Open Wide!

While the American Academy of Cosmetic Dentistry (AACD) indicates that 74 percent of adults feel an attractive smile helps a person's chances for career success, the jury is still out.

by Mickey Goodman

October 1, 2005

B eautiful people with teeth straight and white enough to glow in the dark smile broadly on the pages of slick magazines. Each ad touts glorious results in just hours through cosmetic dentistry. And while a quick look in the mirror might reveal less than perfection, the question of motivation comes to play before opting for new procedures. Though statistics from the American Academy of Cosmetic Dentistry (AACD) indicate that 74 percent of adults feel an attractive smile helps a person's chances for career success, the jury is still out.
 
One thing is certain, however. The business of cosmetic dentistry is booming. According to the American Academy of Dentistry (AAD), incomes rose 30 per-cent from 1997 to 2001 and have continued to rise since then, while over the last five years, whitening procedures increased by 300 percent, accounting for a $300 million industry. Direct bonding increased more than 100 percent and veneers by 250 percent.

There are multiple reasons for this phenomenal growth. One is that in decades past, adults expected to lose teeth as they aged. Now, they retain their teeth throughout their lifetimes and are looking for ways to re-create their youthful smiles. Another is the emergence of new dental materials that enable dentists to achieve dramatic aesthetic results with minimally invasive restorations. (Whitening improves the appearance without harming the teeth; adhesive dentistry or bonding strengthens without destroying tooth structure.) Family dentists have responded to patient enthusiasm by seeking advanced training through organizations like the AACD, which drew record numbers to its 2005 annual meeting.

Another departure from the past is that patients no longer rely on just one opinion. Because insurance doesn't cover cosmetic procedures, they've become informed consumers who seek several opinions, compare prices and insist on referrals. They even try out their new appearance via computer-generated images or snap-on teeth.

Recipe For Success?
Unhappy with the appearance of several old crowns, Debbie Masterson, vice president of administration at Turner Enterprises and assistant to Ted Turner, sought the help of Ronald Goldstein of Goldstein, Garber & Salama, LLC on the recommendation of a friend.

"The equipment and technology are very impressive," she says. "It's like walking onto the set of a James Bond movie. After seeing computer images, I realized my teeth needed more attention than I had originally thought."
 
Masterson decided on whitening, veneers on the top four front teeth and gum surgery to lengthen the appearance of her teeth. She was delighted with the results. "Cosmetic dentistry made me look and feel younger," she says. "Although I can't say I was promoted to vice president because of the smile makeover, it certainly didn't hurt."

An author and instructor in cutting-edge dental procedures, Goldstein has studied the correlation of an attractive smile and success in business. "One employer lamented that he couldn't hire a well-qualified candidate because of the appearance of her teeth," he says. "It upsets me that someone lost a job because of an unattractive smile. One of the best things people can do before a job interview is improve their smiles."

High profile personalities like comedienne Phyllis Diller, Home Depot founder Bernie Marcus and former heavyweight champion Evander Holyfield apparently agree and count themselves among the practice's patients.

Instead of focusing only on beautiful smiles, Goldstein and the five dualdegreed specialists in the practice have a face-focused approach to dental esthetics and look for the smile that best complements the facial features and shape. Because of the range of specialists, from orthodontists to periodontists to oral surgeons, and an in-house laboratory, their multifaceted approach features state-of-the-art technology such as three-dimensional CT scans, computer imaging, digital radiography, laser and extraoral video cameras.

After her husband lamented that she didn't smile any more, Martha English, owner of Romantic Destinations, decided to change the appearance of her yellow, stained teeth.

On the advice of a friend, she chose Debra King, DDS, of the Atlanta Center for Cosmetic Dentistry in Buckhead. English decided on porcelain veneers (wafer-thin pieces of porcelain that are glued over the front of the teeth) for the top teeth and whitening for the bottom.

The results are even more dramatic than she imagined. Not only did her husband applaud the change, but her professional life morphed from a business conducted entirely out of her office via phone or Internet into a business in the public eye. To add value to her travel business, she now plans bridal shows and has become a consultant with Arbonne, a Swiss company that sells cosmetics and health and nutrition products. "I interact with professional women from all over the world now," she says happily. "Without the veneers and whitening, I would never be doing this."

As one of the dentists selected to provide smile makeovers on ABC's Extreme Makeover, King is no stranger to the dramatic changes that can be achieved with cosmetic dentistry. "One of the women I worked on was a mother of three with a wide gap between her front teeth," she says. "The other patient called herself 'the ugly twin.' The results were dramatic and rewarding for me." King counts R&B singer Toni Braxton and rapper Big Boi of Outkast among her clients.

Georganne Fore, a teacher at Sequoia High School in Canton, says her career didn't factor into the equation. Although she was self-conscious about her stained, yellowed teeth with the part in the middle, she says, "I just wanted to feel better about myself."

After seeing Dr. Ruth Clemans' ad in a magazine, Fore sought her help. Despite a "horrible past experience with dentists," she decided on veneers for both upper and lower teeth. She also opted for sedated dentistry (twilight sleep). "I had no pain, even after I woke up, and [due to temporary crowns] the results were instantaneous," says Fore. "I certainly won't get a promotion because I had cosmetic dentistry, but my students tell me I smile more often and ask if I've been in a beauty pageant," she laughs. For Fore, that's satisfaction enough.
 

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74 percent of adults feel an attractive smile helps a person's chances for career success.
-American Academy of Cosmetic Dentistry, 2004

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An Evolution In Dentistry
The practice of cosmetic dentistry has developed into an art form that is marketed aggressively not only in magazines and newspapers but via television ads and programming like The Swan and Extreme Makeover. It is the proliferation of these ads that Robert Eberbaugh, DDS, a dentist with Roswell Dental Care, takes issue. "Cosmetic dentistry has gone too far," he says. "The gist [of advertising] is that you get someone to buy something they may not need. When I went into practice in 1972, dentists could only erect signs with letters two inches tall. Now they advertise on billboards."

He also takes issue with taking healthy teeth and grinding them down in order to add veneers. "I'm an ultraconservative: I want to save teeth," he says. When you [cut down] a healthy tooth, I feel like you're compromising the health of the patient."

Eberbaugh's convictions were formed early in his career, when he taught prosthetics at Emory University and saw firsthand the devastation of lost teeth. "I vowed I wouldn't become part of that," he says. "I believe in preventive dentistry." That said, Eberbaugh performs minimal cosmetic dental procedures like porcelain crowns, onlay sand inlays that preserve teeth.

Dina J. Geisler, DDS, a dentist and fellow in the Academy of General Dentistry, agrees with Eberbaugh on several points and draws the line when it comes to treating teens. "A lot of teenagers want us to put veneers on their teeth. I may do bonding or whitening, which doesn't damage the teeth, but I don't want to put veneers on teens. Some procedures should be reserved for adults," she says. "The mouth is a window to the body. If the mouth is healthy, the body is healthy."

One point of disagreement is the power of advertising, which Geisler does extensively. Another is the focus of her practice. Though she handles everything from fillings to root canals to extractions, Geisler's emphasis has gradually shifted to what she calls "cosmodontics." "Making a mouth look better fulfills a psychological need that gives a person more confidence," she says. "That confidence may give a person the edge to climb the corporate ladder."

Closing The Gap
According to patients, the only downside of procedures like whitening and veneers is the cost, which ranges from approximately $450 for a whitening procedure to over $1,000 per tooth for veneers and caps. But despite the cost, Evette Jones, vice president of sales and marketing for DTH Expediters, feels that her veneers, which closed the wide gap in her front teeth, have given her the confidence to smile more often and interact more effectively with customers. "I was extremely self-conscious," she says.

Jones, who had tried braces on two different occasions, also saw Clemans' ad. This time, she decided to try another procedure - but not before speaking with several other dentists.

The Mableton resident couldn't be more pleased with her veneers. "I didn't even feel the drilling," she says. "It's the least painful dental procedure I've ever had. Though people can't usually figure out what's different about her appearance, they ask, '''What have you changed- do you have a new haircut or highlighting?' I'd do it again in a heartbeat."

Clemans, whose practice is in Marietta, says that Jones's embarrassment about the appearance of her teeth is commonplace. "If people don't like their teeth and don't smile, they're considered unapproachable," she says. Conversely, people who smile appear friendlier. "For someone in sales like Evette, it can make a big difference in their business," she says.

Brace Yourself
In their combined 42 years of practice, the husband-wife duo of Michael Stuart and Melissa Rathburn of Atlanta Orthodontic Specialists have seen their practice evolve from one that primarily treated children to one that is 35 percent adult-based. Their adult-to-child ratio beat that published by the American Association of Orthodontists, which estimates that out of 5 million orthodontic patients in the United States and Canada, 20 per-cent are adults.

"There are several reasons," says Rathburn. "Today, patients have choices. One option is traditional wire braces, which are less visible due to the use of clear bands instead of metal. Another is a unique new system, Invisalign, that uses a series of 10 to 50 clear aligners in sequential sets that are worn 18 hours a day, except when eating. Aligners are replaced approximately every two months for a period of one to two years.

Regardless the system chosen, orthodontic forces move the teeth in the same way for both a 75-year-old and a 12-year-old. "But adults complain a lot more," laughs Rathburn.

The Bottom Line
In an age when cosmetic dentists advertise prolifically in magazines and on the airwaves, patients must be vigilant. It is imperative that prospective patients insist on postgraduate training and the resulting accreditation before selecting a dentist. And don't choose on price alone.

Although there are no statistics to chart the correlation between cosmetic dentistry and promotions at work, patients like English, Fore and Jones are thrilled with the results.

For people in the limelight - models, actors and singers - beautiful smiles are essential. But for others, it's probably the increase in self-confidence rather than the new smile that gives them the edge. Beauty is said to be in the eye of the beholder.

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99 percent believe a smile is an important social asset. Straightness and whiteness are the first two things people notice.
- American Academy of Cosmetic Dentistry, 2004

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Procedure-Definition-Cost
Porcelain veneers: Custom-made porcelain wafers placed over teeth. Cost: $1,000 to $2,000 per tooth
Whitening: In-office treatment and/or custom fitted take-home trays. Cost $400 to $650
Bonding: Composite resin applied directly to teeth, usually in one sitting. Cost: $200 to $500 per tooth
Tooth shaping: Shortens long teeth, rounds off points, etc. Cost: Complete in office in one visit; $25 to $75 per tooth
Resin or tooth-colored fillings: White fillings or bondings used to repair small cavities or chips. Cost: $100 to $400 per tooth
Gum lifts or gingivectomy: Removal of the gum to make teeth appear longer and the gum line even. Cost: $75 to $175 per tooth
Braces: Invisalign/Traditional braces  Cost: $3,500 to $7,500/$5,000 to $6,000
                   
*Fees vary widely from practice to practice. They are based on complexity of the procedure.

Selecting a Cosmetic Dentist
¥ Interview several dentists for compatibility. Choose someone you are comfortable with.
¥ Check professional credentials, such as certification by the American Academy of Cosmetic Dentistry, the American Academy of Esthetic Dentistry or the American Society of Dental Aesthetics and verify 25 to 35 hours per year of continuing education.
¥ Ask the dentist how many procedures similar to yours he or she has performed. The more, the better.
¥ Compare fees; they vary widely.
¥ Ask what laboratory the dentist uses, then check its reputation.
¥ Review "before and after" pictures of work performed by the cosmetic dentist you are interviewing (not stock photos).
¥ Request digital imaging to project the end result.
¥ Secure references and check patient satisfaction.
¥ Verify that the dentist does not have a history of complaints or adverse State Dental Board action (www.sos.state.ga.us).

Source: www.georgiasmiles.com