Ethical marketing in'aesthetic' ('esthetic') or'cosmetic dentistry'. Part 1.

UNLABELLED: Prior to undertaking any elective,'cosmetic' dental procedures, it is vital for the treating dentist to discuss the merits and drawbacks of all viable options. It is important that the patient understands what the consequences and limitations of treatment are likely to be, and what the potential failures could entail later in his/her life. Informed consent should be obtained (preferably in writing) and the clinical notes and records should be clearly documented, with accurate and concise details provided of all the investigations carried out, and their findings, as well as including details of the various discussions that have taken place. Dentists need to be aware of the existence of heightened expectations in this group of patients and be cautious about accepting patients who have unrealistic 'cosmetic' expectations. Where possible, cosmetic or aesthetic dental treatment should be provided which is minimally destructive and, in the long-term, be in the 'best interests' of the patient. Important matters such as the gaining of informed consent and maintaining meticulous, contemporaneous dental records will also be emphasized. It is hoped that the article will provide clear definitions of some commonly used terms such as 'ethical marketing', 'ethics', and 'values', which are often used in association with the marketing, planning and undertaking of supposedly 'cosmetic' dental procedures. The important role of less invasive alternative treatment options will also be emphasized. CLINICAL RELEVANCE: The aims of this article are to consider the common pitfalls that may arise when contemplating the marketing and provision of invasive,'cosmetic, dental restorations and to discuss how best to avoid a dento-legal claim where such treatment plans may not fulfil the patient's desired outcome.

Ethical issues, dilemmas and controversies in 'cosmetic' or aesthetic dentistry. A personal opinion.

Stephen Hancocks' elegant editorial of 11 December 2011 raises interesting questions which deserve discussion. Most experienced dentists would agree that the less that is done to teeth for cosmetic reasons, the lesser are the risks of disappointment, failure of expectation, or threat of litigation. Yet there is an increasing number of cases where aesthetics are the primary concern for dentists and patients alike and some patients are consenting to treatment without being properly informed of the destructive nature of the procedures to their sound tooth tissue and structures to achieve the desired 'cosmetic' outcome. This raises ethical issues, as much of this overtreatment is unnecessarily destructive and goes against the healing and caring principles of the dental profession.

The myth of instant orthodontics: an ethical quandary.

BACKGROUND: There is a clinical trend of using porcelain veneer restorations (PVRs) for the correction of malaligned anterior teeth. Use of PVRs for this purpose raises clinical and ethical dilemmas. TYPES OF STUDIES REVIEWED: A literature review of four different topics (PVR preparation, enamel thickness of anterior teeth, dentinal bonding adhesive effectiveness and PVR long-term success) was conducted to determine the optimal preparation for a successful PVR. The amount of tooth malalignment that may be corrected with a PVR without adversely affecting its success was calculated. RESULTS: The optimal preparation for a successful PVR may have dentin exposed in the body of the preparation. However, most of the preparation must be in enamel, and all the margins must end in enamel. The strength of a dentin bond varies greatly owing to a multistep, technique-sensitive cementation process and is weaker than an enamel bond. It is not possible to correct atypical gingival esthetics (uneven gingival margins, uneven papillae, short papillae and bulbous gingivae) resulting from malaligned teeth through use of PVRs. CONCLUSIONS: and CLINICAL IMPLICATIONS: Aligning a healthy tooth with a PVR is not a conservative procedure and more conservative treatment options (such as orthodontics, bleaching, direct bonding and enamelplasty) should be offered to the patient. In addition, the inability to restoratively improve gingival relationships with PVRs may result in achieving less-than-optimal esthetics. A clinician should present only treatment options that involve predictable, conservative restorations or that preserve healthy tooth structure. Aligning teeth with PVRs may create ethical dilemmas that can be resolved with the help of the American Dental Association Principles of Ethics and Code of Professional Conduct.