Agonizing over the choice of a dentist

Over the years, as I have tried to help various patients get quality cosmetic dental care, I have occasionally run into people who seem destined for trouble. They agonize over the choice of the dentist to such an extent that it reveals that they have trust issues that are going to seriously get in the way of their beautiful smile makeover.

After not hearing from him for over a year, I had an e-mail exchange with a patient that ended this past weekend that got me reflecting on this. I’ll walk you through the progression of his issues over several posts, and share my comments. To help preserve anonymity, I will simply call him “D”.

Here is his initial question, which I received in July of 2012:

Dr. Hall,
I have porcelain crowns on my two front teeth. They are larger and much longer then my other front teeth. I was referred to Vincent Devaud a high end ceramist. He seems to be the best lab in southern California. He referred me to Dr John Willardsen in Redlands, CA. He suggested I put veneers on the other four teeth next to my two front teeth so they will be more proportioned. I am nervous to do this since when it is time for replacement in another 10-15 years I will have to do all 6 again. Have you heard of this lab and doctor and what are your thoughts about doing all six teeth? I would be okay doing four but he said either two or six.
– Thanks, D

Diane,
I had not heard of either the ceramist or the dentist, so I had to do a little research.

But I must admit starting off a little suspicious. Why the suggestion to go to 6 teeth? Esthetic dentistry is patient driven, and a good esthetic dentist is more a listener than a prescriber. Are you dissatisfied with the other teeth? Do you perceive the problem as being that your two front teeth are too large? Or do you feel that the other teeth are too small? But it sounds like the dentist has made this determination for you. This would go against the grain of a truly excellent cosmetic dentist, if this wasn’t done in response to your perception of your problem. An excellent cosmetic dentist will not try to make you dissatisfied with the appearance of your teeth.

And then the other option – doing 6 teeth – that tends to add to my suspicions. Doing a smile makeover of 6 front teeth is a dental school mentality. A smile is at least 8 teeth – sometimes 10 for wider smiles. So either 2 teeth or 8 or 10 teeth makes sense to me, but 6 seems unusual.

As far as my opinion goes, to me, everything else being equal, more conservative is better. Porcelain veneers are beautiful, but they are only beautiful in that they mimic natural teeth. Natural teeth are the ideal. And as you mention, getting this entire new smile commits you to a lifetime of maintenance and eventual replacement. There is no fixed lifespan of porcelain veneers or crowns. 10-15 years is a reasonable, conservative expectation, but they could fail sooner or they could last much longer.

The ceramist, from all I could read, does seem like an excellent, artistic technician and I think you’re in good hands there. The dentist, however, seems more like an excellent practitioner from a functional perspective, but not really an artist. The idea that he seems to have that 6 front teeth is a smile makeover adds to my perception that he isn’t a true artist.

You’re in Los Angeles. There are a number of excellent cosmetic dentists in the Los Angeles area. Dr. Willardsen would be way down my list. If you want one of the best, I would recommend Dr. Les Latner, who is right in Los Angeles. If you want someone closer to the Redlands area, Dr. Tony Cabrera in Chino is an excellent choice. He tends to be rather easygoing and conservative in his approach, and judging from your nervousness about your aggressive treatment plan, he might be a good match for you. Both Dr. Latner and Dr. Cabrera are first-rate artists.

– Dr. Hall

See D’s follow-up question and my next answer: Agonizing over the choice of a dentist, part 2.
And then: Agonizing over the choice of a dentist, part 3.
And: Agonizing over the choice of a dentist, part 4.
Finally, my reflections on “Why some people agonize over the choice of a dentist.”