In light of reality television and many of the popular programs which inform people of the many reconstructive procedures that can be done medically, the term “cosmetic dentistry” has become a popular buzz word. Unfortunately, “cosmetic makeovers” are often done without considering the overall health, needs, and fundamental desires of each individual patient.
In an era of evidence-based medicine, many of these “cosmetic” procedures like porcelain veneers, laser whitening, etc., are coming under close scrutiny. Although each of these, if done properly in the right mouth, can be very effective in creating a lifelong beautiful smile, the majority of “cosmetic” dentistry done today is less than ideal. For example, porcelain veneers may be done on front teeth for esthetic improvement while problems associated with back teeth are overlooked. If the bite is not stable and ideal or if problems like clenching and grinding are present, then veneers will fail. Rarely is the expected longevity of each treatment option discussed. In the case of veneers, the actual longevity of a porcelain veneer may not be much better than a chairside bonded veneer in certain mouths, and a full crown may be a better option at a lower cost.
The multitude of treatment options that modern dentistry has to offer is wonderful and can be overwhelming. “Cosmetic” procedures in the right mouth, performed by skillful clinicians, and in the right situations can drastically improve the appearance of a person for a lifetime. Porcelain veneers, for instance, can be fantastic restorations. However, “cosmetic dentistry” should never be performed at the expense of overall health and long-term stability.
In actuality, every dentist has been trained to be a “cosmetic dentist” even though they may not be doing “smile makeovers” on a daily basis. We have all been trained how to match tooth colors, how to place metal fillings without compromising the esthetics of natural enamel, and when to do certain types of restorations. In fact, there are some dentists who can place gold fillings and onlays to rebuild teeth that can barely be seen when the patient smiles. Isn’t this cosmetic dentistry as well…the ability to hide artificial filling materials? It’s clear and undisputed that some dentists are blessed more than others when it comes to shade selection, artistic ability, and clinical skill levels. However, all dentists are charged with blending scientific knowledge and art to provide excellent care for our patients. Unfortunately, today some dentists tend to emphasize the art more than the science.