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Is cosmetic dentistry 'dentistry' at all?

Cosmetic dentistry: a socio-ethical evaluation

A selection of abstracts of clinically relevant papers from other journals.

The abstracts on this page have been chosen and edited by Paul Hellyer

The implications for funders are discussed.

Holden ACL. Bioethics 2018 10/1111/bioe.12498

Cosmetic dentistry could be defined by the absence of a patient (treatment is initiated by a 'consumer'), pathology and therapeutic purpose. In this article, Holden indicates that cosmetic dentistry is an integral part of the profession of dentistry in the twenty-first century. Drawing on definitions of oral health which include the ability to smile as a significant contributor to overall health, he argues that appearance and self content with one's appearance contribute to self worth and that a perceived deficit in appearance negatively impacts on self esteem. He discusses the cultural differences evident in what is considered aesthetically pleasing and notes that the social norms of today – straight, very white teeth – may change in the future.

The author also argues that all dental treatment has a cosmetic component and that aesthetics go hand in hand with the restoration of function (although he does modify this statement later to the majority of dental procedures have an aesthetic component). In this way, dentistry could be considered different to other surgery, where an unsightly scar may be considered a small sacrifice to make for a life-saving operative procedure. He discusses the differences within the NHS, between dental regulations which stipulate that 'cosmetic dentistry is only available privately' and the freely available provision of breast implants justified by 'improving mental wellbeing and mental flourishing'.

Consumerism, and the consumer's response to advertisements for whiter, straighter teeth, might be considered a threat to the dentist/patient relationship. Patient expectations may be too high, and the pressure for profit at 'dental spas' may interfere with that therapeutic relationship. However, consumer power might be considered a benefit if it reduces professional, clinical authority within that relationship.

Finally, Holden argues that dentists have traditionally subjectively described the oral norm as the absence of disease. The presence of professionally diagnosed disease leads to an intervention in the form of a restoration or preventive advice. However, social media, and perhaps dentists themselves, define the 'normal' smile with pictures and illustrations of the 'perfect' mouth in waiting rooms and websites. These images and consequent pressures make it difficult for dentists to remain objective when deciding when to intervene to alter facial appearance. The dental profession may, however, have the potential to alter prevailing societal attitudes to what is the ideal smile.

The paper concludes that cosmetic dentistry is 'dentistry', contributing to overall self worth and general health. If this is the case, then funders of dental care may need to redefine what is funded. However, the boundary lines between cosmetic dentistry and commercialism need to be discussed openly.

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Cosmetic dentistry: a socio-ethical evaluation. Br Dent J 225, 866 (2018).

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