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cosmetic dentistry_ beauty & science International Edition

I 07 review _ minimally invasive dentistry practice I cosmeticdentistry 1_2015 ciallyfromthemiddle-tohigher-incomepopulation,will have fewer decayed teeth and will need less complex restorativedentalcareastheyage.Thesechangingpat- ternsofdentalcareneedswillbringaboutamajorshiftin thenatureofdentalservicesfromtraditionalrestorative caretocosmeticandpreventiveservices. The increased market demand for smile aesthetics amongpatientsisforcinggeneralpractitionersoftoday to incorporate the art and science of cosmetic dentistry into their practice. Cosmetic dentistry is not yet recog- nised as a separate clinical specialty like orthodontics, periodonticsorpaediatricdentistry.Cosmeticdentistryis synonymous with multidisciplinary dentistry, as its suc- cess and failure are related to the patient’s psychology, health, function and aesthetics. Ethical, high-standard cosmetic dentistry skill training of clinicians is essential fortheincreasedglobalmarketofcosmeticdentistryand itspromotion.Itiswidelyseenthatthetreatmentmodal- itiesofcontemporarycosmeticdentistryaretendingto- wardsmore-invasiveprocedureswithanover-utilisation offullcrowns,bridges,dentineveneers,andinvasivepe- riodontal aesthetic surgery, while neglecting long-term oralhealth,actualaestheticneedsandthecharacteristics ofthepatient.2Theseaggressivetreatmentmodalitiesare indirectlydegradingsocialtrustindentistry,owingtothe trendoffulfillingthecosmeticdemandsofpatientswith- out ethical consideration and sufficient scientific back- ground and promoting the “the more you replace, the moreyouearn”or“moreismore”mindsetindentistry.2 Changing the professional mindset of the practising clinicianisnotaneasytask;itisjustlikequittingsmoking foraheavysmoker.Inordertopractisehealthydentistry, onemustbegroomed,startingfromdentalschooledu- cation,withmoralvalues,ahighethicalstandard,apos- itiveattitudeandapatient-centredpracticephilosophy. Astudentreflectsthemindsetofhisorherteachers,and a teacher or mentor with comprehensive knowledge, clinicalskills,honestyandhumanityisdifficulttofindin today’sbusiness-orienteddentaleducation.Ibelievethat knowledgeshouldbefreeandskilltrainingmustbeuseful and easily affordable to our young practising clinicians around the world. Compromised university dental edu- cation and expensive private skill training with biased mentoring have been promoting health-compromising treatment protocols and costly diagnostic, preventive and treatment technologies. This highly business-ori- ented trend will promote a change in the mindset of practisingclinicianstoadoptmore-aggressiveandinva- sivedentaltreatmentmodalities,leadingtothepractice ofunhealthydentistryinthelongterm. _Aesthetic versus cosmetic dentistry The words “aesthetics” and “cosmetic” are viewed as synonyms by many cosmetic dentists. However, it is necessarytounderstandthecoredifferenceinmeaning. The Oxford dictionary2 defines “aesthetics” as “the branch of philosophywhichdealswithques- tions of beauty and artistic taste” and“cosmetic”as“improvingonly the appearances of something”. In dentistry, “aesthetics” explains thefundamentaltasteofaperson concerning beauty, whereas “cos- metic”dealswiththesuperficialor external enhancement of beauty. Therefore, aesthetic dentistry falls under need-based dental service, and is generally guided by the sex, race and age (SRA factors) of the patient. However, cosmetic dentistry, which is influenced by perception,personalityanddesires (PPD factors), can be categorised aswant-ordemand-baseddental service. For example, a patient’s request to replace old amalgam restorations with tooth-coloured restorative materials can be con- sidered an aesthetic requirement or demand. The request of an old womanforpearlywhiteteethand the ideal smile design is far more than an aesthetic requirement, andmustbeconsideredacosmetic demandorrequirement. Inmyclinicalpractice,Idivideaestheticandcosmetic clinicalcasesintothreedifferentcategories: 1.Preventive, or support based: treatment prevents or intercepts the diseases, defects, habits and other factors that mayadverselyaffecttheexisting or the future smile aesthetics ofthepatient. 2.Naturo-mimetic,orneedbased: treatment is carried out to re- store or mimic the natural aes- thetics, bearing the SRA factors of the patient in mind, and the treatment generally enhances the health and function of the oraltissue. 3.Cosmetic,ordesirebased:treat- mentisperformedtoenhanceor supplement the aesthetic com- ponentsofthesmile;hence,the treatmentoutcomeofcosmetic treatment may not be in har- monywiththepatient’sSRAfac- tors as in nature-mimetic den- tistry, and cosmetic treatment Fig. 5c Fig. 5b Fig. 5a Fig. 6b Fig. 6a CDE0115_06-12_Koirala 26.02.15 10:27 Seite 2 CDE0115_06-12_Koirala 26.02.1510:27 Seite 2

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