ever be needed again for the tooth or teeth. These teeth can still be damaged by tooth decay.’ Decay at the margin of a veneer is both harder to see and harder to restore than decay on an unrestored tooth, and it is one of the failure modes counted in the survival figures above.

So the home care is not optional maintenance, it is what the investment depends on. The ADA's instruction is ordinary and specific: ‘Brush twice per day with fluoride toothpaste and clean between your teeth every day.’ For a bridge it adds a technique point, because floss cannot pass between joined crowns: ‘Your dentist should show you how best to clean beneath your dental bridge. This may involve using superfloss, floss threaders or interdental brushes.’ If nobody has shown you, ask — it takes two minutes and it is the difference between a restoration that reaches its expected survival and one that does not.

The corollary for the decision itself: the maintenance cost is part of the price. Shorter recall intervals, better interdental cleaning, and eventual replacement all belong in the figure you compare against doing less. Dental Cleans and Hygienists and Price Guide.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Every practitioner's registration and any specialist entry can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a published article and its date, with general information. It is not a diagnosis, a treatment plan or a promise of any particular result. Cosmetic dental treatment carries risks, much of it is irreversible, and individual results vary. Third-party published content is not reproduced.

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