Why Understanding Smile Design is So Important. A Cautionary Tale for Those Considering Porcelain Veneers, Crowns, and Dental Implants.

In our 5-part series, we covered principles used by dentists helping to determine the right smile design of a patient. This is something I teach my patients also, so they begin to understand the rationale behind their new smile. Below is a cautionary tale, taken from my book, A Guide to the Perfect Smile, where we see what happens when one doesn’t follow proper smile design.

Signing on and signing off

People who need a lot of work done on their teeth and smile should be very careful when making decisions with their dentists. Why? Because the tendency is for such patients to think that anything they have done is going to be an improvement. Once they see themselves looking better, however, they may very well begin to regret that they didn’t’ have a different procedure or a more extensive one. Compare this with people who already have good teeth and smiles. They make decisions about altering their smiles more carefully because they don’t want to compromise a good thing.

A tall, slim gentleman – let’s call him Frank – came in for a consultation. He was six feet seven but no more than 160 pounds. At first I was very confused by Frank. No matter how he spoke or smiled, I could not see his teeth. I was beginning to think he didn’t have any. But when I examined him in the chair later, I saw that he had been born with microdontia, tiny teeth genetically disproportionate.

We always teach patients the ten principles of smile design, which helps us work together to choose the procedures most appropriate for them. Frank, however, seemed to pay little attention, protesting that he didn’t need the seminar.

“It’s just not necessary,” he said. “You know what you’ve got to do. I’ve come to you and I trust you. Whatever you do is going to be of benefit.”

This made us nervous, but he was resolute in his position. But sure enough, months later, he called us and said he had some concerns. Being an out-of-town patient, he could not come to see us for several months. All we could do was say that is was a big change to go from little teeth to normal teeth. “Obviously, you’re going to feel they look a little odd at first,” we told him.

When Frank finally come to see us, we barely recognized him. He had put on about 75 pounds. He was obviously eating better. He seems happier. We thought we had performed a miracle, transforming this man from sad and self-conscious to happy, healthy, and self-confidant.

To our surprise, Frank proceeded to lecture us for an hour on all the design principles we though he had ignored in our earlier session. The man was an expert… he could have taught the course. He brought up various pattern issues and told us his embrasures were not the way he wanted them.

However, other than a few minor things, there was little we could do. He had signed off on the procedure.

Going back to your dentist the way Frank did is like building a house and then telling the architect, “You know what? I never really wanted a two-storey house.” Too much, too late.

Edward S. Philips, D.D.S.

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