White Lies: Five Secrets Your Cosmetic Dentist May Not Tell You

The allure of a dazzling white smile has hit mainstream America. The annual U.S. cosmetic dentistry market is estimated at around $2.75 billion. According to a survey commissioned by the American Academy of Cosmetic Dentistry (AACD), 600,000 patients every year undergo veneer procedures, costing more than $371 million.

Before you plunk down your hard-earned cash for a smile makeover, here are five secrets your dentist may not tell you:

Secret No. 1: There is no specialty known as "cosmetic dentistry."

Any general dentist can call herself a "cosmetic dentist." Since cosmetic dental procedures are such big ticket items, general dentists have resisted efforts to have the procedures designated as a specialty, which would require certification and training. Patients are left to try to figure out who is really qualified.

Secret No. 2: Not all dentists who perform cosmetic procedures have advanced training.

Not all dentists who hold themselves out as "cosmetic dentists" have significant advanced training in the procedures they will be performing, but such training exists. Meaningful credentials include accreditation by the AACD or extensive training at the Las Vegas Institute for Advanced Dental Studies, the Pankey Institute, the Dawson Academy, the Kois Center or the Spear Education Center.

There are currently fewer than 350 dentists and laboratory technicians accredited by the AACD. Only 53 hold the highest credential of Accredited Fellow.

Secret No. 3: The dental laboratory that makes the veneers is as important as the dentist.

Most likely, the porcelain veneers that will define your smile will not be fabricated at your dentist's office. They are usually sent to outside laboratories specializing in this kind of work. There is a vast difference in the quality of work done by these labs. According to Bob Clark, president of Williams Dental Laboratory, a high-quality lab will employ technicians with training similar to the training required for highly qualified cosmetic dentists, and will work in close partnership with the dentist.

Chester Garcia, CEO of daVinci Dental Studios, notes that his lab uses advanced CAD/CAM software and FDA-approved materials to ensure veneers meet exacting standards.

Patients considering cosmetic procedures should be as focused on the lab as they are on the dentist.

Secret No. 4: Your cosmetic dentist may be using a foreign or non-certified laboratory.

Many dentists use laboratories located in China or in other foreign countries. These laboratories offer far lower prices than U.S.-based labs. The lower cost isn't always passed on to patients. Furthermore, foreign labs may not use FDA-approved materials. Some crowns and bridges manufactured abroad have been found to contain lead. The American Dental Association and the Center for Disease Control and Prevention, however, are not concerned. They believe the "trace amounts" of lead are "extremely unlikely to cause adverse health effects."

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James Kessler, DDS., the Chairman of the Department of Education at the Pankey Institute, is opposed to the use of foreign labs. He believes close, personal communication with the lab technician is very important. He is also concerned about the quality of materials used by some foreign labs.

If your dentist is using a foreign laboratory, you have a right to know. Just because he sends his work to an address based in the U.S. doesn't necessarily mean it's not being outsourced to China or Mexico. If this is a concern, ask your dentist to show you "point of origin" and "list of materials" used for your lab work. This information should be maintained in your patient records, although in most states it is not required to be.

Some of the same issues can be present even when U.S.-based laboratories are used. Government regulation of both domestic and foreign dental laboratories is almost non-existent. The exceptions are Florida, Texas and South Carolina, which require certification for dental technicians and laboratories.

Bennett Napier of the National Association of Dental Laboratories advises patients to ask if the lab their dentist uses is a Certified Dental Laboratory or a DAMAS (Dental Appliance Manufacturers Audit System) accredited laboratory or is certified by the International Organization for Standardization (ISO). You can check a directory of certified technicians and laboratories by city and state here. You have a right to insist your lab work is done at a certified laboratory by certified technicians.

Secret No. 5: There are risks to having porcelain veneers placed on your teeth.

The advantages of porcelain veneers are compelling. A beautiful smile can be a confidence booster, with significant benefits. But there are risks you should know before making this important decision.

The veneers can be damaged or worn down over time, and may need to be replaced. This will cause both inconvenience and additional cost. Dr. Kessler notes that many patients believe veneers will last a lifetime, which is often not true.

By reducing the tooth structure, the tooth is more vulnerable to trauma or sensitivity. In extreme cases, root canal therapy may be required. New advances in cosmetic dentistry can reduce or eliminate this risk. Tara Hardin, DDS, a leading cosmetic dentist in Mason, Ohio, uses Emax veneers, which are custom made in the dental laboratory and bonded to teeth. Dr. Hardin notes the biggest advantage to Emax is their high strength and durability, which permits them to be produced in very thin layers, requiring little or no tooth preparation. According to Dr. Hardin, "no-prep veneers" usually involve no drilling and "we don't even need to numb patients for this procedure."

There are many cases of poorly performed cosmetic dentistry. Scott W. Finlay, DDS, an Accredited Fellow of the AACD, says that veneers can break off or be placed in the wrong position, affecting speech or giving the appearance of "bucked teeth." The burden and cost of repairing this work can be substantial.

While cost isn't technically a risk, the procedure is very expensive. Dr. Finlay advises patients to expect to pay a qualified cosmetic dentist from $1,500 to $2,500 per tooth. "Cheap" can be very expensive. A cosmetic dentist charging $800 a tooth is probably not using a first class laboratory and may be inexperienced. You could be very disappointed with the results.