The Dark Side of Cosmetic Dentistry.

As health care professionals, their priorities must lie in their patients’ well-being and be able to foster trust and reliability in the healthcare system. This brings me to how ethics serve as guiding principles to help achieve this.

Beneficence, nonmaleficence, autonomy and justice constitute ethics. The first two can be dated back to the time of Hippocrates “to help and do no harm”. Beneficence is the obligation of a healthcare professional to act for the benefit of the patient and support several moral rules to protect and defend their rights and prevent harm. Similarly, nonmaleficence is the obligation to not cause a patient harm. However, distinct from nonmaleficence beneficence has a large focus to the benefit on the patient.  Autonomy, as defined by the philosophers John Stuart Mill (1806-1873) and Immanuel Kant (1724-1804), is “that property of the will by which [the will] is a law to itself”. Meaning all humans have intrinsic and unconditional worth, therefore they can choose when to apply their autonomy. It provides patients the option to delegate decision making authority to another person if they themselves are incapable. Finally, justice; in a medical context it is related to the fair treatment of all patients cared for by medical practitioners. This prevents the discrimination of any patients for any reason, ensuring that all decisions are made based on the health benefits of the patients or the patient’s own autonomy. Therefore, patients must be treated with dignity and respect, they have the right to information involving their condition and the right to privacy and confidentiality, allowing them to feel safe in a medical environment. This ensures the comfort and mental well-being of the patient is considered.

So, how do all these vital values integrate themselves within the cosmetic world of dentistry. Nowadays, more frequently, within practical or dental training activities, matters related to aesthetics are commonly explored. Patients often require aesthetic restoration, for example the use of braces to correct misaligned teeth. Additionally, many students have been showing an increasing interest in cosmetic dentistry. Safe to say due to the development of modern society cosmetics and aesthetics is a growing field within dentistry. Why is there a tendency to overtreat? Overtreatment is a considerable issue; there are many possible explanations for this, some of which are more justifiable than others. For example, a dentist who sees a patient for the first time has no means of measuring how quickly or slowly a situation has been developing (periodontal disease or a carious lesion), nor whether a clinical situation has been getting better or worse. Therefore, they may overtreat to solve the problem faster rather than more appropriately.

A systematic literature review was conducted across four databases, yielding an initial 76 articles. After that, 12 articles were chosen for analysis. The results indicated that social media is a primary driver of patient expectations, often prioritising aesthetic outcomes over health considerations. This trend raises ethical concerns about informed consent and autonomy. The commodification of dental care, fuelled by aggressive marketing strategies, has resulted in a notable increase in overtreatment to satisfy commercial pressures and idealized beauty standards. ‘Permanent’ veneers Destructive veneer approaches are reason for significant ethical concern. There is a considerable gap in discussion surrounding the unethical practices of ‘permanent’ veneers, with one study in the UK showing that only 53% of porcelain veneers were present without re-intervention after 10 years. This may seem like a positive statistic, however with a promise of permanence it’s relatively disappointing, and yet the term “permanent veneer” is used by many dentists. Additionally, it has been shown that up to 30% of sound dental tissue can be removed in the preparation for extended porcelain veneers. In this same study it was stated that from 62% to 73% of sound anterior tooth structure was destroyed in the preparation for full coverage crowns. Irreversible interventions.

With this data it’s clear that it’s unethical for these dentists to be misinforming their patients, I believe this goes against the key pillars of medical ethics, mainly beneficences, possibly autonomy and justice. This is because patients are unable to give fully informed consent if they aren’t aware of the setbacks of this irreversible procedure. Furthermore, the destruction of sound dental tissue can arguably oppose the principle of beneficence, masking of orthodontic problems such as spaced or crooked teeth can ultimately lead to periodontal problems adversely impacting dental health and longevity or dentition; the overall well-being of the patient’s dental tissue isn’t being considered. Overall, I believe, to create a safe and beneficial environment for patients these key principles must be followed. As healthcare workers it’s our responsibility to nurture this environment, by ignoring these key values we are not only letting down our patients but ourselves and the profession.