Re: Editorial, When Did the Line Blur? February 2006

I understand Dr. Zamon’s frustration as he discussed in his editorial “When did the line Blur” from the standpoint that certainly, assuming that Dr. Zamon’s clinical description is in fact correct, the dentist misdiagnosed and treatment planned this case. However I take exception to the inference that this was because of the fact that this dentist was a “cosmetic dentist”.

We are all painfully aware that there is no such specialty as cosmetic dentistry — we are all general dentists or prosthodontists, or for that fact, orthdontists, periodontists and even paedodontists who in fact practice cosmetic dentistry. It was therefore entirely incorrect for Dr. Zamon to refer to this dentist as a “so called cosmetic dentist”.

Dr. Zamon continues in his editorial with a negative comment about the fact that many dentists have expressed an interest in creating a “specialty in cosmetic dentistry”. In fact some sort of qualification program, as opposed to “specialty” status in cosmetic dentistry, such as a University based Diploma or certificate, or even the adoption of the AACD’s widely recognized accreditation program, would be highly beneficial to the public as well as the profession.

This idea is nothing new, and in my opinion would help solve the current problem where almost every sign we see says family and cosmetic dentistry, (neither of which is legal in the province of Ontario because neither is a recognized specialty which can be misleading to the public.) How is the public to know who has taken this extra education and proven their proficiency in this developing segment of practice? How does preventing those qualified dentists from being able to advertise that fact protect the public? Does the public not have the right to decide who to see for their treatment, and should informed consent not also include the ability for the patient to know all the qualifications of those they choose to seek various types of treatment from other than a sign?

The students who graduate from our dental school are only given one colour of composite to work with and most have never done a veneer! Principles of smile design and perio aesthetics, implant aesthetics, ridge augmentation, materials selection such as Zirconium cored porcelain crowns, E Pontics, resin cements to alter not only colour but value of indirect veneers, principles of occlusion as it relates to cosmetic dentistry both in the anterior and posterior segments and many other fundamentals of cosmetic dentistry are terms and principles that most students and many dentists have never even heard of. Yet their sign proudly states “family and cosmetic dentistry”. Would it not be better to create a situation where our patients are given the choice to attend a dentist who has proved his or her knowledge and proficiency in the field?

The AACD accreditation program makes sure the dentist is able to demonstrate knowledge and proficiency in all areas of dentistry, both in treatment and treatment planning, including occlusion, perio, ortho and restorative dentistry techniques, before they are granted accreditation.

Many dentists are quite capable of performing cosmetic dentistry at a very high level and I would urge them to attend the TACD and join the CACD and AACD or CAED and prove themselves by attaining accreditation.

The dentist Dr. Zamon described has certainly forgotten that cosmetic dentistry must only be a part of a comprehensive treatment plan developed for the patient according to the needs and desires of that patient, and should be started only after other areas of treatment have been completed to ensure the health of the patient and the practice of minimally invasive dentistry. I applaud Dr. Zamon’s frustration at this dentist’s lack of understanding of the basic principles of treatment planning in this case.

Dr. Ron Goodlin

Aurora, ON


I concur with his observations 100%. The problems are often compounded by some of the courses and extravaganzas that our peers are attending and then implementing in order to increase their practices bottom line by X fold. With the latest scientific evidence linking dental health to overall health it would behoove our profession to allow more resources and expend more of our energies in early detection of diseases. Many Canadians are experiencing difficulties in finding a family physician and as dentists we see these patients on a frequent basis. Taking their blood pressure and glucose readings at a recall visit would lead to early detection and timelier treatment of diabetes and hypertension. Joining the CTI program (Clinical Tobacco Intervention Program) in counselling our patients especially the large numbers of youth who are smoking and helping them quit will lead to personal and professional satisfaction. Continuing public awareness of oral cancer screenings and interpreting medical and pharmacological histories for drug interactions and inconsistencies, would lead to better overall health. I hope the majority of Canadian dentists practice as Dr. Zamon and not like the examples he showed us. Thank you for drawing a clear line.

Ira R. Kirshen DDS

Richmond Hill, ON