The 'Daughter Test' in aesthetic ('esthetic') or cosmetic dentistry.

There has been a re-explosion in the interest in aesthetic dentistry in the last 20 years. History teaches us that the interest in aesthetic dentistry tends to coincide with periods of relative affluence in society. Populist, if somewhat mindless, programmes like ‘Extreme Makeover’ and ‘Ten Years Younger’ have drawn the attention of the public to what aesthetic dentistry can offer. It is clear that many of these programmes concern themselves with producing a rapid change in people’s appearance. However, in this haste for a visual change, those concerned appear to pay little attention to the longer-term consequences of the procedures that are undertaken in order to achieve these seemingly beautiful short-term results. Follow-up examinations at 10 or 20 years would probably show a very different appearance, both clinically and radiographically. The author has coined the term ‘hyperenamelosis’ to describe an imaginary dental condition in which patients are born with too much enamel or an imagined condition in which the enamel prisms grow following tooth eruption and, if left alone and not cut back by a dental bur, would somehow grow out of control. Some dentists seem to imagine enamel prisms like rye grass which, if not cut back, would be somehow likely to result in a poor aesthetic appearance which could best be improved by replacing the enamel with porcelain. This is farcical. Teeth do not suffer from ‘hyperenamelosis’ and teeth do not suffer from a ‘porcelain deficiency disease’. ‘Porcelain deficiency disease’ is an imaginary disease that apparently can only be cured by the removal of sound enamel and dentine and replacing it with porcelain. Most sensible dentists are aware that neither ‘hyperenamelosis’ nor ‘porcelain deficiency disease’ actually exist. Sadly, some superficial, self absorbed, unwitting or easily influenced dentists are seduced by short-term profits and patients’ short-term gratitude for providing a pleasing appearance by undertaking destructive procedures to replace sound enamel and other hard dental tissues with porcelain veneers or porcelain veneered on to various frameworks and copings. In tackling these individuals in public, or in private, as to why they destroy sound tooth tissue to undertake these aesthetic restorations, it is sad to note that many such dentists tacitly agree that this type of destructive treatment is not what they would do for their own daughter. The justification offered is that ‘they do it because the patients ask them The 'Daughter Test' in Aesthetic ('Esthetic') or Cosmetic Dentistry