The Ethics of Nose Jobs and Smile Jobs – Do You “Need” Porcelain Veneers, Crowns, or Dental Implants?

Back when cosmetic dentistry was just starting to come on strong, I published an article in a major newspaper commenting on the public misperception of this branch of the profession as aggressively trying to get the public to accept new procedures. I, of course, defended what we were doing as being an acceptable extension and enhancement of dental care.

An editor from the newspaper came to interview me about what I said in the article.

“Don’t you think that the sort of things you talked about in the article are strictly a way for dentists to increase their income?” she said.

“I beg your pardon?” I said.

“Well, dental income is decreasing, because fluoride treatments and fewer cavities. Aren’t dentists using cosmetic dentistry simply as a gold mine?”

I was offended. “Are you saying that the dentist you trusted five minutes ago to fill a cavity is now going to pick up a drill and file your teeth, simply because they feel they need more work? That all of a sudden they have thrown their ethics out the window?”

We fell into a philosophical discussion about who was responsible for a patient’s dental health, the patient or the dentist. I told her that cosmetic dentistry involved providing information about various procedures to patients, who, at the end of the day, were the ones who decided whether they would have the procedures.

I also pointed out that, on her reasoning, no one should ever go to a plastic surgeon for a nose job. If the nose was actually functioning, why fix it? The ethics of cosmetic dental surgery were exactly the same, I argued. If it’s not immoral to fix a nose, why would it be immoral to fix a crooked smile?

After unburdening myself of these views, I began to sense that the fix was in. sure enough, she asked me in a teasing tone if I would perform a consultation on her. I sensed that she wanted me to suggest a treatment that she could criticize in her paper. She was quite insisting. “Analyze my smile,” she kept saying.

I quickly informed her that she wasn’t my patient, and I had no right to comment. “If you want to make an appointment, you should feel free to do so.”

After all this, I was expecting a negative article. To my surprise, it was well written and fair. She did explain her initial point of view and concerns but also indicated that in the end it was up to the patients to decide what procedures they underwent.

P.S. Months later she did come in for a consultation and had a fair bit of cosmetic dentistry done.

Edward S. Philips, D.D.S.

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