Porcelain Deficiency Disease?

There is an interesting opinion article by dentist Martin Kelleher in the recent Faculty of Dental Surgery journal. He highlights what he terms "porcelain deficiency disease", a made up condition where dentists over-prescribe porcelain crowns and veneers. Unfortunately it has been taken out of context by several tabloid papers with the purpose of shocking the public about "greedy dentists", which is not really what he was trying to say. For a summary of the article click here, for the full article click here..

It's probably not escaped your notice that there is a recent trend for straight white teeth (think Simon Cowell). One way of achieving a very white, very regular smile is to place porcelain crowns or veneers on multiple teeth. A crown is a complete covering of a tooth, whereas a veneer is more like a facing glued to the front. Both are common dental treatments which are widely used for a number of purposes, mainly for restoring teeth that are decayed or broken, but they can also be used for altering the shape, size or colour of teeth. However, in order to accommodate the thickness of the porcelain the tooth is usually reshaped which often involves removing healthy tooth.

Martin Kelleher uses his article to highlight several cases where patients' dental health has suffered following extensive crownwork. The risks of crowns and veneers are well known, and include pulp death leading to root filling, fracture of the tooth underneath and gum disease due to rough edges or poor cleaning. Any responsible dentist will explain the risks to their patient and balance this against the benefits. What happens in a few cases is that the patient is prescribed crowns for EVERY tooth and sooner or later suffer dental health problem because of it. Another dentist then has to try and salvage what they can for the disappointed patient.

So why is this happening? There is certainly a pressure from patients who want to look like their favourite celebrity or their friend who has just had treatment and now looks ten years younger. But there must be a lot of pressure on dentists who perhaps see a colleague down the road doing such treatment and feel they need to keep up to survive, especially in financial terms. Whilst most dentists I know are very ethical and always have the best interests of the patient at heart there are some (like in any profession) who simply want to make money. If a patient appears in your surgery with a fat wallet and requesting complicated expensive treatment then why shouldn't you do what they ask? If you refuse will you lose out when they and all their friends go to a neighbouring dentist?

So, if you want to improve your smile what should you do and who should you believe?

Start by speaking to your dentist about your concerns. A good dentist will take time to find out exactly what your problem is and discuss the options. There will always be more than one possible treatment. Your dentist should discuss the advantages AND disadvantages of all options, but will probably guide you to one preferred option. Any comprehensive treatment should be planned out very carefully, usually with photographs, x-rays and models of your teeth, and sometimes with mockups of the predicted result. Ask to see pictures of previous cases and if you are unsure about anything get a second opinion. If you have irregular teeth has your dentist discussed the possibility of orthodontics? I accept that having treatment with braces is not for everyone, but in most cases it can mean that your natural teeth will be preserved which is much better for your long term dental health. Of course orthodontics itself is not without risks and I always discuss these with my patients before they start treatment.

Sadly there will always be rogue dentists who make headlines and there will always be journalists who will write horror stories about them. This is a very small minority of dentists and the rest are ethical, caring and well trained and would only prescribe veneers or crowns when appropriate. I will certainly be working with my referring dentists to make sure they consider orthodontics as an option.