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As an “insider”, I would be more concerned if a quoted fee for crowns, bridges or porcelain veneers were low.

That would suggest to me that the best materials (like gold and platinum) are not being used and the workmanship is going to a low-level, undercompensated technician.

There are many dental laboratories overseas that heavily advertise low prices and fast return time. Material contents and technical procedures followed are often substandard and/or unknown.

Yes, there are some great Dental Technicians and Dental Laboratories in Europe and Asia, but their fees are as high as or higher than the best here in the USA.

We only get one mouth. My saddest task is to replace dental work that has been recently placed. The teeth are often over prepared, the gum tissues insulted and swollen, and dental nerve damage (requiring root canal treatment) has occurred.

Often my patient has been damaged psychologically from the negative, often painful treatment experience and the disappointing “smile” they received. Now it is much harder for us to get them healthy and smiling again.

Philadelphia Magazine published an article called “How to Buy the Perfect Smile” in February of 2004. The author, Ms. Carol Saline, did extensive research into the fees for cosmetic dentistry. It was well researched and accurate.

She discusses the fees for crowns, bridges, veneers, etc. that the most reputable dentists charge and tells who they are. And, she gives guidelines on “How to choose a cosmetic dentist” which I will repeat for you here (below).

By the way, Philadelphia Magazine has done only 3 issues featuring Dentistry: 2 on “Cosmetic Dentistry” (1981, 2004) and the recent first time “Top Dentists” piece (2010). I am in all 3.

Here’s what Carol Saline said in the above mentioned article (pg 106): “Any practicing dentist can use the word “cosmetic”—and legions of them do.

Unlike in medicine, there is no formal training or board exam to certify a cosmetic dentist as qualified. While there are official-sounding cosmetic dental associations, membership is voluntary.

The American Academy of Cosmetic Dentistry takes pretty much anyone who wants to join…The more exclusive American Academy of Esthetic Dentistry has fewer than 10 local members, who can only be admitted by peer recommendation and must make presentations to be accepted.” (Please note: I have been a member of the American Academy of Esthetic Dentistry, www.estheticacademy.org, for over 20 years.)

Here are 5 of the guidelines from Ms. Saline’s Philadelphia Magazine article:

  • Ask to see a variety of before-and-after photos. Good dentists always document their work.
  • Ask what courses the dentist has taken and whether they were simply lectures or involved hands-on participation.
  • Does the dentist teach? Faculty members tend to be up on the latest techniques and technology.
  • Does the dentist publish? That shows a willingness to expose his or her work to peer review.
  • Is the office clean and modern?

By definition “cosmetics” are surface applied beautifiers like lipstick or eye shadow. So, “Cosmetic Dentistry” procedures can be beautifying additives to teeth, like bonded resins or laminate veneers.

“Esthetics” is the much more holistic study of overall form and symmetry. The process of “Esthetic Dentistry” is designed to enhance overall facial symmetry and attractiveness using dental surgical techniques (gum lifts, jaw surgery), tooth movement (fixed braces or clear aligners), and restorations of varying types (crowns, tooth supported bridges, implant supported bridges, laminate veneers, resin bonding, etc.) that bring the teeth and smile into alignment with the face.

Sometimes I do “Cosmetic Dentistry” when the teeth and smile are in a good place and only need surface enhancements: cosmetic contouring, natural whitening, resin bonding, and/or porcelain laminate veneers. And sometimes I do “Esthetic Dentistry” when the teeth and smile are not attractively composed and actually clash or discord with facial symmetry and harmony.

Re setting the teeth and smile to follow facial symmetry and harmony has produced some of my most spectacular results (see case studies) and most delighted patients.

So, sometimes the right path is “Cosmetic”…and sometimes it’s “Esthetic”…but I always bring a rational thought process based on over 30 years of experience, teaching, inventing and product development to guide my patient in the right direction for them. That is truly “expert smile design”.

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