Forum Excerpt

"The Joy of Cosmetic Dentistry In the New Millennium...The Future is Here and Now" 10/24/00

Our expert for this forum was Joe L. Carrick DDS. Dr. Carrick is a past president of the AACD and serves as an Examiner for accreditation. He has extensive experience in international lecturing and is a faculty member of four universities. Participants enjoyed the opportunity to discuss cosmetic dentistry with this well-respected leader in the field.

Dr. Joe Carrick: "...We've had a few questions about Britesmile and how we've used that in our area to help educate people on what cosmetic dentistry is, and I will just describe briefly how we got involved with it. You might think I am a little bit crazy when I tell you what I just did, but for 26 years I practiced in San Diego. I sold my practice and moved to Madison, Wisconsin for a lifestyle change. Britesmile was basically started on the West Coast and while I was in San Diego, Britesmile felt that they could influence people to look at their teeth in a different way, and so they started Britesmile. What happened soon along the west coast is that with their infomercials about Britesmile they had as much or more interest from the dentists in the community calling in to say how can we be a part of this? Because their patients were coming in and asking about it. Ironically, what we discovered that about 75 percent of the new work we are doing is a direct result of people coming in for bleaching. They've had mixed experiences with bleaching because you know the tray system is a compliance type system and therefore many people have good intentions but they never follow through and so this gives them the ability to do something real quickly. We've also discovered that those folks coming in are looking to have their teeth brighter or lighter and they don't realize that sometimes that is not going to be the solution so it's an opportunity to educate them as to how we can get them to where they want to go and how they think they can get there. And Britesmile is possibly a part of it; it can be the sole treatment or it can be in conjunction with other things that we do.

What we have done differently than they may have taught you is that we have the patients choose. We pick the shade the patient is; the patient and I sit there and we match what we believe and the patient accepts that as where she or he is at that point in time. They hold onto that shade tab until the procedure is finished because as you know they'll lose all point of reference. As opposed to taking a photograph which we've had some skeptics come in and say, "you could alter this or alter that" and so it takes all the guesswork out of it and if there is not a perceived change then there is no fee, so we try to pick the ones that we can do. We are actually looking at using Britesmile in a couple of dental school settings just to see if we can take it, with some different solutions and make it more effective for the hard to bleach teeth such as a tetracycline...

Dr. John Hartman: ...this is John from Indianapolis, we just started with Britesmile about 4 weeks ago, we've probably treated about 20 cases and our patients have been really pleased with the results. Our current fee right now is $550 but right now we are the only provider in the Indianapolis area so we really feel like our fee is still too low and we may take it higher; whether we do that or not hasn't been determined, but we're considering even going as high as $700 until more people come in.

Dr. Carrick: When they come in what do you have them do? Just run them through a patient, when they come in for bleaching, the consult, what do you do, do you sit down....

Dr. Hartman: Well, Britesmile provides you with a lot of great paperwork, I mean we have them simply start with the information that is provided on the Britesmile questionnaires which is very thorough and then it's real important though to establish realistic expectations. We used Apollo previously, however we also sent people home with the home kit so their expectations were that they weren't going to be finished. We've actually had a couple of cases where even though they were brighter than B1, they still thought that they should be brighter and we were really preparing people well enough to say that the gumline maybe a little bit darker than the insides of the ledge and those kinda things. So we back up a little bit and say that we can guarantee you 4 or 5 shades. I know that the pamphlet says up to 9 shades and so we caution people about that.

Dr. Chris Kammer: ..talking about 9 shades, what do they even mean by 9 shades? I mean, does it go from say C4 to D1?

Dr. Carrick: Well actually it is a different system altogether. They are doing it with infrared and measuring and you can actually objectively do that, it measures the yellows and reds.

Dr. Hartman: Well that is a good point, I didn't know that. We're using the Avita shade guide.

Gabby Parsons (Moderator): Well, let me just throw out a question here for everybody here to answer. What is it that prevents people who know in their heart that they want to improve their smile or that they need work from coming into the office?

Dr. Carrick: Well, we've drawn up 4 reasons why we think that people don't have treatment done and 1 and 2 most people received in dental school. One is the cost. Two is the fear of pain. But what we don't really address in our practices as much as we should are 3 and 4. In cosmetic practice number 3 would be, "what am I look gonna like when I am finished?", and probably the most important number 4 is, "what am I going to look like while I am getting finished?" If you address 3 and 4 you then the patient appreciates the value of what their going to be receiving; so number 1 the cost is no longer of issue and number 2, the pain issue can easily be erased either having an anesthesiologist come in or sedate your patient. And we've discovered that once we do that we can even show the patients a destination. What we have them do is come in with pictures: if they are looking at changing their smile, we say , "we want you to pick 4 or 5 pictures out of any magazine, just cover the nose and the chin and I want you to bring them in and let me see what you think looks good". We do what we call a masterdiagnostic waxup and we send those photographs in along with the photographs of the patient as they are. Then the lab can duplicate those embrasure forms or emergence profile or the theme that comes out from all those different pictures the patient has given us. And we can bring it back with a three-dimensional projection of what the end result would look like. And that does not only include the hard tissue but the soft tissue. Then in some cases, if we have the patients that have spaces or were going to lengthen teeth, we can even bring in and use a diagnostic waxup and make a set down splint from a reproduction of that model; fill with this composite with a shade of appropriate resin and let them view what the end result might look like before we've even touched the teeth. And sometimes we can even take that preview, trim it, polish it, glaze it and let them take it home for the significant other to take a peek at. If they come back after that point, then we know that they appreciate the value. So that's how are trying to get people, not to sell them dentistry but to sell them a destination and they pick how they want to; we give them some options for how to get there...

Moderator: Let's talk about the second one for a minute, the fear of pain. I'm relatively new to working in the dental field. I am a marketer but I know that that there are so many dental-phobic people and dentistry has come such an enormous way in the last 5 or 10 years, so what can offices do that to let people know that it's not painful anymore?

Dr. Carrick: Well, first of all they can listen and when the patient is describes their pain they can acknowledge it because it is a real thing. Secondly not to be in too big a hurry to get to where someone is going because many times as you mentioned people put that barrier of fear in front of them to get to the end result they want. And many of these folks are very intelligent people they just have a fear. For a good example, we had a pediatrician that came in on a Sunday afternoon with a broken tooth and you could see she was awfully stressed so rather than going in we just polished things, she was not having a lot of sensitivity at the time. We asked her if she had some anxiety about seeking dental treatment. She was confident enough to share, yes, that's one of the things that kept her from coming in. So I said, "well, look we don't need to do this right now, I'll come in at a time that is convenient for you and I want you to try taking 2 tablets, we use halcion and valium," she can't drive obviously after she's taken those things. And we used the Nitrous. So we brought her in and we ended up doing endodontic treatment on the tooth and she was so thrilled with herself for going through the procedure that she didn't think she could go through, she then came back and had the masterdiagnostic work up and we did 18 units of veneers and crowns on this individual that before that was a nervous wreck.

Gabby: So you think that the really what brought her back in the next time was because she was able to go through the procedure and be really comfortable?

Dr. Carrick: Well, she was able to go through it yes and be comfortable but more than that it gave her, it's like something all her life that was preventing her from doing something that is a wonderful feeling of accomplishment and the second time was even easier. Ironically, her husband who is an opthomologist was so impressed he set up an appointment himself because he like her was a dental phobic and he hadn't seen someone in years. You would think that these folks that were as intelligent as they were and they themselves treat patients would find a way of getting around it. Now the good news about Halcion and Valium; it was recommended to me by the anesthesiologist that came into our office. The lethal dose and the therapeutic dose are 200 times different so it's one of the safer combinations out there and you're using a combination; it's a different animal of course than they are separately.

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