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Cosmetic Tribune United Kingdom Edition | 4/201518 with questions of beauty and artistic taste” and “cosmetic” as “improving onlytheappearancesofsomething”. In dentistry, “aesthetics” explains the fundamental taste of a person concerningbeauty,whereas“cosmetic” deals with the superficial or 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, cos- metic dentistry, which is influenced byperception,personalityanddesires (PPD factors), can be categorised as want- or demand-based dental serv- ice.Forexample,apatient’srequestto replace old amalgam restorations with tooth-coloured restorative ma- terials can be considered an aesthetic requirement or demand. The request of an old woman for pearly white teeth and the ideal smile design is far more than an aesthetic requirement, and must be considered a cosmetic demandorrequirement. In my clinical practice, I divide aes- thetic and cosmetic clinical cases into threedifferentcategories: 1.Preventive, or support based: treat- ment prevents or intercepts the diseases, defects, habits and other factorsthatmayadverselyaffectthe existing or the future smile aes- theticsofthepatient. 2.Naturo-mimetic, or need based: treatment is carried out to restore or mimic the natural aesthetics, bearing the SRA factors of the pa- tient in mind, and the treatment generally enhances the health and functionoftheoraltissue. 3.Cosmetic,ordesirebased:treatment is performed to enhance or supple- ment the aesthetic components of thesmile;hence,thetreatmentout- come of cosmetic treatment may notbeinharmonywiththepatient’s SRA factors as in nature-mimetic dentistry, and cosmetic treatment may not necessarily be beneficial to the health and function of the oral tissue. Practice philosophy in dentistry: The mindset The majority of dental schools around the world focus on teaching knowledge and skills in dental medi- cine that are based on contemporary dental science and art. Dental school educationdoesnotgivedueconsider- ation to healthy dental practice phi- losophyowingtovariousfactors,such as the right to chose one’s practice philosophy and the domination of business rather than service-oriented dental practice in the global market. However, quality and healthy clinical practiceisalwaysadreamofagoodcli- nician, and establishing such practice requires an unbiased vision, learning and serving attitudes, and dedication fromthedentist.Wemustunderstand that science and art in dentistry have no meaning if practised by an un- ethicaloperator,whodoesnotrespect the overall health of the patient. Any scientificadvancementintechnology haspositiveandnegativesides;hence, if not applied properly, it may ad- versely affect the profession and may becomeathreat. I believe that a clinic or treatment centremustestablishitspracticephi- losophy according to its objectives. Whataclinicianwantsandthekindof services he or she wants to deliver to his or her patients guides the clinic. Practically, the practice philosophy in dentistry can be classified into two differentcategories,dependingonthe mindsetoftheoperator. Patient-centred Clinicianswiththiskindofmindset generally have a do no harm dental practice (Fig. 1). Professional honesty and humanity are the fundamental principles of such a practice. Opera- tors with this mindset enjoy sharing their clinical knowledge and skills with their professional friends and juniorcolleaguestopromotepatient- centred clinical practice in society. Thisgroupofcliniciansfirmlybelieves in the word-of-mouth approach to practice marketing and always thinks ofthepatient’slong-termhealth,func- tionandaesthetics.Clinicianspractis- ingdonoharmdentistryaregenerally cheerful, happy and healthy in their professionallife. Financiallyfocused Clinicianswiththiskindofmindset practise a financially focused den- tistryandadoptvariouskindsofdirect marketing approaches to sell their dentistrylikeacommodityinthemar- ket rather than a health care service. Practitioners in this group generally achieve a secure financial position quickly;however,itisfrequentlyseen thattheydevelopchronicstress,burn- outsyndrome,depression,frustration and professional guilt, leading to compromised health and happiness intheirprofessionallife. Dentistryandprofessionalstress Dentistryhaslongbeenconsidered a stressful occupation. Dentists per- ceivedentistryasbeingmorestressful than other occupations.3 Dentists have to deal with many significant stressorsintheirpersonalandprofes- sional lives.4 There is some evidence to suggest that dentists suffer a high levelofoccupation-relatedstress.5–9 A study has found that 83 per cent of dentists perceived dentistry as “very stressful”10 and nearly 60 per cent perceived dentistry as more stressfulthanotherprofessions.11 Stress can elicit varying physiological and psychological responses in a person. Professional burn-out is one of the possible consequences of ongoing professionalstress.Theeffectofburn- out, although work-related, often will haveanegativeimpactonpeople’sper- sonalrelationshipsandwell-being.12–13 Hence, dentists need to take care of theirstaff’shealthandfocusonprofes- sionalhappinessindailypractice. A clinician has full right to adopt thepracticephilosophythatheorshe prefers.However,itisalwaysadvisable to apply oneself to understanding, analysingandcomparingthisphilos- ophywithothers.Iamveryfortunate to have been brought up with the Vedicphilosophyofthelawofnature and the first, do no harm conscious- ness-based philosophy in my life at home, at school and in my society. The spiritual guidance and mentor- ing I received at an early age at home andschoolhavehelpedmetobecome aprofessionalwithafirmphilosophy ofdonoharm;hence,Istartedpractis- ing consciousness-based dentistry earlyinmycareer.Duringmy21years ofprivatepractice,Ihavealwaysexpe- rienced happiness and joy with high patient satisfaction, which has given me complete confidence and faith in mypracticephilosophyandtheMiCD treatmentprotocolthatIapplyinmy practice. Since late 2009, I have been promoting my practice philosophy and clinical protocol in South Asia, andstartedtheMiCDGlobalAcademy in 2012 with the help of like-minded friends, who also practise a similar kind of holistic dentistry around the world.TheMiCDGlobalAcademyhas a mission to share clinical knowledge and fundamental clinical skills free of charge with all clinicians who de- sire to practise do no harm cosmetic dentistry for better patient care and to enhance their happiness in their professionallife. Three-way test: Questions for your conscience Cosmetic dentists can make errors in practice in two ways, first owing to a lack of the required professional knowledge and skills, and second ow- ing to a lack of professional honesty and humanity. The first one can be eliminated with good education and proper training, but the second one demandsatotalshiftinmindset,with a high level of consciousness in pro- fessionalethics,attitudesandrespect towardsthepatient’slong-termhealth, functionandnaturalbeauty. I apply a simple yet very powerful test to keep myself stress- and guilt- free and within the boundaries of professional ethics, honesty and hu- manity when proposing a dental treatment plan to my patient. Clini- cians can apply the three-way test COSMETIC NEWS Treatmentoptions Treatmentprocedures Biologicalcost Non-invasivetreatment: •Smileexercise None whenhardandsofttissueis •Remineralisationofwhitespots notpreparedduringsmile •Oralappliancesandbruxismguard enhancementprocedures •Denturesrequiringnotissuepreparation •Gingivalmask Micro-invasivetreatment: •Cosmeticchemicaltreatment,suchas Verylow whenhardandsofttissueis bleachingandmicro-abrasion preparedatamicro-levelduring •Cosmeticrestorationswithchemicaltooth smileenhancementprocedures preparation,suchasdirectbonding,ultra-thin veneers,adhesiveponticsandoverlays Minimallyinvasivetreatment: •Cosmeticcontouring(teethand/orgingivae) Low whenhardandsofttissueis •Cosmeticrestorationswithminimaltooth preparedatasuperficial preparation,suchasthinveneers,modified orminimallevelduring inlaysandonlays,partialcrowns, smileenhancementprocedures partialdentures,andinlaybridges •Non-extractionconventionaland MiCDorthodontictreatment •Minidentalimplants(smalldiameter) •Gingivaldepigmentation Invasivetreatment: •Toothpreparationforcrowns,bridgeabutments High whenhardandsofttissueis anddeepveneers preparedatadeeperlevelduring •Orthodontictreatmentwithtoothextraction enhancementprocedures •Dentalimplants •Aestheticsurgicalprocedures,suchas periodontal,orthognathicandfacialsurgeries TableI:Treatmentoptions,treatmentproceduresandbiologicalcostincosmeticdentistry. 13b 14a 14b 14c 14d 14e 14f 15a 15b 15c 11a 11b 11c 12a 12b 13a Soonerisbetter Followearlydiagnosis,preventionandinterventionapproach SmileDesignWheelapproach Understandpsychology,establishhealth,restorefunctionand enhanceaesthetics(PHFA—sequencesofSmileDesignWheel) Donoharm Selectthemostconservativetreatmentoptionsandprocedures tominimisethepossiblebiologicalcost Evidence-basedselection Selectmaterials,tools,techniquesandprotocolsbased onscientificevidence Keepintouch Encourageregularfollow-upandmaintenance Table II: MiCD core principles.