Communicating with Your Dentist: Considerations before Getting Porcelain Veneers, Crowns, Dental Implants, and other Cosmetic Dental Treatments

The consultation process should involve a detailed analysis of your smile. This will involve the following:

• History and examination
• X-rays
• Determination of your smile pattern: commissure, cuspid, or complex. You have to make sure you’re getting a smile that fits your particular pattern, so that the lines follow each other and the effect is natural.
• Photographs. I can’t emphasize enough the importance, during the consultation, of a detailed analysis of photographs of your smiles. It is vital for your dentist to take into account your smile pattern and the precise stages of your smile.

There’s nothing more tragic than a patient who, for example, tells their dentist, “I don’t show enough teeth when I talk,” only to find out, after having their teeth made, that they now show far too much tooth when they smile broadly.

• Wax mock-ups to see what your teeth are going to look like. Digital imaging is sometimes done, but this can be highly inaccurate and misleading. Base your decision on digital imaging only if you have been assured that what you’re seeing is what you’re really going to get as a result of your procedure.

Always remember that when you’re looking at a mock-up of your finished smile, you’re looking at you smile without lips. The apparent arrangement of the teeth and gums may not tell you how your lips will interact over them. When you talk, for example, your mouth could look too “toothy.”

• A properly written and executed informed consent contract dealing with the pros and cons of your treatment and potential problems associated with it:
  • How long the work is guaranteed.
  • Whether there will be an extra charge if something goes wrong.
  • What happens if the problem is directly related to the work. What happens if it is indirectly related.

Consider the following scenario. You have your upper teeth capped, and your dentist guarantees the work for two years. If the cap itself breaks during that time, you get a new cap at no cost. But what is something else occurs as a by-product of the process – say, the tooth dies from the capping process and you now need a root canal? You have not paid for a root canal, so it’s not going to be covered under your guarantee.

• Discuss exactly who will do what. What work will the dentist do? What parts of the procedure will be performed by other technicians?
• Also go over the kinds of materials that will be used. In particular, find out about the ceramist and their work.

A smile is only as good as the ceramic work that goes into it. Most dentists in North America do not identify the maker and supplier of the ceramic work. In many cases, ceramic work will be contracted to an off-site lab. Meet the ceramist, if possible. That way you can get personal assurance regarding their involvement in the case and commitment to the results.

There are as many types of ceramic material as there are cars, from Chevrolet ceramics all the way to Ferrari ceramics, with price tags to match. Understand what ceramic materials you’re paying for and why. Why has the dentist chosen this material for your particular problem? The materials used can make a huge difference to the end result of your treatment.

Edward S. Philips, D.D.S.