Ethical Case Presentation?

As dental professionals we are expected to walk the line in helping people achieve whatever they desire that is within our realm. Laypersons expect us to mostly set aside our own desire for compensation; at least for the treatment planning and recommend what we feel is best.

Unfortunately dentists are graduating with limited treatment planning skills and their presentation skills are even worse. The good news is we can all get better at anything but the help we get from continuing education needs to be reviewed carefully. Being able to learn quickly is a pre-requisite for dental school, and yet we all seem to think ethics and this kind of intelligence comes hand in hand. They do not and this has led the profession onto shaky ground from which it seems to be retreating.

We get excited about new technologies and skills, and the training often includes sales skills that employ psychological tricks that are proven to increase the closing rates. While we don’t want to be looked at as super sales people by the public, we do value staff that are good at nailing down a patient to commit to paying for ‘ideal dentistry’. Informed consent includes breaking all the options down to the most simple forms, discussing pros/cons and long term costs. Why do we still use the word ‘permanent’ with crowns when we know they have a limited life…does Mercedes sell ‘permanent luxury vehicles’? Under cross examination a lawyer could use our staff to throw us under the bus with a few short questions.

With the advantage of greater understanding of all the alternatives the dental team needs to consider backing away from the intense focus on selling the most expensive choice. It is not always the best, and for example a mouth full of porcelain can be either the best dentistry has to offer or an example of ruthless greed. My personal breakthrough came from adding orthodontics to my general practice and while I may call myself an ‘UnCosmetic Dentist’ it is just a positioning statement that challenges those who feel they can un-sell one modality (orthodontics) simply because they are unable to provide it.

Leann Rimes drives a cosmetic dentist into bankruptcy?

There were mixed emotions as I researched the lawsuit launched by singer Leann Rimes after an extreme smile makeover gone wrong. She was a high risk client with high expectations, a pre-existing TMJ problem and emotional issues…but what patient these days doesn’t have a few issues? By promising a perfect smile dentists are setting themselves up for the occasional mega lawsuit, and some simply feel this goes along with the job.

When discussing this case with other dentists, some were defensive and blamed Rimes while others said the dentist obviously is in hot water for a reason. Simply knowing she went from veneers to crowns, to root canals to an extraction and gum infection puts me in the celebrity corner. OK, so I do enjoy finding potential examples of abusive cosmetic dentistry…but brought down to the basics you have an unhappy patient in pain and a dentist under the microscope.

There is a possibility that this could turn into the largest cosmetic dentistry malpractice suit in U.S. history. The expert witnesses will easily show how the dentist slipped up somewhere (like we all do) or at least could have chosen a different route. The celebrity seems to growing irritable from personal attacks from the press, a husband’s former wife and the public so striking out at the dentist that she feels hurt her would be coming from a place that is less than ideal. Many dentists work on patients who are either financially or emotionally stressed.

Recently one of our hygienists was accused of being too rough and knocking off an eight year old bridge fabricated at another clinic (she’d never had a similar complaint before this). The preparations were extremely short, the patient was a bruxer and she did not wear a splint. Explaining that a healthy bridge could not come off from a routine cleaning did not cut it, and I simply agreed to pay for the lab bill for repairing the chipped porcelain and re-cemented it at no cost. Certainly I am referring her to the prosthodontist because alarm bells are ringing.

As the celebrity lawsuit progresses we can all learn how to reduce our exposure to the same fate. Doing fewer porcelain veneers may be the first step. If the lawsuit settles for millions, the dentist may have a tough time finding malpractice insurance. Then what? To read what I would have suggested as a different solution for Rimes visit and click on the Leann Rimes webpage.

Snooki DDS – How Celebrities Can Help Dentists Destroy Teeth

You may resent the fact that a person without a dental degree is able to instantly modify the thinking of your patients with a simple press release. U.S. reality television star Snooki sharing her new veneer smile on Twitter and Facebook could easily lead many young impressionable girls to consider asking for porcelain teeth to replace their natural smiles. Who should be held responsible?

We know dentists use celebrities to help promote their practices and this actually can lead to ‘celebrity abuse.’ My own exploitation of John Lennon’s rotten molar into all kinds of publicity stunts and even an upgraded seat on Anderson Cooper LIVE and a better price on an expensive coat are harmless when compared to how a cosmetic dentist could cross the line. You can imagine the racing heart of a dentist who is setting a celebrity up for a smile makeover…it’’s their BIG BREAK.

The issue is certain celebrities can send shock waves of stupidity across the nation like a virus. Sadly, aesthetic dentists will often take full advantage of the public’s lack of understanding of the long term costs and complications from aggressive, expensive and harmful veneer procedures. The celebrity is an innocent pawn in the equation and unless I am proven wrong with intra-oral photographs and radiographs, my guess is ‘Snook got took.’

Yesterday, I did a composite restoration on a single central incisor for an 18-year-old girl who was told at another office that she needed six porcelain veneers. She had enough common sense to know her former dentist was recommending treatment that could be suspect. My simple treatment impressed her and only cost about $200, while the veneers could have easily been $6,000 for the first round of many over her life.

I’m terrified that a person like Snooki has such power over our youth…but again we also have gynaecologists on Dr. Oz dictating the required frequency of periodontal treatment. If the dental profession can’t act responsibly then how can we complain about anything at all?

Dentist Brain Plasticity Discovered

Who would have guessed a DT blogger to be in line for a Nobel Prize, but here it goes…just back from my oceanfront lab in Manzanillo, Mexico, and the answer is staring me in the face. I just inherited my wife’s Kindle and for some reason a few things happened in synch and the truth was revealed. It was there all the time and it would be wrong to hog all the glory but I don’t know if the people with the trophies like to give out extras. If they give me time to thank each person at a podium, I will work it into the acceptance speech.

This discovery is one small step to finding a cure for cosmetic dentistry gone wrong. Of course people with a mental illness are extremely difficult to treat but when the safety of the public is at stake we can’t just sit around for another decade or two and let the victims stack up. That goes against what we are supposed to be as ‘professionals.’ So sure it’s a big advance in understanding, and ‘yes’ it will give me even more things to brag about, but shucks, I just have a knack for solving the impossible.

What we have is a dentist with an actual change in perception working on ‘live people’…this is the place where the drill meets the enamel. After this article is published this is going to make a significant leap forward in our understanding of infectious cosmetic dentist brain toxicity ̶ the same disease mentioned in the introduction of my banned book ‘Confessions of a Former Cosmetic Dentist’. Finally I have the science behind the cause of the illness, or at least enough to possibly get the Nobel.

Predicting the future, I would assume there will be a surge in proposals from dental schools for research on this but let’s not go there yet. I would rather get to the point and explain the precise elements of my discovery. The book ‘The Brain that Changes Itself’ by Norman Doidge that nudged me into another round of fame used the terms ‘brain plasticity’ and ‘brain mapping’ so I will add these words here although in my mind ‘silly putty’ may be a better fit. Not that I want the reader to think this is not perhaps the biggest or at least the latest discovery in our field in 2013, but because to most of us ‘plastic’ is injected molded and often able to withstand the heat of sterilization processing.

The same brain changes occur in pornography addicts, so I must assume any discovery will doubly help dentists who are addicted to both cosmetic dentistry and material as seen on www.Dentist.XXX. Don’t be surprised to find treatment centers pop up all over, but I will give you the option of some online therapy to fit almost any budget. The most basic of steps in a cosmetic dentist’s daily life is color selection and my discovery relates to the perception of ‘brightness’ or ‘whiteness’.

I propose that the cosmetic dentist’s brain actually changes and expands the ‘homunculus shade guide’ effectively adding unnaturally white shade tabs onto the map on the cortex of the brain. This relates to actual monkey studies where the area of the brain dedicated to areas of focus or learning become enhanced on the level of the neuron. To complicate matters and perhaps add to my collection of awards, I propose there is a relationship with the pleasure centers of the brain which relates to the color = money association.

This contamination of normal thinking all happens below or above the level of the cosmetic dentist’s consciousness. In fact, it becomes obvious to any of us that pick up cosmetic dental magazines or hardcore S&M that there is something wrong with them. Don’t they see that what they are doing is not ‘normal?’ According to my research the answer is ‘no’. They have developed a distorted pattern of perception which can be explained by the following:

As my own test subject and experimenter I booked a couple weeks at a small resort called ‘Los Suenos Del Mar’ not knowing that it would lead to such a blog blasting event. To keep it short and sweet, I exposed my skin to the sun’s rays to make it look like I had a sunny vacation. Being distracted by my reading I allowed my wife to pull ahead of me in the units of time and her skin reacted with the usual rich brown glow. My melatonin was not activated by my lazy reading in the shade, so on my last day I looked in the mirror thinking ‘I’m not very tan.’ After a four and a half hour flight and in a new environment (my own home) my mirror tells me otherwise. My skin appeared much darker and maybe I did have a tan after all. A different environment can help a person see things with new eyes.

Most readers would not make the association of this experiment and relate it to how some dentists start making teeth whiter and whiter. Perhaps a few dentists are now slapping their heads thinking they could have been the Nobel dentist. Sometimes the answers to big problems are right there in front of us. Please don’t make me explain how this relates to the unreliability of cosmetic dentist’s treatment planning due to the brain changes. The cure will involve, hmmmm let’s leave that topic for another time.

Undercover Dentist Investigation on CBC Marketplace – Dentists behaving Badly or Just Differing Opinions?

When I was contacted by CBC Marketplace to be a consultant to the episode ’Money Where You Mouth Is’ I knew it had the potential to reveal some of the problems we have in our profession. Many of us are concerned about the way some dentists push cosmetic dentistry on patients and in my opinion this is the number one reason we have sunk down in the level of public trust over the years.

Too many have focused on other issues like marketing as the true evil. The black stain on our profession is the way we have allowed commercial interests to dominate the postgraduate education in dentistry. This has been particularly overpowering in the aesthetic dental programs where many have been sponsored by dental labs that are in business to do more ceramic work.

Just as the medical doctors have been led around by big pharma, thousands of dentists have crossed the border to the U.S. and practiced illegally outside their licensure while training in cosmetic dentistry. Patients have flown down with the dentist for smile makeovers and come back with potential complications. The dentists came back overconfident in their skills and in the mistaken belief that they were anointed ‘smile experts.’

The reality is most of the synthesized rules of smile design have led to a large group of dentists who actually make people’s teeth look worse. Why would the undercover patient need veneer treatment for a midline problem? While it is a matter of opinion, the even greater secret is aggressive cosmetic dentistry will lead to premature tooth loss and substantial long term costs and complications to the patient who entrusts the dentist for a Hollywood smile.

This Ugly Truth about Cosmetic Dentists is our dirty secret. We know there are top level cosmetic/oral rehabilitation dentists, and there are also dentists teaching cosmetic dentistry that have used celebrity patients to hide the fact that they are simply veneer salesman. The new phase of cosmetic dentistry will not be based on trying to find excuses to bond porcelain on as many teeth as humanly possible.

This Marketplace episode goes beyond simple honest variations in treatment planning. The 15-year-old patient who was told she lacked enamel on her teeth and needed 25 crowns was an example of malpractice. Recommending the most invasive treatment for a young patient proved that paying more does not mean better care. This would have been a rip off and could have been considered physical battery.

We tolerate aggressive cosmetic dentistry because we have a code of silence. I was told it is bad karma to speak ill of colleagues, but I think it is bad karma to let this abuse continue. The profession is out of control and as an example sponsored cosmetic programs are trying to reach into the dental schools to start the brainwashing even prior to graduation. Why wait? Dentists are just as vulnerable when they graduate. Dentists have been selected for entry by an amazing power of absorption and regurgitation of information, without critical thinking (which is usually punished).

The dental profession is worried about so many little things. What should be a concern is it is neglecting the safety of the public. More undercover investigations are necessary to help understand the level of inconsistency among our members. Dentistry has a long way to go before it can dilute the toxic thinking that has poisoned those who are a little too quick to recommend ‘advanced’ cosmetic treatment. That’s sad.

“The Fool’s Golden” Proportion

Or should the title be the Golden Proportion for all us fools who have listened to cosmetic experts? If you have been practicing for a while you would have experienced the reference to this pillar of cosmetic training that seemed to dictate the ideal relative proportions of the upper anterior teeth.

I used to cringe hearing it, and was relieved to read an article in the spring issue of the Journal of Cosmetic Dentistry that agreed with my repulsion.

In his article “Keeping It Real!: Mystifying Beauty”, the author Iran Ahmad described in essence how smile design by cosmetic experts has been destroyed by using this misapplication of a Greek scholar’s non-dental theory. If you are like me, you would often pick up cosmetic dental journals and articles mailed from porcelain dental labs to see smiles that were somehow ‘not right’.

Even though patients have flocked to cosmetic dentists for their expertise it seems their trust has often been betrayed. As the author states, perfection does not equal esthetics, and the obsession with getting every tooth dimensionally sized to honor a dead Greek geek has been foolish. The hundreds of thousands of veneers designed with philosophical foundation are now obsolete. Will cosmetic dentists and their labs be sending out notices of a factory recall? Not likely.

It takes a lot of gumption to write an article that questions the beliefs of fellow professionals, but I don’t think the author will be sitting alone in the convention cafeteria. He will be able to enjoy his meal with the author of another article in the same journal (Jason J. Kim) that essentially stated porcelain veneers are often too white to have a chance at looking natural.

Maybe those of us who are a little sloppy in our measurements and simply eye-ball with thumb and finger are the new real-life experts in Un-Cosmetic Dentistry. Maybe we will have our day in the sunshine sooner than others would have dreamed.