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Dentist fooled her about the all-porcelain crowns

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Dr. Hall,
I recently had all six of my upper front teeth crowned. I researched this thoroughly and asked my dentist many important questions. He told me that he was going to use all porcelain crowns. He said that often these cannot be used on the front teeth because they would hit the bottom teeth and cause them to grind down. He said that I had “25% spacing” (or something like that). I was told that this was adequate to get the all porcelain crowns. Yesterday I went to get my new crowns placed and was very disappointed to see that the teeth in my mouth were silver on the back. I was certain that he or the lab had made an error. He told me that half way through the procedure he realized that there was not enough room to give me the all porcelain and decided to go with the porcelain fused to metal crowns. He assures me that this was his only choice. I am very disappointed and frustrated. What should I do? This was a huge investment for me (both financially and emotionally). My crowns do not look bad from the front, but I am worried about the dark line as my gums recede. I am also self-conscious about the back of my teeth. My current dentist assures me that if I get a second opinion, I will be told the same thing that he is telling me. I called the office to ask what the difference was in price between what I paid for and what I received. I was told that both types of crowns are the same price. After reading the information on your site that does not seem like it would be true. What do you feel that I should do next? Thank you for any advice that you can offer.
– Amanda in Arizona

Amanda,
Porcelain fused to metal is NOT the only choice in this situation. I always placed all porcelain crowns on upper front teeth.

If you went to any dentist on our list of real Arizona cosmetic dentists, they would all agree that your situation of six crowns on front teeth is clearly a situation for all-porcelain crowns. They wouldn’t dream of using metal in a situation like that. But they’re artists, and they’re different.

What you’re dealing with is that you have a technician dentist, like 98% of the dentists, who went into dentistry because they like to fix things, and the beautiful translucence of pure ceramic just doesn’t impress them much, and they don’t know what to do with it besides. They just don’t get it. And he lives in a different world where the dentist knows best and these crowns look “good enough” and it’s not that important what you think of how they look. It will be illuminating to you, I think, to read our web page about the difference in personality between a cosmetic dentist and the other 98% of dentists at www.mynewsmile.com/cosmeticdentist.htm.

But I don’t know what to tell you to do with where you are right now.

I don’t think there’s any point in trying to get this dentist to do all-porcelain crowns. He doesn’t seem to appreciate them.

I think your only recourse is that he did the metal without your consent, and if you wanted to press him legally, you could possibly have a good case, depending on whether or not he gave you a full opportunity to refuse to have him put them in once you found out they were porcelain fused to metal. He could be in an awkward situation legally if he didn’t give you that full opportunity. And handing you a mirror while you’re upside down in the chair and saying “here they are, we’re ready to cement them” I don’t think is giving you a full opportunity. There is a clear difference between pure ceramic and porcelain fused to metal. And it doesn’t matter if 100% of dentists agree with him if he did this without your consent. But you would have to be willing to fight that issue and I’m not sure you’d be willing to do that. You wouldn’t have to sue him, but you have to be ready to threaten to and willing to follow through if you really had to. Then you could get a real cosmetic dentist such as we recommend to re-do them at his expense. You could get a lawyer to write him a threatening letter and see where that goes. There is a key legal principle in medical and dental care called “informed consent,” and if a dentist violates that, the courts consider that a very serious thing. Anything they do to your mouth has to be with your consent.

I hope this is helpful.

On the cost issue, the cost could very well be the same in his office. Some dentists just have a set fee for a crown and it doesn’t matter what kind.

Most porcelains will wear the opposing teeth that they chew against, and this could be an issue in your mouth. But there are materials such as Empress crowns that do not wear the opposing teeth. A real cosmetic dentist would know how to do your case.

I hope this is helpful.
Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

This dentist claims any dentist can do cosmetic dentistry

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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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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Cosmetic dentist training programs

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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 (https://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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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Too Young for Porcelain Veneers?

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Hi,
I have a chipped front tooth, and some slight spaces in my smile seven years after braces. I am twenty-four and am looking into porcelain veneers from an LVI preferred expert cosmetic dentist. I am wondering how young is too young to get veneers? Am I too young? Should I maybe consider bonding or a combo of Invisalign and bonding?

I just want to make sure I am making the right decision before anyone grinds down my tooth enamel and there is no turning back. Which would look better? Also, is it better/healthier to bond than to veneer? And once you veneer can you ever go back to your natural teeth or will they look weird or not be strong enough on their own?
Thanks,
– Brittany from Colorado

Brittany,
You aren’t too young for porcelain veneers. It’s good to have your teeth fully erupted before you get porcelain veneers, which is at about age 18 or older.

And I hope you’re in the hands of an artistic cosmetic dentist. Being LVI preferred isn’t any kind of a guarantee. It just means that they’ve attended the LVI course and have paid the fee to be on the “preferred” list. Some of the LVI preferred cosmetic dentists are excellent, and some aren’t very good. It’s a mixed bag.

Direct tooth bonding isn’t a good choice for a complete smile makeover. It’s very difficult to do bonding and have it look beautiful, and then it can scratch and get dull and stained too easily. Porcelain veneers don’t stain and they last a long time. But if it is for slight gaps between the teeth, direct bonding could work well.

Orthodontics, including Invisalign, doesn’t work well for spaces between the front teeth because the teeth tend to want to move back to their original position.

I wouldn’t make a decision based on whether or not you could go back to your natural teeth. Why would you want to do that anyway? No one ever goes back to their original teeth once they get a beautiful new smile. Just be sure you have a good cosmetic dentist who does beautiful work.
– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Unhappy with appearance of porcelain veneers

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Dr. Hall
My girlfriend had two crooked front teeth from an accident when she was young. She has always wanted to straighten them but hasn’t been able to afford it. I told her I would help her and found an orthodontist on the island where we live. He told us he was skeptical as to whether the teeth would stay in place due to ligament damage.

We went to a dentist supposedly specializing in cosmetic dentistry who suggested porcelain veneers and put us on a payment plan. $6000 later Natalie has six new front top teeth. Unfortunately neither of us are pleased with the shape or size of her new teeth. They look very large and unnatural. Can something be done at this point? Does the dentist have any obligation to help us? Should we see someone else? We are really unhappy with the results, and I am disappointed that we were never shown a model of what they would look like. Thanks for the tips.
Aloha
– Eric in Hawaii

Eric,
You are showing that you have insight into the problem you have by referring to your dentist as someone “supposedly specializing in cosmetic dentistry.” “Supposed” is the word to use because not many of the dentists who declare themselves as cosmetic dentists could actually be called specialists.

Cosmetic dentistry isn’t a legally recognized specialty, and thus any dentist, with no special training at all, can claim to be a cosmetic dentist. This dentist doesn’t have a legal obligation to help you just because you don’t like how they look. As long as the porcelain veneers are functional, that’s ordinarily the extent of his legal obligation.

There are two really good cosmetic dentists in Hawaii. One of them isn’t accepting new patients. The other is Dr. Wynn Okuda in Honolulu. I’d suggest you see him and see what he thinks of your case and what he can do to help.
– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Empress Crowns and Dental Insurance

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Hi. I am a 52 yrs young woman, needing several crowns due to huge fillings loosening, root canal treatments and the like. I have been prepared for 1 crown so far and asked the dentist for all porcelain crowns, wanting to rid my mouth of ANY metal as the work continues on. They told me it would be an Empress crown. My insurance company pays for Porcelain/ceramic substrate crown at a certain rate. Even though the Empress crown is all porcelain or ceramic my dentist says that the Empress is not coded on the insurance form and he will have to charge me over $1000 for the crown. (The insurance says the charge for code 2740 porcelain/ceramic substrate s/b $370). I am not sure if I am being told the truth by the dental office. It just doesn’t make sense to me. Can you comment on this affair? Thanks. PS. I do have some budgetary issues, so if I need 8 or so crowns, the cost does count!
– Pam in Florida

Pam,
I think you are being given correct information by your dental office. There is no special code for Empress–Empress is a brand. And $1000 is on the low end of fees for dental crowns so that’s a reasonable deal. Dental insurance isn’t like auto insurance or life insurance or medical insurance, which is designed to cover risk. Dental expenses are pretty predictable, so think of your insurance as a benefit plan where they are helping you a little with the costs. So unlike medical insurance where the higher the cost the more you need to rely on the insurance, this is a case where the higher the cost, the more the insurance company wants to protect itself, so it can make a profit. From what you said, you implied that the all porcelain crown was your idea, not the dentist’s. I need to warn you about this. This is very risky, doing an all porcelain crown, if the dentist didn’t recommend it. Many dentists are not very good at the sophisticated bonding techniques for placing all porcelain crowns, and you could be pushing the dentist out of his or her comfort zone. Good cosmetic dentists will really resist doing porcelain fused to metal crowns on front teeth, because they’re ugly. So if your dentist didn’t recommend all porcelain, I’d take that as a signal that you’re in the wrong office, if that’s what you want. 
– Dr. Hall

Related information:
Read about one-visit CEREC crowns.

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

What is the whitest shade?

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Dr. Hall
I recently had Lumineers applied to my 2 front teeth for cosmetic reasons to brighten my teeth. The surrounding teeth are naturally very “bright white” and the cosmetic dentist and hygenist told me that I had the lightest shade. What is the lightest shade?? They appear darker than the other teeth. He said to stop using the at home tooth whitening. He said, “Don’t whiten your teeth anymore and they will match up.” How true is that? My teeth are still going to be darker in the front. They will never match I don’t believe. What am I to do?
– Toni from Tennessee

Dear Toni,
I’m not sure why you are referring to a cosmetic dentist that you went to. What makes you say he is a “cosmetic dentist?” Just because he said so?

I am suspicious and wondering if he is really what I would call a cosmetic dentist, because you are telling me he and his hygienist said they gave you the lightest shade. When they use terminology like that, that sounds to me like it’s coming from a general dentist, not a cosmetic dentist.

To a general dentist, B1 is considered “the lightest shade” because that is the whitest color that teeth tend to ever be without bleaching. But when you bleach your teeth, you can usually get them whiter than “the lightest shade.” So I don’t usually hear expert cosmetic dentists talking about “the lightest shade.” Most expert cosmetic dentists, when they do a smile makeover with porcelain veneers, will encourage their patients to go beyond the lightest natural shade, because almost everyone wants a bright, sparkling smile, and usually B1 simply isn’t white enough.

Read about the difference between a general dentist and an expert cosmetic dentist, and this will help you understand better what is going on with the advice you’re getting.
– Dr. Hall

Click here to find a cosmetic dentist.

About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

How can I tell a good cosmetic dentist?

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Dr. Hall,
I am interested in straightening my top front teeth with porcelain veneers and tooth whitening. I have visited a few dentists who claim to be trained in cosmetic dentistry. Can you give me some examples of questions I need to ask to be sure of their expertise? Also, can you please tell me the average price of veneers in my area. Any advice is appreciated.
– Shannon from Pittsburgh

Shannon,
This is a great frustration with people, finding out who are good cosmetic dentists. I know there are people and web sites where they give you a list of questions to ask or things to look for. I am a retired accredited cosmetic dentist myself, and I will tell you that I don’t know what to tell you to look for. I don’t think there is any list of questions you can use. The way I tell is that I look at photos of their work and I look at things like emergence profile, gingival health, an understanding of color and translucency, an artistic sense, passion for beauty, and attention to detail. I don’t think there is any list of questions that can equip a patient to tell who is good and who isn’t.

Let’s change the situation a little and help you see my point. Let’s say that there was no such thing as a dental license – that anyone could claim to be a dentist. And let’s say that there is no uniform educational standard – that many universities had courses in dentistry, some good and some bad. How would you tell who is a good dentist and who isn’t? Well, it would be pretty tough.

So that you don’t have to face this situation, governments have set up licensing boards with strict standards and laws prohibiting anyone who isn’t qualified from saying that they are a dentist. But there are no such legal standards for cosmetic dentistry. And because of the politics at play in the dental profession, such standards are very unlikely. So you’re vulnerable. And by visiting various offices, my guess is that you’re experiencing some confusion. I estimate that for every dentist who is truly an artist and a genuine cosmetic dentist, there are fifty who claim to be cosmetic dentists.

If you want a little help, check my article on the difference between a general dentist and a cosmetic dentist. And if you want a recommendation from me, check our web page where we list excellent Pittsburgh cosmetic dentists. So here’s what I’d recommend. Visit the offices of the cosmetic dentists we recommend in the Pittsburgh area, and then come back and you tell me how different they are from the other offices you’ve visited. You will sense a difference, I’m pretty confident of that. Try it. You’ll see what I mean.

As far as the cost of porcelain veneers, I’d expect to pay a fee somewhere between $1100 and $1900 per tooth in your area.
– Dr. Hall

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About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

The great cosmetic dentist disconnect

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Dear reader,
I’m sitting at my computer musing at this last exchange I had with a sweet patient in Massachusetts who is being advised to get her porcelain veneers from Dr. So-and-So, because he’s an excellent dentist. Let me help you understand the disconnect there is in the dental profession over this issue of cosmetic dentistry.

The American Dental Association asserts adamantly that there is no such thing as a cosmetic dentist. Dentists, they say, learn in dental school how to do cosmetic dentistry. They go even further than that. They have written into their code of ethics that it is unethical for a dentist to tell the public about any special training they have in cosmetic dentistry. But it’s worse than that. There are some state dental boards that have made it illegal for dentists to say that they are any better at cosmetic dentistry than any other dentist. They have decreed that any dentist can do cosmetic dentistry, and their official position is that it is harmful to the public to say anything different.

Now I’d like you to construct in your mind a humorous scene. Let’s create a television studio, and three chairs on the set. Put Jessica Simpson on the left, a host in the middle, and then a spokesperson for the American Dental Association on the right. Jessica Simpson just says that she wants a new smile. The ADA spokesperson responds that she can go to any dentist in the country and get a perfectly fine new smile. Can you see where I’m going? What do you think Jessica Simpson will do? Well, she wants to laugh. If she’s polite, she will just ignore the spokesperson. And we all know what she will do for her new smile. She will get a recommendation of a high-powered cosmetic dentist who can do dazzling smiles and, no matter where he or she is in the country, she will fly there and get the work done. And she will end up with an absolutely stunning smile.

I wish the American Dental Association would one day awaken to the great disconnect they have with reality on this issue. ADA, everyone knows that there are dental artists out there who do beautiful work that 98% of dentists cannot possibly create. But you people at the ADA won’t admit it.
– Dr. Hall

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

Recommending a cosmetic dentist

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Dr Hall
Thank you so much for your reply. I really appreciate your advice. I don’t think I will go for the whitening because I feel as though I will be locked into whitening to match the veneers. My teeth are aleady pretty white so if the veneers match my teeth instead of “whitened teeth” then they should look more natural. Is this line of thinking sensible? I was going to get six veneers, do you think eight is better? My teeth are in very good shape. I had an accident recently and vertically fracture the front one and horizontally broke the one beside it. The nerve died after two weeks on the front one and a root canal was performed. The one beside it was bonded in an emergency appointment but the color is all wrong. I figured six veneers would make the repair look natural but if you recommend eight to look more natural I will follow your advice. Dr —- —- DMD will be doing the work. Do you know anything about him? My regular dentist, who is a periodontist, recommended him. Her name is —- —-. Again, I sincerely appreciate you taking the time to correspond with me as this is a significant investment and I really miss my smile.
– Deb from Massachusetts

Deb,
I would go to a real cosmetic dentist for a second opinion before you start investing thousands of dollars in a new smile. I’m sure Dr. —- is a nice person and probably an excellent dentist. But he doesn’t show up on any of my lists. He isn’t even a MEMBER of the American Academy of Cosmetic Dentistry.

Here’s the deal. Dentists are technicians. At least over 95% of them are. They fix things that break. They heal you when your teeth have problems. But you want a beautiful smile. Your periodontist believes that Dr. —- is a great dentist who fixes things really well. I don’t know if you’ve been to him yet or not, but you need to get some exposure to what a dentist-artist could do. And then discuss this issue of the tooth whitening and the porcelain veneers with him or her. You need some perspective from someone who has an eye for beauty. Read my article on the difference between general dentists and cosmetic dentists. That should help you understand this issue a little better.

Then you won’t end up among all the hundreds of people who write to me after they thought they were getting a new, beautiful smile and wondering what went wrong–why it didn’t happen.

As far as how white you want them to be, I will tell you that in twenty years of doing smile makeovers, I never had a single patient come back and wish that I had made their teeth darker. I did have a number of them, however, that wished they had made them a whiter color. They can be quite white and still look completely natural. That’s one of the big differences between a general dentist and a cosmetic dentist. A general dentist will tell you that you don’t want them too white or they won’t look natural. A cosmetic dentist will ask you what color YOU want, and will listen. So cosmetic dentists make new smiles that are considerably whiter than general dentists do, because that’s what people are asking for.

And as far as saying you want six veneers and not eight, you sound like you’re being influenced by a technician-dentist. Dental schools teach that there are six front teeth, and that a new smile involves six teeth. But almost everyone shows eight upper teeth when they smile. Some show ten. I said eight veneers, because that is the usual case. But maybe you only need four. It depends on the color and shape issue. Don’t try to figure it out for yourself. Go to a dentist-artist and discuss it.

Check our list of Massachusetts cosmetic dentists. Everyone we list is an artist, not just a dentist. There’s a big difference between the two. Visit one of them, and see what a completely different approach they have to you when you are looking for a new smile.
– Dr. Hall

Click here to find a cosmetic dentist.

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.

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