The quest for the perfect smile has gone mainstream

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The quest for the perfect smile has gone mainstream
May 25, 2007
Katherine Michalske
The Denver Business Journal

The last place you might expect to have a spending spree is in a dentist's chair. But for a growing percent of the population, that $12,000 nest egg won't go towards a cruise to the Bahamas or a 2007 Yamaha YZF-R1 motorcycle. They'll be putting their money where their mouth is.

"Do you buy the big screen TV, or do you get the smile you always wanted?" said Dr. Jeff Hurst, DDS, and vice president of the Colorado Dental Association.

This is the question many of his patients are considering.

Dental offices are seeing more and more of the discretionary dollar as cosmetic dentistry grows in popularity.

"It's certainly one of the fastest-growing arms of dentistry," said Eric Nelson, director of public relations for the American Academy of Cosmetic Dentistry, located in Madison, Wis.

Membership in the American Academy of Cosmetic Dentistry has grown from 4,200 to 7,800 in the last five years, making it the world's largest organization dedicated to elective aesthetic dentistry. Cosmetic dentistry, however, is not a legally recognized specialty, like orthodontics or prosthodontics. Membership is open to all general dentists, because any licensed dentist can perform cosmetic procedures.

This is what makes the cosmetic industry so hard to corner. There are no chains or franchises that cater exclusively to cosmetic dentistry. The Colorado Board of Dental Examiners doesn't allow dentists to list their names under "cosmetic dentist" in the phone book.

"It's a funny line. It's not as if there are aesthetic dentists and non-aesthetic dentists. Almost everybody that practices avails themselves of cosmetic practices," said Dr. Daniel Wilson, DDS, and chairman of restorative dentistry at the University of Colorado School of Dentistry.

While there aren't sanctified divisions in the academic world, and every dental procedure has some aesthetic standard to satisfy the patient, insurance companies see the matter in black and white.

Most carriers won't cover elective aesthetic procedures, which patients have to pay for out of pocket. If it's not a matter of function, it's cosmetic. This is the reason many dental offices offer three-month financing or use Care Credit, a GE Money Company based in California that offers rotating loans for cosmetic procedures.

Dentists have been using Care Credit for 20 years. The company pays the dental office in full, minus a service fee. The loan is then a matter between the patient and Care Credit, and out of the hands of the dental office. If a patient doesn't pay, the dentist doesn't hear about it. Capital One Healthcare Finance, based in Virginia, is another company that will provide loans for cosmetic procedures.

Finding the money upfront is the patient's obligation. While some dentists will arrange in-office financing, they're less likely to do so when it's not a matter of health or pain, Hurst said.

For elective aesthetic procedures, most dentists will ask for the money upfront.

"We can't send the repo man to get back the veneers. When it's coming out of their wish list books, they've got to pay for it. The patients understand that. They'll start saving their money and they'll do it," Hurst said.

A popular cosmetic procedure, porcelain veneers, which bond to the teeth to make them look straighter and whiter, can cost anywhere between $600 and $1500 per tooth. That brand-new smile could cost $12,000, and be ready in one visit.

"I've seen the industry come around to the idea that we're not just drilling and filling. The prevalence of tooth whitening has really created an awareness of cosmetic dentistry, and has made people want it more and desire it more," Barotz said.

For Dr. Gary Radz, a dentist in Denver with an international reputation for his knowledge of cosmetic dentistry, his general practice is in the process of shifting to a cosmetic office. More than half of Radz's work is purely cosmetic, and he expects that in three or four years that may be all that he does.

"It's almost happened by accident. The last four years we were getting such a demand from patients that wanted cosmetic dental work done. It's taking up more of my time," Radz said.

He's received so many requests he had to hire another dentist to keep up with the demand. Radz doesn't contribute his success to an large-scale marketing scheme. In fact, his only marketing tools are a Web site and word of mouth.

"In the past, no one ever said anything [about cosmetic dentistry]. Dentists were reluctant to advertise it because they didn't think it was good for the practice. It demeans the profession," Hurst said.

In many states, it's illegal for dentists to market themselves as cosmetic dentists. While it's beginning to change, for the most part this doesn't hold for Colorado.

It wasn't until this year that dentists could no longer list themselves as cosmetic dentists in the phone book. But type in the words "cosmetic dentist Colorado" in an online search and the first listing is Radz' Web site, Cosmetic Dentistry of Colorado.

As the field grows, the marketing is becoming more apparent. Flyers with the words, "implants in a day," and "veneers in one visit" tout the advances of dentistry with promises of instant gratification. Some dentists are attempting to distinguish themselves from every other general dentist who can legally perform the same cosmetic procedures.

As the field grows, the marketing is becoming more apparent. Flyers with the words, "implants in a day," and "veneers in one visit" tout the advances of dentistry with promises of instant gratification. Some dentists are attempting to distinguish themselves from every other general dentist who can legally perform the same cosmetic procedures.

Radz has also distinguished himself by pursuing an extensive amount of continuing education. He's competed more than 1,000 hours of course work in cosmetic dentistry and written more than 100 related articles. Radz will be the chairman for the 2008 annual meeting for the Academy of Comprehensive Esthetics.

However, Colorado doesn't require any continuing education for general dentists.

Technology and products have developed quickly in the last five years. Most current dentists didn't have the chance to learn about these techniques in school, and didn't cover the extensive products accessible today.

"What you learn in dental school doesn't even come close to modern practices and techniques in cosmetic dentistry," Radz said.

So dentists must choose to continue their education on their own.

American Academy of Cosmetic Dentistry offers an accreditation process for members, as an attempt to officially recognize the field. They offer courses and workshops through affiliate schools, which can cost anywhere from $100 to $250. American Dental Association also offers lectures, courses and workshops, which can range from $100 to $7,800 for a seven-day clinical.

Many dentists take these courses just to keep up with the fast pace of new products.

"I completed 200 hours of continuing education last year. That's how fast things are changing," said Dr. Neil Dobro, DDS, and prosthodontist in Denver.

Dentists can use a laser to detect cavities that an x-ray wouldn't catch. Patients can get a filling with no anesthetic and chew on it immediately. Veneers and crowns used to come in one color, called "tooth". Now dentists have a vivid array of colors to match a patient's teeth.

"Patients are developing a pretty good dental IQ," Hurst said. "If your patients are asking you for services you can't do for them, you need to decide if its something you should start doing."

Patients are developing a pretty good dental IQ," Hurst said. "If your patients are asking you for services you can't do for them, you need to decide if its something you should start doing."

Hurst said the public's awareness grew with the onslaught of reality makeover shows a few years ago. Since then, patients bring in magazines with advertisements for new techniques and products. More often it's the patient asking for cosmetic procedures than Hurst promoting them, he said, and dentists have to keep up with rapidly advancing techniques or refer their patients elsewhere.

"Right now, we have someone in the office who's getting laser whitening, and it's because his dentist doesn't offer it," Dobro said.

Bright Smile, a company that offers teeth whitening products and services in 17 locations nationwide, has begun slicing away at one portion of the cosmetic market. Beyond teeth whitening, no franchise has attempted to cover the cosmetic dentistry market.

Many dental chains offer cosmetic services in addition to general cosmetic practices, but none have attempted to corner the rapidly expanding market.

Cosmetic procedures cost the patient more money than typical visits, but this doesn't mean the dentist is pulling in more money by satisfying patients' demands.

"On the surface it would appear so, but by the time you do the job properly and you get the proper lab to do your work, it's probably no more lucrative than anything else we do in dentistry," said Dr. Nick D'Amico, DDS.

His office has seen an increase in cosmetic work because that's what his patients are asking for, D'Amico said. Overall, cosmetic work only accounts for 5 percent to 10 percent of their overall revenue.

Even Radz, whose practice is shifting into the cosmetic realm, said he isn't seeing much more money than any other successful general practice. The amount of time he needs to spend with a patient balances out the higher prices a cosmetic procedure will draw in. A general dentist can probably turn over more patients in the chair, Radz said.

As cosmetic dentistry develops with increasing public demand, some dentists hope it will branch off from general dentistry. Radz said he hopes to see some recognition for the area by the end of his career, but he doesn't expect anything to change in the near future.