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ple into the dental surgery with unrealistic goals, which subsequently can pose a moral issue for the treating dentist. “The risks involved in porce- lain veneers are significant, but this fact is often lost on people who are continually bombarded with images of ‘perfect’ teeth in the media. Although fracture or loss of cementation of a veneer is rare, deterioration in appearance particularly due to marginal dis- colouration is more common and constitutes a failure. There- fore, it is our responsibility to inform patients of the risks and benefits of veneers before they willingly agree to the removal of healthy tooth structure. “Interestingly, an increasing number of people opt for veneers simply to make their teeth whiter. For a dentist to agree to this meth- od of treatment solely for this reason is unethical, as more often than not, the results look unnatural, over the top and sim- ply odd. In many cases, bleach- ing teeth can achieve much of the desired result without the loss of healthy tooth structure. It is one of the least harmful procedures and many patients who were con- sidering aggressive treatments such as veneers are often com- pletely happy with the results of whitening alone.” “This illustrates why dentists should always explore a range of options with the patient (includ- ing no treatment), before agree- ing to a more complex approach. Investigating other avenues al- lows the patient to make an in- formed decision and the dentist to convey the benefits and risks of each procedure, while protect- ing professional ethics. Remem- ber, just because a patient says they want something, does not mean that a dentist must do it.” Another trend to appear in recent years is that of ‘instant orthodontics’. How do you think this will affect younger patients? “More and more patients, young adults in particular, are com- ing to dentists for treatments such as implants and veneers to avoid the traditional ‘train- track’ orthodontic route. This, however, is simply bad den- tistry. To destroy good teeth for a quick aesthetic result is not only unethical but will subject the young patient to a lifetime of repeat treatments and recur- ring problems. “ “As a profession we should be ensuring that teeth outlast people, not the other way round. The first principle is to preserve the pa- tient’s tooth structure wherever possible. The life of the tooth is far more important than the life of the crown or veneer. Treatments such as all ceramic crowns and aggressive preparations for ve- neers may mean the extensive re- moval of tooth tissue. In the event of a restoration failure or future problems, there can be little tooth structure left to work with. “As healthcare professionals we should be continually work- ing under a system of compliance, education and communication. All dental treatments are temporary: deterioration and failure are in- evitable. Dentists should reflect on modern trends and decide wheth- er the demands of their patients out-weigh their moral obligations. As such, it should be a matter of professional pride to decline treat- ments if they are felt to be unnec- essary or unethical. If we fail to do this it is only a matter of time be- fore we are truly a lost profession.” Final thoughts I didn’t know it at the time, but back in the Seventies I became an enthusiast for minimally in- vasive dentistry. Back then, the idea of keeping as much tooth structure intact seemed much more appealing than gambling on the success of full dentures and this is still true when look- ing at the costs of implants today. It is clear that both Richard and I are keen supporters of prevention where possible and high-quality preservation when appropriate. To act otherwise is a breach of our professional ethics: and this should apply whether the impetus for treatment origi- nates with the dentist’s diagnosis or the patient’s aspirations. Both are legitimate, and both need the same care in evaluating. DT Prof Richard Ibbetson Richard Ibbetson – Di- rector, Edinburgh Post- graduate Dental Institute and Honorary Consult- ant in Restorative Den- tistry, Lothian Primary Care NHS Trust. Richard graduated from Guy’s Hospital in 1974 and com- pleted an MSc at the Eastman Dental Institute in 1979. He worked at the Eastman for 20 years before taking up the post of Director of Postgradu- ate Dental Institute in Edinburgh. His main clinical interests centre on the postgraduate teaching and practice of Fixed Prosthodontics. Nena Puga Tel.: +1 310 696 9025 E-mail: nena@gidedental.com website: www.gidedental.com Contact Person in Athens: Lito Christophilopoulou +30 210 213 2084, +30 210 222 2637 E-mail: lito@omnipress.gr For Registration & More Info: AD DENTALTRIBUNE Middle East & Africa Edition Practice Matters 9

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