White Lies: Five Secrets Your Cosmetic Dentist May Not Tell You

The allure of a dazzling white smile has hit mainstream America. The annual U.S. cosmetic dentistry market is estimated at around $2.75 billion. According to a survey commissioned by the American Academy of Cosmetic Dentistry (AACD), 600,000 patients every year undergo veneer procedures, costing more than $371 million.

Before you plunk down your hard-earned cash for a smile makeover, here are five secrets your dentist may not tell you:

Secret No. 1: There is no specialty known as "cosmetic dentistry."

Any general dentist can call herself a "cosmetic dentist." Since cosmetic dental procedures are such big ticket items, general dentists have resisted efforts to have the procedures designated as a specialty, which would require certification and training. Patients are left to try to figure out who is really qualified.

Secret No. 2: Not all dentists who perform cosmetic procedures have advanced training.

Not all dentists who hold themselves out as "cosmetic dentists" have significant advanced training in the procedures they will be performing, but such training exists. Meaningful credentials include accreditation by the AACD or extensive training at the Las Vegas Institute for Advanced Dental Studies, the Pankey Institute, the Dawson Academy, the Kois Center or the Spear Education Center.

There are currently fewer than 350 dentists and laboratory technicians accredited by the AACD. Only 53 hold the highest credential of Accredited Fellow.

Secret No. 3: The dental laboratory that makes the veneers is as important as the dentist.

Most likely, the porcelain veneers that will define your smile will not be fabricated at your dentist's office. They are usually sent to outside laboratories specializing in this kind of work. There is a vast difference in the quality of work done by these labs. According to Bob Clark, president of Williams Dental Laboratory, a high-quality lab will employ technicians with training similar to the training required for highly qualified cosmetic dentists, and will work in close partnership with the dentist.

Chester Garcia, CEO of daVinci Dental Studios, notes that his lab uses advanced CAD/CAM software and FDA-approved materials to ensure veneers meet exacting standards.

Patients considering cosmetic procedures should be as focused on the lab as they are on the dentist.

Secret No. 4: Your cosmetic dentist may be using a foreign or non-certified laboratory.

Many dentists use laboratories located in China or in other foreign countries. These laboratories offer far lower prices than U.S.-based labs. The lower cost isn't always passed on to patients. Furthermore, foreign labs may not use FDA-approved materials. Some crowns and bridges manufactured abroad have been found to contain lead. The American Dental Association and the Center for Disease Control and Prevention, however, are not concerned. They believe the "trace amounts" of lead are "extremely unlikely to cause adverse health effects."

James Kessler, DDS., the Chairman of the Department of Education at the Pankey Institute, is opposed to the use of foreign labs. He believes close, personal communication with the lab technician is very important. He is also concerned about the quality of materials used by some foreign labs.

If your dentist is using a foreign laboratory, you have a right to know. Just because he sends his work to an address based in the U.S. doesn't necessarily mean it's not being outsourced to China or Mexico. If this is a concern, ask your dentist to show you "point of origin" and "list of materials" used for your lab work. This information should be maintained in your patient records, although in most states it is not required to be.

Some of the same issues can be present even when U.S.-based laboratories are used. Government regulation of both domestic and foreign dental laboratories is almost non-existent. The exceptions are Florida, Texas and South Carolina, which require certification for dental technicians and laboratories.

Bennett Napier of the National Association of Dental Laboratories advises patients to ask if the lab their dentist uses is a Certified Dental Laboratory or a DAMAS (Dental Appliance Manufacturers Audit System) accredited laboratory or is certified by the International Organization for Standardization (ISO). You can check a directory of certified technicians and laboratories by city and state here. You have a right to insist your lab work is done at a certified laboratory by certified technicians.

Secret No. 5: There are risks to having porcelain veneers placed on your teeth.

The advantages of porcelain veneers are compelling. A beautiful smile can be a confidence booster, with significant benefits. But there are risks you should know before making this important decision.

The veneers can be damaged or worn down over time, and may need to be replaced. This will cause both inconvenience and additional cost. Dr. Kessler notes that many patients believe veneers will last a lifetime, which is often not true.

By reducing the tooth structure, the tooth is more vulnerable to trauma or sensitivity. In extreme cases, root canal therapy may be required. New advances in cosmetic dentistry can reduce or eliminate this risk. Tara Hardin, DDS, a leading cosmetic dentist in Mason, Ohio, uses Emax veneers, which are custom made in the dental laboratory and bonded to teeth. Dr. Hardin notes the biggest advantage to Emax is their high strength and durability, which permits them to be produced in very thin layers, requiring little or no tooth preparation. According to Dr. Hardin, "no-prep veneers" usually involve no drilling and "we don't even need to numb patients for this procedure."

There are many cases of poorly performed cosmetic dentistry. Scott W. Finlay, DDS, an Accredited Fellow of the AACD, says that veneers can break off or be placed in the wrong position, affecting speech or giving the appearance of "bucked teeth." The burden and cost of repairing this work can be substantial.

While cost isn't technically a risk, the procedure is very expensive. Dr. Finlay advises patients to expect to pay a qualified cosmetic dentist from $1,500 to $2,500 per tooth. "Cheap" can be very expensive. A cosmetic dentist charging $800 a tooth is probably not using a first class laboratory and may be inexperienced. You could be very disappointed with the results.

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Gabriele Calcagno

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November 07 2012 at 5:23 AM Report abuse rate up rate down Reply

Excellent article! My personal goal is to help raise awareness that there is no speciality for cosmetic dentistry and that patients MUST do their research. My Book, The Naked Tooth: What Cosmetic Dentists Don't Want You to Know, discusses these points in detail. It also shares what treatments are available and more importantly, how to choose the right dentist to perform your smile enhancement. The AACD is a great place to start. You can check out my book for free on Amazon or www.thenakedtooth.com. Good luck!!

March 27 2011 at 1:34 PM Report abuse rate up rate down Reply

Too superficial as a commentary on cosmetic dentistry. No prep veneers could be a problem when there is no room to restablish the natural contour of the teeth and place them in the proer relationship to the ginigval tissues(gums) without causing other problems.
There are also many other institutions and education programs that train dentists to do great treatment than the few memtioned.

March 26 2011 at 7:01 AM Report abuse rate up rate down Reply

Secret #1- CORRECT!
There is no specialty known as "cosmetic dentistry."

Secret #2- There is a fundamental difference between TRAINING and FORMAL EDUCATION. NONE of the mentioned institutes are ACCREDITED by the American Dental Association or have independent assessment mechanisms to establish the performance of the dentists who participate in continuing education. The term “meaningful credentials” is used very loosely. There are dentists recognized by the American Dental Association that satisfy specialization requirements in performing the mentioned procedures. They are called PROSTHODONTISTS. A Prosthodontist is a dentist who specializes in the esthetic restoration and replacement of teeth, completing three years of additional formal education beyond the fours years of dental school. Their discipline provides principles to follow to restore optimum appearance and function to every smile. PROSTHODONTISTS are educated through hospital- or university-based post- doctoral programs accredited by the American Dental Association, during which students are continually monitored and supervised by credentialed educators. Their education includes reviews of the literature, lectures, treatment of patients and laboratory experience based upon a detailed knowledge of the materials and processes required to manufacture restorations.
Secret #3- Many PROSTHODONTISTS have laboratories in their own offices and have direct interaction and collaboration with their dental technicians. This enables better control of the patient’s treatment outcome and eliminates the need to send laboratory work outside the office.
Secret #4- See secret #3! IN HOUSE LABORATORIES! I agree with James Kessler, DDS., the Chairman of the Department of Education at the Pankey Institute, He believes close, personal communication with the lab technician is very important. It doesn’t get any closer if the technician or technicians are in your office!

Secret #5- Please visit www.prosthodontics.org to find out more about what a Prosthodontist can do for you!

March 25 2011 at 1:14 PM Report abuse +1 rate up rate down Reply

I am from Windsor Ontario - looking for a reputable, certified, patient and caring dentist, to put my pieces back together. I have been through 'the fire' in terms of trying to have my bite aligned - to much information to share at this time (I could write a book). Looking for leads. ~ Thanks

March 25 2011 at 10:48 AM Report abuse rate up rate down Reply

The truth about Foreign dental labs should be HEAD LINE news. The patient needs to be educated. Whats in your mouth. Beards Dental Lab. (CERTIFIED)

March 25 2011 at 8:46 AM Report abuse rate up rate down Reply

Excellent, informative article. Bob Clark that is quoted in the article makes all my restorations. He does great work and charges a fee to match. Advanced training is very expensive also. Those that want to be the best, spend the time and money to get trained well. Quality costs money - pure and simple.

Advice for prospective patients - be proactive and ask questions. Ask about the dentist's advanced training, ask to see actual case results, ask to speak to satisfied patients. Above all, expect to be give options, expect to be educated about the pros and cons of each option - including fees and choose the option that best suits your goals.

If you choose on "price" alone, ask yourself why is to so cheap? Long after the sweetness of low price is gone, the bitterness of poor quality will linger.

March 25 2011 at 8:10 AM Report abuse +1 rate up rate down Reply

An interesting and informative article. I do have one problem with a serious omission: the specialty of prosthodontics would be the "official" specialty to deal with cosmetic dentistry. I prefer to call what I do "esthetic" dentistry as opposed to "cosmetic", the difference being that esthetic work implies that a patient's problem is solved as ideally as possible rather than merely disguised or hidden. One example of this would be the case where orthodontics was indicated but laminates were placed for expedience. Often, this results in gum problems due to improper contours. I have seen this too often in my 30 plus years of practice!

March 25 2011 at 7:33 AM Report abuse rate up rate down Reply
1 reply to drfgneurohr's comment
english language

Your response is correct and can be applied to all of the dental specialties. I am a Board Certified Specialist in Periodontics with over 20 years of professional experience and I share the same concerns which you presented about the misunderstandings and confusion surrounding the valuable role of the dental specialties in patient oral health care. Much of this misunderstanding is unfortunately being generated by general dentists who do not want to see their patients leave their practices ...for any reason. In my professional opinion, the profession of dentistry has changed dramatically for the worse in the past decade with many general dentists now attempting to perform advanced clinical procedures on their patients without the proper education and training rather than referring these difficult cases to qualified specialists. As a specialist in gum diseases, I am concerned about general dentists operating "Hygiene Mills" under the recommendation of "profit-motivated" practice management consultants and, instead of referring these patients with advanced periodontal disease for evaluation and effective treatment by a qualified "expert" in this field, they choose instead to have their hygienists perform round after round of "deep cleanings" often accompanied with localized antibiotic placement only to collect enormous fees for these ineffective services. Hygienists speak openly about the unethical demands placed on them by their employer-dentist but little can be done if these hygienists want to keep their jobs. The public must become aware of the limitations of their general dentists and assume responsibility for seeking out qualified experts to help them when they are confronted with oral health problems which are beyond the skill level of their general dentist.

March 25 2011 at 1:16 PM Report abuse +1 rate up rate down Reply

so is getting an implant where they pull the old tooth completely rather than grind it down to nothing and then delay the inevitable root canal a better or good option? My dentist/surgeon is proposing this instead. Personally I like the sounds of this rather than grinding a dead tooth down to nothing and then covering it till you need root canal work. Thoughts?

March 25 2011 at 5:59 AM Report abuse rate up rate down Reply
1 reply to raretoy's comment

Whether it's right for you or not depends on your personal situation. If restoring your natural tooth requires heroic efforts, then you're probably better off with a dental implant. It sounds like you have a good dentist and it's a great question to ask. If you're tooth has a large filling that's breaking down, or you've broken off a piece of it and there's nothing else going on with the tooth (like bone loss from gum disease), then a crown is the best choice. Just because you need a crown doesn't mean you'll need a root canal. Many people have crowns without root canals on their teeth. Again...your dentist will be the best person to advise you on your personal situation. Good luck with whatever you decide to do...crowns or implants are both great dental treatments.

March 25 2011 at 6:19 AM Report abuse rate up rate down Reply

What an informative article. This should help patients investing in cosmetic dentistry make the correct choices, understand the cost and how important is is to pick an educated dentist in the area of cosmetics.

March 25 2011 at 5:44 AM Report abuse rate up rate down Reply