Introduction

According to the American Academy of Cosmetic dentistry (AACD), Cosmetic dentistry

is comprehensive oral care that combines art and science to optimally improve dental health,
aesthetics and function. The desire to look younger and beautiful in general population is
increasing. “An improved smile is one of the most easily changed aspects of the aging process”.
According to a 2007 survey commissioned by the AACD, the demand for cosmetic dental
treatment is growing each year (Citation). In 2006, the last year for which data are available,
American adults spent $511 million on teeth bleaching and veneers.

Besides AACD, any other sources which indicate that cosmetic dentistry is big business.
Your whole paper is essentially health vs. money.

Why is cosmetic dentistry so big? Paragraph on each of these

Aggressive media

Longer life span means people are looking to stay younger

The psychological benefits of looking better

Each of us has a general sense of beauty. However, our own individual expression,
interpretation, and experience make it unique, however much it is influenced by culture and self-
image.

Gradually, the public has been made more aware of the “aids to nature” that Hollywood stars
have been using since movies began. They discovered that their favorite actors, models, and
singers used techniques of dental esthetics to make them- selves more presentable and attractive.
Some followed the Hollywood lead and asked their dentists to give them teeth like those of some
celebrities and thus learned of methods and materials that could improve their appearance.

A desire to look attractive is no longer taken as a sign of vanity. In an economically, socially,

and sexually competitive world, a pleasing appearance is a necessity. Since the face is the most
exposed part of the body, and the mouth a prominent feature, teeth are getting a greater share of
attention.

Esthetic dentistry can help achieve self-assurance, it must always be predicated on sound dental
practice and keyed to total dental health. The limitations of esthetic treatment must be
communicated to the patient by dentists who are fully conversant with the procedures, methods,
and materials available.

The purpose of this paper is to discuss the ethical dilemmas involved in cosmetic dentistry and
propose certain guidelines which can aid the practitioner in decision making. Also to propose
certain esthetic dentistry scenarios and provide ethically based decisions.
What are all the necessary components necessary in order to provide esthetic treatment?

According to Du Rubaix, patient should be mature. He gives criteria such as the decision should
not be a whimsical one, the patient understands irreversibility, the patient understands advantages
and disadvantages.

Autonomy:

According to the ADA, principle of autonomy expresses the concept that professionals have a
duty to treat the patient according to the patient’s desires, within the bounds of accepted
treatment, and to protect the patient’s confidentiality. It is dentist’s duty to inform the patient
about all the risks and benefits of the treatment and any reasonable alternatives. Once patient
understood let him/her choose the treatment. Cosmetic dentistry provides an interesting
dilemma when a patient would like a particular treatment and that treatment is not for any illness.
In this case, the dentist is not producing any concrete health benefit and is only providing the
risks of treatment. The dilemma is one of the patient’s autonomy versus non-maleficence. The
problem arises when patient requests for a treatment which is not suitable for him/her. Let’s take
an example of a patient who asks for a gold crown on a healthy lateral incisor. The patient is
choosing this as an esthetic treatment. Benefits include the following. Risks include the
following. Now as a health professional, you would first explain the risks and benefits of the
procedure. In this case the only benefit esthetics but risks are way more like sensitivity, pulp
exposure, possibility of root canal, or even extraction. Talk about how dentists should be held in
higher regard than a tattoo artist.

Dentists must “ensure that the patient’s expectations are realistic” – SR Mousavi

In this situation

- Conflict between ethic principles

- Respect autonomy or (beneficence, nonmaleficence, and justice)
-

Beneficience

As defined by the ADA code of ethics, beneficience is the following. “medical practitioners act
in the patients best interest” – SR Mousavi. Improving self-image and thus self-esteem is a valid
and beneficient reason to provide elective cosmetic surgery. Spend more time talking about the
benefits. People who get their diastemas fixed decide to lose weight. People who get veneers
can smile again and run fortune 500 companies. Unfortunately, self-esteem is a tough metric to
compare against risks. Is providing a gold tooth to a 15 year old going to turn him into the class
president when eventually it could become compromised by sensitivity? This is where many of
the potential issues arise. If there is minimal self-benefit to the patient other than that the patient
wants this, then it is a good assumption that the treatment may not be worth it. If there are
minimal benefits, then any risk would outweigh.

The dentist should also be cautious of BDD (body dysmorphic disorder) which is a psychiatric
syndrome (citation: SR Mousavi). This disease is defined by blah blah blah. Patients will
frequently cite cosmetic defects which are difficult to see.

The patient may not be the only person who creates cosmetic defects. The dentist, who can be an
exacting professional, may find faults in a dentition when the patient is unaware. Only after the
dentist points out these “faults” then the patient chooses a treatment. This approach is not
recommended (Cite Gilbert)

Non-maleficence

The issues of doing harm may be smaller in dental work than say in its medical counterpart.
However, the medical concerns which arise during cosmetic surgery are still risks. Risks in
dental treatment with cosmetic dentistry include blah blah blah.

A big problem arises when the dentist is performing procedures for his own personal gain.
When monetary issues become a significant reason for treatment then we have benefits for the
professional and risks for the patient.

Based on these ethical principles, the authors provide the following chart to aid in decision
making for the dental professional.
Chiodo GT, Tolle SW.

Oregon Health Sciences University, Portland, Oregon, USA.

Abstract
Patient requests and treatment goals may exceed the limits of professional practice and may have
an adverse effect on health. When doctors encounter these types of requests, they first must
decide whether the patient has the capacity to consent to such care. In the case of child patients,
no such capacity exists and surrogate consent to care must be, in the opinion of the doctor, in the
child's best interests. Parents who request potentially harmful procedures for a child with no hope
for any health care benefit should be refused politely. Adult patients who request harmful
elective procedures for themselves also should be educated and helped to fully understand why
the request represents substandard treatment. The long-term consequences of these requests must
be detailed clearly for these patients. Elective cosmetic treatment that will lead to long-term
adverse effects on function and health raises serious ethical concerns in which the principle of
nonmaleficence likely will trump the patient's autonomy.

PMID: 12004671 [PubMed - indexed for MEDLINE]

Is esthetic dentistry really a health service? Are we spending

too much time emphasizing esthetics and helping patients

look their best? Are we answering our patients' needs or our

own needs when we speak of the advantages of cosmetic

dentistry?

When you look at a face, what do you see? Most dentists tend to see teeth, because they are
trained to do so. However,
others see a face and then determine from that visual image of
the face whether the individual is friendly, intelligent, plus a
number of other characteristics, based on physical appearance.
The shape of the face, teeth, and lips and other physical
characteristics influence our own physical and psychological
reactions to another person. Most significantly, faces, and
especially the smile, can also influence our decisions about
what we buy. Magazine publishers will tell you that issues
that show full faces, particularly those with smiles, sell more
copies ofthose magazines than other issues. Some advertising
authorities have called it "smile power".

Should resources be spent on porcelain

veneers for individuals with mild tetracycline staining or

on the millions of Americans with limited access to dental care

and a huge unmet need for basic treatment?

As far as ethics

is concerned, should insurance pay for such services, especially

since Gilbert says that some dentists may be creating the need

for services that were not a problem for the patient until the

esthetic analysis occurred.