Authors
1
Pediatric dentistry department, dental school, north khorasan university of medical sciences, Bojnurd, Iran
2
Dental Public Health, School of Dentistry, Mashhad University of Medical, Mashhad, Iran
3
Dental Research Center, School of Dentistry, North Khorasan University of Medical Sciences, Bojnord, Iran.
4
Pediatric Dentistry Department, Faculty of Dentistry, North Khorasan University of Medical Sciences, Bojnord, Iran.
,
Document Type : Original Article
Abstract
Background: Nowadays, the demand for cosmetic dental services has become widespread among many patients. This qualitative field study aimed to examine dentists’ treatment plans in response to a request for cosmetic services from a single patient.
Methods: The researcher visited general dental offices in one of the privileged region’s streets in Mashhad after receiving a standard treatment plan from a specialized dental council as an unannounced standardized patient (USP) and a "real" patient. The researcher visited all the private general dental offices on that street using the total population sampling. In each visit, the researcher discussed the need for cosmetic dental services, and divided the dentist's cosmetic treatment plan into three categories: intervention, intermediate, and non-intervention. Dentists’ medical council numbers were divided into four categories: 1) 0 to 50 thousand, 2) 50 thousand to 100 thousand, 3) 100 thousand to 150 thousand, and 4) 150 thousand to 200 thousand.
Results: A total of 24 offices were visited. The treatment plans of eight dentists were prone to intervention (orthodontics and restorative cosmetic services of 1 to 10 units of composite veneer or ceramic laminate), nine dentists were not inclined to intervention, and seven dentists were classified as intermediate. Dentists proposed most interventional treatment plans with medical council numbers 100-150 thousand, and most non-interventional and intermediate treatment plans related to dentists in the 50-100 thousand group.
Conclusions: There was a wide range of cosmetic treatment plans for a single patient. Therefore, standard instructions appear to be necessary to prevent non-standard treatments and overtreatments in cosmetic dentistry. It may be possible to improve the quality of cosmetic dental service provision by further examining dentists’ and dental students’ educational needs regarding the diagnosis and treatment of cosmetic complaints.
1 .Holden AC. Cosmetic dentistry: a socioethical
evaluation. Bioethics. 2018;32(1):602-10.
https://doi.org/10.1111/bioe.12498.
2 .Blatz MB. Chiche G. Bahat O. Roblee R.
Coachman C. Heymann HO. Evolution of
Aesthetic Dentistry. Journal of dental research.
2019:98(12):1294-304.
https://doi.org/10.1177/0022034519875450.
3 .Araujo E. Perdigão J. Anterior veneer
restorations-an evidence-based minimal-
intervention perspective. Journal of Adhesive
Dentistry. 2021;23(1):91-110.
4 .Holden AC. Consumed by prestige: the mouth,
consumerism and the dental profession. Medicine,
Health Care and Philosophy. 2020;23(1):261-8.
https://doi.org/10.1007/s11019-019-09924-4.
5 .Doughty J. Lala R. Marshman Z. The dental
public health implications of cosmetic dentistry: a
scoping review of the literature. Community Dental
Health Journal. 2016;33(1):218-24.
https://doi.org/10.1922/CDH_3881Doughty07.
6 .Ahmad I. Risk management in clinical practice.
Part 5. Ethical considerations for dental
enhancement procedures. British Dental Journal.
2010;209(1):207-14.
https://doi.org/10.1038/sj.bdj.2010.769.
7 .Imre MM. Preoteasa E. Tancu AMC. Preoteasa
CT. Pantea M. Perlea P. Ethical limits between
aesthetic and cosmetic dentistry. Romanian Journal
of Military Medicine. 2018;121(1):16-20.
https://doi.org/10.55453/rjmm.2018.121.2.2.
8 .Hirata R. Sampaio CS. de Andrade OS. Kina S.
Goldstein RE. Ritter AV. Quo vadis, esthetic
dentistry? Ceramic veneers and overtreatment—A
cautionary tale. Journal of Esthetic and Restorative
Dentistry. 2021;34(1):7-14.
https://doi.org/10.1111/jerd.12838.
9 .Sykes LM. Evans WG. Gani F. " In my mouth":
Part 11: Ethical concerns regarding dental over-
treatment and under-treatment. South African
Dental Journal. 2017;72(1):281-3.
http://dx.doi.org/10.17159/2519-
0105/2017/v72no6a9.
10 .Kazemian A. Berg I. Finkel C. Yazdani S.
Zeilhofer HF. Juergens P. et al. How much dentists
are ethically concerned about overtreatment; a
vignette-based survey in Switzerland. BMC
medical ethics. 2015;16(1):43.
https://doi.org/10.1186/s12910-015-0036-6.
11 .Asadzadeh n. gharechahi j. ghorbaneyan f.
rejatei h. Surveying Dentists Graduated from
Mashhad Dental School about Educational
Curriculum and Their Professional Requirements.
Horizons of Medical Education Development.
2016;7(1):4-13.
12 .Zabar S. Hanley K. Stevens D. Murphy J.
Burgess A. Kalet A. et al. Unannounced
standardized patients: a promising method of
assessing patient-centered care in your health care
system. BMC Health Services Research.
2014;14(1):1-8. https://doi.org/10.1186/1472-6963-
14-157.
13 .Park SE. Anderson NK. Karimbux NY. OSCE
and Case Presentations As Active Assessments of
Dental Student Performance. Journal of Dental
Education. 2016;80(1):334-8.
14 .Frazer M. Lindsay S. Development of a
questionnaire to measure concern for dental
appearance. Psychological Reports.
2001;89(1):425-30.
https://doi.org/10.2466/pr0.2001.89.2.425.
15 .Honigman RJ. Jackson AC. Dowling NA. The
Preface: a preoperative psychosocial screen for
elective facial cosmetic surgery and cosmetic
dentistry patients. Annals of Plastic Surgery.
2011;66(1):16-23.
https://doi.org/10.1097/SAP.0b013e3181d50e54.
16 .Shetty D. Bhat S. Recognition of oral and
maxillofacial surgeons by dental Professionals and
their Perceptions regarding cosmetic facial surgery
- a questionnaire-based study. Journal of Oral and
Maxillofacial Surgery. 2019;77(1):1-7.
https://doi.org/10.1016/j.joms.2019.08.008.
17 .Howley L. Szauter K. Perkowski L. Clifton M.
McNaughton N. Quality of standardised patient
research reports in the medical education literature:
review and recommendations. Medical Education
2008;42(1):350-8.
18 .Cortés-Rodríguez AE. Roman P. López-
Rodríguez MM. Fernández-Medina IM. Fernández-
Sola C. Hernández-Padilla JM. Role-Play versus
Standardised Patient Simulation for Teaching
Interprofessional Communication in Care of the
Elderly for Nursing Students. Healthcare
2022;10(1):1-8.
19 .Escribano S. Cabañero-Martínez MJ.
Fernández-Alcántara M. García-Sanjuán S.
Montoya-Juárez R. Juliá-Sanchis R. Efficacy of a
Standardised Patient Simulation Programme for
Chronicity and End-of-Life Care Training in
Undergraduate Nursing Students. International
Journal of Environmental Research and Public
Health. 2021;18(21):11673.
20 .Dios PD. González NP. Lestón JS. Carmona IT.
Posse JL. Varela-Centelles P. “Scheduling delay”
in oral cancer diagnosis: a new protagonist. Oral
Oncollogy. 2005;41(1):142-6.
https://doi.org/10.1016/j.oraloncology.2004.07.008.
21 .Hompashe DM. Gerdtham U-G. Christian CS.
Smith A. Burger R. ‘The nurse did not even greet
me’: how informed versus non-informed patients
evaluate health systems responsiveness in South
Africa. BMJ Global Health. 2021;6(1):e004360.
22 .Daniels B. Shah D. Kwan AT. Das R. Das V.
Puri V. et al. Tuberculosis diagnosis and
management in the public versus private sector: a
standardised patients study in Mumbai, India. BMJ
Glob Health 2022;7(1):009657.
23 .Mafi E. Abdoulahzadeh M. Assessment of
Social sustainability in Mashhad Metropolis.
Journal of Urban Ecology Researches.
2017;8(1):65-78.
24 .Morse JM. The significance of saturation.
Qualitative Health Research. 1995;5(2):147-9.
25 .Merriam SB. Qualitative Research: A Guide to
Design and Implementation. New Jersey: John
Wiley & Sons; 2009.
26 .Pinho S. Ciriaco C. Faber J. Lenza MA. Impact
of dental asymmetries on the perception of smile
esthetics. American Journal of Orthodontics and
Dentofacial Orthopedics. 2007;132(1):748-53.
https://doi.org/10.1016/j.ajodo.2006.01.039.
27 .de Deus Tupinambá Rodrigues C. Magnani R.
Machado MSC. Oliveira Jr OB. The perception of
smile attractiveness: variations from esthetic
norms, photographic framing and order of
presentation. Angle Orthodontist. 2009;79(1):634-
9. https://doi.org/10.2319/030508-131.1.
28 .Springer NC. Chang C. Fields HW. Beck FM.
Firestone AR. Rosenstiel S. et al. Smile esthetics
from the layperson’s perspective. American Journal
of Orthodontics and Dentofacial Orthopedics.
2011;139(1):91-101.
https://doi.org/10.1016/j.ajodo.2010.06.019.
29 .Holden AC. Adam L. Thomson WM.
Overtreatment as an ethical dilemma in Australian
private dentistry: A qualitative exploration.
Community Dentistry and Oral Epidemiology.
2021;49(1):201-8.
https://doi.org/10.1111/cdoe.12592.
30 .Simonsen RJ. Commerce versus care: troubling
trends in the ethics of esthetic dentistry. Dental
Clinics of North America. 2007;51(1):281-7.
https://doi.org/10.1016/j.cden.2007.03.002.
31 .Mtolo TM. Motloba PD. Grillz and Gold Teeth-
Esthetic, Economics and Ethics. South African
Dental Journal. 2021;76(1):498-500.
http://dx.doi.org/10.17159/2519-
0105/2021/v76no8a10.
32 .Majumder D. Hegde MN. Singh S. Gupta A.
Acharya SR. Karunakar P. et al. Recommended
clinical practice guidelines of aesthetic dentistry for
Indians: An expert consensus. Journal of
Conservative Dentistry. 2022;25(1):110-21.
https://doi.org/10.4103/jcd.jcd_32_22.
33 .Al Shahrani I. Self-perception of personal
dental appearance among students of King Khaled
University Abha, Saudi Arabia. European Journal
of General Dentistry. 2014;3(1):181-4.
https://doi.org/10.4103/2278-9626.141662.
34 .Al-Omiri MK. Karasneh JA. Lynch E. Lamey
P-J. Clifford TJ. Impacts of missing upper anterior
teeth on daily living. International Dental Journal.
2009;59(1):127-32.
https://doi.org/10.1922/IDJ_1994ALOmiri06.
35 .Afshar MK. Eskandarizadeh A. Torabi M.
Mousavi MJ. Mohammadzadeh I. Patient
satisfaction with dental appearance and related
factors—A cross sectional study. Journal of
Evolution of Medical and Dental Sciences.
2019;8(1):3569-75.
https://doi.org/10.14260/jemds/2019/771.
36 .Akarslan ZZ. Sadik B. Erten H. Karabulut E.
Dental esthetic satisfaction, received and desired
dental treatments for improvement of esthetics.
Indian Journal of Dental Research. 2009;20(2):195-
200. https://doi.org/10.4103/0970-
9290.5290210.4103/2278-9626.141662.
37 .Lajnert V. Kovačević-Pavičić D. Pezo H.
Stevanović A. Jović T. Šnjarić D. et al. Patients'
general satisfaction with the appearance of anterior
maxillary teeth. Vojnosanitetski Pregled.
2017;74(1):520-5.
https://doi.org/10.2298/VSP151110248L.
38 .Alkhatib MN. Holt R. Bedi R. Age and
perception of dental appearance and tooth colour.
Gerodontology. 2005;22(1):32-6.
https://doi.org/10.1111/j.1741-2358.2004.00045.x.
39 .Xiao J. Zhou X. Zhu W. Zhang B. Li J. Xu X.
The prevalence of tooth discolouration and the
self‐satisfaction with tooth colour in a Chinese
urban population. Journal of Oral Rehabilitation.
2007;34(1):351-60. https://doi.org/10.1111/j.1365-
2842.2007.01729.x.
40 .De Jongh A. Oosterink FMD. van Rood YR.
Aartman IHA. Preoccupation with one's
appearance: a motivating factor for cosmetic dental
treatment? British Dental Journal.
2008;204(1):691-5.
https://doi.org/10.1038/sj.bdj.2008.522.
41 .Fortes JH. de Oliveira-Santos C. Matsumoto W.
da Motta RJG. Tirapelli C. Influence of 2D vs 3D
imaging and professional experience on dental
implant treatment planning. Clinical Oral
Investigations. 2019;23(1):929-36.
https://doi.org/10.1007/s00784-018-2511-1.
42 .Lyu H. Xu T. Brotman D. Mayer-Blackwell B.
Cooper M. Daniel M. et al. Overtreatment in the
united states. PLoS One. 2017;12(1):e0181970.
https://doi.org/10.1371/journal.pone.0181970.
43 .Kale MS. Bishop TF. Federman AD. Keyhani
S. Trends in the overuse of ambulatory health care
services in the United States. JAMA Internal
Medicine. 2013;173(1):142-8 .
44 .Berwick DM. Avoiding overuse - the next
quality frontier. Lancet. 2017;390(1):102-4.
https://doi.org/10.1016/S0140-6736(16)32570-3.
45 .Lee DS. Sulkowski T. Bocklage C. Frazier-
Bowers SA. Wiesen C. Mihas P. et al. Identifying
factors that impact general dentists’ referrals to
orthodontists. American Journal of Orthodontics
and Dentofacial Orthopedics. 2022;161(1):147-71.
https://doi.org/10.1016/j.ajodo.2021.07.010.
)