COSMETIC DENTISTRY FOR THE 21ST CENTURY Introduction Dentistry is ever evolving. This is especially true of the cosmetic revolution, which has now reached the UK. Patients are now electing to have treatment done rather than just needing it. Programmes such as “Extreme Makeover UK” and “10 Years Younger” have further accentuated this and have opened the general publics‟ eyes as to what is now possible. Their aspirations are changing and we must be able to meet these if we are to keep them as patients in our practices. By not evolving ourselves they will find another practice that does offer them what they want. However, with this change, we cannot only consider our clinical skills in isolation. We need to consider what now constitutes a 21st century practice. This includes getting your team fully on board and suitably trained, understanding the power of marketing and, most importantly, making our patients the centre of attention whenever they are in the practice, so that their expectations are met and, ideally, exceeded at every visit. Benefits of the 21st century practice 1/Job satisfaction Employee satisfaction and retention have always been important issues for dentists. After all, high levels of absenteeism and staff turnover can affect our bottom line, as temporary staff, recruitment and retraining take their toll. Satisfied employees tend to be more productive, creative and committed to their employers, and recent studies have shown a direct correlation between staff satisfaction and patient satisfaction. Dentists and the members of their teams are, by and large, caring people whose motivation is the optimal health of their patients. The cosmetic revolution, however, has meant an increase in job satisfaction as the job itself, the tasks and skills involved and the interest and challenge of the work have broadened horizons for all the team. No longer are we just bringing health to our patients but outstanding cosmetic solutions too and everyone involved feels real joy at the final result (not just the patient). The most important word in all of this is involvement. As we seek to build a strong cosmetic practice on top of an already strong restorative practice, the training we receive and the exposure to new concepts and ways of working are shared throughout the team giving cohesion and a shared sense of purpose. This job enrichment generates an increase in responsibility, promotes a feeling that everyone‟s contribution has been upgraded and brings about a real sense of “team”.

2/Increased turnover In the past 5 years the demand for cosmetic dentistry has increased dramatically and patients are choosing to visit the dentist to take advantage of the latest advancements. Here, at Senova, we have certainly seen that trend, so much so, that our turnover has increased by 350% in the last 5 years. Cosmetic dentistry is profitable not just because of its high value but also because there is no more profitable use of surgery time.

That increase in profitability has had a beneficial effect on all concerned. We are able to invest in the future of the business, add new facilities, attract support dental professionals and remunerate ourselves and our team to a high level. It‟s a win-win situation for everyone. 3/Happy patients and raving fans Even for our patients it is a win-win situation .An example of what is possible is the following extract from a Senova patient: „I now enjoy looking after my beautiful new teeth and I am only sorry that

my visits to you will be significantly reduced from now on! Thank you all so very, very much for your kindness, caring and enthusiasm – every single member of staff has shown a real interest in my transformation from day one.’
Clinical aspects In order to fulfil the dental wishes of our patients we need the appropriate clinical skills. Hands-on training on a live patient is the best way to acquire, and from there hone, these skills. Many day courses can give the vital information to begin this journey. The following topics should be addressed: 1/Smile design: The following quote from Dr Chip Steele best sums this up.

„Learning smile design is the process of training your eye to spot details you can fix‟ Attention to detail and an understanding of how all of the different aspects of a smile relate to each other is absolutely crucial. It is outside of the scope of this article to consider this in detail but Table 1 gives a short list of the criteria to consider. 2/Diagnosis and treatment planning- this can only be achieved following a comprehensive examination along with full mouth radiographs and photographs. 3/Principles of tooth preparation, provisionalisation and cementation. 4/Occlusion – a sound understanding of this is fundamental to all restorative dentistry. 5/Understanding comprehensive care: Comprehensive care is about the whole patient: the individual‟s wants, needs, emotional motivators and personality and how their oral health relates to their overall systemic and emotional well-being. „The Aesthetic team, journal of cosmetic dentistry 2002‟ - Bobbi Anthony Treating patients comprehensively leads to less single tooth dentistry and subsequently a decrease in volume of patients thus enabling the dentist to jump off the treadmill they feel they may be on. For example, when treating one tooth in a quadrant, attention should be given to the quality of the restorations in the teeth either

side and in particular their contact contour along with any over eruption. Consideration should be given to idealize the quadrant otherwise the limitations of the old restorations are perpetuated. All options should be discussed with the patient to allow them to make an informed choice for themselves. This can be done via codiagnosis. In this way they also can take ownership of what is happening in their own mouth and how to care for themselves.

Team aspects Thorough and appropriate training allows delegation of a number of tasks that dentists may have previously thought lay only in their domain. This in turn creates a career pathway and professional development within even a small dental practice. A good example of this is clinical photography. Train your team to take the full range of clinical photographs required. This frees up the clinicians time for more productive activities. All of the above leads to a happier team, greater team involvement and most importantly collective responsibility and accountability Spa and wellness environment The term dental spa is now much abused, as is the phrase “I am a cosmetic dentist because I do posterior white fillings”. A dental spa is about looking after your dental guest and ensuring their experience is the most positive it can be. This involves more than just lighting a few candles. At Senova we have evolved from patient comforts such as music, cozy blankets and paraffin hand wax treatments to a concept of “complete wellness”. Alongside our traditional spa menu, we aim now to create an environment that relaxes and energizes all of those who are present, both patients and team. Technologies such as magnetic filled cozy blankets and far infrared technology support a comfortable environment and promote healing. We even consider the quality of the water we offer our guest and the air quality they breathe. Our aim is to consider the well being of every individual and create a unique experience. Finally the use of new materials can also help in the patient experience. One example of this is CollarDam ( shown in the photograph. This provides the ultimate in patient protection ensuring the patients‟ neck remains dry and their clothes protected. Conclusion Over the past 5 years our practice has changed out of all recognition and there is no reason why the same cannot be true for your practice. A vision is required of what you want to achieve and the pathway to getting there. A team must be completely involved in the visions and goals of any practice. If not, then progression is very slow or worse still, non-existent. But there is never a true end point as the goal posts constantly change and, if we stand still we, in effect, go backwards as our competitors overtake us.

Co-op.R8 seminars are running a one day programme entitled „ 21st century dental excellence – a master class „ on 20th April 2007 at the Belfry hotel. See for details and to download an application form. Acknowledgments Luke Barnet dental ceramics Roy Higson and IPSO for their Hands on training in occlusion

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