Everyone that graduates from dental
school is a general dentist, and most of them also claim to be
cosmetic dentists. But there is a great difference, which we will explain
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The Difference Illustrated
The best way to explain the difference is with photographs.
Here is a photograph of a case treated by an excellent general dentist. The person who reported this story to us said that the dentist "raved about his own work and thought it was gorgeous!"
The patient, however, didn't agree. In fact, she was so unhappy that she paid thousands of dollars to have it done over. Notice the problems—The color of the teeth is flat and kind of yellow. They are opaque. They don't sparkle. From a distance, there appear to be dark triangles between the teeth. And their shape is more like Chicklets than natural teeth.
Work by an excellent general dentist
And here is a photograph of a re-do by a highly artistic cosmetic dentist in our referral network—Dr. Thomas Oppenheim of Thomasville, Georgia.
Notice that her smile is now warm and inviting, as opposed to the cold, clinical look created by the general dentist. The teeth are translucent and natural-looking. They are whiter. They truly sparkle. They have subtleties embedded in their shapes and the coloration to make them look real.
The patient, was of course, thrilled with the results.
Click here to see more photographs of cosmetic dentistry mistakes re-done by mynewsmile network cosmetic dentists.
Truly artistic cosmetic dentistry
Here's the basic problem: Cosmetic dentistry is not a legally recognized specialty. This means that there is no restriction on a dentist saying that he or she is a cosmetic dentist. So, many dentists take advantage of this lack of a legal definition and claim to be cosmetic dentists.
And I believe that they are usually innocent in
this claim. They think that they have learned in dental school how to use
composite fillings and how to do porcelain-fused-to-metal crowns which are
white on the front, and they feel capable of addressing appearance
concerns with patients.
However, doing cosmetic dentistry
properly requires extensive extra training that can take years. This means
a heavy commitment of time, money, and energy for the dentist. And, if dentists can
announce themselves as cosmetic dentists without this training, why should
they go through all of that expense, travel, and time away from the
Read the amazing
article from the June 29, 2004 Wall Street Journal, "New
Business for Dentists: Fixing Botched Cosmetic Work."
letters that we have received from disappointed
patients about cosmetic dentistry mistakes.
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Besides this, there is a very different
temperament and a different approach to dentistry by a true cosmetic
dentist. Here are some of the fundamental differences:
- A cosmetic dentist is passionate about
the appearance of the work and getting it to look as beautiful as
possible. General dentists have a much lower expectation of "beauty" in
- Cosmetic dentists are very attuned to
the patient's perception of the work. General dentists are trained in
dental school that they are the best judge of what is best for the
patient. Cosmetic dentistry, however, is the art of addressing the
self-perception of the patient. A cosmetic dentist knows that if the
patient is not pleased with the appearance of the work, the case is a
failure. This goes directly against the grain of dental school training.
It is not uncommon, when a patient addresses cosmetic concerns with a
general dentist, that the dentist will say that there is nothing wrong
with the patient's teeth, or he or she may emphasize
the risks of the treatment, and really not understand the depth of the
patient's concerns. The general dentist should be applauded for his or her
honesty, but the patient needs more than that.
- General dentists are trained to fix
things. Cosmetic dentists are trained to create things. General
dentists tend to have the mind of a technician—giving their attention
only to detail and to function. Cosmetic dentists, to be successful, also must
have that great attention to detail, but must have that added spark of
creativity and attention to beauty. It's like the difference between a
building contractor and an architect—it takes a completely different
personality type to succeed with each dimension.
- Cosmetic dentists must dedicate
themselves to extensive hours of education after dental school, knowing
that it isn't required, simply for the passion of being able to create
smiles of beauty. There is a certain "fire in the belly" that they
And there is a great deal they have to learn:
- The white materials that cosmetic dentists work with have properties that
are very different from the materials generally promoted in dental
schools. There are complex bonding agents, luting agents, various
porcelains, opaquers, tints, etc., that require a great deal of training
to master. There is a chemistry of bonding that they have to thoroughly
understand. Different materials have different properties of texture,
color, translucency, strength, and polishability, and these all have to be
manipulated to produce a beautiful and natural result.
- The concept of smile design is an artistic subject that general dentists,
just as a matter of personality, have great difficulty with. But cosmetic
dentists learn this art, the elements of beauty in a face and in the
shapes and alignment of the teeth. It is difficult to teach this subject
to someone that doesn't have the aptitude.
- It takes more than attending lectures to learn the many aspects of color
that a cosmetic dentist needs to know—he or
she needs some hands-on training in this subject.
Tooth color is very complex. Not only are there multiple colors in one
tooth, but there are many variations in depth of the color. Some tooth
colors are on the surface, some are just beneath the surface, and some are
deep within the tooth. Color is influenced by reflectivity and texture—how shiny a
surface is changes the color perception of that surface. Even contours can
alter color perception by creating lines and spots of reflection. But the most
difficult issue for general dentists is translucency and opacity. Teeth
transmit light besides reflecting light—and to make a tooth look
natural, the dentist has to master this understanding of degrees of
translucency. There are differences in translucency between one tooth and
another, and even within the same tooth there are great differences, and
the way tooth translucency interacts with tooth color is very complicated
and takes time and effort to master.
- Finally, there is a great art of communication in great cosmetic
dentistry. The dentist has to take all of this artistic and scientific
knowledge and apply it to the perceptions of the patient. General
dentistry is a matter of diagnosing what is wrong with the tooth: decay,
infection, cracks, or other structural problems, and then simply fixing
them. However, a cosmetic dentist diagnoses the self-perception of the patient and
then addresses that. If a patient is satisfied with his or her smile, then
there is no cosmetic dental problem. If a patient is not satisfied, then
the dentist has to determine what to do to create that satisfaction
and meet the patient's needs. It's
a different level of communication, and it requires considerable training
and experience to
How many of the
dentists who claim to be cosmetic dentists actually are? It may be
impossible to say, but I'll give my best guess. From what I have seen, and
from what I know of the dentists who have pursued extensive additional
training in cosmetic dentistry and have shown a level of skill that I
would consider acceptable, I would guess that it's some number under 2%. That's as
close as I'd like to guess, and it's my
personal guess. Fewer than one-quarter of one percent are accredited in
So how do you tell if a dentist has had
the proper training to be a fully qualified cosmetic dentist? It's
difficult for the consumer. Dentists may be able to cite courses that
they've attended, but, as a patient, you would probably have no way of
evaluating whether these courses are adequate to prepare the dentist.
Complicating the issue for the patient is the lack of appreciation even by
many dental authorities of the requirements of real cosmetic dentistry.
Thus, when interviewed by The Wall Street Journal for an article about the
poor quality of much cosmetic dental work that is being done by general
dentists, the spokesperson from the American Dental Association disagreed
with all of the cosmetic dentists who were interviewed and said that
current ADA guidelines and state regulations provide "sufficient
oversight for the protection of the public." To make a statement like
that he has to believe that if the dentistry is functional, then it's acceptable.
He fails even to see the problem. Cosmetic dentistry is very different
from general dentistry, and, if we are to please the patient, it can't be
judged by the same standards.
—Dr. David A. Hall
retired accredited cosmetic dentist
and author of this web site
- See Dr. Hall's blog postings where he
answers questions from visitors about choosing and
finding a cosmetic dentist.
- Read about
- Read about all
porcelain crowns and the difference
between them and porcelain fused to metal crowns. Find out how you can
have a crown that perfectly mimics a natural tooth.
- Find out about
Invisalign invisible braces - how you can
have your teeth straightened without wearing ugly, uncomfortable
brackets and wires.
- Learn all about