The other day I had a consultation with my long term patient, Chris.  Recently I had the opportunity to replace some old discolored crowns he had with one other porcelain crown on his upper front teeth; and the result we achieved was very pleasing to him.  He liked what I had done so much he started thinking about his crowded and discolored lower front teeth; and he wanted to know what, if anything, I could do for these teeth to improve his appearance.

As an experienced cosmetic dentist, the answer for his lower front teeth was quite simple really:  7 porcelain veneers or perhaps porcelain crowns in his case (see previous blog) would make a vast improvement and I knew he would be very happy with the result.

 Unfortunately, it was not quite that simple in Chris’s case.  Chris has been missing 2 molars on his lower right side.  Although he has managed adequately without these teeth; in the long term there would be consequences from not replacing these missing teeth:  his other teeth would shift, his unbalanced bite would lead to premature breakdown of other teeth or crowns, due to not having adequate support from his back teeth. 

Although Chris had the means and the desire to carry out the cosmetic dentistry on his lower front teeth; it would be imprudent of me to do so without addressing his missing lower back teeth.  I believe this is one of the factors involved in choosing a cosmetic dentist.  We should not focus entirely on esthetics without looking at the entire mouth as a whole.  Besides the factors I mention here, there are other dental areas that need to be addressed as well: such as the periodontal health of our patients.

In my office all patients that want cosmetic dentistry are first thoroughly screened for any other comprehensive dental problems that may exist.  This balance of ethics,integrity, and professionalism is a hallmark of a competant cosmetic dentist.

Most of the marketing you see for cosmetic dentistry these days has its emphasis on Porcelain Veneers.  In Fact; the term: “Lumineers” has recently come in vogue as if its a new concept.  A “Lumineer” is simply a thin porcelain veneer: one whereby there is little or no tooth structure removed prior to its placement.

 The major problem with Lumineers lies in the advocated technique: Unless you remove tooth structure, the resulting restoration is going to be bulky and lack the color properties desired for a nice result.

The technique is desirable to the public because it advocates that “no shots or no drilling” are necessary.  Of course this is the case if zero or little tooth preparation is needed; but I believe most people would gladly accept the needed local anesthetic to accomplish the tooth preparation needed for a proper set of veneers.  It is up to the experienced, confident cosmetic dentist to set the public straight about Lumineers.

Most people are familiar with the term “chicklets”: a slang term denoting bulky, overcontoured dental restorations.  This is the most likely outcome with Lumineers.  I believe that the proper amount of tooth reduction is a concept better understood by experienced cosmetic dentists; along with the dental laboratories and technicians that fabricate porcelain veneers. 

There very well may be select indications for lumineers, but my opinion is they are few and far between; and the public should be informed of this.