Cosmetic dental treatment is a risky business so make sure you reveal all to your clinician


Imagine the scenario, you have your wedding in a matter of weeks but are hugely self-conscious of the appearance of your crooked front teeth.

You book an appointment with the dentist, who briefly examines your mouth and advises you that you can improve your appearance by fitting veneers on eight of your anterior teeth – and that it will take two weeks to complete.

After agreeing the cost, you make two appointments at the earliest opportunity.

During the first appointment, the veneer preparation is carried out but the dentist has difficulty in obtaining adequate anaesthesia.

The following day, you return to the practice, experiencing sensitivity. The dentist applies a fluoride varnish and recommends desensitising toothpaste until the permanent veneers are fitted.

Two weeks later, you return to have the veneers fitted and again mention the pain. The dentist assures you this will settle down and he cements the veneers in place. You’re not really certain about your new look, but are reassured by the dentist who says they will look much better once the gums have healed.

You return to the practice the following week, accompanied by you husband-to-be, to express your disappointment at the results. You’re also pretty concerned at the volume of painkillers you’ve been taking.

The niggling tooth is still painful, your gums are swollen and bleeding, the bite feels uncomfortable and there are unsightly gaps between the veneers and the teeth. Quite simply, you’re fed up and the wedding is fast approaching.

But this is the first time you’ve told the dentist you’re getting married in a matter of weeks and – now that complications have occurred – it’s unlikely your new smile will be ready for your big day.

You also haven’t told him that your wore braces as a kid and never wore the retainer that you were told to. In fact, you never bothered to get one fitted – and this too was a piece of information the clinician needed.

Although cosmetic dentistry is increasingly commonplace, there are potentially serious consequences with any treatment when it fails to go to plan. All procedures come with risk and sometimes, despite your protestations, a dentist may refuse you treatment if, for example, your oral health isn’t stabilised

This can sometimes result in a conflict between you and the dentist or rather, your treatment desire and what he or she is prepared to carry out

Cosmetic treatment should only ever be provided after a thorough assessment has been carried out. This will involve an intraoral investigation of your mouth and a written record of your medical history.

Dental history
In the scenario outlined at the start, it would have been useful for the dentist to know that you had recently undergone fixed orthodontic therapy, but failed to return to have a permanent retainer fitted. Because of this, any cosmetic treatment was always likely to fail.

Social history
What motivated your concern about your appearance? The imminent wedding was an important piece of information that you both failed to discuss.

It is always essential that you discuss with your clinician your expectations so he can manage this accordingly. Taking in a photograph of a 20 year old celebrity with newly straightened teeth is pointless if you are 50 and you have neglected to retain your straightened smile from when you were a teen!

Before starting a cosmetic case, a thorough clinical and radiographic assessment is always necessary – with all the findings meticulously recorded. A radiograph will alert a dentist to any gum disease that needs further investigation and treatment.

Treatment options
A dentist should always offer you alternative treatments for consideration in order to achieve your wishes. Sometimes this means doing nothing. A second opinion can also often assist in your decision-making or you may be referred to a specialist.

On occasions, patients can apply considerable pressure to the dentist to carry out treatment but they should never embark on treatment they do not feel competent to undertake. Don’t try to flatter them into submission – they have your best interests at heart!

You may believe your dentist is the only person you to touch your teeth, but you must respect their professional opinion if they refer you elsewhere.

Also, listen to what they tell you about what is realistically achievable and ask them for mock-ups or ‘before and after’ photos of their own patients who have undergone similar treatments.

Computer imaging systems can also help you to see your dream smile at the touch of a button, but it is important that this doesn’t raise your hopes and expectations too much and to an unrealistic level.
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