Last month, I was able to interview Dr. John Moore Jr., DDS. and find out more information about the world of cosmetic dentistry. Dr. Moore decided to dedicate his life to dentistry after an orthodontist “literally saved his smile from buck-toothed ruin at a young age.” However, in addition to the normal training of a dentist in traditional math and sciences, Dr. Moore took the highly unusual step of engaging in formal art education, as well. Currently, Dr. Moore is the principal of Cosmetic Dental Associates (CDA). In addition to learning about traditional orthodontic practices, the interview focused on how he invented “diamond veneers” and the thought behind this amazing innovation.
How did your formal art training help you in dental school?
It gave me a tremendous advantage. By the time I got to dental school my eye-hand coordination and motor skills were developed well beyond my peers. Because art in large measure is a study of creating three-dimensional images on two-dimensional media, understanding the tomes of anatomical and dental research, texts and images seemed easy and even delightful from the very beginning of dental school. Translating the concepts from the two-dimensional images into three-dimensional action was second nature because of the art training. It allowed me much more time to perfect my skills rather than fumble through basics and struggle to get my hand to do what my mind wanted it to do. Sculpting (in 3D) needless to say is a fundamental skill in dentistry so any and all of my studies in sculpting and creating three-dimensional objects was extremely important in developing my skills for dental school.
How did your formal art training change the way you did dentistry?
The main thing the art provided me was the skill to observe something and translate it into a three-dimensional creation. Conversely, it also gave me the skill to observe something three-dimensional and translated into a two-dimensional image. It was this skill that landed me a job while in dental school of illustrating dental training manuals, dental books, and dental drawings teaching how to look at teeth and dental anatomy. From here it was a short jump to playing the game of figuring out what makes a tooth or teeth look real. This forever changed the way I did and now do dentistry because while all teeth have certain predictable repetitive shapes they all also differ infinitely from each other. It was this challenge and fascination with trying to discover what it was that brings this together. It’s like every case is the same and at the same time, every case is different. In this discovery, I found that the art would always remain interesting and challenging.
What made you compare teeth to diamonds when shaping veneers?
This began innocently enough because of collecting gemstones as I was fascinated with how beautiful they were and had always been curious about why this was so. Many stones of equal size were priced quite differently than each other and the common denominator always seems to be how much prettier one looked than the other. Intrigued by why this was the case I began studying why some stones were so much more dazzling and sparkly than others. Materials aside, it became apparent that the artist’s role in cutting the stone was of paramount importance. So much so that the skill of cutting stones is recognized around the world. It turned out that the art of cutting facets on the stones exactly in the right places and in the right sizes and the right positions were the art of making one stone look so much better than another. It was while drawing pictures of teeth, learning how to shade them and make them sparkle, that I realized that light had to flash and spark off the surface of the tooth to make it dazzling. Later while photographing teeth I discovered that this spark and flash of light was absolutely vital to making the veneer or crown come alive and look real.
If by botched we mean the restorations don’t look real or don’t sparkle or gleam to the patient’s expectations then no, there are no standards. – Dr. Moore
Are there standards in place to prevent botched procedures from occurring?
Yes, there are standards. I think the answer to this question would have to be yes and no. If we mean by botched procedures that the crown does not fit well or violates the standard of care in our community then yes, of course, there are standards. If by botched we mean the restorations don’t look real or don’t sparkle or gleam to the patient’s expectations then no, there are no standards. At this point aesthetics really becomes something in the eye of the beholder or something for which there is no real standard measure. We do have a procedure which is not necessarily standard that we are able to employ to minimize a patient’s dissatisfaction or maximize their aesthetic outcome. This would be chair side ceramic technicians and artists able to interpret and ultimately understand the patient’s desires and marry this to the reality of the patient’s dental condition. In other words with the patient, we can achieve results of realism and aesthetic detail that without we have not been able to achieve before. Whenever you can ensure the fit and finish and most of all the patient’s satisfaction I think it’s safe to say we’ve avoided a botched outcome.
If there are, is a lack of oversight the reason why botched procedures are still rising?
Yes, I think this probably contributing to the case but it is an odd problem. After looking at all the regulations that have come down the pike over the past 10 years I’d have to say further regulating is something I’d like to reject. Of all the things that there are to regulate, aesthetics and art would have to be pretty much impossible. I think that this one would really have to stay more the responsibility of the consumer. It would be like commissioning an artist to do a painting for you and you had no idea of what the painter was capable of. The only way I can see this to be remotely possible would be for the patient to see samples of the cosmetic work they are contemplating. Can the dentist actually show you photographs of patients that he has done that represent the cosmetic outcome you’re expecting? If there was to be any oversight it might come in the form of patient education on how to interview a cosmetic dentist and what you might expect from a truly experienced artist. Beyond this, the bulk of the rising numbers of botched cosmetic cases is probably a result of the demand for cosmetic dentistry coupled with the need for dental offices to meet their rising overheads and dropping numbers of new patients.
Looking at current growth rates, where do we see cosmetic dentistry going within the next 5 years?
I think cosmetic dentistry is going to grow within the next five years. I also think there’s going to be a greater and greater demand for better and better looking cosmetic dentistry. As people begin to realize that they can get cosmetic dentistry that is so stunning and so real looking that it’s hard for even a dentist to tell, they’ll begin to demand and also realize how to get such work done. Along with this, I would say it’s inevitable that more and better cosmetic dentistry training will become available to the general dentist. In this training, I see an increase in the teaching of artistic perceptions as they apply to the dentist’s responsibility in the role of creating truly beautiful dental restorations.
Is there a next step innovation we can expect to follow the “diamond” porcelain restorations? Innovations to me mean that we should see new materials or new techniques or new instruments that make visualizing and placing light facets easier and more predictable. First would come an understanding of where they need to be, what size they are and what shape they should be. Special lighting to see the facets easier and better-improved polishing compounds and instruments designed to make the polishing easier seems like it would be a natural evolution. This is necessary because all too often the restorations need to be placed in their final positions in order to determine exactly where the facets themselves need to be placed for an optimum aesthetic outcome.
What meaningful changes have occurred in your patients’ lives after getting the smiles they always wanted?
I think some of the most meaningful changes that I’ve seen in patients that have had cosmetic dentistry done is this increase in their self-esteem or confidence. All too often we get to see emotional relief from the correction of a lifelong ruin turned into tears of joy and exclamations of how much more confident they feel facing life. We see people come out from hiding behind their hands and people that haven’t dated in decades suddenly get married. We hear stories of a better life, better deals, promotions, and happier more fulfilled personal lives. This area of dentistry without a doubt generates some of the most rewarding and flattering testimonials from our patients. It is made coming to work exciting for me for over 30 years.