Wednesday, December 17, 2008


Hey all,

Before we start I want you to look at this image.
I want you to appreciate how pretty this person's smile is.
Now I want to do this exercise with me. Could you improve it?
Would you improve it?
So lets play....
All of you non-dental people I want you to double click on the image and try to find all the things you don't like about this person's smile.
All you dental people I want you to think about how you could improve this persons smile. Could you improve on the beauty that God gave this person?
We will come back to this in a while.
Now I will talk about me for awhile.
I know you think I crazy but I signed up to be the coach of my son's basketball team again.
If you are not a reader from way back you might know my trials and tribulations in 3rd grade basketball.
We were 1-6 and the last game of the season we got beat by a team that never won a game.
But the parents kept telling me how much the kids enjoyed it and they couldn't wait to be on coach Gammichia's team.
The two kids that were the toughest to control are not on the team this year but one of the better kids isn't playing either.
It is going to be another tough year. But I have to keep telling myself that, "its for the kids".
I can't get discouraged. I went to the 6 and 7th grade practices this week to see how disciplined they are and to scout some drills.
I am going to try to be the best coach I can be and stop worrying about all the other stuff.
Only two more days of work until my two week vacation.
Nothing yet on the National Championship ticket search. It is going to be real tough ticket.
But I am doing the best I can. Don't any of you have family that works for FED EX.
Help a brother out.
Okay the topic.
Did you look at the picture?
Don't you think this person has a beautiful smile.
Okay here is the deal, I got the 2008 American Academy of Cosmetic Dentistry "Special Edition"
this week.
You know that I think I am a pretty good dentist. You know that I can also appreciate it when someone else is a good dentist.
Now I look through this magazine and I feel like a shmuck.
The dentistry in this magazine is really good. I look at this stuff and feel like I still have a ways to go.
If my work is a 5 this work is an 11.
I read alot of the articles and see the types of materials the dentists in there use. It is really good stuff.
I am not jealous but...okay, I am a little bit.
Occasionally I have a problem with some of the stuff that someone does.
In this particular magazine I have a problem with someone's work.
It has to do with the above picture.
This was the BEFORE picture of the cover model of the magazine.
Gordan Christianson wrote a STATE OF DENTISTRY article about 5 years ago.
I don't remember exactly what it said he was addressing the cosmetic locomotive that was dentistry and he said there was way too much over treatment going on.
I believe in the AACD and what it represents. I am happy they are educating their students. I am thrilled by the strict hoops the dentists have to jump through to get in the academy.
They are making great dentists (the beauty in the magazine proves this). But I have to agree with Dr. Christiansen sometimes.
Okay before I go on here is after photo.

This patient was a hygienist/model.
I walked around my office and showed everyone the before picture and asked if they thought that this person had nice teeth. They all said, "YES".
So then I showed them the after.
Then I asked them if this person walked into the office and wanted veneers what would you say.
I can tell you I am really on the fence with this one.
I know in my heart of hearts that this woman has a beautiful smile.
I know that if I stand on firm ground and tell her that I don't want to mess with the beautiful smile God gave you.
She would leave my practice and go to the dentist down the street and get the veneers done.
I know that I can give her what she wanted. I know that I can do a good job for her and I know that she would be thrilled but....
So what is she thinking...that if I have a straighter, whiter smile, my career is really going to take off.
My assistant talked about the plastic surgery field. People have this perceived need...I hate my eyes or my nose is too big, I hate my double chin, my butt is too flat.
If the plastic surgeon doesn't do cosmetics he is getting past by.
But thank goodness we are not plastic surgery.
What is this woman/hygienist/model going to make it big because of this new smile. I don't think so. I mean she is beautiful. She is beautiful without the veneers.
What door is going to open up because her laterals are 1mm longer?
How is she going to feel about this decision when she is having them replaced for the third time when she is 75?
Now I am going to end this and I don't want you to think that I am bashing anyone.
I have not really made my decision about what I would do if this woman walked in my office.
I do know that if it was my daughter, she wouldn't be doing veneers.
My wife has 4 composite veneers because of peg laterals. My father and I did them about 16 years ago.
Does she need veneers right now? No
Could I do veneers now? Yes
Would they look great? Yes
Am I struggling with this? Yes
I mean they look pretty good. No non dental person would ever know.
But I know every dentist probably knows.
Okay enough back and forth for today.
What do you think?
ps I did a lecture in North Carolina (about 5 years ago)and asked this very question to a bunch of dentists.
If a patient came in with nice teeth and wanted veneers would you do the veneers. I think about 95% of them would NOT do them.


Anonymous said...

I showed this exact thing to my wife last night and we both thought the before looked better than the after. Are we as a profession trying to change what is "beautiful"? Plastics has managed to create a new standard for breasts. Is that good? I would pass on this case 100% of the time. I recently saw a lecture by the Magne brothers on "biomimetics". Dentistry at the highest level doesn't look like dentistry. This case took a beautiful smile and replaced it with very nice dentistry. There was some beautiful work in the AACD mag. but I, too, was confused by the selection of the cover story. When we start changing things that naturally looks that good, it is a slippery slope and, in my opinion, lacks humility. By the way, I am in North Carolina. I am curious if your question posed about the questionable veneer pt. would have had the same response in a different region of the country? Thanks for bringing up this issue!

gatordmd said...

Hey Will,
Thanks for your comments. I get worried when I speak out. I want to talk about an issue and not offend. This issue does have a potential to really get people riled up.
About the survey in North was the only state that was weighted so heavy to the conservative side.
Thanks again,

Unknown said...

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