- Email: [email protected]
Balancing esthetics and ethical practices
viewer through it. Many possibilities haven’t yet been explored, but the potential for communicating simply and rapidly is enormous.
Conclusions It seems that everyone has a smartphone today and can download apps to help them shop and access information on the go. Advertisers can reach these mobile devices through QR codes and increase sales. Dentists and other health care practitioners can learn a few tricks from marketing people and use the same approaches to build their practices, expand their presence electronically, or enhance communication. Offering patients a quick, easy way to contact the dental office seems like an easy choice for our advertising dollars. Other applications are still being developed. Now would be the perfect time to invest in this simple technology.
Douglas Berkey, DMD, MPH, MS, Editor-in-Chief, Dental Abstracts Professor, University of Colorado, School of Dental Medicine, Aurora, Co E-mail: [email protected]
References Dr QR Codes: Learn more ways dentists utilize QR codes, posted March 15, 2012 at orangeqr.com. Duty S: QR codes in dental marketing, posted April 2011 at moderndental marketing.com. Kokich VG: Do you know what this image represents? Am J Orthod Dentofacial Orthop 140:599, 2011.
Balancing esthetics and ethical practices Background.—Most experienced dentists share the belief that performing cosmetic procedures carries the risks of disappointing patients, failing to meet their expectations, and increasing the chance of litigation. However, esthetics can be the primary concern of many dentists and patients to the point that patients consent to treatment without being sufficiently informed about the destruction of tooth structure that is inherent in achieving a desired cosmetic outcome. This raises ethical issues that must be addressed. Permanence and Informed Consent.—A study in the United Kingdom found that just 53% of porcelain veneers remained without repeat intervention after 10 years. Although the term ‘‘permanent veneers’’ is often applied to these approaches, a 10-year lifespan cannot be considered permanent. In addition, up to 30% of sound dental tissue may be removed during the preparation for extended porcelain veneers. All-ceramic full-coverage crown preparations can destroy between 62% and 73% of sound anterior tooth structure. These are irreversible steps that are often not explained fully to patients before they accept treatment. Patients need to know the relevant figures concerning the loss of tooth tissue and structure at the planning stage and be informed of the possibility that pulpal problems can develop down the road. Marketing Issues.—The ‘‘ideal smile design’’ concept involves doing various amounts of dental damage to achieve repaired teeth that will match one another or conform to a formula, often through an overprescription of
treatment. The outcome can be an unnatural, depersonalized, monochromatic appearance. Often adjacent or opposite healthy tooth surfaces are sacrificed so that the repaired teeth will match one another or conform to patients’ demands. The ethical principles dictating that clinicians do no harm can be ignored in this process. Another marketing issue is the publication of glossy, but sometimes superficial and destructive articles that may lure inexperienced dentists into performing unneeded dental destruction just because the patient asks for an improved smile. Patients may desire a simple improvement that can be accomplished with minimally invasive methods, but the dentist may be influenced into recommended and performing extensive techniques. There is also the danger that ‘‘pseudo-research’’ may legitimize destructive techniques or the use of unproven materials to replace sound dental tissues. Discussion.—Experienced ethical dentists tend to be attuned to their patients’ reasonable desires and aspirations for esthetic dental health. Most have acquired the training and skill needed to provide procedures that improve their patients’ dental appearance using thoughtfully chosen, biologically sound, and minimally destructive ethical means. Cosmetic dentistry offers the opportunity to eliminate or reduce dental disease while improving or maintaining good function and achieving a healthier, more attractive appearance. The risk-to-reward ratio must be kept in balance during the process of providing esthetic benefits without incurring excessive dental destruction.
Volume 58
Issue 3
2013
117
Clinical Significance.—Most dental esthetic problems can be addressed through bleaching or bleaching plus resin composite direct bonding with or without orthodontic alignment. Patients can experience desirable esthetic improvements without destroying sound tooth tissue, diminishing structural strength, or compromising dental pulpal health. Ethically clinicians should seek to provide an improved dental appearance without causing undue structural or biologic damage. In addition, patients must be fully informed about any tissue
destruction that is foreseen in cosmetic procedures so that they can make an appropriate judgment as to the risks that they may face.
Kelleher M: Ethical issues, dilemmas and controversies in ‘cosmetic’ or aesthetic dentistry. A personal opinion. Br Dent J 212:365-367, 2012 Reprints available from M Kelleher, King’s College London Dental Inst. at Guy’s, King’s College and St. Thomas’ Hospitals, United Kingdom; e-mail: [email protected]
Filling materials Background.—Amalgam fillings used to be placed all the time. They looked terrible but were easy to place, took little time, were inexpensive, and lasted a long time. Then we moved into the age of composites. Amalgam was bad, full of mercury and other poisons, and ugly. Composites were tooth-colored and beautiful and desirable. Eventually composites had to be replaced, though. Then the best material was gold, but the expense put it out of reach for many patients. So dentists’ point of view changed from amalgam to composite to gold, but where does this leave the patient? Advantages and Disadvantages.—Amalgam offers the advantages of lasting much longer than composites, being easier and faster to place, and costing less than either composite or gold (Fig). Composites are beautiful, toothcolored restorations but they have to be replaced. Esthetically, composites are highly desirable, but who wants to get new fillings every 10 years? Gold lasts the longest but it is also the most expensive tooth filling material. Patient Considerations.—Patients ask for composite because it looks good, but they need to be informed about the risks and rewards of using each of the various filling materials. Factors that often influence the patient’s choice include financial considerations, work schedules, the inconvenience of returning for additional treatment at regular intervals, age, gender, and lifestyle considerations.
Clinical Significance.—We need to make sure that we don’t discount any option when it comes to filling materials. Each one has advantages and disadvantages. We need to be willing to carefully
118
Dental Abstracts
Fig.—(Courtesy of Farran H: Are you a dentist or an extremist? Dentaltown pp 18, 20, June 2012.)
Conclusions It seems that everyone has a smartphone today and can download apps to help them shop and access information on the go. Advertisers can reach these mobile devices through QR codes and increase sales. Dentists and other health care practitioners can learn a few tricks from marketing people and use the same approaches to build their practices, expand their presence electronically, or enhance communication. Offering patients a quick, easy way to contact the dental office seems like an easy choice for our advertising dollars. Other applications are still being developed. Now would be the perfect time to invest in this simple technology.
Douglas Berkey, DMD, MPH, MS, Editor-in-Chief, Dental Abstracts Professor, University of Colorado, School of Dental Medicine, Aurora, Co E-mail: [email protected]
References Dr QR Codes: Learn more ways dentists utilize QR codes, posted March 15, 2012 at orangeqr.com. Duty S: QR codes in dental marketing, posted April 2011 at moderndental marketing.com. Kokich VG: Do you know what this image represents? Am J Orthod Dentofacial Orthop 140:599, 2011.
Balancing esthetics and ethical practices Background.—Most experienced dentists share the belief that performing cosmetic procedures carries the risks of disappointing patients, failing to meet their expectations, and increasing the chance of litigation. However, esthetics can be the primary concern of many dentists and patients to the point that patients consent to treatment without being sufficiently informed about the destruction of tooth structure that is inherent in achieving a desired cosmetic outcome. This raises ethical issues that must be addressed. Permanence and Informed Consent.—A study in the United Kingdom found that just 53% of porcelain veneers remained without repeat intervention after 10 years. Although the term ‘‘permanent veneers’’ is often applied to these approaches, a 10-year lifespan cannot be considered permanent. In addition, up to 30% of sound dental tissue may be removed during the preparation for extended porcelain veneers. All-ceramic full-coverage crown preparations can destroy between 62% and 73% of sound anterior tooth structure. These are irreversible steps that are often not explained fully to patients before they accept treatment. Patients need to know the relevant figures concerning the loss of tooth tissue and structure at the planning stage and be informed of the possibility that pulpal problems can develop down the road. Marketing Issues.—The ‘‘ideal smile design’’ concept involves doing various amounts of dental damage to achieve repaired teeth that will match one another or conform to a formula, often through an overprescription of
treatment. The outcome can be an unnatural, depersonalized, monochromatic appearance. Often adjacent or opposite healthy tooth surfaces are sacrificed so that the repaired teeth will match one another or conform to patients’ demands. The ethical principles dictating that clinicians do no harm can be ignored in this process. Another marketing issue is the publication of glossy, but sometimes superficial and destructive articles that may lure inexperienced dentists into performing unneeded dental destruction just because the patient asks for an improved smile. Patients may desire a simple improvement that can be accomplished with minimally invasive methods, but the dentist may be influenced into recommended and performing extensive techniques. There is also the danger that ‘‘pseudo-research’’ may legitimize destructive techniques or the use of unproven materials to replace sound dental tissues. Discussion.—Experienced ethical dentists tend to be attuned to their patients’ reasonable desires and aspirations for esthetic dental health. Most have acquired the training and skill needed to provide procedures that improve their patients’ dental appearance using thoughtfully chosen, biologically sound, and minimally destructive ethical means. Cosmetic dentistry offers the opportunity to eliminate or reduce dental disease while improving or maintaining good function and achieving a healthier, more attractive appearance. The risk-to-reward ratio must be kept in balance during the process of providing esthetic benefits without incurring excessive dental destruction.
Volume 58
Issue 3
2013
117
Clinical Significance.—Most dental esthetic problems can be addressed through bleaching or bleaching plus resin composite direct bonding with or without orthodontic alignment. Patients can experience desirable esthetic improvements without destroying sound tooth tissue, diminishing structural strength, or compromising dental pulpal health. Ethically clinicians should seek to provide an improved dental appearance without causing undue structural or biologic damage. In addition, patients must be fully informed about any tissue
destruction that is foreseen in cosmetic procedures so that they can make an appropriate judgment as to the risks that they may face.
Kelleher M: Ethical issues, dilemmas and controversies in ‘cosmetic’ or aesthetic dentistry. A personal opinion. Br Dent J 212:365-367, 2012 Reprints available from M Kelleher, King’s College London Dental Inst. at Guy’s, King’s College and St. Thomas’ Hospitals, United Kingdom; e-mail: [email protected]
Filling materials Background.—Amalgam fillings used to be placed all the time. They looked terrible but were easy to place, took little time, were inexpensive, and lasted a long time. Then we moved into the age of composites. Amalgam was bad, full of mercury and other poisons, and ugly. Composites were tooth-colored and beautiful and desirable. Eventually composites had to be replaced, though. Then the best material was gold, but the expense put it out of reach for many patients. So dentists’ point of view changed from amalgam to composite to gold, but where does this leave the patient? Advantages and Disadvantages.—Amalgam offers the advantages of lasting much longer than composites, being easier and faster to place, and costing less than either composite or gold (Fig). Composites are beautiful, toothcolored restorations but they have to be replaced. Esthetically, composites are highly desirable, but who wants to get new fillings every 10 years? Gold lasts the longest but it is also the most expensive tooth filling material. Patient Considerations.—Patients ask for composite because it looks good, but they need to be informed about the risks and rewards of using each of the various filling materials. Factors that often influence the patient’s choice include financial considerations, work schedules, the inconvenience of returning for additional treatment at regular intervals, age, gender, and lifestyle considerations.
Clinical Significance.—We need to make sure that we don’t discount any option when it comes to filling materials. Each one has advantages and disadvantages. We need to be willing to carefully
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Dental Abstracts
Fig.—(Courtesy of Farran H: Are you a dentist or an extremist? Dentaltown pp 18, 20, June 2012.)