Girl smiling

Cosmetic Dentistry - Do we always need to grind down teeth?

Author: Dr Sam Koh

Date: 11 Sept 2023

Cosmetic dentistry is my big passion. I love the way we’re able to genuinely transform people’s lives by changing their smiles through improving their aesthetics. I love the fact that cosmetic dentistry requires a clinician to treatment plan the smile as a whole, pooling together all of their wisdom and knowledge in multiple facets of dentistry in order to improve the aesthetics of a patient’s smile. But when someone speaks about cosmetic dentistry, there sometimes is an associated stigma that cosmetic dentistry may not be good for your teeth, it may not be safe, and especially through various news outlets and social media, we sometimes see people going overseas in particular, and getting so-called “cosmetic veneers” done by shaving down their teeth. As dentists, I feel that in general we believe the less we can touch a tooth the better. So this begs the genuine question I commonly get asked by my patients - Do we always need to grind down teeth when doing cosmetic dentistry?


Most of the time when a patient refers to cosmetic dentistry, I feel they are referring to porcelain veneers. It’s the most common treatment we get asked for at my cosmetic practice, and to the general public appears to me to be synonymous with all things cosmetic dentistry. It’s important to us as cosmetic dentists to help guide them through this journey, as at the end of the day, we want what’s best for our patients to ensure the result looks good, and lasts as long as possible.


Porcelain veneers

Porcelain veneers are a really popular cosmetic dental treatment. It involves permanently glueing a very thin layer of porcelain over the surface of natural teeth to cosmetically change the shape, straightness and colour of a patient’s anterior teeth. Depending on what needs to be changed, we may have  to smooth back the surface of the tooth. When cases are not planned properly, including  some I see on social media these days, a lot of tooth structure is prepared, or as patient’s sometimes say to me, “shaved down to pegs and stumps”. This can lead to long-term issues such as weakening the tooth structure and integrity, as well as affecting the health of the nerves and blood vessels within. However, in most cases where the new veneers are designed and provided by an experienced cosmetic dentist, and where the treatment is planned well, we can potentially not have to prepare the teeth at all, or if we do, at most, we may only remove mere tenths of a millimeter of tooth structure.


However, apart from porcelain veneers, there are so many other treatments that can enhance the look of someone’s teeth and all together form what we call “cosmetic dentistry”. This includes composite resin bonding, braces/clear aligners, implants and teeth whitening.


Composite resin bonding

Bonding is a general term we use to describe addition of resin composite material to change the shape or straightness of teeth. A big advantage of resin bonding is that in a lot of cases, when done well, it does not require a lot of preparation (if any) of the teeth, as we are only adding material to the teeth structures. This can make it a rather appealing option to a lot of patients, especially when it is done in conjunction with other cosmetic dental treatments such as teeth whitening and orthodontics in a protocol called “align bleach and bond”.


Braces / clear aligners

A really great way to improve the cosmetics of teeth is to align them with either braces or clear aligners. Not only does this make the teeth look nicer, but it can also be done prior to veneers or resin bonding to reduce the amount of tooth structure which needs to be prepared, and improves the overall outcome of the cosmetic treatment, if planned well.


Teeth whitening

I may be biased, but I think teeth whitening is one of the best options when it comes to cosmetic dentistry, and should be included in almost every cosmetic dental treatment plan. It’s non-invasive, and can very quickly improve the colour of teeth in a lot of patients. It can also further improve the cosmetic outcome when done in conjunction with other cosmetic dental treatments. For instance, by whitening the teeth prior, we may not need to shave down as much of the underlying tooth in order to change its colour artificially with veneers. It may even reduce the need to do more veneers in order to change the colour and look of a smile.


So in general - there are lots of cosmetic dental treatments that are available to our patients. When treatments are planned well, in conjunction with each other, they can give us and our patients incredible results without having to prepare or shave down teeth very much, if at all. So it’s best to speak to our patients when they come in for a cosmetic consultation to help guide them to the right treatment option for them to help improve their smile, in a safer manner which is ideally the least-invasive to achieve their cosmetic needs.

Author Bio: Dr Sam Koh is a general dentist in private practice, with special interests in Cosmetic Dentistry and Orthodontics. He is the principal dentist and director of Dental Boutique Mornington. Dr Koh has been awarded with prestigious fellowships from the International Academy of DentoFacial Esthetics in New York, the Pierre Fauchard Academy in London, as well as a fellowship in Orthodontics. He is the co-founder of the Young Dentist Hub, a mentor for DentalX, and a speaker/Key Opinion Leader for several dental companies. Dr Koh is a founding member of the Colgate Advocates for Oral Health Editorial Community.