We talked with John Sullivan, immediate past president of the American Academy of Cosmetic Dentistry (AACD). In practice since graduating from the University of the Pacific School of Dentistry in 1984, Dr. Sullivan concentrates on cosmetic and restorative dentistry in his hometown of Tulare, CA. He has been a member of the AACD since 1998, has served two terms on the AACD board of directors, and just finished the 2011-2012 term as AACD president.
John Sullivan, DDS, immediate past president, AACD
Dr. Sullivan discussed the effect of the economic recession on demand for cosmetic dentistry and the need for responsible aesthetics. He also addresses the controversial issues of teeth whitening offered by non-dentists and whether dentists should be allowed to administer Botox.
DrBicuspid.com: Demand for cosmetic dentistry services has declined 13% since 2007 primarily due to the ongoing recession and its impact on patients' spending behaviors, according to a recent AACD survey. What has been the overall impact of the economic recession on cosmetic dentistry?
Dr. Sullivan: The demand for cosmetic dentistry is still there, but the urgency that many patients used to have is reduced. Patients still want the broad, white smile they have wanted for years, but with new techniques and enhanced services, that smile may be achieved by orthodontics and whitening instead of porcelain veneers. Exclusively cosmetic practices have found ways to still provide the bread-and-butter treatment that patients need on a regular basis, while proper treatment planning allows the patient to plan different methods to achieve their goals.
Teeth whitening offered in malls and salons has prompted state dental associations to take legal action against these services. What are dental professionals' key concerns when it comes to teeth whitening performed by nondentists?
“We must be creative in our financial models.”
— John Sullivan, DDS
Whitening is not always the answer for all patients. If the patient has restorations in the area they are whitening, the teeth will change color but the restorations will not, often resulting in a less than ideal appearance. If disease is present, whitening can also increase sensitivity and pain if not addressed first. Most dentists will agree that a comprehensive exam is necessary before any whitening process to protect the patient.
More than 20 states in the U.S. currently allow dentists to administer Botox in some form. Still, opponents say that Botox is best left to plastic surgeons and dermatologists. Is this a turf war, or is patient safety really at stake?
Botox can be administered easily by those properly trained in the process. Dentists are experts at the musculature and innervation of the face, so they can be trained to do the job very well. But the key is training and experience. With proper experience, dentists will get an excellent result, but like any type of cosmetic treatment, the more experience, the better.
Accurate shade matching is one of the primary challenges of aesthetic dentistry. Do you have any tips or recommendations that could be useful to dentists looking to improve this skill?
Digital photography has made a huge difference in communication with your laboratory and technicians. It is so easy to shoot some photos with shade tabs to show color comparison and translucency, which enhances our communication. There are also a number of very accurate shade selection devices to give the lab more information.
A DrBicuspid article from last year discussed concerns that some dentists are compromising sound enamel and dentin to give patients unnecessary porcelain crowns and veneers instead of choosing more conservative treatment options. Can you comment?
The AACD believes in the concept of responsible aesthetics, where treatment is done with the goal of altering sound tooth structure as little as possible to achieve the final result. A proper treatment plan should include periodontics, orthodontics, and any other interdisciplinary approach to give the best result with a minimalistic approach to tooth destruction. The urgency of the patient's desire to have a better smile should not alter the amount of sound tooth structure loss to achieve their goals.
What are some of the exciting/useful new products and materials that cosmetic dentists should be aware of?
New composite materials that release fluoride, milled porcelain for aesthetics, digital technology; it's a whole new world in how to provide care.
What are some of the key challenges cosmetic dentistry faces today?
Offering cutting-edge technology while keeping a business model consistent. There are new materials and technology that will help every practice, but the inclusion of those items must be balanced with running a business. Most cosmetic dentists want to be on the cutting edge, not the trailing edge, but we all need to monitor the results and not act as beta testers. We must also be creative in our financial models to allow patients the opportunity to afford the treatment they desire, either by utilizing financing models or phasing treatment.