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Ethical Cosmetic Dentistry

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  Posted by: The Probe      7th January 2022

In the last few decades, the ethics of cosmetic dentistry have been widely discussed. There was a time when it became the norm for celebrities to flash perfectly squared, bright white teeth on the red carpet. Of course, this set the tone for beauty standards in society and a full set of veneers eventually became another unattainable aesthetic for most. However, as time went on veneers became something the general public had more access to.

The Hollywood Smile

A lot of patients are under the impression that veneers are a permanent solution to achieving the “Hollywood smile”. Realistically, however, veneers are not as permanent as one may think and this is why patients need to be told clearly (and the clinician needs to ensure they understand) what they are committing to when they embark on the journey to a full set of veneers, for example. A study analysing data from over 80,000 adult patients revealed that 53% of porcelain veneers survived without intervention after ten years.[i] Suggesting that a large proportion of patients will have to undergo further treatment within ten years indicates that veneers are not an easy fix to achieving life-long aesthetic outcomes. Therefore, most would agree that neglecting to share facts and figures with patients whom show an interest in veneers is unethical.[ii] Furthermore it is argued that patients should be made aware of these figures as part of the process in order for them to provide informed consent.

Overtreatment

Various platforms of dental media exhibit pictures of what looks like overtreatment.ii Sometimes overtreatment occurs in cases where healthy teeth have undergone some kind of restoration in order for them to match the look of the teeth that required restorative treatment. These procedures do usually result in an acceptable aesthetic result but some might appear unnatural, false, de-personalised, and monochromatic. This kind of overtreatment also causes unnecessary destruction to healthy teeth which is generally deemed unethical in the profession.

Famously, Katie Price was pictured throughout full crown treatment which caused concern in terms of ethics. Unfortunately, however, this and other kinds of overtreatment happens more than one may care to imagine. A survey involving 681 people aged 20-34 revealed that 39% of adults received one or more replacement restorations in nondecayed teeth with fillings at baseline, while 18% of adults had one or more restorations in teeth with no decay or fillings.[iii] This shows that those who already had more fillings were more likely to be subject to overtreatment. There were other factors that led to overtreatment and these included a younger dentist, a busy practice, the dentist having less continuing education, a solo practice, higher fees, and a practice that advertised. As the survey focuses on people with fillings in terms of overtreatment one can only infer that a similar occurrence may appear in those whom have received crowns or veneers. It seems that patients who have already undergone some kind of restorative treatment are generally more likely to receive overtreatment.

It has also been argued that composite bond restorations can be a more ethical and less destructive option for patients.[iv] The UK generally presents more patients with severe levels of tooth wear in comparison to the US, for example, and many dentists have used composite bonding at an increased occlusal vertical dimension (OVD). It’s widely accepted that most patients adapt well to moderate changes in vertical dimensions without any issues. Therefore, many dental professionals believe that composite build-ups should be the preferred treatment option, having demonstrated success.

An Ethical Community

While there has been a lot of controversy and examples of unethical practice over the years, the majority of the profession are indeed concerned with ethics. A study based in Switzerland examined the ethical concern of dentists in response to different scenarios and revealed that dentists are sensitive to ethical concerns, even if the profession is susceptible to overtreatment.[v] However, the British Academy of Cosmetic Dentistry (BACD) could be the answer to one’s ethical concerns. Their mission it to make a difference to people’s lives by providing exceptional, ethical cosmetic dentistry. Uncompromising ethical standards is one of their values and they ensure this by educating their members. Membership means you will receive discounted access to CPD events, among many other benefits. In particular, The Modern GDP: The Anoop Maini Memorial Lecture in June 2022 will focus on occlusion, orthodontics, align bleach bond techniques, and more. As the modern GDP will need to prepare for all aspects of dentistry, the BACD actively promotes and facilitates well-rounded education for cosmetic dentistry.

Overall, ethics will always be a concern in dentistry and especially in the aesthetic field. As cosmetic dentistry is still part of the profession which is growing, dentists must stay educated and informed in order to maintain high ethical standards in practice.

 

For further enquiries about the British Academy of Cosmetic Dentistry, visit www.bacd.com

 

*All profits from this event will be donated to a charity chosen by Dr Neera Maini in memory of Dr Anoop Maini

 

[i] Burke, F.J.T., and P.S.K. Lucarotti. “Ten-Year Outcome of Porcelain Laminate Veneers Placed within the General Dental Services in England and Wales.” Journal of Dentistry, vol. 37, no. 1, Jan. 2009, pp. 31–38, 10.1016/j.jdent.2008.03.016. Accessed 25 Oct. 2021.

[ii] Kelleher, M. “Ethical Issues, Dilemmas and Controversies in ‘Cosmetic’ or Aesthetic Dentistry. A Personal Opinion.” British Dental Journal, vol. 212, no. 8, Apr. 2012, pp. 365–367, 10.1038/sj.bdj.2012.317.

[iii] Grembowski, David, et al. “Factors Influencing the Appropriateness of Restorative Dental Treatment: An Epidemiologic Perspective.” Journal of Public Health Dentistry, vol. 57, no. 1, Jan. 1997, pp. 19–30, 10.1111/j.1752-7325.1997.tb02469.x. Accessed 26 Oct. 2021.

[iv] James Trevor Burke, Frederick, and Martin Kelleher. “The ‘Daughter Test’ in Elective Esthetic Dentistry.” Wiley Online Library, 1 June 2009, onlinelibrary.wiley.com/doi/abs/10.1111/j.1708-8240.2009.00249.x. Accessed 25 Oct. 2021.

[v] Kazemian, Ali, et al. “How Much Dentists Are Ethically Concerned about Overtreatment; a Vignette-Based Survey in Switzerland.” BMC Medical Ethics, vol. 16, no. 1, 19 June 2015, bmcmedethics.biomedcentral.com/articles/10.1186/s12910-015-0036-6, 10.1186/s12910-015-0036-6. Accessed 26 Oct. 2021.


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