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Inside Dentistry
May 2006
Volume 2, Issue 4

From the Editor

Gerard Kugel, DMD, MS, PhD

Dear Readers:

On behalf of everyone at Inside Dentistry, we would like to thank you for contributing to the success of our publication. Since our premiere issue, we have tried to remain faithful to providing you with in-depth coverage of current topics, along with clinical content.

This month we chose to look at the esthetic component of the dental profession with our cover feature, “The Smile Makeover Craze: What It Means to You and Your Patients.” Some may argue that “craze” is an overstatement. However, the fact is that more patients than ever before are requesting—and receiving—some sort of cosmetic enhancement to their smiles.

The Media’s Message. With the recent success of shows like Extreme Makeover, cosmetic dentistry has been brought into the spotlight and into mainstream attention. Patients are requesting the procedures they see being performed on these shows and assume that they can just as easily receive the same results. They may even insist upon having certain procedures, whether or not they are warranted or realistic. What’s more, they may even believe that the way procedures are performed on television is the only way to achieve an improvement in their smile. It is our responsibility as caring and ethical professionals to carefully counsel our patients about the many alternative esthetic possibilities available. Educating patients is not a choice, but a responsibility.

What’s the True Motivation. In most instances, smile makeovers refer to any combination of cosmetic dental procedures that enhance the beauty and appearance of the smile, and they are typically created with the use of tooth whitening, porcelain veneers, porcelain crowns, and/or porcelain onlays. Some people want to be the best in every aspect of their life, and if their teeth are not what they perceive to be perfectly esthetic, change is demanded. Older “baby-boomer” Americans want to look and feel more youthful, and a new smile is just one way for them to achieve that. Understanding the patient’s psychological state and motivations before treatment is very important; we are never just dealing with teeth in these cases but also the personalities behind them. If the patient is very unhappy with themselves, smile makeovers are not likely to make them feel better in the long run. Although a smile makeover can benefit many people, for others it might be inappropriate. We as oral health care providers must be able to balance patients’ expectations with the reality of what we can achieve.

A Case in Point. Some patients demand certain procedures that dentists might feel are unnecessary, It is our professional obligation to do what is best for the patient, not to do only what the patient requests. However, patients can be persistent, sometimes visiting multiple clinicians until someone takes their case. A former colleague referred a 50-year-old patient to me that he was uncomfortable treating because she was requesting veneers to enhance her smile. He felt she did not need this elective treatment. I consulted with the patient and told her I saw no reason for veneers, but she insisted they were the best thing for her based on what she had seen on TV. I told her that performing any procedure that has the potential for complications, let alone cost, would be unethical, especially when other less aggressive options exist. I explained that the minute I prepare her teeth, there would be no turning back. I suggested that a better option would be to whiten her teeth and perform some minor bonding, which at least as a first step she agreed to do.

The Patient’s Best Interest. It is our job to prioritize the oral care needs of our patients. We must educate patients about the risks as well as the benefits of the procedures they are requesting. As clinicians, we do our patients a disservice if we do not focus on their needs—and what they don’t need—as much as on what they want. We need to feel comfortable about the procedures we choose to do, and do everything in our power to inform patients about what is truly most appropriate for them based on our clinical experience.

On behalf of everyone at Inside Dentistry, we hope you enjoy this issue. As always, we encourage you to send us your feedback to And to ensure that you continue to receive everything Inside Dentistry has to offer, please sign up for your free subscription by visiting or by mailing the business reply card found in this issue.We look forward to your thoughts, opinions, and reactions to our clinical content and editorial coverage. Thank you for reading and, most of all, thank you for your continued support.

With warm regards,

Gerard Kugel, DMD, MS, PhD
Associate Dean for Research
Tufts University School of Dental Medicine

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