In the simplest sense, the hope would be that every dentist would be a cosmetic dentist.  After all, the ultimate goal in dentistry is to make teeth look and function like teeth.  The reality is however, that some dentists have had more training than others focusing on those criteria related to the health, function and appearance of the smile.  As with all professions, the journey to become proficient in one’s field requires a lifetime of learning.  In dentistry this learning continues from the day the dentist begins his or her practice until the day they retire.  Materials, procedures and knowledge evolve everyday, and it is the responsibility of the dentist as an advocate for the dental health of their patient’s to separate the hype from reality and seek those advances that will improve the predictability, durability and the absolute best esthetics possible. 

 The United States is undisputedly the leader in dental esthetics.  Dentists have the opportunity from all over the world to seek post-graduate education related to esthetics at centers that offer lecture and hands-on programs from coast to coast.  Those blue chip, founding continuing education centers that focus on a comprehensive vision of esthetics/function without the influence of hype and marketing include the Dawson Academy, the Kois Center, the Pankey Institute and the Spears Education Center.  Each center may present slightly differing concepts related to philosophy and techniques, but they represent the respected mainstream of literature-based knowledge for the practice of quality care today.  There are many other centers that offer advanced dental education as well related to dental esthetics.

 Currently, dental esthetics is not a specialty.  Any dentist in practicing in the US can perform these types of procedures.  However, there are credentials that are awarded on a peer review basis that designate those that meet a level of excellence that is recognized as the gold standard in dental esthetics.  These credentials or accreditation are measured by the American Board of Cosmetic Dentistry (ABCD) through the American Academy of Cosmetic Dentistry (AACD), which is the largest academy related to dental esthetics in the world.  These credentials, Accreditation and Fellowship, are simply a measurement of the dentist’s ability to create an excellent result through their clinical skill and knowledge.  The actual accumulation and training of this subset of skills may have been learned from a variety of sources.  Because of this anonymous and open examination process, the credential is not available for purchase or award simply because someone has attended a program.  It must be earned.  The achievement typically takes years to accomplish and requires written examinations, clinical documentation of actual cases and oral exams.  In the level of Fellowship, it represents a lifetime body of work demonstrating the skills related to esthetic care.  Currently there are less than 350 dentists and laboratory technicians that are Accredited by the AACD, and only 53 that have been awarded it’s highest honor: Fellowship.  Any dentist that is licensed certainly has the potential to provide an excellent result, with or without the credentials.  Credentialing only provides an irrefutable measurement by other dentists and lab technicians that are recognized experts in the field of cosmetic dentistry, who endorse those that avail themselves to this evaluation to confirm that candidates are who they say they are: qualified to provide excellence in cosmetic dental care.

 In providing restorative esthetic dental care, one of the team members that the dentist will rely on heavily is the laboratory technician when creating restorations like veneers or crowns.  This same credentialing process is available for the lab technicians.  Information related to locating a credentialed dentist or lab technician can be found at http://www.aacd.com/index.php?module=aacd&cmd=memberreferral.  The synergy of the team of the restorative dentist and the ceramist/lab technician is the key element in creating a predictable and beautiful result. 

 Our goal is obviously to have the smile you desire the first time it is done.  Improper care can result in:

• Bulky unnatural appearing restorations.  In a social setting, the desire is to have others observe your smile as natural and beautiful, and not be able to perceive that any dentistry was completed.  Bulky restorations can also result in tissue (gums) that bleed and are infected.
• Restorations that break or fall off.
• Restorations that are in the wrong position or are too big that affect speech or give the appearance of “bucked teeth”.
• Restorations that are monochromatic (one shade) that don’t reflect what we would normally see in nature.

Proper care can involve a significant investment.  Veneers or crowns delivered by a qualified provider can range from $1500 – 2500/ tooth depending upon the economic conditions of an area and the experience of the restorative dentist.  Finding the right dentist is the beginning of a long-term relationship to help insure the health of your smile.  Cost and insurance coverage can often be a limiting concern, but always keep in mind that having something done twice, because it didn’t meet expectations the first time is always far more expensive, often yielding a compromised result.  Some practices tout themselves as a destination practice for cosmetic dental care.  These are practices that offer cosmetic treatment without providing maintenance and recurring care with periodic check ups and visits with the “in house hygienist” after treatment is completed.  They provide the restorative care and you return to your “regular dentist” for “cleaning visits”.  This is a concern.  Ideally, you want the dentist that completed your care and has been intimately involved in what was done, to monitor and help maintain the result.  It is beneficial to find a professional, if possible, within a reasonable distance that you will be willing to travel to on an ongoing basis for maintenance and evaluation.

 So how does the public find a dentist that has the training, experience and tenure to predictably deliver the results they are seeking? Here are some recommendations in gathering information to help make this important selection:

•Contact friends and family and ask who their dentist is and what their experiences are. ?

•If you are looking for a cosmetic dentist, contact other dental specialists (such as an oral surgeon, orthodontist or periodontist) and ask for a referral.  Ask for the best in your area, who they would seek care from if they had an immediate concern. ?

•Call perspective offices and ask questions about the types of dentistry that the practice provides.  Is the staff member friendly and inviting?  Are they willing to take the time to answer your questions? ?

•Set up a visit to the practice for a visit.  Is the facility up to date, clean and reflect the professionalism that you expect.  Does the team enthusiastically support the doctor? ?

•Ask to look at photographs of examples of the treatment that the doctor has completed. ?

•Has the doctor made a career commitment to continuing education?  Is he passionate about the care he provides? ?

•Has the doctor earned additional credentials related to his field of practice?  Have other professionals recognized him as a leader in his field? Some potential resources on the Internet are www.AACD.com and www.MyNewSmile.com.

 In the end, you want to put yourself in the hands of a team of providers that has the training, credentials, experience and tenure to meet your needs.  The patient does not want to be overly focused on veneers, crowns or implants.  These are only products on the shelf that a qualified restorative cosmetic dentist has at his or her disposal.  Allow the dentist to design a plan that is best for you. It often will involve a variety of techniques and procedures. This will allow for the most conservative, predictable and durable result possible.

At the same time, the Environmental Protection Agency is announcing that it will study the issue of fluoride in water, based on a 2006 report from the National Academy of Sciences that questioned whether the EPA’s current maximum allowable level of fluoride in water—4 ppm—should be reduced. The EPA announcement does not question the safety of optimal water fluoridation.

That said, government officials anticipate some public confusion over fluoridation safety. HHS has asked the ADA and its members to help minimize any concerns and reassure the public that water fluoridation is a safe and effective way to prevent dental disease. The ADA will support the government’s work and will continue advocating for communities to fluoridate their water at the new optimal level. We have released this statement to the media, explaining our support for the federal government’s action and our continued support for community water fluoridation at optimal levels.

Making changes to your smile without considering the impact it has on the health and durability of those changes is like putting up a false storefront without the building. The results can only be predictability disastrous. The teeth exist in an environment that is exposed to extreme temperature changes, caustic and staining chemicals, and hundreds of pounds of force per square inch. If these factors are not well managed, the results will be the introduction of disease (decay or periodontal infection) or fracture and structure failure. If what God has made failed, then what are our expectations of placing glass (ceramic) in such a hostile setting?

The concepts of true esthetics evolved from the principles of health and the potential to endure.  We are attracted to those factors in human esthetics that may be indicators of survivability and this is certainly true in the mouth.  If teeth are worn, broken, discolored or crooked; there is probably a very real reason related to health why the conditions have deteriorated.  Esthetics can therefore only be assumed to be a mirror of the relative health of someone’s smile.  If it is healthy in form and function, then it will probably be visually acceptable and be free of active disease and infection.  Esthetics is the feature of a great smile, but the true benefit is health, function and predictability.

When considering esthetic chances to you smile, it is first important to identify what elements exist that are not desirable.  The next critical step is to identify why these conditions exist before designing solutions.  It is only through proper diagnosis and treatment planning that predictable beautiful results can be achieved.  Modern dentistry is unveiling better techniques and materials everyday.  These advances hold promises of better results and esthetics.  The key point however, is to recognize that failures that are commonly seen in restorative and  cosmetic dentistry are typically the result of failing to diagnosis and plan, not the technique or material used.

So what is the answer?  The solution is to put yourself in the hands of a trained, tenured and credentialed cosmetic/restorative dentist that has the skills and knowledge to create a beautiful, predictable and healthy result.  The solution does not lay in products that are selected off the shelf like veneers or bonding.  These techniques may very well be part of the solution but the primary predictor of success is the synergy of a custom treatment plan that is focused on restoring the health of your smile and your esthetic goals.

Veneers can be a predictable and beautiful technique to enhance someone’s smile, but they need to be utilized only with proper diagnosis and treatment planning.  Dr. Scott Finlay is a Fellow in the American Academy of Cosmetic Dentistry and is routinely involved in the comprehensive esthetic and restorative management of many patients’ smiles.  He is also actively involved in mentoring and teaching dentists across the country those techniques that he utilizes to successfully and predictably restore beautiful smiles for his patients.  For more information about his practice near Annapolis, Maryland visit www.AnnapolisSmiles.com.

Annapolis, Maryland – Thanks to the blitz of reality television makeover programs and direct-to-consumer marketing of teeth whitening products, consumer awareness of cosmetic dentistry has reached an all-time high. With so many options available to consumers to improve their smiles, it is now more important than ever for patients to ask their dentist about their experience in performing cosmetic procedures.

“Any patient considering a ‘smile makeover’ should ask their dentist about the education in cosmetic dental procedures that the doctor has undergone,” said American Academy of Cosmetic Dentistry (AACD) accredited cosmetic dentist Dr. Scott Finlay of Annapolis, Maryland. “A great indicator to know if your dentist focuses on cosmetic procedures is whether he or she is a member of the American Academy of Cosmetic Dentistry.  The American Board of Cosmetic Dentistry now provides the gold standard in measuring the talents of a qualified cosmetic dentist via the accreditation credentialing process.”

AACD Recommendations When Seeking a Cosmetic Dentist
In order to make sure your dentist is skilled in cosmetic dentistry, the AACD recommends that you ask for the following items before undergoing treatment. As is the case when undergoing any dental treatment, please consult with your dentist to find out which procedure is right for you.

Before and After Photos – Examine the dentist’s treatment results on other patients to make sure their work fits your dental needs.

References – Get a sense from other patients as to what type of quality care the dentist provides.

Continuing Education – Be certain that your dentist is an active AACD member and has taken continuing education courses to keep up-to-date with the latest techniques in clinical cosmetic dentistry.

Dr. Scott Finlay is an accredited member dentist with the American Academy of Cosmetic Dentistry and practices in Arnold, Maryland.  Information about Dr. Finlay and his practice can be found at www.AnnapolisSmiles.com.