by Jean A. Sagara
Surveyed dentists concur that cosmetic imaging boosts case-acceptance rates and improves case-planning and communications.
Elective dentistry is evolving. It looks as if the tooth fairy soon will be bringing a new tooth - or even several teeth - to anyone who wants them simply by visiting the local dentist. You already can drop into a spa and have an assortment of cosmetic dental work done while receiving a massage or other indulgences. Teenagers can go to the mall (to the alarm of many dentists) and buy a home bleaching kit.
Cosmetic dental services are exploding. The consumer is driving this trend together with emerging improvements in technology. To quote from David A. Garber, DMD, in a press release issued by the ADA before its October 2000 conference:
"We're moving from a needs-based dental practice to a wants-based practice; that is, from taking care of pain to improving the way people look and feel about themselves ... Up until recently, we didn't have the techniques and materials available ... the cosmetic techniques were primarily focused on taking care of problems in single teeth. Now, we look at the whole smile. We can revamp an entire smile and develop harmonious dental-facial relationships."
An image comes into focus
Cosmetic imaging (CI) frequently is the early handmaiden of cosmetic restoration. It is a way to educate the patient about treatment outcomes. It certainly is a potential way to secure commitment and establish reasonable expectations as our April article on this subject detailed. Something as popular as tooth whitening frequently sells itself, but the advertisements illustrating the benefits - relying as they do on the "before" and "after" images from cosmetic simulation - have supported dramatic growth. Today, tooth whitening is estimated to be a $600 million industry reportedly growing by 15 to 20 percent per year.
To see just how commonplace CI is in an e-library, we took a stroll down "Web Lane" on www.google.com. The results were stunning. For example, by keying in the words dental cosmetic imaging, 11,400 references are found. If you then scroll through every fifth page, (assuming you have the time), and click on the occasional item of note, google.com actually shortcuts the review by eliminating all duplicates. This results in an edited listing of more than 800 references! A visit to a sample of sites reveals many articles, professional dental associations that report on the service for the industry, consumer-directed tooth-whitening clinics, media/news clips, and the occasional trade or academic journal reference. The vast majority of references for dental cosmetic imaging, however, are Web sites for individual dental practices.
The way of the Web
While it may be unrealistic to scroll through all of these references, the frequent use of the term dental cosmetic imaging is impressive. Otherwise, the search engine would have reported on far fewer references. Clearly, cosmetic dentistry is changing the dialogue between dentists and patients. CI has not only expanded the vocabulary of that conversation, it also has illuminated it. As a set of key words, dental cosmetic imaging is linked with most aesthetic and restorative dentistry references. Importantly, it has become a term of art for many dentists. Apparently, if the google.com search is representative, the number of dental practices whose Web sites talk about CI is great. The term cosmetic imaging has assumed a familiarity that suggests widespread understanding and use. Certainly, imaging of various sorts is becoming associated with contemporary dental care. In this particular instance, however, the broad sweep of a search engine lets the Web traveler find his or her way to a finer smile, or at least to a computer-simulated one.
Position is everything on a search engine listing. At the top of each search page produced from the key words dental cosmetic imaging were two other sites: www.dentaldocshop.com and www.dentistryinamerica.com. Both provide consumer information on dental health care. No doubt, each site is supported by an advertiser paying for a strategic location and capturing sustained traffic. While not as strategically placed, but more captivating by its name alone, is www.floss.com. This site advertises itself as "... the one-stop source for all dental information online." We took only a passing glance at all of these sites, but they appear to provide the visitor with various forms of information on both cosmetic dentistry and CI services.
Consumer outreach
Professional associations, particularly the American Academy of Cosmetic Dentistry (AACD) and the Academy of General Dentistry (AGD), provide additional CI information. These sites appear early in the google.com listings for dental CI - a useful feature for the consumer who would not otherwise be familiar with the names of these professional organizations.
Given the numbers of dental Web sites the imaging search uncovered, it is safe to speculate that many of the approximately 36,000 members of the AGD are introducing more cosmetic dentistry into their practices. In fact, the AGD reports that more than 88 percent of their members routinely perform cosmetic procedures. Market demand is the key stimulus. At the 48th annual meeting of the AGD in Toronto last summer, they reported that "... more than 1,800 consumers called their SmileLine on one day, July 20, to seek cosmetic and general dental advice." Tooth whitening was at the top of the list of inquiries made by these callers.
Another indication of consumer demand stimulation is a promotion on the AACD site for the "Gift of a Smile" program. Begun in the spring of 2001, this program allows a consumer to purchase gift certificates redeemable for cosmetic dentistry procedures at any AACD member's office. The certificates carry a monetary value and are not tied to specific procedures. Presumably, a visitor to this site is attracted to the promotion and uses the AACD Web directory to locate a professional member nearest them. By using the dental cosmetic imaging key words, once again, the search takes a Web traveler to these and many other helpful sites.
A journal of the University of Pennsylvania Medical School, IntelliHealth, stated it best in considering the phenomenon of rising demand for all forms of aesthetic dentistry. It indicated that the dental industry was experiencing "smile inflation." The AACD clearly supports this. It reports that the use of cosmetic restorations using veneers has increased by more than 250 percent, while the use of dental implants has increased by 200 percent. For some of this treatment, the patient's election to proceed with treatment was made with the help of simulation imaging. In addition, the opportunity to provide patient education through simulation imaging can be seen as one of the most important benefits associated with CI. Robert Pick, DDS, a noted national lecturer and practicing periodontist in Chicago, made the case for the education value of CI even more eloquently: "Cosmetic imaging is very powerful as an educational tool. Photos, CI, and other visual aids are so often left out of the diagnostic process in educating our patients to what we can do."
The dentists weigh in
To follow up on our cosmetic imaging and communications survey conducted with labs and imaging providers last month, we posed a similar set of questions to a small cross-section of practicing dentists. Surprisingly, only half of the participants indicated that they use CI. Some of this can be explained by the specialty nature of their work in serving distinct communities for which cosmetic dentistry would not be an option. Others either did not attach a value to CI or were too early in their careers to move in that direction.
Case acceptance is the leading benefit: Of those who use CI in their practices, case acceptance ranks as the number-one benefit ascribed to the technique. Sharing the second benefit position were improved laboratory communication and case planning. Managing patients' expectations and increasing business tied for third place.
Diastemas lead with most indicated use: We asked the dentists to indicate what cases were most often associated with CI. The most frequent use indicator was a correction for diastemas, followed by the general category of restorative dentistry. The survey did not break this category down any further. Procedures to lengthen teeth were identified as the third most likely indicator, followed by teeth whitening as the fourth most frequently cited reason to use CI.
A growing contribution from technology: All the dentists who use CI in their practices agreed that the technique would see increased use in the future. Even those dentists who reported no current use of CI acknowledged that it was a growing trend in dentistry. The drivers for expansion included the desire to secure a successful outcome on the part of the dentist and patient demand, respectively.
Lab communications and technology
On the matter of lab communication, surprises occurred once again. With the exception of one respondent, CI was not seen by any respondent as a way to improve laboratory communication. Indeed, the majority of survey participants - including those who are not using CI services - indicated that lab communication in their practices was working well.
Technology can take no particular credit here, at least for these few survey participants. Two-thirds of them use the telephone as their preferred means of communicating with a lab, which is explained by the number of surveyed dentists who have practiced for at least two decades. "Don't fix something if it's not broken," could be one philosophy. Moreover, people generally enjoy the success of their habits.
Another one-third chose the online lab script as a useful communication tool with their labs. This question was not specific as to a lab's own online prescription template or the online services such as eLabRx or DentistRxOnline. Email is the third most frequently used communication channel with labs. Many respondents, of course, selected more than one communication method.
The survey respondents included general-practice dentists and specialists who graciously agreed to complete a questionnaire. To profile them further, the experience level ranged from recent graduates to a dentist in practice for 32 years. The average time in practice was 19 years. The average number of labs that a dentist worked with was four. The range went from two to seven labs (one participant did not work with any lab). Generally, these participating dentists practice in the Northeast and Southwest.
Without regard to the use of CI services in their practices, all of the surveyed dentists were willing to rate their comfort level with other forms of technology. This included cameras, online radiology, consultation, purchasing, CI, and several more. (For a more complete review of the Technology Comfort Grid, visit Jean's Resource Listing at www.transcendonline.com).
The highest comfort for all of the dentists responding was with digital cameras, followed closely by intraoral cameras. Online networking, online purchasing, and online lab scripting took a collective third place on the technology comfort scale. Ironically, online CI received a low comfort score, suggesting that those who use CI services do so by contracting with an imaging vendor or lab that offers this service. Many dentists acknowledged no familiarity with a given technology such as online Web rounds or online second opinions. Naturally, other individuals marked a high comfort with technologies across the board. Dr. Dwyte Brooks, DMD, a general practitioner from Nevada who has been in practice for 26 years, is an ardent technology enthusiast. He gave us permission to share his survey comments:
"We currently have 22 workstations online and on the Internet 24/7. [We have been] chartless for four years, [have had] digital X-ray only for five-plus [years]. We are constantly bringing new technology online. The latest is shade matching."
Dr. Claudio Levato, DDS, a nationally recognized lecturer on technology who practices in Bloomingdale, Ill., provided a similar endorsement for the future of technology in dental care. In the survey, he remarked that current trends are moving the industry toward "... total image management incorporated into clinical computer applications ..." To our question concerning the Web as a workplace, Dr. Levato replied, " ... ultimately, most of what we do with computers will be Web-based."
Where does that leave us with cosmetic imaging? For one thing, it leaves us with a public eager to look their best; for another, with prospective patients seeking a dentist's intervention, because society approves of it and technology allows for it. The times have improved both the choices and the results. Today, online images can inspire, but, importantly, as Dr. Pick reported, they also can educate. So it seems reasonable to strike a note of cautious optimism concerning these developments in dentistry. While CI brings many benefits, it is merely the beginning of what may be its highest value: the opportunity to engage the patient in an instructive dialogue.
"Ah, Vanity," Hamlet wryly comments, "thy name is Ophelia." As the 21st century unfolds, one might observe that Shakespeare's heroine no longer stands alone! That which is human for all the ages remains just that.
