Are you a Cosmetic dentist?
Kind of an interesting question. When a patient asks me this, I’ve always wanted to say, “No, I try to do ugly dentistry.” But, I haven’t. I am not sure what really defines a “Cosmetic Dentist.” I see many dentists self-describing themselves as “Cosmetic Dentists” in their advertising. I do not advertise, nor do I want to be associated with many of those advertising as “Cosmetic Dentists,” as they seem to prey on patients’ weaknesses and vanity to sell dentistry. I do not try to “sell” patients on the idea that they need to change their teeth. I really think there is more than enough emphasis in our society on aesthetics. If a patient expresses an aesthetic concern about their teeth I will explain the possibilities for improvement, the benefits and risks. Unfortunately, twice in my career, my failure to recognize a patient’s desire has resulted in them returning from a “Cosmetic Dentist,” who thoroughly ruined their smile by crowning multiple teeth resulting in a smile that looked like pieces of chalk or a denture. Looking back, I know a better, more natural result could have been achieved with bleaching and a little bonding. I hold myself partially responsible for that result and try to be more sensitive to people’s unexpressed desires.
An example of “Cosmetic dentistry” we have done.
A young man who has spacing, crooked teeth and a tooth darkened by a root canal procedure. He plays basketball professionally in Europe and on the Swiss National team. Orthodontics, crowns or veneers are not good choices because of his potential to get hit. Crowns or veneers would require tooth removal, weakening the teeth and are more difficult to repair if fractured. We went over the options and together decided on doing “Cosmetic” bonding. To my amazement, they are holding up well even though he refuses to wear a mouthguard and was MVP in the European championship game.
Does Television Define Cosmetic?
If the patient is really asking if we do full mouth veneers and and crowns like the “cosmetic dentists” on Complete Makeover TV shows, the answer is, yes, but only when absolutely necessary. I think it interesting that most of those shows have rapidly disappeared. Watching many of those dental procedures it seemed obvious to me that they were doomed to an early failure and at other times the teeth looked like chiclets or horse teeth. Making teeth look individually natural and pretty using conservative dental procedures is much more difficult than making a mouth full of picket fence white teeth.
Is More Always Better?
The truth is that it is much easier to do a full mouth of veneers or crowns and get a color match than doing a single front tooth. Ask any dentist what the most difficult cosmetic procedure is and most will tell you a single front porcelain crown or bonding. In fact some “cosmetic” dentists simply sell multiple crowns because it is easier for them. You could also say more profitable. Cutting down perfectly good teeth simply to replace the missing tooth structure with man made porcelain concerns me. It may be convenient and easier for the dentist, but the long term effects are irreversible. It has also become obvious to patients and dentists that aggressive veneers or crowns that require significant tooth reduction are not the best answer to most aesthetic problems. The problem is that no dentistry lasts forever. Hence, the rapid disappearance of the TV shows and the introduction of “no preparation” veneers. More on this “new” procedure in a following blog. Before bleaching became available, I remember a young woman patient who had perfectly shaped but dark teeth and she insisted that I should cut down her teeth and put on white veneers. I refused. When bleaching became available we were able to bleach her teeth to a pleasing color without removing any tooth structure. She thanked me for refusing to cut down her perfectly good teeth.
Conservative Cosmetic Treatment
So, I approach aesthetic cases with the goal of using the most conservative treatment that will produce the best aesthetic result with the least amount of tooth loss. In many cases the most conservative method involves bleaching, minor re contouring and bonding. Bonding has several advantages including it is largely reversible and less exspensive. Certainly, creating teeth freehand in the mouth requires skill and an artistic eye, but I enjoy bonding because it gives me the most control. Below are some examples of cases that show the potential of bonding. I will discuss veneers and crowns in another blog. I know the photos could be better, I am a dentist not a photographer. At least these are actual photos of our patients not canned photos purchased and provided by an advertising company.
Here are some before and after photos of some of our cosmetic bonding cases:
The patient presented with a previous bonding on a tooth fractured in a swimming accident. Again we could have done a crown or veneer but that would have required taking away good tooth. We opted for bonding. Much less expensive and invasive. Yes the bonding may stain but that can be easily taken care of or you can always do a crown.
Skateboarding is not a crime but it can be dangerous to your teeth. We simply bonded the tooth because he could not find the piece of tooth.
Poorly matched bondings made this young boy feel self conscious. We removed the old bondings and changed the shape and shade to give him a happy smile. Not my best photos.
Young girl who wouldn’t smile because whe hated her smile. We bonded her four front teeth without grinding them down and did not even have to use anesthetic.
She now smiles in all her photos.
She hated the gaps in her teeth. Yes we could have done veneers but it would have cost four times as much and required cutting down the teeth. We bonded he front four teeth to make her smile.
The patient came in with large cavities caused by drinking coffee with sugar and soda.
The replacement of a broken and decayed Silver filling with porcelain filling.