Cosmetic dentistry is difficult to define because many
of the procedures blur the line between the purely aesthetic and the
practical. Procedures that are considered cosmetic range from bleaching to
attaching porcelain covers to the front of teeth. Yet some patients without
dental problems are opting for crowns -- in which a dentist grinds down an
existing tooth to attach a cap -- to cosmetically change a bite (which
usually is corrected with braces when it is an orthodontia problem).
Cosmetic procedures, which typically are performed to
improve the color and shape of teeth, are risky and can cause permanent
damage to teeth, roots and gums if done incorrectly. If a crown isn't
cemented properly, for instance, infections can result.
Ronald E. Goldstein, an author of cosmetic dentistry
textbooks and founder of the American Academy of Esthetic Dentistry -- which
isn't affiliated with the ADA -- estimates that half of the $70.3 billion
spent annually on dental work in the U.S. is related to cosmetic procedures.
Of that, the Atlanta dentist says, redoing other dentists' shoddy work and
misdiagnoses accounts for $10 billion of that. Several other academic
dentists back the estimates.
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"For the patients, it's a problem -- how do you
determine who the best cosmetic dentist is?" says California
Cosmetic Dentist Larry Addleson, president
of the American Academy of Cosmetic Dentistry (AACD), a group also not
affiliated with the ADA. He says 15% to 20% of the patients in his San Diego
practice are victims of poor work.
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Eric L. Fugier says that at least half the clientele at
his Hollywood, Calif., practice come with botched jobs he fixes. For Robert
Vogel, a Manhattan dentist who works on celebrities such as Madonna and
Nicole Kidman, it is upward of one-fourth.
Some dentists who sweep up after their colleagues' poor
work blame inexperience or the temptation to lure patients into costly
procedures. Others say that as more cosmetic procedures are performed, the
number of mistakes rises.
Experts say that even though further training isn't
mandatory, practitioners should take it upon themselves to boost their
education. "To do an entire mouth restoration and crowns is usually out of
the scope of recent graduates without more continuing education," says
Dennis Tarnow, professor and chairman of implant dentistry at New York
University's College of Dentistry.
For-profit companies offering "continuing medical
education" charge dentists as much as $10,000 a course, and business is
booming.
The Las Vegas Institute for Advanced Dental Studies,
for instance, is teaching 600 dentists this year, compared with just 200
four years ago.
LVI also offers courses in financial strategies, such
as "The Dental Concierge -- Developing a CA$H Practice," according to its
Web site. Some dentists are critical of LVI's commercial bent. "They give
the wrong message to the dentist that it's OK to grind down teeth and sell
the patient that their life is going to change and improve," says Simon
Gamer, a dentist in Beverly Hills, Calif.
LVI founder and Chief Executive Bill Dickerson
disagrees, saying the school trains dentists to be professional and to
handle "any situation that comes to the office. We tell them to diagnose the
patient's mouth as if it were your own."
Makers of cosmetic-dental products and laboratories
supplying goods to cosmetic dentists say their businesses are expanding at
double-digit rates. Da Vinci Studios Inc., a West Hills, Calif., lab that
customizes veneers and crowns for 1,500 dental practices -- and whose
veneers are featured on the "Extreme Makeover" and "Swan" reality shows --
says sales rose 25% last year. MicroDental Laboratories Inc., a Dublin,
Calif., lab, had $23 million in revenue from porcelain veneers last year, up
from $12 million in 2000.
Patients are paying thousands for a million-dollar
smile. Veneers and crowns can range to as much as $4,000 a tooth, and
in-office whitening can cost as much as $1,000. That compares with $50 to
$250 a tooth for conventional procedures such as cavity fillings.
As a result, dentists' incomes are soaring. Their
average annual income was $173,140 in 2001, the most recent year for which
figures are available from the ADA, up from $133,430 in 1997. Larry Winans,
a 39-year-old Lewisburg, Pa., dentist who took courses at LVI, says he went
from earning about $100,000 in 1999 to more than $200,000 today, mostly
because of increased business in cosmetic work.
Dentists learning cosmetic procedures sometimes turn to
colleagues for instruction. Malcolm L. Henley, an Orlando, Fla., dentist who
has practiced for nearly 45 years, wrote in March on the AACD's online
forum: "My veneer seating technique is, to say the least, not a fun
experience!" He says glue removal for veneers is "a bit horrific. Can anyone
advise a source to improve my results?''
William Dorfman, a Century City, Calif., dentist who is
featured on "Extreme Makeover" and who sees 200 new patients each month,
says their "dental IQs have skyrocketed" since the show began because now
they are aware of the kinds of cosmetic dentistry available.
"In the old days, it took a lot of time to explain the
procedures," Dr. Dorfman says. Now, "it's almost like all I have to do is
verify what they want done."
Some dentists worry about colleagues who allow patients
to dictate their treatment on their limited knowledge, and they urge
dentists to offer less-invasive procedures. Gordon J. Christensen, a clinical professor at the
University of Utah and owner of the for-profit, continuing-education
Practical Clinical Courses in Provo, Utah, says a "degeneration of ethics"
has made his profession "highly upset."
Dr. Christensen, who has served on numerous ADA
councils, says the onus to halt the rise of botched work falls on the ADA,
which can recommend additional guidelines for cosmetic dentistry to state
and local dental associations.
The ADA, which represents the vast majority of the more
than 155,000 U.S. dentists and advises the dental boards of each state,
believes current ADA guidelines and state regulations provide "sufficient
oversight for the protection of the public," says Matt Messina, an ADA
consumer adviser and a dentist in Cleveland, Ohio.
Dentists say it also is up to patients to check their
dentists' credentials and complaint records with their state dental board
and county dental association, ask about more conservative treatments, and
get second and third opinions before major work.
Write to Amir Efrati at amir:efrati@dowjones.com
Click here to read Dr. Hall's blog post about how to ask for a
refund from your dentist.
