Dr. Dale Kates always thought his business was recession-proof. The waiting rooms in the orthodontist's Cleveland Heights and Warrensville Heights offices were always filled with parents dedicated to giving their children the gift of perfectly straight teeth. In many cases, those parents had never seen an orthodontist and become patients, too.
But in 2009, the number of adults on Kates' schedule dropped. Many were like the 47-year-old father who put his teenage son in braces in 2008 but delayed treatment for himself until business at his small enterprise picked up.
Now that the economy has started to stabilize, those adults — including that small-business owner — are starting to return to dentists' and orthodontists' offices and book some of the most popular cosmetic-dentistry procedures in the industry.
"They are now saying, •I do really want this for myself,' " Kates says.
Braces remain the go-to method for straightening and closing gaps between otherwise healthy teeth. The mouthful of metal so many adults remember, however, has been replaced by clear brackets and translucent wires.
A fashionably invisible alternative is Invisalign braces, a series of clear plastic aligners that cover the teeth. Kates says the removable custom-made appliances, each of which is worn for two weeks at a time, are so thin that patients often forget they're wearing them.
Both options cut the average two-year treatment time with old-fashioned braces in half. The method Kates suggests depends in part on the patient.
"If a patient says, 'Well, I'm not very disciplined, and I lose things a lot,' that's not a person I would recommend Invisalign to," he says. "You have to be self-motivated."
Bleaching is the most frequently requested way to improve a set of straight but not-so-pearly whites. Beachwood dentist Dr. Stuart Katz notes that "it's relatively inexpensive, relatively quick."
He offers at-home bleaching, a one- to two-week process that involves wearing a custom-made tray filled with peroxide gel for a prescribed amount of time every day. But most of his patients prefer in-office bleaching, a variant in which the gums are covered with protective dams and a stronger peroxide gel is applied to the teeth.
Katz says the procedure yields results similar to or better than those achieved through at-home bleaching in a single hourlong appointment for about the same price. "It works well for most people," he says.
For patients with misshapen, chipped, broken or badly discolored teeth, porcelain veneers are the cutting-edge choice for getting the winning smile they once enjoyed or always wanted.
Rocky River dentist Dr. Anthony Heibili says that many aesthetic problems can be corrected with "no-prep" veneers, contact-lens-thin shells of porcelain that are bonded directly onto the front of the teeth with a composite-resin cement without first removing tooth structure, a step required to accommodate the thickness of traditional veneers.
"They can be taken off," Heibili says of the "no-prep" product, which includes the Lumineer brand of veneer he uses. "Your teeth are still underneath in sound condition."
Like Heibili and Katz, Dr. John Heimke, a dentist with offices in Rocky River and Sandusky, uses veneers along with restorations such as bridges and crowns to recreate a smile. An implant topped by a porcelain crown is a popular option for replacing a missing tooth when there's enough bone to support it. Heimke calls the tiny titanium post "an artificial tooth root" that, together with the crown, looks, feels and works like the real thing.
A smile restoration can even start at the gum line. Dr. Scott Rose of The Center for Aesthetic & Restorative Dentistry in Solon says the too-short teeth some patients bemoan is often the result of altered passive eruption, a condition in which the gum tissue doesn't fully recede to expose the full crowns of the teeth as they emerge from the jaw. Rose uses a laser to trim and reshape excess gum tissue around the front six to eight teeth if the condition
"If you put a veneer on a small tooth, it's just going to look like a whiter small tooth," he explains. "Laser recontouring brings back the natural proportion of the teeth to the face and the natural proportion of each tooth to each other."