by Matthew Brady
For 10 years, George Labbad of West Palm Beach avoided dentists. “I had this thing against dentists,” he says. “They inject you, they drill, they fill, then on to the next patient.” Then a friend recommended highly rated cosmetic dentist Karen Glerum of Boynton Beach, Fla. After two years with Glerum and between $12,000 and $15,000 in procedures that included porcelain crowns, whitening, tooth-colored fillings and Invisalign braces, Labbad, 54, is all smiles.
“I can laugh and open my mouth and all you see is white,” he says. “The experience has totally enlightened me about dentistry.”
Almost 32 percent of Angie’s List members polled say they’ve had cosmetic dentistry, with crowns being the most popular procedure, followed by whitening, veneers and braces. While some say they get cosmetic work for healthier teeth or to feel more confident, 50 percent say they did it to improve their appearance.
The cosmetic dentistry category is the fastest-growing in the dental industry, according to the American Academy of Cosmetic Dentistry, with 200 percent growth in procedures since 1996 and 300 percent growth in teeth whitening alone. But the line between the profession of who can offer general and cosmetic dentistry is ill-defined and in many cases, nonexistent. The American Dental Association doesn’t recognize it as a specialty and any general dentist can market himself or herself as a cosmetic specialist.
Although about 93 percent of cosmetic dentistry reports on Angie’s List bear a grade of B or better, experts agree consumers must find a dentist they can trust. Dr. Glerum compares it to hiring a plumber or house painter — you get what you pay for, except the stakes are much higher. Bad cosmetic dentistry will at best leave you with an ugly smile, she says. At worst, it can devastate your oral health.
Few regulations for specialization
Who can do cosmetic dentistry or even what it is remains largely up to the interpretation of each dentist. Procedures the ADA considers potentially cosmetic —braces, porcelain crowns, veneers, bridges and bonding — can be legally performed by a general dentist but also overlap into the specialties of orthodontics and prosthodontics.
“Cosmetic dentistry can range from low-level whitening — I’m talking Crest White Strips — to full-mouth reconstruction,” says highly rated Dr. Karen Glerum, a cosmetic dentist in Boynton Beach, Florida. “Just because [a dentist] can do something doesn’t mean he or she should do it or is capable of doing it to the same standard of care as the doctor who has specialized training”, says Dr. Glerum.
Consumer caution necessary
Georgia McNulty-Hook of Redwood City, Calif., outside of San Francisco says she knows all too well the high cost of bad dentistry. “I wanted my teeth to look like a movie star’s,” she says, and adds that she went to Dr. Glenn G. Lew based on his glossy advertisements and plush offices.
“I’m 64. Old people get old-looking teeth — yellow. When Dr. Lew told me, ‘I’m going to crown every tooth,’ I thought, ‘Why not?’ He said it would be beautiful.”
The process took two years, required more than 15 crowns and cost more than $20,000. In fall 2010, one of her front crowns fell out. She paid Lew, who has a negative grade on Angie’s List, about $1,500 out of pocket before stopping payments on her 20 percent share of the insurance cost.
She says she’s been told by another dentist the remaining crowns will fall out eventually because her gums can’t support them.
Lew declined to comment on her case, citing federal privacy laws, but says his track record speaks for itself. “I have many, many happy patients from a career that spans 33 years now,” he says. “On occasion, as in any profession, difficulties arise with cases. I deal with these on an individual basis and always stand by my work.”
Glerum, not commenting specifically on McNulty-Hook’s situation, says bad cosmetic dentistry is fairly common and estimates about 25 percent of her practice is doing over other dentists’ shoddy dental work.
Patients should expect quality cosmetic dentists to offer an abundance of before-and-after photos. “If a dentist can’t show you her work, it probably means she hasn’t done any or it looks bad,” Glerum says. Also, make sure the photos are of that dentist’s work, she adds, pointing out that some dentists buy before-and after photos to misrepresent their skill.
Regardless of a dentist’s background, aesthetics always should take a backseat to oral health. That means a full oral exam that includes X-rays, gum exam and cleaning. Dentists shouldn’t start the aesthetics until they’ve addressed the other issues.
“Just because we do cosmetic dentistry doesn’t mean we can ignore that for which we are trained,” Glerum says. “Especially gum disease. If you have gum disease in the front of the mouth and then you do veneers, that tissue is going to recede and then it looks like hell.”
Broken or cracked teeth also point to problems with a person’s bite that a good cosmetic dentist will correct rather than cover up. Glerum turns away patients who don’t want to address oral health problems.
“I had a woman in here, she wanted six veneers,” Glerum says. “I said, ‘No problem, but your bite is wrong. If we don’t correct that first, whatever work I do will break.’ She didn’t like what I said, went to another dentist and came back several months later with broken veneers.”
In extreme cases when a patient needs full-mouth reconstruction, Dr. Glerum recommends consulting a dentist who has done many reconstructions like her. “The dentist in these cases acts like a project manager,” she says. “There’s got to be one person in charge. I’d send you to the orthodontist. I’d send you to the periodontist or oral surgeon. I’d coordinate [dental care] for you.”
Patients say they feel like Dr. Glerum is interested in their oral health, not just expensive procedures, because she looks at the entire mouth and not just one tooth at a time.