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762: Cosmetic Dentistry vs. Healthcare Dentistry – Dr. Christian Coachman

What is the number-one enemy of teeth? Sometimes, it’s the dentist! Esthetic dentistry is rising in popularity — and harming many patients. To highlight the difference between esthetic and healthcare dentistry, Kirk Behrendt brings back Dr. Christian Coachman, founder of Digital Smile Design, to explain why esthetics has its place, but shouldn't be the priority. Cosmetic dental procedures won't improve your patients’ health! To change the way you think about cosmetic and healthcare dentistry, listen to Episode 762 of The Best Practices Show!

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Main Takeaways:

  • Esthetics should be the byproduct of great dentistry, not the priority.
  • There is nothing better than having your own dentition in your mouth.
  • Teeth are the key to longevity. Esthetic procedures destroy good teeth.
  • Stop pretending that esthetic dentistry is healthcare dentistry — it’s not.
  • Dentists play a big role in shaping the perception of beauty and esthetics.
  • A nose job won't improve heart function. Veneers won't improve your bite.
  • Cosmetic dentistry is camouflage dentistry. It won't treat underlying problems.

Quotes:

“The impact of what we do in the mouth in systemic health — how much do we actually know about how much harm we do to our patients through dental treatments? How much do we know about the link between what we do with the bite and the posture of an individual, what we do with tooth position, arch position, and airway? How much do we know about oral health and systemic health? How much do we know about toxicity of everything that we do in the mouth? How much do we know about chronic pain, about chronic inflammation, about chronic infection, about these things that may be happening in the mouth, and little by little may be ruining the long-term health of our patients?” (7:28—8:26) -Dr. Coachman

“Esthetics shouldn't be the priority, but the beautiful consequence of the right treatment. Initially, I was repeating to myself and said, ‘Do I really think that's right?’ Now, 100%, esthetic dentistry is not necessarily bad. I mentioned it came into dentistry as an added value. The problem is when we start to persuade patients and harm their long-term health in the name of esthetics without educating them properly, by just telling them what they want to hear. Of course, everybody wants to hear, ‘Look, we have this amazing procedure that is going to make you look much younger. There are no contraindications. It's only positive. You're going to feel great about yourself.’ Who's going to say no? Nobody.” (13:16—14:22) -Dr. Coachman

“In medicine, physicians are obliged to really disclaim everything that can go wrong, almost like pushing you out of the procedure, almost like trying to convince you not to do the procedure. This is what esthetic dentists should do. But we do the opposite. We even say that esthetic dentistry is healthcare dentistry when it's not. My comparison is with plastic surgery, for example — and the medical world is far from being ideal. It's also a disaster in many other aspects. But when it comes to plastic surgery, you don't go to a plastic surgeon to live longer. You don't expect it. Right? You know that you're going there because of pure vanity. You just want to look better, even if you may take some risks. You know the risks. You know you're going to go through surgeries. You know they can cause negative effects on you. You know you're going to take medication that is not necessarily good for your health — you know. It's clear. ‘I just want to look better.’ And the plastic surgeon is not fooling you about, ‘Your system is going to work better because I'm going to give you bigger boobs.’ No. ‘Because I'm going to stretch your face, your heart is going to function better.’ No. There's nothing to do that. ‘I'm here just to superficially make you look better for a little while — for a little while, because everything else will come back. Do you want to look better for a little while? I'm the guy.’ I think that's fair. That's okay. It's really honest.” (14:25—16:26) -Dr. Coachman

“Imagine that you go to a cosmetic dentist, and upfront he's very honest about, ‘Look. Not only am I not going to make you healthier, I'm going to create harm because to make you look better, I'm going to extract teeth that don't need to be extracted, and I'm going to grind down teeth that don't need to be grinded. I will make your bite less efficient because there's nothing more efficient than natural dentition biting together. I'm going to make you less efficient with aligners. I'm going to make you less efficient with veneers and crowns. You will be less efficient.’ Telling people that you're going to do 24 restorations and make them bite better is usually bullshit, in 90% of the cases. You're biting better with your natural dentition. Now, with your artificial teeth, I'm going to try to make you bite as best as possible. But usually, not better than your natural dentition.” (17:02—18:11) -Dr. Coachman

“If you don't have a TMJ problem, if you don't have a bite problem, if your natural dentition is there, even if it doesn't look great, even if it's worn down, they're functioning, usually, very well together. You've been using them against each other for decades. And now comes a bullshit esthetic dentist saying, ‘I'm going to do 24 restorations and I'm going to make you bite better.’ No, you will not. Now, do you want to pay the price to destroy enamel that doesn't need to be destroyed, to extract teeth that don't need to be extracted, to maybe slightly make your bite slightly less efficient, just to look better for the next five to ten years? Because in ten years, you're going to look bad again and we're going to have to redo it. Maybe in 15, if we are lucky. But I can guarantee probably in ten years — not because restorations are failing. Even if the restorations are not failing, you will be coming back saying, ‘They don't look good anymore. What can we do about it?’” (18:14—19:24) -Dr. Coachman

“It's also okay to have the cosmetic dentist, this new type of honest, cosmetic dentist that is not trying to take over healthcare pretending they're delivering healthcare. So, we have them as well. But now, we need to find a way to empower this new generation of healthcare dentists, preventive dentists, amazing super diagnosticians, amazing in minimally invasive procedures, amazing in systemic issues, amazing in preventing TMD, preventing airway issues, starting with babies, starting with young kids, preventing functional disorders, all of these issues. I believe that this is something that we need to talk much more about, and we need to find a way to create a business model that will reward the brave dentists that are willing to work for healthcare: prevention, diagnosis, and longevity.” (20:33—21:54) -Dr. Coachman

“There's amazing science, proven, that the less teeth you have in the mouth, the more prompt you are for dementia and mental diseases. Teeth play a key role in longevity, systemically and mentally. Old people that have teeth live longer for many reasons, but also because they have teeth. Even psychologically, it plays a huge impact. Knowing you have your own teeth, perception, connection between what you feel in the mouth and what goes on in your brain, what it stimulates in your brain when you have your own teeth, that doesn't happen when you have implants or dentures.” (27:33—28:28) -Dr. Coachman

“There are amazing connections between the mouth and the body, and there's absolutely nothing better in the mouth than your own dentition, even if it doesn't look perfect, esthetically. It's such a stupid, dumb decision to destroy teeth in the name of esthetics, and the problem is that people don't even have that perception. And dentists don't talk enough about it.” (28:30—29:02) -Dr. Coachman

“Thirty years ago, my father told me, ‘The number-one enemy of teeth are the dentists. It's very sad to say that.’ The biggest enemy of teeth are the dentists — 30 years ago. We are seeing this getting worse, and worse, and worse.” (30:33—30:59) -Dr. Coachman

“The reward in dentistry today, even for privately owned practices, is on the treatments, not on prevention, not on diagnosis, not on longevity. You don't make more money in dentistry because you're fighting for longevity. You may even make less money, unfortunately. You don't make more money because you are an amazing diagnostician, and you're preventing stuff, and you are honestly educating your patient that the best treatment is no treatment, many times. You don't make more money because you're investing in an amazing hygiene department and prevention, as much money as you can make with fitting every patient in the same box and doing hundreds of All-on-4s, and hundreds of veneers, and hundreds of aligners per month. The best way to make money in dentistry is to try to fit patients into the same box. That's why practices that are only focused on aligners, practices that are only focused on veneers, practices that are only focused on All-on-X are usually the most profitable ones. All they do is master the process of attracting more patients into that workflow, converting more patients into that workflow, convincing patients that that is the best for the patient, repeating as much as possible, not complicating by trying to analyze, ‘Is this the best for this person?’ So, the actual business model of dentistry rewards the wrong dentistry.” (34:00—36:02) -Dr. Coachman

“We are rewarding procedures. We are rewarding immediate success. We are rewarding shallow, superficial, short-term benefits. That's the 12-veneer thing. We are not only not disclosing the real harm — we are pretending it’s great and we are even fooling patients, saying that it's a healthcare procedure. ‘I'm going to do a nose job plastic surgery on you, and your heart is going to be better.’ That's what we do in dentistry. We fool people, and we try to camouflage it by saying, ‘You're going to be more confident. And because you're more confident, you're going to be mentally healthier. And because you're mentally healthier, it impacts your systemic health.’ And that's actually true — but it's a big loop that you need to make to justify it, and you're not balancing the pros and the cons. So, the business model is wrong.” (39:28—40:44) -Dr. Coachman

“When dentists have dental issues, they are the worst to actually do something about it. They postpone it. And I'm saying myself we, as dentists, postpone our dental procedures as much as possible because, consciously or unconsciously, we know the number-one enemy of teeth is the dentist. We know that the best thing that we can do to ourselves is prevention, diagnosis, and longevity. That's why you see dentists with crooked lower teeth, and you say, ‘You're not going to align these teeth?’ ‘No. You know what? I'm going to leave it like that,’ because the dentist knows the percentage of cases with aligners that actually mess up your bite, that actually leave some kind of issue that will harm your TMJ, that down the road in 15 years, you're going to be like, ‘Why did I bother aligning my lower teeth? They were fine.’ So, they don't align their teeth. They don't prep that extra enamel to do 12 veneers, many times. They need to really be a disaster to actually do dental treatment because we know the problem. So, what is the solution? We all need to sit at the table, start discussing this more often, and the solution will come when we can develop a business model that rewards prevention, diagnosis, and longevity.” (41:13—42:53) -Dr. Coachman

“We love, for example, airway dentistry because it's really about improving your quality of life and, naturally, because of that, looking better. It's beautiful to see the link between if you position the teeth and the bone properly in the face, you will improve airway. And because of that, you're going to improve esthetics. But if you do camouflage dentistry — that's what we call it, camouflage dentistry. Camouflage is the short-term reward, the short-term benefit, the superficial benefit. Meaning, the veneers or the restorations look “cute”, but don't treat the underlying problem, don't address the hidden problems, don't really take care of health. You look better for a few years, but you're not really improving health. And because of that, you're not generating natural beauty.” (46:50—47:55) -Dr. Coachman

“I believe there's space for everybody. There’s space for disease dentists. There's space for cosmetic dentists. But there's a huge space for healthcare dentists that are almost untouched, untapped, and this should be the majority. This should be the main dentistry. I also believe that there is space for cosmetic dentistry. But we need to completely change the way we sell it and the way we educate patients about it.” (49:05—49:41) -Dr. Coachman

“We need to help change the perception of beauty. We need to work on the right side of history. This obsession for perfection and perfect beauty is harmful. We know that, and social media, of course, is making it a disaster. It is a disaster. We need to change the definition of beauty, and cosmetic dentists and plastic surgeons play a key role. Instead of helping educate people, they are making it worse. We are making it worse. We're also making it worse by creating a huge generation of younger doctors that want to be very successful. And what do they see? The super successful cosmetic and plastic surgeons because, for some reason, these are usually the doctors that are most valued, the ones that have the biggest rewards, that make more money, are more successful on social media, unfortunately. So, you see that guy developing the cure for cancer. Nobody cares. But the plastic surgeon that has a private jet, oh my God. Everybody wants to be like the guy. I don't know, man. I feel there's something wrong.” (49:50—51:20) -Dr. Coachman

Snippets:

0:00 Introduction.

1:43 Why this is an important topic.

12:17 Esthetics shouldn't be the priority.

14:25 The rise of the bullshit esthetic dentist.

21:57 There is nothing better than having your own teeth.

29:04 The biggest enemy of teeth are dentists.

31:02 It’s easier to sell the wrong dentistry.

36:24 Society’s exacerbation of “beauty”.

43:53 The real link between function and esthetics.

47:59 Final thoughts.

51:36 More about DSD.

Dr. Christian Coachman Bio:

Combining his advanced skills, experience, and technology solutions, Dr. Christian Coachman pioneered the Digital Smile Design methodology and founded Digital Smile Design company (DSD). Since its inception, thousands of dentists worldwide have attended DSD courses and workshops, such as the renowned DSD Residency program.

Dr. Coachman is the developer of worldwide, well-known concepts such as the Digital Smile Design, the Pink Hybrid Implant Restoration, the Digital Planning Center, Emotional Dentistry, Interdisciplinary Treatment Simulation, and Digital Smile Donator. He regularly consults for dental industry companies, developing products, implementing concepts, and marketing strategies, such as the Facially Driven Digital Orthodontic Workflow developed in collaboration with Invisalign, Align Technology.
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