Veneers: The Real Cost of a Hollywood Smile

The vogue for veneers may be lining dentist' pockets, but this procedure is not the quick
fix it seems to be – and is far from risk-free.

Tuesday, 17 June 2008

Question: what do you call a bad Harley Street dentist? Answer: a veneereologist – at least, that's the word at the respectable end of the burgeoning cosmetic dental industry.

TV shows such as 10 Years Younger have proved the power of the beautiful smile. Four out of five of us keep our mouths firmly shut when we're being photographed because we're so self-conscious about yellowing, grey, chipped, cracked, crowded or uneven teeth – and all too aware of the contrast with the white, even Hollywood smiles that are now a prerequisite for the stars of the big screen.

And one in three of us is considering getting something done about it, according to the British Academy of Cosmetic Dentistry (BACD).

What most of us are considering, it seems, is a veneer – or probably several of them. The wafer-thin strip of pearly white porcelain that is bonded to the offending tooth after the original has been filed down is top of the list for instant oral beautification – more natural-looking than false teeth, and a quicker fix than caps or crowns, which both require more invasive dentistry.

But the growing demand for cosmetic dentistry is occurring in an industry that largely lacks regulation, and does not demand more than basic training. Any high-street dentist is able to offer veneers and – with prices at anything from $800 - $1500 per veneer – make a very good living from it too, all with the full support of the profession's leaders.

Dr. Nigel Carter, chief executive of the British Dental Health Foundation, an independent charity that aims to promote good dentistry, says it's perfectly acceptable that every dentist is able to offer cosmetic dentistry. "Fitting a veneer involves routine techniques that every dentist is trained to provide," he says.

But that view is increasingly being challenged. The cosmetic consultant Wendy Lewis argues in a new book, Plastic Makes Perfect that aesthetic dentistry is "a highly specialist area, with a steep learning curve to doing it well".

The BACD president, Dr. David Bloom, agrees. "A good-quality veneer that fits well and feels comfortable requires a well-trained and skilful dentist conserving the maximum amount of tooth, as well as a good relationship with a highly trained and skilful laboratory technician," says Dr. Bloom. "The benchmark of a good veneer is that another dentist shouldn't be able to spot it and that's very difficult to achieve."

In fact, the quality of cosmetic dentistry varies enormously. At one end of the scale, cosmetic dentists offer toilet-white veneers made of poor-quality porcelain that lacks durability, which are virtually mass-produced in laboratories to a uniform shape. At the other end, skilled ceramists such as Eva Furst of the Fusion Dental Laboratories (FDL) in Newbury, Berkshire, use high-quality materials to create an individualized veneer, or a set of veneers, in a procedure that she likens to making fine jewellery.
"Getting a color match, especially for a single veneer, is a great challenge. It will often have more than one color, as do the surrounding real teeth, and the shape of the tooth, the gums and the mouth as a whole are entirely individual and need to be treated with great subtlety," Furst explains.

What's more, a good dentist will always advise patients to have the least invasive solution and work from there, according to Shaun Smith, senior partner at The Dental Surgery in the City of London, one of a handful of dental practices that work with FDL. "Cosmetic dentistry is far more than just veneers," he says. "White fillings or tooth whitening can make a big difference, and so can braces – and they all involve keeping the original tooth. And 15 to 20 years down the line, when the veneer needs replacing, as most will, the patient will be delighted that they have consulted a dentist prepared to make the extra effort."
The problem, Bloom says, is that many dentists don't inform patients that other options might suit them better. "A veneer is an amazingly successful procedure, but it should be avoided if there is a less invasive alternative. Some dentists are too quick to suggest a veneer, or more often, a whole mouthful of veneers," he says.

The results can be disastrous, both aesthetically and financially. Myles Dakin, senior partner at the Cambridgeshire practice Specialist Dental Partners, has several patients "who have been over-treated by unqualified dentists and now face having all the work re-done".

Wendy Lewis has one UK client on her books "whose veneers are already chipping and who now needs the entire top arch of her teeth redone". She is also aware of several people who regret having been "talked into having far more work than they need".
The work involved in fitting a veneer varies considerably. Some practices boast that the procedure can be completed in a single visit. The Dental Surgery insists that planning for the treatment take place over several visits, with detailed wax mock-ups created initially so that the shape and appearance of the new teeth can be assessed by both patient and dentist before the final constructions are cemented in.

And when a row of veneers is planned, an expert dentist will work with the patient to get the shape and length of teeth aesthetically correct and acceptable to the individual. "Getting the length of the teeth right, especially the two front teeth, is paramount so that some tooth length is visible even when the lips are relaxed and with the upper teeth roughly following the curve of the lower lip," says Dr Tim Bradstock-Smith, senior partner at the London Smile Clinic. "The width of the smile is another vital ingredient, as the ideal smile should fill the width at the corners of the lips."

In the meantime, personal recommendation remains the best route to good service, along with advice not to skimp on costs, Bloom says. "I would be cautious about having a veneer that costs less than $1000; it simply won't cover the cost of a good laboratory and allow for sufficient attention to detail," he says.