The Cosmetic Dentistry Blog

September 15, 2009

Thanks for your comments about Lumineers

Filed under: Lumineers, Thank yous — iowasmiles @ 8:07 pm

Dear Dr. Hall,

I just read your “Lumineers cost“article at  and also the “example” question and answer which pertains to this topic and I was so pleased to read it. I write dental websites, and because of my familiarity with the dental world I have long been aware that Lumineers are not the best option available. I prefer not to write about them in favorable terms, but it is sometimes required as part of my job. I was pleased to read this direct and honest representation of Lumineers. In writing for dental websites, I have seen innumerable before and after images of Lumineers and of truly custom porcelain veneers, and the difference is almost always highly noticeable. While I cannot write website articles that warn individuals against Lumineers in a professional sense, I was very pleased to see that someone else has. Your article came up 3rd when I Googled “Lumineers.”

Because of the nature of my work, I prefer not to make my name available and would appreciate your discretion regarding my email address. However, I wanted to thank you for representing Lumineers as an option, but one which may have more negative than positive aspects.

I am amused to read your “hate mail section” - to find that dentists who are not willing to undergo the training which will allow them to do really great dental work are disparaging toward your article and email, and see it only as confirmation of their lack of interest in their patients’ welfare. Sincerely, &tc.

“L”

Dear “L”,
Thanks for your kind comments.

August 29, 2009

My cosmetic dentist wants to restore all my teeth

Filed under: Finding a Cosmetic Dentist — iowasmiles @ 7:26 pm

I have seen a “cosmetic dentist” who is not on your list, and he is suggesting replacing all of my teeth—even the ones that have nothing wrong with them, with all porcelain crowns to correct bite, beautify look of smile. I am concerned about grinding down perfectly good teeth for this. I chose the dentist in question because he has a good reputation in the community, puts a three-year guarantee on his work in writing, does sedation dentistry (I am VERY nervous patient) — and he has spent a good amount of time answering my questions, doing wax-ups that I am supposed to view on Wednesday. However, I am really feeling quite concerned now…and even more anxious.

After reading your website, I am even more ambivalent than I was, and feel that I should RUN to the dentist recommended for the St. Petersburg/Tampa area.

What do you think? Thank you in advance for your reply.
- Pat from Florida

Dear Pat,
Your instincts are good. While I can’t evaluate your case without seeing it and it’s possible that you do need the aggressive treatment being proposed, the way you’re explaining it to me makes me distrustful of this dentist.

Ethical cosmetic dentists will be very careful to avoid unnecessary dentistry. I heard it continually repeated in various cosmetic dentistry lectures, that if the patient is happy with his or her smile, there is no treatment indicated. The majority of excellent cosmetic dentists believe in that ethical standard and would not try to push cosmetic dentistry onto a reluctant patient. For me, personally, I would not trust a dentist who came up with an aggressive treatment plan like you’re explaining without my requesting it.

My general advice is to stay away from dentists who appear to be dental salespeople, and stick with professional dentists who tend to be conservative in their treatment recommendations. There are occasions when the treatment proposed for you would be indicated. You are talking about a full mouth reconstruction. But that should only be required if you have serious bite problems that are causing pain, or if you have a collapsed face, or a large number of broken-down teeth.

You’d be smart to go to one of the dentists on our list for a second opinion.
- Dr. Hall

Related links:
Read more about cosmetic dentistry costs.
Click here for referral to an expert cosmetic dentist.

June 13, 2009

Shame on you, Dr. Hall

Filed under: Hate mail — iowasmiles @ 8:05 pm

Dear Dr. Hall,
I read your respose to Lesly [sic] (A Bad Experience with Lumineers) and was very shocked and disappointed that you without seeing the patient jumped to the conclusion that the treating dentist made an error and that his skills as a a cosmetic dentist are not up to the standards. As someone who claim that you try to educate and help the public you should be very objective and avoid judging your peers without knowing the whole truth…shame on you.

Dear Anonymous,
Shame on me? Before you talk to me about shame, I think you should have the decency to identify yourself. But your message came with no e-mail address, phone number, or first name. People who make comments behind a cloak of anonymity don’t have much credibility with me.

I am proud of what I write. So much so that I put my name on it, my address, my phone number, and all about the company I run. And I think Lesley is very glad that I didn’t pull any punches when I answered her question.

Lesley’s case was pretty clear cut – she had three crowns and three Lumineers placed on her front teeth and within a week, one of the crowns started turning dark. I think that any decent, self-respecting dentist would take responsibility for that. I certain would, if that happened with a case that I just inserted, and I don’t think it is out of line to expect that from her dentist. Do you think that is within the standard of care, to give a patient a dark crown on a front tooth?
Dr. David Hall
Phoenix, Arizona
Putting my name on everything I write.

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February 2, 2009

Thank you

Filed under: Thank yous — iowasmiles @ 5:15 am

Dr Hall,

I don’t have a question, rather I wanted to thank you for putting together and maintaining this excellent web site on cosmetic dentistry. I am currently looking into getting some cosmetic dental work done, and your web site has been an invaluable resource. All the content is very well written, easy to follow, and extremely informative.

Thanks and keep up the good work,
-Joe from Boston

Joe,
Thank you for your kind words, and taking the trouble to write just to say thanks. You’re a classy individual.
Dr. Hall

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October 20, 2007

A toast to Dr. Hall at a pub in Ireland

Filed under: Thank yous — iowasmiles @ 10:54 pm

Dear Dr. Hall,
I’m sure you are a very busy man, so I would like to thank you wholeheartedly for taking the time to reply to me. Your answer to my question about dry socket has done a lot to reassure me and help me calm down. I had been really worried about it.

My dentist has prescribed antibiotics, as you suggested.

Last night, on the other side of the Atlantic Ocean, in a quiet pub in Galway, your name was spoken and glasses raised to toast your good health. Go Raibh Maith Agat!

- Patrick in Ireland

Patrick,
Thanks. When people like you are so gracious and kind, it really warms my heart.
Dr. Hall

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August 4, 2007

Cosmetic dentistry isn’t a specialty – so he says.

Filed under: Hate mail, Lumineers — iowasmiles @ 5:24 pm

Dr. Hall!
I cannot believe a member of my profession could possibly act as unprofessional as you have in putting down Lumineers. I just finished a course on Lumineers yesterday and in searching the ‘net last night I happened on your website.

Cosmetic Dentistry is not a recognized specialty, it’s an area of interest. You mention that ferric sulphate might have caused discoloration of a veneer. If a dentist was using Viscogel, he didn’t learn that from Denmat. We were told to not even consider doing veneers if there was marginal gingivitis. And Lumineer preps do not require gingival margin preparation, so where did the blood come from?

If you really think you expert cosmetologists are so hot, have a look at Peter Rinaldi’s videotape from the Chicago Midwinter Convention where he chops the teeth all to hell – right into dentin. This is endorsed by “powers that be” for continuing education points. And you have the unmitigated gall to criticize a non-invasive method of placing veneers?

I’m awaiting your feeble defence [sic], my friend. Because whatever you are going to say is not going to be evidence based, only the opinion of someone who has a lot of time on his hands and might think about taking a Lumineers course to see what it’s really all about.

- Dr. H – a 68 year old dentist. I’ve been around as long as you have, buddy. And I don’t criticize other dentists’ work, especially in a public forum.

My friend and fellow professional, Dr. H,
My web site is intended to benefit patients. And for their benefit, I say forthrightly what I think. I do understand that some dentists don’t like what I say, but I believe the highest professionalism comes not in circling the wagons in defense of fellow professionals, but in honestly answering the needs of the patients.

I believe that cosmetic dentistry is a specialty, though not a recognized specialty. :-)   It sounds like you disagree. I think of those who have taken the pains to become accredited, after their eyes are fully open to all there is to learn, that probably all of them would agree with me. Those that haven’t taken the discipline to that extent, many of them don’t think cosmetic dentistry is that difficult and think that it is just an “area of interest” as you say. But those who are swimming in the pool have a better understanding of what the water is like than those who are sitting in the lawn chairs just looking on, in my opinion.

In the Lumineers case you’re referring to (see post: porcelain veneers turning gray), I think you need to read it more carefully. It wasn’t a veneer that was discolored, it was a crown. I think emotions are getting in the way of clarity here.

And to those of us who are passionate about appearance-related dentistry, if the patient, after the seating of the case, says that her teeth look a little gray and they had lost translucency, to us that case is a failure. It maybe looks ok to the dentist, but it isn’t beautiful. But I know that many dentists think that “a little gray” and “lost a lot of the translucency” is not a big deal.

I think that a no-prep technique for porcelain veneers, as the Lumineers people recommend, can be appropriate in some circumstances. I think that’s what I say on my web site. I think that generally a light-prep technique is ideal, and I think most cosmetic dentists would agree. I don’t know any cosmetic dentist who advocates “chopping the teeth all to h-.”

I do have a beautiful Lumineers case posted on my web site, done by Vancouver cosmetic dentist Dr. Michael Drance. But I’m getting a lot of e-mail from unhappy Lumineers patients.
- Dr. David Hall

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July 17, 2007

This dentist claims any dentist can do cosmetic dentistry

Filed under: Hate mail — iowasmiles @ 1:26 pm

You are illusionists if your feel that only the “real cosmetic dentist” can achieve wonderful results. It would seem that you all are trying to promote the idea that only you all are “masters” of the art. As I see all the promotional articles it would appear that you all are masters of “hard sell.” I feel sad for the mentality that now pervades our once great profession. You may reply.
- Dr. Bob in California

Dr. Bob,
On the contrary, a good cosmetic dentist is very much a soft-sell person who tries hard to please the patient and who knows that any cosmetic dental treatment must be driven by the patient. If the patient is unhappy with his or her smile, then the case needs to be done. If the patient is happy with how they look, then no treatment is indicated. That’s what I was taught in my cosmetic dentistry courses. And a good cosmetic dentist knows that the case is a success only when the patient is happy with the results.

There is a distinct mental attitude difference between a technician-oriented dentist who is very good at what he or she does, and an artistically-oriented dentist who loves creating beautiful smiles and is very good at it.

Imagine yourself trying to convince Julia Roberts, for example, if she wants a new smile, that the dentist on the corner can do that just as well as say Dr. Debra Gray King in Atlanta, or Dr. Jerry Bellen in San Francisco. You’ll never convince her that there aren’t certain dentists that are excellent artists and many that aren’t. You and I know that she’s going to be very fussy about who she lets do that for her.

But I understand the sensitivity that many dentists feel when we discuss the differences in abilities between dentists. Every dentist wants to be an expert, and it takes a big person to admit that others, who have the same advanced degree that they do, are better at certain things. And the general public who visit this web site are very appreciative for our pointing out who are the great artists in this profession.

There is a philosophy of professionalism that wants to uphold the “status” of the professional and is hyper-sensitive to criticism. But I adhere to the philosophy that the greatest professionalism is to be of service to the public.

Dr. Dave Hall

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July 6, 2007

Cosmetic dentist training programs

Filed under: Cosmetic dentists — iowasmiles @ 8:36 pm

Dear Dr.Hall,
I was just happened to surf in the internet, looking for articles that I can use as references for my paper and then I saw your web site about cosmetic dentistry. I found it very interesting and I would love to have more information about how I can get training or eduaction about cosmetic dentistry. I am now working as a general dentist and I am also a student at the faculty of dentistry, University of Indonesia, taking specialisation, majoring in prosthodontics. Thank you very much for your help.
Yuliana in Indonesia

Yuliana,
There are several excellent post-graduate programs in cosmetic dentistry. The best way to get educated in this, in my opinion, is to join the American Academy of Cosmetic Dentistry and go to their annual meetings.

But, being from Indonesia, maybe you want a program where you can go there once and learn everything and not have to keep making repeat trips. For that I would most recommend the Las Vegas Institute for Advanced Dental Studies (http://www.livdentist.com).

There are other intense programs conducted by Universities in the United States that may involve several weekends. You can find them at Baylor, Louisiana State, SUNY at Buffalo, University of Minnesota, and other places.
- Dave Hall

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April 17, 2007

Thank you!

Filed under: Cosmetic dentists — iowasmiles @ 11:35 pm

It is so refreshing to find a site that OFFERS information; extensive information rather than just promoting oneself.

Thank you, and congratulations on an excellent presentation!  I am taking your referrral to Dr Montrose, your Portland, Oregon cosmetic dentist.  I’m sure after reviewing the content on your site you would refer no one but the best!
- Sandi in Oregon

March 31, 2007

Cosmetic dentists and dental boards

Filed under: Cosmetic dentists — iowasmiles @ 5:57 am

I had someone ask about a dentist who wasn’t on good terms with their state dental board, and thought I’d comment about this. Consumers need a little background to evaluate this issue fairly.

There is often a degree of tension between cosmetic dentists and the rest of the dental community. And that tension mounts if the cosmetic dentist is accredited and begins to make that known. It’s rooted in a “turf war.” I would guess that 95% or more of dentists are attracted to dentistry because they have a technician mentality. They’re trained to fix things. Dentistry to them is a matter of looking for what is “broken” and then fixing it. These people have very little appreciation for esthetics in dentistry. They think that esthetics is “no big deal” and furthermore, they have all the training they need to be able to deliver cosmetic dentistry. So they are upset with dentists who focus on cosmetic dentistry, especially if they make claims such as being “accredited,” because that label implies that the “non-accredited” dentist somehow isn’t good enough. They want to have their share of the cosmetic dentistry business, as there is a strong demand for these services.

And these non-accredited general dentists can be very good people. They just see the world of dentistry very differently. They also tend to have authoritarian personalities. Their attitude toward patients reflects the attitude that is strongly inculcated into dental students at dental schools: the dentist is trained to know what is best for the patient. They think that the approach of the cosmetic dentist, who, because of the nature of cosmetic dentistry and a different personality type will spend a great deal of effort listening to the patient to find out what the patient wants – they tend to view that approach as pandering to the patient and demeaning to the profession. They think it isn’t professional for the dentist to give up that role that says, “I know what is best for the patient.”

So it isn’t difficult for jealousies and hard feelings to develop between general dentists and cosmetic dentists. In fact, the American Dental Association, through it’s internal political processes, has enacted a code of ethics that prohibits cosmetic dentists from letting the public know that they are accredited. The ADA also refuses to grant specialty status to cosmetic dentistry. Even though it takes years of training after dental school for a cosmetic dentist to get really good at it, it will never become a specialty because of this very attitude I’ve told you about. Maybe 95% of dentists think that esthetics is no big deal. So there’s this ADA ethical guideline that encourages state boards of dentistry to prohibit any advertising that makes any claim that some dentists have extra qualifications in cosmetic dentistry. And a number of state boards have adopted this provision. The problem they have in enforcing it is that the Federal Communications Commission has ruled against some state boards that have tried to enforce it because it is an infringement of free speech. Accreditation in cosmetic dentistry is a legitimate credential. The examination is very difficult. Failure rates for the examination have sometimes approached 60 and 70 percent. The boards have tried to claim that announcing accreditation “deceives the public” because cosmetic dentistry isn’t a specialty that is recognized by the ADA. But the FCC has decided that claiming accreditation is legitimate. This is very frustrating to some dental boards. So when a dentist doesn’t “toe the line” on this issue, sometimes dental boards, since they are legally restrained from acting on their true feelings, they can go hunting for technical violations and really make life miserable for the dentist.

An example is a recent rule from the Alabama dental board that no dentist in that state can publicly say that he or she is any better than any other dentist. When I hear things like that I want to say, “Yes, let’s hear it for mediocrity!” This type of rule is directed squarely at cosmetic dentists and implant dentists. Both fields require extensive additional training, but the ADA refuses to grant them specialty status. But can you imagine telling a supermodel like Pamela Anderson that if she wants a new smile the dentist on the corner is just as good as anyone? Of course not. We all know what Pamela Anderson is going to do. She’s going to try to find out who is the best, and she is going to fly there and have her teeth done. And we all know that there is a best, and that 99% of dentists wouldn’t be able to deliver the beautiful smile that she wants. But the Alabama dental board wants us to not talk about that. And they’re doing this under the guise of “protecting the consumer.” But clearly they’re really just protecting their power base. We all know that.

So consumers, just be aware that this is going on. And dentists, step carefully. Dental boards wield a tremendous amount of power. Often, they do what they want, and there are no checks and balances. When a dentist crosses them, you need to know that they are investigator, prosecutor, judge, and jury all rolled into one, and rarely does any court or legislature act to rein them in when they get oppressive. The FCC, fortunately, has stepped in to check their power.

Remember that it wasn’t that long ago that dentists weren’t even permitted to advertise. It was the FCC in the late 1970s that came in and put a stop to that muzzling of free speech.
- Dr. Hall

http://mynewsmile.com/blog

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