By Dr. Ryan Swain
I was eating lunch with some dentists a few years ago and a very interesting conversation took place. I’ve spent a lot of time thinking about that conversation because it raised some important concepts that I believe all dentists should consider. The conversation began when one of the dentists said: “When a patient asks me if they need cosmetic dentistry, I just tell them that it is totally up to them.” Another dentist at the table jumped in and responded by saying: “It’s your job to tell your patients about their cosmetic options and whether or not you think they could benefit from cosmetic dentistry.”
The conversation continued and turned into a fiery exchange between these two colleagues. They had very different opinions about what a dentist’s duty is in regard to cosmetic dentistry and cosmetic recommendations. I’ve thought about that conversation many times over the last few years and some important ideas have crystallized for me during that time. I’ve realized that there are essentially two types of dentists when it comes to cosmetic treatment recommendations:
Dentist #1 believes that his/her duty as a dental professional is to diagnose and treat disease and structural issues but does not believe that he/she can or should diagnose cosmetic discrepancies unless the patient inquires about them. Dentist #2 believes that his/her duty as a dental professional is to diagnose and treat disease, structural and cosmetic discrepancies because these are all important aspects of complete dental health. If you fall into the category of Dentist #1, this article is an attempt to shake you up a bit and perhaps even persuade you to become a Dentist #2. In other words, get with the program!
As dentists, we are teeth people. We know how much a person’s smile affects their overall appearance. In fact, we spend most of our time during conversations staring at teeth and diagnosing all of the cosmetic discrepancies that we see. When we look through a magazine, we stare at the smiles on the page, when we walk through the mall, we consciously think about the models’ smiles on the banners – especially if there are cosmetic problems! We are the experts. We can identify the aspects of a smile that can and should be changed in order to drastically improve the symmetry and esthetic appeal. There is a tremendous amount of value in this expertise we have all developed during our years as clinicians. I believe that if we hide this expert ability away, only drawing from it when patients ask us for our opinion, we do a tremendous disservice to our patients and our practices. Health and beauty go hand in hand and we owe it to our patients to educate them about both aspects of their smiles.
This idea was conveyed to me in a very poignant way when I was fresh out of dental school. I was a new associate and had just started working in a dental practice. I was performing a hygiene exam on a man in his late forties and noticed that he had a stainless steel crown on #8. I had never seen an anterior stainless steel crown on an adult before. The crown was contoured properly, the margins were good but boy was it ugly! I asked the patient how long he had had the crown and he told me that it had been placed when he was about eight years old. I asked him “Do you have any interest in replacing that steel crown with a porcelain crown?” He asked a simple and concise question that I can still hear in my head to this day…”WHY?” I was dumbfounded. I didn’t know what to say. I had all kinds of thoughts racing through my head but I was a good boy and resisted the urge to say something like “Because silver teeth are ugly!” or “Because you look like a cyborg!”
After further discussion with the patient, I realized that he honestly had never thought about the cosmetic appearance of the steel crown on #8. It had been in his mouth since he was eight years old and was fundamentally a part of him. He didn’t question it. He simply didn’t have the dental IQ or cosmetic awareness needed to recognize the impact that the crown had on his overall appearance. But, even as a new dentist with little experience, it wasn’t hard for me to clearly see the cosmetic gravity of the situation (in other words, he had “metal mouth!”). I knew that the steel crown was a serious detriment to his appearance and was a social hindrance for him. I knew that the steel crown negatively affected the manner in which others perceived this gentleman. Since I cared about the well being of this man, I felt responsible for educating him. I spent some time with him over the next few months and explained to him the characteristics of a nice smile. I asked him to pay attention to other people’s teeth during conversations and while watching TV.
After a few weeks, he called the office and set up an appointment. We removed the steel crown and replaced it with a nice porcelain restoration. The difference was amazing. When he returned to the office for his next hygiene appointment, I asked him how the crown was working for him. He shared some amazing stories about the great comments he had received. The patient thanked me profusely and then said something that has stuck with me. He said “If you hadn’t told me that I should have that crown replaced, I probably would have lived with that darn silver tooth for the rest of my life!” This extreme case made me realize firmly that I had a duty to my patients to inform them about cosmetic discrepancies and corresponding treatment options. Their social health and well being could depend on it!
Since that time, I started a practice that focuses almost exclusively on Short Term Ortho (www.6MonthSmiles.com) and other cosmetic dental procedures. I realize now more than ever the dramatic improvement that cosmetic dentistry can provide for our patients. Improving the overall symmetry of a smile is paramount in creating a pleasing look. The stories of improved self esteem, self confidence and social status that my patients report continue to bolster my belief in the importance of the services I provide. So, if you’re a dentist who feels that cosmetic dentistry should only be discussed when a patient brings up the topic, please consider a paradigm shift. Our patients depend on us for our expertise – ALL of our expertise. They want us to have their best interest in mind. If we turn a blind eye to the appearance of their smiles, we are doing a disservice. We can and should tactfully and respectfully educate our patients about their cosmetic discrepancies. I believe that a cosmetic exam should be a regular part of our comprehensive examinations and all offices should have a chief cosmetic complaint form as part of their new patient/recall paperwork.
People desire to look and feel their best and we can do a lot to help them achieve this. I encourage you to utilize all of the abilities you’ve acquired throughout the years to the benefit of your patients. We’re not just tooth mechanics; we are highly trained clinicians and oral esthetic experts. Everyone benefits when we understand these roles and play them appropriately. If you’re not a Dentist #2, please join the club. It’s a good one!
Dr. Ryan Swain is a graduate of the University of Florida College of Dentistry. He practices in Rochester, NY and focuses on Short Term Ortho and other conservative cosmetic dental procedures. He is president and chief clinical instructor for Six Month Smiles. Dr. Swain is a pioneer in the field of Short Term Ortho and constantly on the forefront of GP orthodontics. He has trained dentists internationally and prides himself on de-mystifying orthodontics for GPs.
