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MiCD: Do no harm cosmetic dentistry COSMETICTRIBUNE The World’s Cosmetic Newspaper · United Kingdom Edition Published in London www.dental-tribune.co.uk Vol. 9, No. 4 6a 6b 7a 7b 8a 8b 9a 9b 10a 10b 4a 4b 5a 5b 5c ByDrSushilKoirala,Nepal The demand for cosmetic dentistry is a growing trend globally. Increased media coverage,the availability of free online information and the improved economic status of the general public has led to a dramatic increase in pa- tients’ aesthetic expectations, desires anddemands.Today,aglowing,healthy and vibrant smile is no longer the ex- clusive domain of the rich and famous; hence, many general practitioners are nowbeingforcedtoincorporatevarious aestheticandcosmeticdentaltreatment modalities into their daily practices to meetthegrowingdemandofpatients. Cosmetic dentistry is a science- based art guided by the desire of the patient. Many young clinicians who plan to incorporate it into their prac- ticeareconfusedaboutwhattheyand theirpatientsactuallywishtoachieve. It is to be noted that the treatment modalities of any health care service shouldbeaimedattheestablishment of health and the conservation of the humanbodywithitsnaturalfunction andaesthetics.However,itisworrying tonotethatthetreatmentphilosophy and technique adopted by many cos- metic dentists around the world tend towards macro-invasive protocols, and millions of healthy teeth are ag- gressively prepared each year for the sakeofcreatingbeautifulsmiles. The practice philosophy adopted bytheclinicandtheprofessionalteam membersgenerallyguidestheoverall output of the practice. Minimally in- vasive cosmetic dentistry (MiCD), a do no harm practice philosophy, has four fundamental components: level of care, quality of operator (dentist), protocol adopted and technology selected, which must all be respected in daily clinical practice. Adopting this holistic medical science practice philosophy is not an easy task, as it requires a change in the mindset of professionals. In Parts I and II, I explain MiCD, do noharmcosmeticdentistry,basedon my Vedic Smile concept, which I have been practising successfully in Nepal for the last 20 years, and advocating globallysince2009astheMiCDglobal mission. It is to be noted that both parts are based on fundamental sci- ence (truth and available evidence), clinical experience and the common senserequiredinholisticdentistry. Cosmetic dentistry, a global trend Theprevalenceandseverityofden- taldecayhavebeendecliningoverthe lastdecadesinmanydevelopedcoun- triesandthistrendisshiftingtowards developing countries as well. With in- creasedmediacoverage,theavailabil- ity of free online information, public awareness has fuelled the demand for cosmetic dentistry globally. Now, a glowing, healthy and vibrant smile is no longer the exclusive domain of the rich and famous.1 The population of beauty- and oral health-conscious people is increasing every year and data from various sources shows that the coming generations of children, especiallyfromthemiddle-tohigher- incomepopulation,willhavefewerde- cayedteethandwillneedlesscomplex restorative dental care as they age. Thesechangingpatternsofdentalcare needswillbringaboutamajorshiftin thenatureofdentalservicesfromtra- ditional restorative care to cosmetic andpreventiveservices. The increased market demand for smile aesthetics among patients is forcing general practitioners of today to incorporate the art and science of cosmeticdentistryintotheirpractice. Cosmetic dentistry is not yet recog- nised as a separate clinical specialty likeorthodontics,periodonticsorpae- diatricdentistry.Cosmeticdentistryis synonymous with multidisciplinary dentistry,asitssuccessandfailureare related to the patient’s psychology, health, function and aesthetics. Ethi- cal, high-standard cosmetic dentistry skill training of clinicians is essential for the increased global market of cosmeticdentistryanditspromotion. It is widely seen that the treatment modalitiesofcontemporarycosmetic dentistry are tending towards more- invasive procedures with an over- utilisationoffullcrowns,bridges,den- tineveneers,andinvasiveperiodontal aestheticsurgery,whileneglectinglong- termoralhealth,actualaestheticneeds andthecharacteristicsofthepatient.2 These aggressive treatment modali- ties are indirectly degrading social trustindentistry,owingtothetrendof fulfilling the cosmetic demands of patientswithoutethicalconsideration and sufficient scientific background and promoting the“the more you re- place, the more you earn”or“more is more”mindsetindentistry.2 Changingtheprofessionalmindset ofthepractisingclinicianisnotaneasy task; it is just like quitting smoking for a heavy smoker. In order to prac- tise healthy dentistry, one must be groomed, starting from dental school education, with moral values, a high ethical standard, a positive attitude and a patient-centred practice philos- ophy. A student reflects the mindset ofhisorherteachers,andateacheror mentor with comprehensive knowl- edge, clinical skills, honesty and hu- manity is difficult to find in today’s business-oriented dental education. I believe that knowledge should be free and skill training must be useful and easily affordable to our young practisingcliniciansaroundtheworld. Compromised university dental edu- cation and expensive private skill training with biased mentoring have been promoting health-compromis- ing treatment protocols and costly diagnostic, preventive and treatment technologies. This highly business- oriented trend will promote a change inthemindsetofpractisingclinicians toadoptmore-aggressiveandinvasive dental treatment modalities, leading to the practice of unhealthy dentistry inthelongterm. Aesthetic versus cosmetic dentistry The words “aesthetics” and “cos- metic” are viewed as synonyms by many cosmetic dentists. However, it is necessary to understand the core difference in meaning. The Oxford dictionary2 defines“aesthetics”as“the branch of philosophy which deals 1 2 3 DTUK0415_17-18_Koirala 10.09.15 15:19 Seite 1 123 DTUK0415_17-18_Koirala 10.09.1515:19 Seite 1