Kelsy Johnson

Today's dentists provide much more than a quick cleaning and a checkup every six months.

Hit reality shows like "Extreme Makeover" have revealed how small changes to a person's smile can dramatically improve their personal appearance.

The desire for cosmetic dentistry -- a category of dentistry focused on improving a person's smile, includes procedures like teeth whitening, porcelain crowns, veneers and dental implants -- continues to grow as the public becomes aware of available options. Dr. Maria Axvig-Dwyer, a dentist at Smiles by Design in Bismarck, has noticed that the average person knows much more about dentistry, and especially cosmetic dentistry, than in the past.

"People have a higher dental IQ," Axvig-Dwyer said. "Information is more accessible." The reason most people seek cosmetic dental procedures has to do with identity. Many patients come in embarrassed about their smiles or unhappy about certain aspects of their teeth.

"A smile is the most eye-catching feature of your face," Axvig-Dwyer said. "Even a subtle change can make a big difference in how you feel."

Middle-age females make up the largest demographic of cosmetic dentistry clients, but Dr. Kristin Schoch from Nelson Family Dentistry notes that people of all ages come in for these procedures. In fact, men are the largest growing demographic. More people are seeking out cosmetic dental procedures, but cosmetic dentistry is also becoming a common part of dental care.

Dr. Crystal Overby from Nelson Family Dentistry said the reason cosmetic procedures have become more commonplace is that the industry has moved away from a strictly functional role. While in the past, dentists focused on oral hygiene, they now offer more in terms of physical appearance.

"We're able to make the teeth more aesthetic," Overby said.

White dental fillings have become standard in dentistry. Axvig-Dwyer has had patients come in to have their silver fillings replaced with white fillings.

Patients do not have to worry about crowns on their front teeth. Previously, many people were concerned that crowns would not match the surrounding teeth, but today's porcelain crowns look just like the natural tooth.

"The better the materials get, the more likely we are to use those procedures," Schoch said. "[For example,] implants have become the standard of care in many situations."

When patients need dental implants or reconstructive surgery, they are referred to oral surgeons like Dr. John Stanley, owner of the Institute of Facial Surgery.

Stanley describes the surgeon's role as the foundation builder for the dentist to work from.

Less than 10 percent of cosmetic dental procedures require the help of an oral surgeon. About 40 percent of Stanley's business involves this kind of work.

While the oral surgeon's role is limited when it comes to cosmetic dentistry procedures, reconstructive surgery plays a large role in the patient's overall appearance.

"It really does affect the cosmetic appearance of the teeth," Stanley said.

Patients often go in to places like the Institute of Facial Surgery after major dental work to have filler and botox done to improve the overall facial appearance.

"Dentists, when they alter tooth position, affect the lower third of the face," Stanley said. This change sometimes requires extra work from Stanley's office to improve the overall appearance of the face.

Cosmetic dentistry is becoming more efficient and convenient. A new procedure called "teeth in a Day" offers the patient the opportunity to go in to a surgeon to have teeth removed and implants placed. Within the same day, they can go to a dentist to have the new teeth built on top of the implants. Before this procedure became available, patients had to wait months after the implants were placed in order to get their new teeth.

"It's all driven by people's desire for cosmesis," Stanley said.

"Teeth in a Day" has yet to become a standard process in North Dakota, but it may become available to patients in the next year.

Axvig-Dwyer said only a minority of patients would qualify for this expedited procedure. The majority of patients would have to wait. She and Dr. Daniel Axvig are still considering whether their practice will offer this procedure to their patients.

Another efficient treatment is Zoom Whitening, a two-hour procedure that allows patients to leave the dentist's office with instantly whiter teeth. Both Nelson Family Dentistry and Smiles by Design offer this service to their patients.

Cosmetic dental procedures can be costly depending on whether insurance covers the work that is done. Many procedures have to be paid for out of pocket. With such an investment, Axvig-Dwyer believes that a strong relationship between patient and dentist is crucial. Patients should look for a dentist they can communicate well with.

"Your first appointment is a consult," she said. "That first appointment is critical."

The dentist should be able to answer questions and genuinely care about the patient's needs.

Axvig-Dwyer suggests that patients ask for examples of the dentist's work at the office. Online photos are not enough because there is no proof they belong to that particular doctor. They can easily be taken from other sites. If possible, it is best to use referrals from other satisfied customers like friends and family.

Any dentist can claim to be a cosmetic dentist because many of the procedures are standard among dentists, and a goal of dentistry is to improve a person's smile. There are no special licenses for cosmetic dentistry, although dentists may receive additional training for specific procedures.

It is important, then, to establish a good relationship with the prospective dentist and then see examples of their work get a clearer picture of what they can offer.

Cosmetic dentistry is a growing industry, but it is not a trend that will likely fade away, Schoch said. Demand for a more aesthetic smile will continue to push local dentists to offer more options to their patients. With this increased demand, the technology continues to improve so even a basic filling looks more natural.

Although these procedures can be a costly investment, they give many people the confidence to smile.

Kelsy Johnson, a native of Bismarck, works as a freelance reporter and nonprofit writer in Fargo. She divides her time between her two passions: storytelling and martial arts.