Kelleher Ethical Marketing in ‘ Aesthetic ’ ( ‘ Esthetic ’ ) or ‘ Cosmetic Dentistry ’

Prior to undertaking any elective, ‘cosmetic’ dental procedures, it is vital for the treating dentist to discuss the merits and drawbacks of all viable options. It is important that the patient understands what the consequences and limitations of treatment are likely to be, and what the potential failures could entail later in his/her life. Informed consent should be obtained (preferably in writing) and the clinical notes and records should be clearly documented, with accurate and concise details provided of all the investigations carried out, and their findings, as well as including details of the various discussions that have taken place. Dentists need to be aware of the existence of heightened expectations in this group of patients and be cautious about accepting patients who have unrealistic ‘cosmetic’ expectations. Where possible, cosmetic or aesthetic dental treatment should be provided which is minimally destructive and, in the long term, be in the ‘best interests’ of the patient. Important matters such as the gaining of informed consent and maintaining meticulous, contemporaneous dental records will also be emphasized. It is hoped that the article will provide clear definitions of some commonly used terms such as ‘ethical marketing’, ‘ethics’, and ‘values’, which are often used in association with the marketing, planning and undertaking of supposedly ‘cosmetic’ dental procedures. The important role of less invasive alternative treatment options will also be emphasized. Clinical Relevance: The aims of this article are to consider the common pitfalls that may arise when contemplating the marketing and provision of invasive, ‘cosmetic’, dental restorations and to discuss how best to avoid a dento-legal claim where such treatment plans may not fulfil the patient’s desired outcome. Dent Update 2012; 39: 313–326 Introduction and general considerations The ethical marketing of aesthetic or cosmetic dentistry is a complex, difficult and potentially dangerous subject. It is complex because of the range of problems that present. It is difficult because of the perceptions of the patients who have those problems. It is dangerous because, in this particular arena, opinions are abundant and facts are rare. It is possible sometimes to see quickly that the problem is an obvious physical one. However, more often than not, the reasons for the patient seeking cosmetic treatment are less obvious, or why the patient is seeking such treatment now may be shrouded in mystery. Furthermore, these patients do not represent the ‘average patient.’ Their hopes, aspirations and expectations are sometimes difficult to discern. Some patients think that a change in their dental appearance will markedly improve their life. While this is possible, particularly if they have an obvious, easy to spot, physical problem, their expectation Martin G D Kelleher, BDS, MSc, FDS RCPS, FDS RCS, Consultant in Restorative Dentistry, King’s College Hospital, London SE5 9RS, Serpil Djemal, BDS, MSc, FDS RCS, MRD RCS, Consultant in Restorative Dentistry, King’s College Hospital, London SE5 9RS and Nicholas Lewis, BDS, MSc, MFDS(Edin) FDS(Rest Dent) RCS, Consultant in Restorative Dentistry, The Eastman Dental Hospital, London WC1X 8LD, UK. can be that beautifying the appearance of their teeth will lead to a better job, an improvement in their love life, or even long term success and happiness. Such patient hopes, wishes or aspirations need to be gently teased out in discussions with the patient early on and then challenged as appropriate. It is unethical to provide treatment for patients whose ‘cosmetic’ aspirations are completely unrealistic, particularly if any such treatment involves destructive dentistry. It is important to understand an individual patient’s hopes and expectations. If these are in any way unrealistic it is important to challenge these expectations early and sometimes brutally. This is part of the diagnostic and discussion process in aesthetic or ‘cosmetic’ dentistry. A finding at the beginning of treatment is called ‘a diagnosis’ and a finding at the Serpil Djemal and Nicholas Lewis