Now that your cavities are under control, your incisors are straightened and your root canal crisis has passed, just how stained and yellow are those teeth? In a recent North American poll, queries about teeth whitening topped the list of questions asked of dentists by their patients.

"I prefer to call it re-whitening," says Dr. Ed Philips who, right off the top, wants to correct the perception that stained or yellow teeth are somehow whitened by the addition of white colouring in the process that many dentists now offer.

They’re not.

In the dental office whitening process and in the home-whitening kits which proliferate on drugstore shelves, teeth are only "de-stained" and "un-yellowed." In other words, their colour is only brought back to what the colour of the teeth might have been, say, 20 years ago.

Whiter teeth are part of the social evolution of the mouth, says Philips, who runs Toronto’s Studio for Aesthetic Dentistry.

"Historically, during caveman times, teeth were weapons used to eat and to chase someone away. Strong teeth and a scary, gap- toothed, awful smile were good things."

Today, Philips adds, we ask exactly the opposite of the smile.

"Today, it means ‘I’m friendly. Come closer to me.’ Whiter teeth appear healthier and cleaner and that’s more socially acceptable."

It’s true that some people have almost pure white teeth, but when you look at a porcelain palette (the array of colours the dentist holds against your tooth to match the filling to the right natural shade) there’s a wide range of natural colours and many of them have a slight yellowish tinge.

The "Chiclets" smile? False, jarring and not the goal in the whitening process, experts say.

Like crow’s feet and morning stiffness, darker teeth are a product of aging but are accelerated by coffee, tea, red wine, tobacco – even eating lots of curry or beets.

"These are outside stains," says Dr Kenneth Montague, a Toronto dentist. "They enter the tooth enamel on a surface level only."

Montague explains that the tooth’s outer enamel is composed of little pores and that these stains go into the micro pores.

"These stains are hard to get out with a toothbrush but respond well to the tooth-whitening products," Montague adds.

But what exactly are these products? How much do they cost? And how safe are they to use?

Dentist-supervised bleaching is the method most preferred by the Ontario Dental Association. With it, an impression is made of your upper and lower teeth. Then customized trays that fit around the teeth are made. You take the trays home, squeeze in some bleaching material that your dentist has dispensed, then stick the tray to either your upper or lower teeth in much the same way kids make orange- peel teeth or put in a hockey mouthguard.

Because it sticks on pretty snugly, you can sleep on it and speed up the whitening process. It generally works after doing it about 10 nights, but not necessarily 10 nights in a row.

Montague says the process costs under $500.

Many people prefer the daytime method. Also under a dentist’s care, you wear your trays while you’re awake 30 minutes each day. The only setback is you can’t talk, eat or smoke during that time, which is why some people still choose the overnight versions. The price is the same.

Montague says the bleaching process uses an agent like a peroxide that leeches into the teeth. It lightens up, not unlike Javex, but using it effectively is a control issue.

"We don’t condone people using chemicals on their teeth," Montague says.

The chemicals contained in these products have to be powerful enough to do the job but not powerful enough to harm.

Philips explains that the whitening pumps oxygen molecules into the natural pores of the tooth. In doing so, it binds to the artificial colouring that has built up over the years in these pores. The combined oxygen and the yellow pigment join and break down the colour to lighten the teeth a shade or two.

In a survey done of 8,000 dentists in the U.S., 66% of patients reported varying degrees of irritation with bleaching kits although several studies show that tooth whitening is safe when performed properly.

"We are very concerned about the misuse of home-bleaching kits," Montague says.

By home-bleaching kits, he’s referring to the growing number of products available over-the-counter from drug stores. I bought the Natural White 5-Minute tooth whitening system. At less than $15, it was a deal – but dentists say these home whitening kits don’t have the strength that their systems do.

"If you insist on using these, bring them into your dentist and discuss the process. You don’t want it to be harmful," Montague says, adding that some unsupervised home bleaching can burn or irritate gums.

He adds that no whitening treatment can make teeth whiter than their original colour and the process won’t work on crowns or teeth that are darkened as a result of illness or drugs. (Some antibiotics, taken in childhood, can darken teeth right through, and not just on the surface.)

Tooth whitening isn’t a quick answer. Stains return and the process has to be repeated.

Nonetheless, Montague says, "I’m a believer. Twenty years ago, nobody talked about it. A decade ago it was a mumble. Today, it’s a roar."

"Aging is the number 1 cause of darkening and yellowing teeth,” says Billie Sabo, director of The Studio for Aesthetic Dentistry in Toronto. But she advises watching what you eat to help put off the inevitable. "Everybody’s saliva has a different makeup-either alkaline or acidic-which affects the breakdown of foods and, consequently, the colour of your teeth," says Sabo. But there are common "stainers" to avoid: ‘tea, coffee, colas, red wine and, of course, smoking," she says. And while she says there are no de-staining foods, she recommends calcium, found in milk products like cheese and yogurt, to add strength to your teeth.

Smiling takes less work and causes fewer wrinkles than frowning. According to Dr. Wayne Carmen of The Cosmetic Surgery Institute in Toronto, "when you smile you use the muscles in your lower face and a few around the eyes, but when you frown, you use your entire face," So, if you need motivation, consider smiling an antiwrinkle treatment.

"Generally, the perfect tooth should be longer than it is wide and slightly rounded," explains Toronto dentist Dr. Sol Weiss. "Only about 20 percent of the population are born with such teeth," he says. My teeth were what he calls ""orthodontist teeth-perfectly aligned after years of braces, but imperfectly shaped. Almost as wide as they were long and very square, my "heaver teeth" made me so self-conscious that I rarely smiled in photographs and wouldn’t even consider it on a first date. Perhaps cosmetic dentistry would be my smile salvation.

Dr. Weiss, who specializes in cosmetic dentistry, has a practice now numbering in the thousands, including many models who go to him for "smile therapy.’ My first visit turned out to be not only painless, but exciting. On TV screens in Dr. Weiss’ consultation room, I was shown a multitude of before-and-after images-yellow teeth that were now white: gaps closed; overlapped teeth straightened, and even reshaped, to pearly perfection.

According to Dr. Weiss, teeth are one of the most neglected components of beauty. But they shouldn’t be. "A smile is an invitation. People who are insecure about their teeth don’t smile and, therefore, don’t invite. When their teeth are reshaped, their appearance changes, but so does their attitude. Doors open," he says.

ORTHODONTICS
While cosmetic work covers up misaligned teeth to give the appearance of a Hollywood smile, braces actually move the teeth into proper position to effect structural change. Dr. Donald Woodside, a professor of orthodontics at the University of Toronto, who is also in private practice, says that adult orthodontics has been made a more attractive option due to new techniques: clear ceramic or plastic braces (visible only by those standing within 3-6 feet); retainers worn only at night; and even braces applied just to the inside of the teeth-a technically demanding, costly and lengthy procedure practiced by only a handful of orthodontists. For clients who are TV personalities or performers, Dr. Woodside will even remove the visible portion of the brace work for a period of time, reapplying after the client has finished filming or performing.

What orthodontists can’t do, however, is change the colour or the shape of individual teeth-something cosmetic dentists accomplish using bleaching, cosmetic contouring, veneers, bonds and bridges. An ideal situation, for those who need it, is to work with an orthodontist to move teeth into proper position before a cosmetic dentist moves in to perfect the aesthetics.

BLEACHING
"White, bright teeth is where it all starts," says Dr. Weiss. And, start to finish, whitening is the easiest of cosmetic dentistry procedures. At- home kits come complete with teeth guards that are filled with a gel- like whitener and worn overnight for 2-3 weeks. I couldn’t take much more than six hours at a stretch before my teeth started feeling sensitive to the whitener-and my pride began bruising from the humiliation of sporting guards that made me feel like Lennox Lewis. The newest (kinder and gentler) cosmetic whitening technique is laser bleaching, an in-office procedure that takes only about two hours to complete. An argon laser made specifically for whitening teeth removes years of stains (coffee, smoking, wine, genetic yellowing) built up on the teeth. While fast and relatively pain-free, the process costs $1 000*_about twice the cost of the take-out whiteners.

COSMETIC CONTOURING
For those with longer, "rabbit" teeth, with one tooth slightly longer than the other, or chipped teeth, dentists can use a filing procedure to shave the teeth, shortening them permanently. Although a quicker, less expensive option to veneers (see below), cosmetic contouring is not advisable for shorter, square teeth, as it can create even worse proportions. This can cost $30-$60, though many dentists will do it for free.

VENEERING
Veneers are actually porcelain overlays that are affixed to the front of the teeth. (Not to be confused with crowns, more commonly known as caps, which are also made of porcelain, but fit over the entire tooth- more for corrective than cosmetic reasons.) Veneering, perhaps the most common technique in Dr. Weiss’ practice, works much like press- on nails do. The tooth is first shaved down to make room for the veneer that will sit atop it, then the porcelain is stuck on using an acrylic cement. The porcelain is virtually translucent, allowing light to refract as it does with natural teeth, making veneers the most natural and permanent cosmetic technique.

Beyond practicality, however, the beauty of veneering is that the dentist is able to shape the veneers to suit the proportions of an individual’s face or to perfect imperfections like gaps and crooked or misaligned teeth. In my case, Dr. Weiss sought to "feminize" my front teeth by making them longer and thinner (apparently in dentistry, like life, you can never be too tall or too thin). He first "sanded" about a millimetre from the width of both front teeth, then shaved the top of the tooth to accommodate the porcelain overlay, and then cemented on suitably shaped veneers. In all, the process takes about 3-4 hours, depending on the number of teeth being veneered, at a cost of $500-$650* per tooth.

BONDING
At one time, bonds were used as an inexpensive alternative to veneers. Now, however, with significant improvements in veneers (they look better and last longer), bonds are mostly used as a temporary fix. Ideal for growing children with chipped teeth or for anyone wishing to experiment with the shape and size of their new teeth before committing to a permanent process, bonds are made of resin and last only 3-4 years. Like veneers, the bonding is glued on to the tooth with acrylic, a process taking 2-6 hours at a cost of $350* per tooth.

BRIDGES
Teeth seek contact from their neighbouring mates. When a tooth is missing, therefore, its neighbours will grow toward each other, creating distorted bites and an unsightly smile. When a fake, or replacement, tooth is inserted, a bridge is created. The process is lengthy-three hours and up, over two visits-and costly-starting at $1,000* and escalating depending on the number of bridges. -Liza Finlay

When chosing a lipstick that makes teeth look whiter and brighter, you should consider colour for contrast. Phil Jin, a colour expert at Pantone, the world leader on standardized colour systems for the design and fashion industries, says, "If you want to make a colour spot look lighter, the key is not to surround it with a colour that is any lighter than itself. That will only make the target spot look darker" -so avoid white, silver, gold and peach lipsticks. "Make your choice as dark as possible to act as a contrast to your teeth," Jin says. Try: Chanel Rouge A Lèvres Hydrabase Creme Lipstick in 97 Rouge Ténèbre. Diana Carreiro, a Toronto makeup artist, says that in lipstick we don’t have true pigments, only undertones- blue-based (cool) and yellow- based (warm). So if you’re trying to take the attention off yellow- tinged teeth, look to a blue- based lipstick to neutralize the yellow. Finally, for a flawless smile, you’ll want to avoid having lipstick rub off on to your teeth. Choose matte lipsticks, which are formulated to facilitate a lasting hold. Try: M.A.C Lipstick in Media and Shiseido Matte Variations Lipstick in Underground Brown. Sweater Dma Merulla – Boz International.

A great smile is me sum of its parts and the look of the lips is just as important as that of the teeth. According to Tricia Sawyer, a film makeup artist and a spokesperson for Prescriptives, the au naturel, less-contrived route is best. "A great nude colour with a gloss that enhances your lips is very appealing to show off your teeth and smile.’

How do whitening toothpastes whiten? According to Dr. Robert Ibsen, president of Den-Mat Corp., the makers of Rembrandt toothpastes, "many toothpastes remove surface stains by using strong detergents." Rembrandt’s patented Citroxain formula contains hydrated aluminum oxide, sodium citrate and papain (an enzyme derived from papaya) to "remove plaque, stains and tartar on the surface of the tooth and take out deeper protein stains within the tooth with a minimum amount of abrasion."

"The more even and white and clean they are, the more uninvasive they look and, therefore, the message seems to be that this is someone you could work with, that you could be in love with, that you could feel comfortable with, that you could feel good around," he says.

Dr. Philips, who has been practicing dentistry for 20 years, is passionate about his work in crafting attractive smiles. He left his general practice five years ago to open The Studio for Aesthetic Dentistry in Toronto.

"I just had a real passion for esthetics, which was not easily deliverable in a general practice environment," Dr. Philips says, adding patients often feel uncomfortable or pressured when their general dentist advises them about esthetics.

Esthetics were not historically a priority in dentistry. It was not until the 1970s, when the first generation of children was born under a system of preventive dental care, that people started having fewer dental problems, such as cavities and gum disease. Today, there is a growing emphasis on esthetics.

Cosmetic dental procedures include whitening or bleaching, restoration of teeth with porcelain veneers, gum sculpting and the replacement of missing teeth with implants, which involves the placement of titanium screws that act as roots for new porcelain teeth.

Porcelain veneers are covers placed on teeth to change their shape or colour and are now a popular tool in cosmetic dentistry.

"Four years ago, people thought a porcelain veneer was something you put into your washroom," Dr. Philips says.

A veneer can also be used to correct chips and cracks, fill gaps and replace worn surfaces.

"This is like a false fingernail that is put over the teeth," he says. "They are really wonderful because you can instantly more or less change the colour or change the shape of your teeth."

Corinne Davis, 43, a bookkeeper from Uxbridge, Ont., had been considering getting her crooked front teeth fixed for a longtime.

She had twice received an estimate for braces but could not get a guarantee of the results, so she began searching for alternatives and found Dr. Philips on the Internet. She had porcelain veneers put on her front six teeth in 2001. She is happy with the result.

"I love it," Ms. Davis says. "There is not a day that goes by that I don’t look and smile and think it’s the best thing I ever did in my whole life. I would have my whole mouth done if I could." She is particularly pleased with the way the veneers match her natural tooth colour.

"I specifically said to him, ‘I don’t want these great big, honking, shiny, white teeth. I want it to look natural. They don’t need to be absolutely perfect,’" she says.

The new porcelain veneers have a depth of colour that looks natural, while the older veneers looked as though they were painted on, Dr. Philips says.

Tooth bleaching or whitening is another major trend in cosmetic dentistry.

The most effective, and most expensive, whitening products are prescribed by a dentist.

Self-bleaching products that can be purchased at drugstores without prescriptions from dentists are considerably less expensive, but their effectiveness is questionable.

Dr. Philips does not have much faith in self-bleaching products and says many patients who come to him for whitening have already tried these products.

"They just don’t work," he says. The whitening products prescribed by dentists typically require a patient to wear custom-made trays filled with whitening formula on their teeth at night or for several hours each day, for a week or more. These custom-made products range in price from about $250 to $950.

Other cosmetic dental procedures can be more expensive. The Web site for the Studio for Aesthetic Dentistry lists the prices for a number of its services. These include $1,000 a tooth for porcelain veneers, $600 to $1,200 for laser gum surgery, $3,500 a tooth for implants and between $550 and $950 for whitening.

Cosmetic dentistry is not covered by insurance plans.

Ms. Davis admits her veneers were pricey, but says they were well worth it.

"If I didn’t have three kids to educate and all of that, I’d jump right back in that chair and have them all done. But it’s not inexpensive, either:"

Cost is only one of the considerations before undergoing a cosmetic procedure.

Another is the patient’s expectations.

"If I get the feeling from a person that they think that whitening is going to change their life, I’ll say, ‘You know what? It’s not going to change your life,’" Dr. Philips says.

Cosmetic dentistry is also discouraged for people who have other dental conditions, such as gum disease and open cavities, that should be looked after first, Dr. Tam says.

Dental surgeon Ed Philips, right, with patient Corinne Davis at his cosmetic dentistry clinic in Toronto:

An attractive smile sends a positive message "that this is someone you could feel good around."

So one month ago, she decided to spend $1,000 for a laser whitening treatment, a relatively new method of lightening teeth that takes about three hours and is, for the most part, painless.

"I deal with a lot of people, so my smile is important to me," said Buzzanca, who is an office manager.

The treatment, which has been used in Canada for about two years, is the newest development in whitening. While heralded by some, others urge caution because of potential risks.

laser whitening works like this: A protective covering (usually a rubber dam, wax or cotton rolls) is placed so that it covers the gums, tongue and cheeks, and the teeth are then painted with a special whitening gel. The laser, which looks like a pen, is then held in front of each tooth for about three minutes, and this is repeated about six or seven times per tooth.

"It is time consuming," admits Dr. Ed Philips, of The Studio For Aesthetic Dentistiy in the Ontario Hydro building at University Ave. and College St. Philips teaches cosmetic dentistry at University of Toronto.

"I usually book a patient in for the entire morning."

There’s no freezing involved, and the only side effect reported is a bit of sensitivity for a few hours afterward.

Following the laser treatment, patients should try to cut back on the main teeth stainers – coffee, tea, red wine and smoking – advises Andrea Radman of The Perfect Smile, a salons on Yonge St. just north of St. Clair Ave. that has had about 100 laser clients since it opened four months ago.

She’s what’s called a laser certified technician, which means she’s taken the two-day course required by the manufacturer for those who operate the laser.

Her background is in dental administration. The salon has two other certified technicians, one who’s a dental hygienist and the other a dental assistant.

To maintain the look, patients rely on at-home whitening kits, which can be used instead of the laser treatment to whiten stained teeth. The at-home kits have been used in Canada since the early ’90s, according to the Canadian Dental Association. They cost anywhere from $250 to $500.

A mold of the patient’s mouth is taken and plastic "trays" that have a vacuum-like seal are custom-made to fit over the teeth. All the patient has to do is put the whitening gel (usually carbamide peroxide) into the mold and then wear the mold for a few hours a day, as often as recommended.

Someone who’s had the laser whitening may only have to do this once or twice a year.

Penny Freedom, co-owner of The Smile Salon on Bay St. and Cumberland Ave., said her clients are anywhere from 32 to 70 years old.

"It’s not the rich who get this done, it’s very average people who don’t like their smile," she said.

Freedom, who’s been a dental hygienist for more than 30 years, said her salon has seen more than 200 patients since it opened in 1996. She’s found that the treatment is popular, especially among men.

"They want instant gratification. They don’t like the mess (of at-home kits). Women are used to cosmetics, we’ll do anything to help improve us. This is one thing men can do to change their look."

In general, "people like the technology" of laser whitening, "they like the long-lasting effect and generally don’t want to put solutions in their mouths more than they have to."

She said studies have indicated that teeth, after any type of laser treatment, are more resistant to decay and less sensitive.

While laser whitening maybe faster – the at-home treatments can take two weeks – and easier, the whitening gels are a concern for the Canadian Dental Association.

It has lobbied Health Canada since 1990 to regulate the oxidizing gels and liquids as "drugs" rather than "cosmetics" for stricter controls.

The association is concerned because there have been no long-term safety studies and warns that temporary damage can be done to soft tissue, and to the pulp of the teeth. It advises people use whiteners "selectively and carefully" and only under consultation with a dentist.

The treatment is hot right now because lasers are very hyped, he said, but he only uses it in a couple of cases: when patients have stubborn stains (such as those from medications) that just won’t come off with home whitening kits or when they need their teeth whitened quickly – "they come in and say, I know I should have done this months ago, but I’m getting married this Saturday."

Philips has done about 1,000 whitenings over the past four years. About 150 of those were done with laser, and he’s never had any problems with it, though he does warn that it is "more caustic, more powerful" and could cause damage if not done properly.

He also finds that "rebound" time- the time it takes before teeth naturally darken again, which will happen no matter what treatment is used – is much sooner with laser treatments, sometimes in as little as three months.

Radman at The Perfect Smile said results can last three to five years, and clients have a touch-up kit to fix any discolouration.

The total cost for laser whitening, including the at-home kits, runs from $900 to about $1200.

Got a tooth problem? Fax it to your dentist.

"Okay, okay, I know it sounds outlandish but I really do think that this is the wave of the future," says Dr. Edward Philips, a dental surgeon who specializes in cosmetic techniques.

"This" is the array of gently beeping technological devices crowding Philips’ downtown Toronto consulting rooms.

"Look at this, this is great, every home should have one" he enthuses, picking up the handset of an AT&T Picasso-C Still Image phone.

The state-of-the-art device can transmit images over the telephone line on to a video monitor, and can store up to 32 pictures.

"If you had one of these at home, you could plug your video camera into it and send me a picture of your teeth. Then I could send you back some options on what you could have done to make your smile look better," says Philips.

Welcome to the brave new world of interactive technology, where dentists put their money where your mouth is by investing in a variety of high-tech toys aimed at giving patients something to smile about.

"This is cutting edge technology right now, but it will be the way all dentistry is done soon, I’m absolutely sure about that," says Philips who envisions a dazzling future of cyber-smiles.

While Philips is somewhat of a pioneer in embracing technology of this sort in Canada, it’s a small but growing trend.

About 5 per cent of dental offices here are currently using this kind of technology, while in the U.S., it’s 20 per cent, says George Osterbauer of the dental supply company Ash, Temple Ltd.

"It’s been a growing market during the ’90s, and it’s just starting to really take off," he says.

Markham dentist George Freedman likes to take his patients "for a magical mystery tour of the mouth" with an intra-oral camera.

The camera, which is small enough to fit behind the last tooth in the mouth, has a strong light attached to it and is hooked up to a video screen the patient can watch.

"That way, they can really see the gums they’re not talcing care of, the cavities starting on the side they miss with the brush, and they see it all magnified on the big screen," he says.

Freedman believes his office was the first in Canada to use interactive imaging for diagnosis and patient information. Using the intra-oral camera and a computer, patient and dentist experiment with different treatments and cosmetic techniques, seeing the results on the screen.

The computer digitalizes the photo images of the patient’s real teeth, and the dentist can then play with those images.

Want to see how you’d look with whiter teeth? With straighter or more even teeth through bonding or veneers? With that gap filled in or those long eyeteeth smoothed down? The digital world knows.

The pictures can also be stored on videotape and taken home for further study.

For Toronto businessman Allan Dew, the imaging system helped make a difficult decision easier.

At age 52, he was self-conscious about his dingy, filling-laden teeth. Previous dental work had yellowed and cracked, adding to the problem.

"1 had spent a lot of years in the dentist’s chair and it was something I dreaded. I had to be sure I would open my mouth and like what I saw after it was done," says Dew, who runs a color separation business and is familiar with computer imaging technology.

He spent $12,000 to have his mouth renovated. Old fillings, crowns, and a partial plate were removed and replaced, and his lower teeth were filed and shaped.

"Everybody thinks I look just great, and while it took me about four days to get used to the new guy in the mirror, I’m really pleased," he says.

Freedman, noting "a more informed patient makes for better dentistry," also uses laser disc teaching programs in his office for patient education.

As well, he says, processing insurance claims with technology such as the Picasso phone could save time and money.

In the case of a broken tooth, for instance, an image of the tooth could be sent over the phone line to a dental adjudicator while the patient is in the chair. With an immediate go-ahead the work could be done right then.

The whole idea behind interactive technology, according to Philips, is to get information out to potential customers in the easiest most comfortable way possible.

"Here’s something I really use a lot," he says, hefting a Sharp Viewcamteleport. He uses the audiovisual device – essentially a camcorder attached to a playback screen – to send pictures of a patient’s teeth to the ceramic lab where porcelain veneers and crowns are made.

It streamlines the procedure for dentist, lab and patient.

"We send Images of teeth back and forth with it and I can work with the dentist when he’s in the dental office and I’m in the lab," says Tom Williams of the Krest ceramic laboratory.

Philips sees a "huge market’s for cosmetic dentistry which is increasingly replacing the dentist’s traditional work of drilling and filling, thanks to fluoridation, better brushing, flossing and dental hygiene.

Most of his cosmetic dentistry clients, he says, are "everyday people, housewives, secretaries, business people.

"1 like to say, we used to fix your teeth, now we fix your smile."