When I was consulted about an undercover investigation into dentist treatment planning by the television program CBC Marketplace I was shocked by the findings. Not only were dentists pushing all kinds of cosmetic dentistry, but the dental associations were zipping their lips and pretending there wasn’t a problem. Who are we trying to kid? It may be the most dangerous time for patients to see a dentist since the days dentures were the cure all for any dental ailment. Veneers are being glued all over the place and implants are being screwed in by doctors with inadequate training.
Naturally some dentists are threatened by the possibility their advice may be questioned, but apparently there is good reason for alarm. In a separate interview with a money magazine related to the same topic, I confessed that dentists are not always offering patients a reasonable range of choices. Informed consent is the basis for my next book project that will include contributions many prominent co-authors and even a victim of abusive dental care.
On a local level I had an ethical question for a new orthodontist. If treatment on a patient from the previous owner of the practice does not match what he or she feels is appropriate, what responsibility does the orthodontist have to the patient and the referring dentist? I have called and not yet had a response but it is going to be interesting. The case involves a severe Class II skeletal situation where the former orthodontist was attempting to correct it with a Herbst appliance. My opinion is she was too extreme a case and it should have been a surgical treatment. Will the orthodontist continue to torture the child even if he or she feels it is incorrect or will we have a discussion that may be complicated? We’ll soon see how long we can hide these things from the public.
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.