A need for specialization

June 1, 2005
Why is cosmetic dentistry so hot? Why do many general practitioners now offer porcelain restorations?

Why is cosmetic dentistry so hot? Why do many general practitioners now offer porcelain restorations?

One reason, of course, is economics. As insurance companies drive down fees for general dentistry, general practitioners look to specialized services to help sustain their income. Esthetic dentistry is particularly attractive because the market is booming and prices are high. Advertisements, fashion magazines, and television shows like “Extreme Makeover” show people that beautiful teeth aren’t just for celebrities. More and more people are willing to pay out-of-pocket for an attractive smile. But, income aside, I suspect that many general practitioners also deal with porcelain because the work is intrinsically interesting and professionally satisfying. The exploding demand makes it financially possible for dentists to do something that they really enjoy, and that patients appreciate.

That being said, I think the days of crossing over between general and cosmetic dentistry might be numbered. New materials, products, and procedures are rapidly developing. I think those who specialize in cosmetic dentistry are more likely to keep current with these changes and implement them into their practices. So, while it may have been possible for a general practitioner to also perform work in cosmetic dentistry five or six years ago, many believe that esthetic services today should be done by specialists. For instance, when people consider a $10,000 investment for veneers, I believe they now are more inclined to seek a specialist in cosmetic dentistry rather than a general dentist who treats a variety of situations encountered in a family practice.

Although I have great respect for general dentists, I think patients are more likely to receive consistent, high-quality esthetic results from a specialist who has a full-time commitment to the craft. Cosmetic dentistry requires extensive training through courses like LVI. This training is not offered by standard dental schools where students generally don’t specialize in adhesion, porcelain, partial coverage, or preparation. Thus, dentists must do a lot of postgraduate work in programs offered by institutes and labs. This work must be continuous to keep current with industry innovations. An effective cosmetic dentist is a perpetual student.

Also, practice makes perfect - or at least perceptive, flexible, and resourceful. An individual will master cosmetic dentistry by doing it every day, usually by beginning under the mentorship of experienced cosmetic specialists. “You can’t see what you don’t know,” says Dr. Kenneth Hamlett, an award-winning cosmetic dentist and lecturer. “Much like the Eskimo who sees 40 shades of snow, a dentist who practices on a daily basis encounters so many idiosyncrasies in so many mouths that crucial esthetic features just begin to stand out. I often know what’s wrong immediately - not because I’m a genius, but simply because I’ve seen similar cases.”

One important element of my experience involves tooth reduction. It’s crucial that dentists remove no more tooth than necessary. If there is not enough tooth structure left, a dentist can’t create acceptable replacements in future procedures.

For these reasons, I recommend that dentists who are interested in cosmetics make a full-time commitment. Esthetic dentistry can be very rewarding. Although cosmetic dentistry patients are often quite picky, they also can be very appreciative. Since you most likely see fewer people than a general practitioner, and tend to work with them longer, you develop close friendships. Clients have a great deal of respect for what you do because they consider cosmetic dentistry to be artistic - the creation of beauty.

When general dentists transition to full-time esthetic dentistry, they have plenty of help. Several institutes offer outstanding training. Dental laboratories are a tremendous resource, both for formal training and for informal support. MicroDental, for example, spends millions of dollars annually on continuing education, and structures its services so that dentists can take maximum advantage of its technicians’ expertise. Since these technicians see far more cases in a month than most specialists see in a career, their advice is often invaluable.

Don’t be afraid to take the plunge; there’s plenty of opportunity and plenty of support. You’ll enjoy yourself immensely.

Dr. Christopher Pescatore lectures worldwide on topics such as state-of-the-art esthetic procedures, techniques, and materials. He holds a U.S. patent for a nonmetallic post system to restore endodontically treated teeth. He is the former clinical co-director and current featured speaker at the Las Vegas Institute for Advanced Dental Studies. He has a full-time practice in Danville, Calif., dedicated exclusively to esthetic dentistry. He can be reached at (925) 362-9330 or at [email protected].