Re: Oral Health, April, 2007 (July 01, 2007)

First, I am not sure that the picture on the cover page is appropriate for a professional magazine. Could not the message have been equally “affective” with a head and neck photo, which shows the smile. We are dealing with teeth.

Second, yes many of the articles are showing great post-op smiles. I am not sure that a three quarter porcelain crown qualifies as a veneer as many of the articles seem to state. We all have our own visions.

Third, the rebuttle by Dr. Soll is probably justified to some extent but it does seem rather negative. I am not sure that is the role of an editorial board member for the magazine. When a professional makes comments about the dentistry he has seen done by others without any knowledge of what had been explained to the patient. We all know that we frequently suggest to patients that they require a crown and it is not done — this does not mean the dentist had any role in “under treating the patient.” I am sure there are many dentists that see my patients and those of every other dentist including Dr. Soll, and wonder why certain things were not done.

We need to get away from the notion and the accompanying banter, that veneers are right or wrong. That cosmetic dentistry is right or wrong or even that amalgam or resin restorations are right or wrong. Each of these is a valid treatment modality that needs to be explained to the patient. The real issue is has the treating dentist obtained full informed consent?

If the patient knows all the pluses and minuses of any treatment then it is the patient’s decision and that decision is right for that patient. Has the dentist explained that the veeners are not permanent treatment? That the expected longevity depends on the patient’s oral habits including personal hygiene routine, bruxism, fingernail biting, etc, etc.. Gone are the days when the “doctor knows best.” To the best of my understanding, Dr. Dorfman, of Extreme Make-over fame, explains to the patient that according to the ADA they could last 10 years or more but they may last less. If that has been explained then it is the patient’s decision to remove the protective enamel from the teeth for cosmetic reasons and that, in a younger person, this will have to be redone multiple times over their life of that patient. Do I do veneers? — yes, probably not as many as others; however, I do tend to find that many people shy away when they are provided all of the information to make their decision. They seem to think that everything we do is permanent and we know that it is not. We even know that is what they think. We need to tell them that it is not permanent. The result will be that some patients will not have the treatment done. It is cosmetic, it is optional, it will not hurt the patient physically if they do not do elective treatment — it is their choice.

Dr. Christopher Cottle

Barrie, Ontario