British teeth: something to smile about at last?

The dentist's assistant had me gripped in a headlock when I fell into a reverie. Suddenly, I was back in the mid-80s, sitting in a chair just like this, terrified by the latest in a series of extractions I was about to undergo due to my overcrowded jaws. I'd come to hate the deep injections of anaesthetic, the needles so long they felt as if they might pierce my brain cavity. But there was hope. My brother had told me that, when he'd had his previous filling, he'd been offered something new – a spray that worked like magic and you didn't feel a thing. So when the dentist asked me, "Would you like an injection?" I smiled gratefully, "No thanks!" "Are you sure?" he asked. "I'm sure!" I replied, grinning, because the funny man was mucking about. But he wasn't mucking about. There was no magic spray. He reached in with his pliers and began wrenching at my healthy, young, firmly planted tooth. I remember the raw pain and how he twisted it, left, right, left, right, left, right…

Thirty years later, here I am again. A few days ago, one of my wisdom teeth shattered. I was going to leave it, as I did the last time a bit of tooth dropped out, but a stubborn shard keeps cutting the side of my tongue. So I've come here to open wide. My examiner squinted this way and that, and finally made his assessment. "Your teeth…" There was a silence. "Are…" There was another silence. "Interesting."

What did he mean? "Interesting" for a dentist can't be a good thing, can it? If you've devoted your life to the fight against bad mouths, then see an exceptionally grotesque specimen – stained, rotting, swollen – well, that's the kind of thing you're going to find interesting. And true, I hadn't been to the dentist for a decade, maybe two. But what's the point of putting yourself through all that scraping and blood if you haven't even got toothache? And so the top of my lower-left incisor crumbled away a couple of years ago – but the razor edge it left behind has, if you think about it, just made it a better tooth. "Interesting." "Interesting?" Really, this was passive aggression on a level I'd not previously encountered.

But wait. I'm an Englishman. I have English teeth. If the world knows anything at all about the state of our nation's dentistry, it is that it is interesting. Not for us the simple pristine blocks of the Americans. Our teeth are not so blandly uniform. They show spectacular variety in shape, shade and the angle at which they sprout from our gums. They're not bleached or straightened or manufactured in laboratories, they're honest products of the natural world. Like stalactites or rock formations or fossils on dear old Chesil beach, they are, if they are nothing else, interesting.

At least they were. As I sit, worrying silently beneath the inscrutable scrutiny of my dentist, I have a vague understanding that things may have changed since my last visit to the chair. It's only later I'll realise quite how much. Between 2000 and 2010, the UK dentistry market grew by around 46%. During that same period, its private sector, whose domain includes not merely oral health but also oral beauty, doubled in value from £1.2bn to £2.4bn. While I've been away, it seems, Britain has had a revolution in its mouth.

"There's been a huge, huge increase in demand," Dr Mervyn Druian of the London Centre for Cosmetic Dentistry, tells me. "If you look at 20 years ago, people like Denis Healey, their teeth were terrible." When Druian arrived from South Africa in 1960, he says it "was like going back 10 years. In America they used to laugh at British teeth. But things have improved enormously."

Today's tooth-aware Brits can choose from an array of celebrity dentists, including Khalid Khan of Liverpool, who has worked on footballer John Barnes and singer Ian McCulloch; Jamie Newlands of Glasgow, who honed the smiles of Robert Carlyle and Sharleen Spiteri; or the Welbeck Clinic in London, which has treated Sophie Ellis-Bextor and Helena Bonham Carter. Some opt for simple clean-ups, for plaque and swollen gums, some have their ragged edges filed, some have plastic bonding to cover blemishes, some have gum-shield-style "invisible" braces with names such as Invisalign, some have porcelain veneers fused to their teeth. "Sometimes the front teeth are of different lengths and you can have the gums contoured and made to look straighter," Druian says.

I am aghast.

"You're actually cutting away the gum?" I ask.

"It's very simple," he shrugs. "You just use a laser."

The greatest smile of all, for Dr Druian, belongs to Carol Vorderman. "She's terrific," he says. Then I ask him about the worst. As I do, I see an image of what must surely be his answer that's so powerful it's almost as if I'm sending it down the phone line to him via ESP.

"I don't know if you've watched any of the reality TV…" he begins, and I think, "Oh God, oh God, I know what he's going to say."

"…but some people become a caricature of what they could look like. There's this guy called…"

Rylan! It's Rylan!

"Rylan. Thank God I never did his teeth. I'd be so embarrassed."

"It's like they've grown too big," I say. "I can't work out what's happened to them."

"That's exactly what it is," he says. "He's got veneers and they're too big and too white."

It's not unusual for patients to insist on a whiter shade than is appropriate. "When people have had horrible teeth they often want to go to the other extreme," Druian says. "I had one who complained because the whiteness wasn't as white as his shaving cream. It drives me crazy. But in the end, you've got to do it. Cosmetic dentistry is to do with patient choices as well. It's not like you're treating a disease."

But this brightness boom has brought trouble. A new legal specialism has emerged, the market leaders being Nantwich's Dental Law Partnership. "When we started, in 2000, most of our caseload involved neglect or technical execution issues," says director and trained dentist Chris Dean. "But in the last five years we've seen cosmetic dentistry also feature very significantly." Many complaints come from patients with veneers, which some dentists sell hard. "It's a high-profit procedure," he explains. "Even at the very best laboratories, each veneer costs £100. In London, you can be charged £1,000. Your average dentist down the road might charge £400. That's a good mark-up, especially if you're doing multiples."

Dentists sometimes tell their patients that having a veneer fitted is as simple as sticking on a false nail. Don't believe it. "They take one to two millimetres off the face of the tooth," Dean says. "That's an irreversible procedure. Then you get a cycle of replacement." Each veneer lasts up to eight years. "Then you have to drill a bit deeper. Generally you get two cycles, then you're into crowns. Twenty per cent of crowns result in the teeth underneath them dying. So if you're having 10 veneers done, the likelihood is at least one of your teeth, possibly two, will die. And patients don't get told that."

Dean gives me the number of a former client, a cafe manager from the New Forest called Emma Bulman. She was leaving a routine checkup when she mentioned the little gaps between some of her side teeth and the small chip off another. They weren't big problems, but what did the dentist think? "She looked at my gaps for three seconds and said, 'No problem. I can fix them anytime,'" Bulman says. She made the appointment there and then.

On the day, she was told they were going to make some impressions and do some filing and the treatment wouldn't cost much. The dentist began smoothing the chipped tooth and rebuilding it. An hour later, she was becoming worried. What was taking so long? The dentist injected her mouth. She started working on more teeth. Slowly, Bulman became convinced something was going horribly wrong. Eventually, she gathered the courage to pick up a hand mirror. "They were stubs. Tiny little stubs," she says. "My perfect front teeth were gone. I felt like I was going to vomit."

The dentist, it turned out, had decided to give her a full set of crowns – false teeth that attach to the plugs left behind after you've filed down the natural tooth. Her bill was handwritten on "the tiniest Post-it note you can imagine" – £3,310. Bulman had to go on antidepressants and still has nightmares about it. Eventually, she managed to win £16,000 compensation, £4,000 of which went on legal fees. "It was horrendous," she says.

Another unintended consequence is the seeking of bargain work in Asia and eastern Europe. London dentist Meg Keddie often sees patients who've been significantly damaged. "They'll sometimes have roots of teeth left over in the jawbone, which have been covered by restorative work, so they can't clean them," she says. "They're likely to have abscesses."

Amy Grier has a happier story. The 28-year-old media executive was born with crowded jaws, a 1cm overbite and front teeth that stuck out in a V. She was bullied at school and was devastated to be told, at 12, she couldn't be fixed until her bones stopped growing. "That goes down as one of the worst hours of my life," she says. "I remember thinking all my friends were going to get prettier and prettier, and I was going to have hideous buckteeth for ever." As an adolescent, she was constantly thinking about them. "I used to sit with my hand over my mouth. If I was with someone I fancied, I'd always think they were looking at my teeth. I was always aware of these things before people met me."

Following her operation, a £4,000 set of veneers gave her life-changing teeth. "I went on dates and did internships on magazines. I had to do the party pages for for a magazine and interview celebrities." Today, she's features editor on a national magazine. "I wouldn't be sat here today if I hadn't had that work."

The first murmurings of revolution were begun 60 years ago, by the welfare state. "Pre-1948, the vast majority of the population had dentistry only when they were in pain, and that probably resulted in an extraction," says Dr Nigel Carter, chief executive of the British Dental Health Foundation. Then the NHS swooped in to rescue us. Well, as best it could. "If you went to the dentist in the 50s and 60s, for the first time possibly, you probably had half a dozen badly broken-down teeth and another half-dozen that would need heavy restoration. You'd end up with all your teeth taken out: full dentures. By the first Adult Dental Health Survey in 1968, 37% of the population over the age of 16 – and you really have to think about this figure twice, over the age of 16 – had got full dentures."

"Full dentures?"

"Yep," he says. "No teeth at all. I think the reputation we had was because of those missing teeth. But we were unfairly pilloried. In the US, if you look at the have-nots in the southern states and middle America, their experience of dentistry today is very like ours was pre-1948."

American cultural anthropologist Professor Alexander Edmonds, from the University of Edinburgh, remembers when our teeth were an international joke. Beautifying procedures were normalised much earlier for the children of the US. "When I was in high school, in the 1980s, cosmetic orthodontic work was seen as a necessary rite of passage," he says. "A large number of my friends were getting braces and the adults who'd deny this to their children were seen as bad parents."

Many of us grew up viewing the American smile with a characteristically British blend of fear, mockery and secret envy. But this wasn't always the case. In the 19th century it inspired only condescension. "They would say things like, 'that wan American smile'," says Dr Barry Gibson, a medical sociology lecturer at the University of Sheffield. "It was used in a derogatory sense, to reflect the dim, simple character of American colonial people." Now, though, all has changed. "The American smile's become almost a symbol of revenge," he says. "One of the covers of Time magazine, back in the 1990s, talks about the American smile as a symbol of her greatness."

Our own nation's desire for toothy dazzle started in the 90s. "There was an explosion of whitening toothpastes and dental products you can administer at home," Gibson says. "So there was a certain amount of supplier-induced demand." Then, in 2006, the deal between the NHS and the industry was rewritten. Many dentists, fearful of drops in revenue, increased the amount of private work they carried out. This meant ordinary patients in ordinary waiting rooms were exposed to a sparkling new world of bright, straight, white possibilities. "Dentists are businesspeople, too. They're going to supply something if there's a demand."

Throughout this period, of course, television was casting out its noisy propaganda, presenting millions of viewers with ever more unattainable versions of what it means to be normal. "Research from New Zealand found that 56.8% of dental practitioners felt their patients had higher expectations of their aesthetics as a result of a reality show called Extreme Makeover," Gibson says. "On the X Factor, dentists will be doing a smile makeover for most of the contestants."

Now, what was normal for US kids in the 1980s has become normal for us. Emma Mackie, director of scouting at Premier Model Management, has witnessed the change since she started 18 years ago. "Lots more kids are coming in with braces," she says. "And the braces themselves are much less heavy tackle than they used to be. A girl came in the other day with pink ones. I said, 'Ooh, I like your braces!' Could you ever have imagined saying something like that before?"

But as the American century recedes ever further into memory, a new and fascinating shift is taking place. "We've gone full circle," says Dr Zaki Kanaan of the British Academy of Cosmetic Dentistry. "Originally it was America saying, 'We want really white teeth.' They were using veneers that were of a shade you can't get teeth to naturally. But now Europe leads the way. People used to want the Hollywood smile, now it's the European smile, which is a more reasonable colour. America is following our lead."

I think we can all agree on the smile that nobody wants, and that's the Can't Remember the Last Time I Went to the Dentist But My Teeth Have Started Crumbling Out of My Face smile. It's testament to the power of modern toothpaste that the dentist who announced my teeth were "interesting" went on to conclude that I didn't need any fillings. But then his attention fell upon the dagger of bone sticking out of my gum.

"That's going to need extracting," he said.

I'd heard about wisdom tooth extractions. You went into hospital, didn't you? For general anaesthetic.

"When can it be done?"

The dentist shrugged, "Now?"

Slightly confused, I nodded my consent. The needle came out, my mouth was numbed, then the silent assistant stood behind me and gripped me in a headlock as the dentist reached in with his pliers and pulled, left, right, left, right, left right…

I sat in a state of swimmy shock, zooming between the present day and my traumatic memories of the 80s. It seemed incredible. Three decades had passed, all those shifts in fashion and leaps in technology, from the whitening toothpaste to the gum-trimming lasers, and still there's no magic bloody spray.