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Cosmetic dentistry: Reasons to smile

June 1, 2005
Dr. Nicholas Davis, president of the American Association of Cosmetic Dentistry, talks about recent growth and future prospects in the field.
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Dr. Nicholas Davis, president of the American Association of Cosmetic Dentistry, talks about recent growth and future prospects in the field.

Cosmetic dentistry has developed into one of the fastest growing facets of the dental industry. DE spoke with AACD President Dr. Nicholas Davis about the current boom in cosmetics, the AACD, and what the organization is doing to improve the cosmetic dental experience for its some 7,000 members.

DE: Through the years, how has cosmetic dentistry evolved?

Dr. Davis: Cosmetic dentistry has evolved because new dental materials have enabled dentists to achieve superior esthetic results without mechanical retention and with minimally invasive restorations. Adhesive dentistry utilizing composite materials has made it possible to improve the esthetics and strength of teeth without destroying tooth structures unnecessarily. This has made dental procedures more appealing to the general public.

Porcelain restorations have achieved ideal esthetic results by creating natural-looking teeth, and enhancing the overall appearance of the patient. Patients have been able to see the cosmetic outcomes that we have worked so hard to achieve in our operatories and laboratories. The desire of patients to look the best they can by improving their teeth, and the dentist’s ability to achieve these results, have led to an overwhelming positive awareness by the public. These positive reactions of the patients and dentists have encouraged and led to the evolution of cosmetic dentistry.

DE: Why is cosmetic dentistry one of the fastest growing areas in the dental field?

Dr. Davis: Dentistry in the past has focused on fixing problems because of tooth caries, missing teeth, or other destructive factors that necessitated restorations. The advent of cosmetic dentistry has allowed the dentist to provide elective procedures for cosmetic improvement in addition to problem-solving. The positive feedback by patients from their cosmetic dental experiences has been gratifying to dentists, and has been the impetus to further treatment plans with cosmetic improvement.

The continual development and evolution of dental materials and procedures have made it possible to replicate the lifelike properties of the natural tooth structure. Cosmetic tooth lightening, for example, has become increasingly convenient for the public, and is one of the most sought after in-office and over-the-counter cosmetic dental procedures. Tooth lightening is an entry-level cosmetic procedure that has proven to be a pathway for smile enhancements and other cosmetic dental-related procedures. This process has encouraged many patients to enhance the appearance of their smiles beyond the limits of age and nature.

DE: Down the road, what do you envision taking place in cosmetic dentistry?

Dr. Davis: I see the development of a clinical philosophy that is integrated with other supporting dental and medical specialists as one of the keys for the future. This philosophy will act as a template for incorporating cosmetic dentistry as an integral part of comprehensive treatment planning for ideal esthetic and functional dentistry. This philosophy will deal with long-term predictability by comprehensive problem-solving for the most ideal treatment results. This philosophy also will identify the indications and limitations of cosmetic dentistry, and will develop teamwork with all dental and medical specialists for ideal goals.

Teamwork will be encouraged with not only the dental specialists, but also medical cosmetic specialists to make cosmetic dentistry an integral part of facial esthetic treatment planning. The involvement of the medical community, especially cosmetic surgeons, needs to be addressed so the cosmetic dentist and cosmetic surgeon have a closer working relationship for the best esthetic outcomes for their patients.

The predictability of long-term results of cosmetic dentistry also will need to be studied. Cosmetic dentistry, as we know it, is in the infant stages of growth. There may be some shortcuts taken to facilitate cosmetic dentistry that prove to be a problem as dental cases mature. Gingivectomies, altered axial alignment of restorations, nonaxial forces during parafunctional habits, and occlusal discrepancies will need to be the focus for long-term success. This will allow us to better understand the limitations of cosmetic dentistry, along with the indications and rationale for our treatment proposals.

The education of the patient and the general public will continue to be paramount in building the practice of cosmetic dentistry, and is part of the mission of the American Academy of Cosmetic Dentistry.

DE: Tell us a little about the history and mission of the AACD.

Dr. Davis: The American Academy of Cosmetic Dentistry is a nonprofit organization that was co-founded in 1984 by Drs. Jack Kammer and Jeff Morley. Through the years, this organization has flourished - growing to approximately 7,000 members this year. The AACD, with members in 60 countries around the world, is dedicated to advancing the “Art and Science of Cosmetic Dentistry,” and encouraging the highest standards of ethical conduct and responsible patient care.

In those early years, the founding fathers felt a need to educate and build a network of qualified cosmetic dentists across the country that could be used as a referral source for patients seeking superior cosmetic dental care. This quickly evolved into much more.

Today, the AACD is the largest cosmetic dental organization in the world. It offers educational opportunities for dentists while providing accurate and useful information to the public. It has set the standard for cosmetic dental care, and offers an accreditation process for dentists to test their skills.

DE: Who and how can one join the AACD?

Dr. Davis: The AACD is unique because anyone can join the academy. Dentists, laboratory technicians, hygienists, assistants, business personnel, and corporations all comprise the membership of the AACD. Additionally, 43 dental schools participate in the academy’s University Advisory Committee, and 15 private institutions participate in the Private Education Advisory Committee. The academy views these universities and private institutions as playing a synergistic role in cosmetic dental education for dentists, laboratory technicians, and staff. To join, visit the AACD Web site at or call (800) 543-9220.

DE: What are some of the benefits or programs offered via AACD membership?

"It is important that cosmetic dentistry understands its niche in comprehensive dental care for the well being of the patient. A multidisciplined approach always should be considered when establishing an ideal treatment plan."
— Dr. Nicholas Davis
President, AACD
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Dr. Davis: The key benefits of membership in the AACD are associated with the ongoing information source available to its members. The annual scientific session is a five-day educational event, which has proven to be the premier source of cosmetic dental information. The Journal of Cosmetic Dentistry has emerged as the members’ number one acclaimed benefit. Other academy publications and pamphlets provide useful information for the cosmetic dental practice. The academy has established a credential in cosmetic dentistry that is known as accreditation for members who seek to pursue it and be tested to that level of excellence. For those members who qualify, the academy provides a referral service for the public on its Web site, which receives some 500,000 hits per month. The academy also has a charitable foundation, GBAS (Give Back A Smile), which restores smiles for victims of domestic violence. This foundation provides the organization with a humanitarian effort.

DE: What makes the AACD’s scientific session the primary source for cosmetic dental information?

Dr. Davis: This year’s annual scientific session in Nashville (held April 19-23) represented the 21st year of continuing education in cosmetic dentistry. The academy is grounded in education that is scientifically based, and provides cosmetic dental information to attendees for creating consistently successful results. In addition, the scientific session has courses that incorporate different treatment philosophies. The AACD has developed the reputation of being an open forum for new and innovative ideas and philosophies. Exposing the membership to this type of leading-edge information stimulates creative thinking, and cultivates an environment that often leads to breakthroughs in dental materials and techniques.

The academy brings together a collection of leading educators, who span the spectrum of cosmetic dentistry, for this annual meeting. It also has a myriad of other educational opportunities. These include hands-on courses, round-table discussions, digital photography courses, and tracks of learning for dentists, laboratory technicians, and dental team members. Many of the educational presentations focus on developing an artistic eye.

When you combine this type of educational experience with an extensive exhibit hall full of the latest in the field, social events such as a Dolly Parton concert, which we did this case this year), a 5K run, and a golf tournament, you have an event that is difficult to match.

DE: Explain the AACD’s accreditation program and the steps involved in the process.

Dr. Davis: The AACD’s accreditation process has evolved to reflect the protocol of traditional specialty examinations and testing. There are three key areas of testing. The first is a written test to establish a basic understanding of cosmetic dentistry and its role in the overall health and function of all the oral structures.

The second and most challenging section involves the treatment of five specific cosmetic dental cases, which are documented and achieved with dental photography. The cases include a direct veneer bonding case, a complex bonding procedure (diastema closure or Class IV composite restoration), an anterior tooth replacement case, one or two indirect anterior restorations, and six or more indirect anterior restorations. This may seem like a simple task since only five cases are necessary, but the challenge is that all five cases must demonstrate excellent dentistry. The dentistry and the tissues are evaluated with finite detail in this process. The degree of improvement is not as important as the excellence of the final treatment. Cases are blind-judged by a panel of calibrated accredited members. The pass rate for cases in the latest examinations was about 56 percent.

The final phase of the accreditation process is an oral examination in which the treating dentist must explain the treatment procedures and defend treatment choices. Treatment planning of a preselected case is the second part of the oral examination. There are slightly different criteria for laboratory technicians, who also are eligible for accreditation.

DE: What is the AACD doing to enhance its accreditation process?

Dr. Davis: This is a great question because several steps have been taken to help candidates improve the success of their submitted cases. Courses and workshops are offered that demonstrate ideal treatment, and the proper photographic standards for documenting a case. Digital photography is a newly accepted method of photographic documentation. The details of how these images are to be captured and presented are also described in academy courses. There was also a new “Accreditation Track” at this year’s scientific session in Nashville for those interested in seeing cases treated to accreditation standards.

In addition, particular attention has been paid to making the testing process impartial and nonbiased. Cases are evaluated by calibrated examiners without knowledge of the treating doctor’s name. Only a number accompanies each case to be evaluated.

DE: What are the future plans for the AACD?

Dr. Davis: It is important that cosmetic dentistry understands its niche in comprehensive dental care for the well-being of the patient. A multidisciplined approach always should be considered when establishing an ideal treatment plan. We want to establish cosmetic dental treatment guidelines that will help foster and maintain the academy’s respect and confidence with other dental and medical specialties and the public.

The academy hopes to increase its public affirmation so that AACD membership represents leaders in cosmetic dental care who are specially trained and capable of providing the highest level of consistent cosmetic dental care. These member dentists are the experts because of their education, training, and skills - not because of a marketing program that stands alone without the backing of advanced cosmetic dental education and experience.

The AACD also hopes to represent all cosmetic dentists, and to protect and gain special recognition for their additional training and ability. By setting standards of excellence, this organization has proven to be the leader in the field of cosmetic dentistry.

Dr. Nicholas C. Davis is a 1973 graduate of Loma Linda University School of Dentistry in Loma Linda, Calif. A member of the university’s faculty, he teaches esthetic courses to dental students, hygienists, and graduate dentists. He has earned a Master’s in the Academy of General Dentistry degree as well as a fellowship in the International Academy of Dental Facial Esthetics. In addition to publishing numerous articles on various topics, he has lectured nationally and internationally on cosmetic dental procedures and comprehensive dentistry. He maintains a cosmetic practice in Newport Beach, Calif.

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