Healing or Hustling?

The world is full of double-edged swords, and the profession of dentistry is no exception. New technology can at once be beneficial and damaging. As is often the case, it is not the technology that is the hero or the villain, but rather the individuals who choose either to use it properly or abuse it. One such area that seems to generate a great deal of emotion amongst our dental colleagues is esthetic dentistry, in particular, the question "When does esthetic dental treatment become overtreatment?"

There is no doubt that an esthetic revolution has occurred in the dental profession. Our ability to restore teeth has been elevated to such a level that a restored tooth often cannot be distinguished from adjacent natural teeth. The main factors that have driven this revolution are technology and demand. Technological improvements have occurred in both the materials we have available and the techniques developed to utilize those materials. Demand has come from dental professionals who continually strive to provide more and more natural-looking restorative dentistry as well as from patients who more frequently do not want any visible dental work in their mouths. The result of this revolution is that there has been a tremendous benefit to patients and an undeniable sense of satisfaction amongst dentists providing these benefits.

This very same esthetic revolution has also forced the profession to face an ethical dilemma. When does dental treatment in the name of improving appearance go too far? Or, as I like to think of it, are we hustling our patients into artificial smiles? The answer will no doubt vary from dentist to dentist, however colleagues I have surveyed feel that there certainly is a problem with overtreatment in our profession. What seems to be especially contentious is the area of "cosmetic dentistry." To distinguish it from "esthetic dentistry," cosmetic dentistry refers to dental treatment specifically for the purpose of changing appearance while esthetic dentistry is merely any dental treatment deemed beautiful or attractive.¹ Porcelain veneers, tooth-colored restorations both direct and indirect, teeth bleaching in all its forms -- these have joined not only the dental lexicon but also that of the general public. We are seeing more and more patients inquiring about these procedures, and it is up to us to understand their concerns and guide them toward the best treatment for them.

Complicating the situation is a media-fueled image of what is beautiful or desirable. One need not look far in popular magazines to see smiles of snow-white, perfectly symmetrical teeth. While some may argue that this adds to an attractive look, most dentists seem to agree it is far from natural. Tabloid-style magazines, however, don’t provide dental treatment. When it comes to cosmetic overtreatment, sadly, it is our own profession alone that is to blame. We patronize a dental industry all too quick to move the latest cosmetic materials and practices to the marketplace whether or not they have a proven track record. We can obtain remarkably important-looking certificates by completing "training" at so-called esthetic centers, institutes, academies, and continuing education programs whose promotion of cosmetic dentistry to practicing dentists ranges from somewhat palatable to downright shameless and tasteless. And perhaps most troubling is the dizzying array of yellow page and other print advertisements from practicing dentists who all but defile our profession’s established ethical standards of advertising.

Enough is enough. Questionable cosmetic dental practices have become too well accepted within dentistry. Teeth are put at risk by removing and replacing perfectly serviceable restorations simply because they are silver- or gold-colored. Teeth are put at risk when they are damaged by permanently removing healthy tooth structure for the placement of porcelain veneers. Many of us have seen unhappy patients who have suffered deleterious effects because such practices were carried out and they were not made aware of these risks. Whether they are victims of carelessness, risky, and unproven techniques or worst of all, profit-motivated treatment, they are, nevertheless, victims of the cosmetic hustle.

Dentistry has a rich history of individuals who devoted their lives to promote our vocation as a respectable and valuable healing profession. While some envision a future providing treatment tantamount to liposuction, collagen injections, and electrolysis, others wish dentistry to remain a healing profession. Perhaps we need to look to our history and the words of the grandfather of the healing professions, Hippocrates: "I will follow that method of treatment which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. With purity and with Holiness I will pass my life and practice my art."

Healing or hustling? It’s our decision. May we choose wisely.

References

1. The Academy of Prosthodontics, The Glossary of Prosthodontic Terms. Mosby, 1999.