The desire for cosmetic procedures has grown at an exponential rate. The aesthetic smile can improve job prospects, social acceptability and self-confidence. Our evolutionary underpinnings, including the need to separate friend from foe, coupled with the advent of social media indicates that this carping desire is here to stay.
As early as 1920, orthodontics was marketed to make children more likeable and freer of personality issues. In the 1960s misalignment was considered a threat to the marriage prospects of females, making them the major receipt of orthodontic alignment. Of course, the modern marketing techniques are less crude, directed more at a functional or disease correctional approach, but the underpinning of most of the dental work still hinges on our primal social need to fit in. The enhancement of our peacock feathers.
Let’s start with amalgam as an example. Amalgam restorations are a safe option for most restorations. They are non-toxic for the patient, cheap, do not require extensive moisture control and can last a long time; however, if you’d recommend this restoration option to a majority of young adults in America, they’d scoff at the thought and go to the next available cosmetic dentist. This may make the case that a profitable modern dental practice must embrace composites entirely and leave the traditional amalgam restorations in the past, but that’s for another ithink topic.
Another example is a full set of anterior crowns. While this can provide a Hollywood-esce smile that lasts for an extended period of time, it involves cutting away at a major portion of dental tissue. It may involve compromising the long-term endodontic prognosis of those teeth. This option has grown in favorability, despite other less invasive options like veneers and composite crowns existing on the market.
More and more dentists are stepping into the terrain of botox and fillers, but the medical benefits of these procedures are limited. Taken together these examples indicate that dentistry is no longer just about oral health and that’s never been truer in modern human history. They also make the case that each time we restore a carious lesion, we also help or enhance our patient’s perceived social hierarchal standing.
The implications of a perceived smile anomaly can be devastating. People are inundated daily with pictures of perfect smiles, forcing them to question the likability of their own. If perceived to be subpar, they smile less, decreasing their social prospects and further reducing their self-confidence. Less smiling in WEIRD nations (as smiling norms differ globally) leads to less serotonin and dopamine release as well as reduced chances of social interactions. This indicates that a modern dental practice needs to be mindful of its recommendations as to not distort someone’s self-perception. A minor misalignment or discoloration likely poses no functional problem. In this case, the desire for treatment is purely cosmetic and may warrant a further understanding of the patient's psyche.
This growing trend for cosmetic surgery also begs the following questions: how soon is too soon? How much is too much? Where do doctors draw the line? What age is too young? What procedures are too invasive given the ever-increasing life-expectancy?
There is data to support that our evolutionary underpinnings may favor a straight, white smile as metrics of health and youthfulness; however, when cosmetic procedures go far off from the natural, more factors need to be considered. For example, when a patient comes in looking for an ostentatious chicklet-like smile, and every measurement technique, composite shade matching acumen, golden-ratio calculation and aesthetic protocol is thrown to the wayside, the doctor is in a unique position of complying with patient wishes while providing a more fantastical rather than a natural result.
While measurements and standards exist to create the ideal smile, the very existence of these parameters may be inadvertently toxic. It may take away from unique characteristics and may fail to understand the complexity of a smile. There is a psychological, subjective and cultural underpinning for every aesthetic case and the most successful dentists will recognize all three.
The metrics of beauty are constantly changing within the media and the successful dental practice has the adjust its treatment options to meet these standards. This adjustment should not go without a deep recognition of the underlying motivations for the procedures. If the desire is to see the patient healthy, then aesthetic dentistry needs to consider sociological and psychological points of view.
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