Sixty-seven percent of Angie's List members polled say they've spent $1,000 or more on cosmetic dentistry. Although nearly 54 percent of Americans have dental insurance, according to Rene Chapin, spokeswoman for the National Association of Dental Plans, cosmetic work such as porcelain veneers, bonding and porcelain crowns, typically isn't covered.
The only time cosmetic dentistry insurance coverage applies is when the dental procedure restores tooth structure or improves a patient's oral health. Then major cosmetic dental work is usually covered at 50 percent.
Dr. Lawrence Addleson. a highly rated dentist in San Diego, says a porcelain veneer can cost as much as $3,000 per tooth, depending on the job's complexity and the dentist's experience. "Someone who is. good and in demand is going to charge more than a kid just starting out," he says.
With a typical dental insurance policy, including an annual cap of only $1,000 to $2,000, the consumer must cover any remaining costs. Member Carl Vonderau of San Diego paid $1,000 out of pocket for a porcelain inlay, which was covered at 50 percent. "I'm sure I could go to a cheaper dentist within my plan," he says, but prefers Addleson's experience. George Labbad, a self-employed contractor in West Palm Beach, paid the full cost of his $12,000 to $15,000 cosmetic dentistry tab. "There's no adequate dental insurance," he says. "You buy it and you still have to pay out of pocket."
Know your options for cosmetic dentistry
Dr. Michael Moats. a highly rated dentist in Buffalo Grove, Illinois, recommends you ask your dentist about less-expensive options. While a porcelain veneer may be best, for example, he says he can save patients money and achieve acceptable results with bonding or tooth whitening.
Almost 32 percent of Angie's List members polled say they've had cosmetic dentistry, with crowns being the most popular procedure, followed by whitening, veneers and braces. While some say they get cosmetic work for healthier teeth or to feel more confident, 50 percent say they did it to improve their appearance .
Cosmetic dentistry is the fastest-growing category in the dental industry, according to the American Academy of Cosmetic Dentistry, with 200 percent growth in procedures since 1996, and 300 percent growth in teeth whitening alone. But which dental professionals are better suited to cosmetic dentistry is ill-defined and in many cases, nonexistent. The American Dental Association doesn't recognize it as a specialty and any general dentist can market himself or herself as a cosmetic specialist.
The majority of cosmetic dentistry reports on Angie's List are highly rated. However, experts advise consumers to go to a dentist they trust. Addleson compares it to hiring a plumber or house painter - you get what you pay for, except the stakes are much higher. Bad cosmetic dentistry will at best leave you with an ugly smile, he says. At worst, it can devastate your oral health.
What is considered cosmetic dentistry?
Procedures the ADA considers to be potentially cosmetic, include braces, porcelain crowns, veneers, bridges and bonding. Legally each procedure can be performed by a general dentist, but they also overlap into the specialties of orthodontics and prosthodontics. "Cosmetic dentistry can range from low-level whitening - I'm talking Crest White Strips - to full-mouth reconstruction," Moats says.
Consequently, the consumer may be confused about whom they should see for cosmetic work, says highly rated prosthodontist Dr. Keith Progebin of Washington, D.C. "Just because [a dentist] can do something doesn't mean he or she should do it or is capable of doing it to the same standard of care as the specialist."
Prosthodontics is the only specialty recognized by the ADA for cosmetic procedures. It requires a three-year accredited fellowship in all aspects of cosmetic dentistry, implants, dentures, full-mouth reconstruction and other complex issues.
Yet Progebin isn't looking to attract patients who want only teeth whitening. basic inlays and veneers. In the absence of regulation, he says patients must be proactive in evaluating the work they need, asking good questions of their general dentist and seeking a second opinion of a specialist, if necessary.
The cost of bad cosmetic dentistry
Georgia McNulty-Hook of Redwood City, California, outside of San Francisco, says she knows all too well the high cost of bad dentistry. "I wanted my teeth
to look like a movie star's," she says, and adds that she went to Dr. Glenn G. Lew based on his glossy advertisements and plush offices. "I'm 64. Old people get old-looking teeth - yellow. When Dr. Lew told me, 'I'm going to crown every tooth,' I thought, 'Why not?' He said it would be beautiful."
The process took two years, required more than 15 crowns and cost more than $20,000, she says. In fall 2010, McNulty-Hook says one of her front crowns fell out. She says she paid Lew about $1,500 out of pocket before stopping payments on her 20 percent share of the dental insurance cost. McNulty-Hook says she's been told by another dentist the remaining crowns will fall out eventually because her gums can't support them.
Lew, who is highly rated, declined to comment on McNulty-Hook's case, citing federal privacy laws, but says his track record speaks for itself. "I have many, many happy patients from a career that spans 33 years now," he says. "On occasion, as in any profession, difficulties arise with cases. I deal with these on an individual basis and always stand by my work."
Addleson, not commenting specifically on McNulty-Hook's situation, says bad cosmetic dentistry is fairly common and estimates about 25 percent of his procedures are done to correct other dentists' shoddy dental work. Progebin estimates he spends closer to 50 percent of his time correcting other dentists' work.
Before committing to cosmetic dentistry, patients should ask to see the dentist's portofolio of before-and-after photos. "If a dentist can't show you his work, it probably means he hasn't done any or it looks like crap," Addleson says. He says to make sure the photos are of that dentist's work because some dentists buy before-and-after photos to misrepresent their skill. "Ask to talk to the patients in the photos," he says. "Every photo on the wall, I not only did the work, they are only my patients."
Finding a qualified cosmetic dentistry specialist
The American Academy of Cosmetic Dentistry, with more than 6,500 members worldwide, is the largest cosmetic dentistry association. It offers six levels of membership, from general members with no requirements up to accredited fellows, like Addleson, who must pass oral and written exams and submit 50 examples of work for peer review.
Regardless of a dentist's background, providers who spoke with Angie's List say aesthetics always should take a backseat to oral health. That means a full oral exam that includes X-rays, a gum exam and cleaning. Dentists shouldn't start the aesthetics until they've addressed any health issues, which dental insurance often covers, although a deductible may apply.
"Just because we do cosmetic dentistry doesn't mean we can ignore that for which we are trained," Addleson says. "Especially gum disease. If you have gum disease in the front of the mouth and then you do veneers, that tissue is going to recede and then it looks like hell." Broken or cracked teeth also point to problems with a person's bite that a good cosmetic dentist will correct rather than cover up.
Addleson says he turns away patients who don't want to address oral health problems. Moats says he does the same. "I had a woman in here, she wanted six veneers," Moats says. "I said, 'No problem, but your bite is wrong. If we don't correct that first, whatever work I do will break.' She didn't like what I said, went to another dentist and came back several months later with broken veneers."
In extreme cases when a patient needs full-mouth reconstruction, Progebin recommends consulting a prosthodontist. "The specialist acts like a project manager," he says. "There's got to be one person in charge. I'd send you to the orthodontist. I'd send you to the periodontist or oral surgeon. I'd coordinate [dental care] for you."
Vonderau says he feels like Addleson is interested in his oral health, not just expensive procedures, because the dentist declined to whiten one of his teeth. "It had a root canal and he would have to drill into the tooth to do an effective bleach," he says. "It would weaken the tooth too much. He's a perfectionist and that's good."
Editor's note: This is an updated version of an article originally posted on December 20, 2011.