DENTAL ETHICS


Is it fair to criticise the so-called “destructodontics” of aesthetic dentistry? MDDUS dental adviser Doug Hamilton offers a perspective


“BEAUTY is power; a smile is its sword”


time when conventional tooth brushing methods were scarce. A complete, flashing smile would have been a rare and valuable commodity. Mind you, since life expectancy in Ray’s time was 36 one suspects there was little to smile about. Nowadays, those in the developed world can expect to live at


T


least twice as long, with increasing numbers of the population dentulous. We live in an age which is not only healthier, but also more affluent and image conscious. Fewer people are content with simply keeping their teeth. Tey also want them to look good.


A new art form Dentistry, once the preserve of amalgam, plastic dentures and GA extractions, has risen to the challenge. Increasingly sophisticated ceramics have enhanced the aesthetic appeal of crowns which can now be swiſtly created using CAD CAM technology. Less invasive alternatives include veneers and adhesive restorative materials. Malaligned anteriors which might previously have required extractions followed by months of wearing fixed appliances, can now oſten be straightened with


The price of


rapid orthodontic techniques. On the face of it, dentistry is becoming an art. Yet, these new


techniques have not met with universal acclaim. While there is little opposition to the use of innovative, recognised means of restoring diseased, fractured or missing teeth, ethical concerns emerge in non-therapeutic cases. Initially, criticisms were euphemistic, even humorous – elective veneer preparation may have been described as “treatment for hyper-enamelosis”. Recently, however, less subtle neologisms such as “destructodontics” and “mutilectomy” have appeared in journals, oſten submitted by respected clinicians. Why, in the midst of this apparently positive trend, do we read such dire warnings? It cannot be denied that cosmetic dentistry involves a degree of


risk. A significant percentage of pulps become non-vital following crown preparation. While veneers are certainly less destructive, studies suggest they have a relatively high failure rate and, with each replacement, further tooth tissue may be removed. In contrast, rapid orthodontics involves little if any enamel loss. However, the almost inevitable fracture or de-bond of permanent


18 SUMMONS


HE words of 17th century naturalist John Ray remain one of the most poetic endorsements of beautiful teeth. Ray’s aphorism has particular resonance considering it came at a


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