Why are Dentists Smiling?

By Hannah Wallace October 31, 2005

TV makeover shows, persnickety baby boomers, expanded media coverage of popular whitening procedures and savvy marketing are giving area dentists a reason to smile. With veneers starting at $1,000 a tooth-and people rushing to get them-the cosmetic dentistry business is booming.

Aesthetic dentistry services grew an average of 12.5 percent nationwide in the last five years, with some doctors reporting close to a 40 percent increase, according to an American Academy of Cosmetic Dentistry survey that queried 9,000 general and cosmetic practices in the United States. Nowhere is this more evident than in Sarasota.

"Sarasota is an area of well-educated people who want nice things and want to look good. They're able to afford it," says Dr. David Sundeen, who has been practicing dentistry in Sarasota for 20 years.

And cosmetic dentistry is no longer just for the wealthy. Sarasota dentist Dr. Christine Koval estimates that half of her patients use some sort of financing, often a home equity loan. "Just as individuals are goal oriented about automobiles, vacations and technology, we are seeing that people see the value in a smile makeover to budget into their monthly expenses," she says.

Indeed, the cosmetic dentistry business is lucrative. More than half of all dentists surveyed estimated that patients in both general practice and cosmetic-only offices spend between $201 and $600 on aesthetic procedures per year; 31.5 percent estimated that their patients spend more than $600. (The remaining 17.3 percent reported that patients spend $200 or less annually.) The most popular services are whitening and veneers. Tooth whitening and bleaching increased by over 300 percent between 1996 and 2000, according to the AACD study.

While some practices top the $1 million mark, 48.3 percent of the practices surveyed by the AACD reported annual revenue exceeding $700,000 annually. Local dentists would not provide exact revenues, but they did confirm that those figures are in line with their earnings, and some said their production was greater.

This region's demographics, particularly baby boomers and retirees, are a big part of the success of cosmetic dentistry here. (AACD membership includes six dentists in Sarasota and one in Bradenton.) "It's been great because of the baby boomers," says Dr. Jill Morris. "They move in and they have a lot of old, old dentistry: short teeth, collapsed spaces. They want to look good and feel good."

Extreme Makeover and other shows have helped. Ten years ago, no one knew what a veneer was. "Today people call our office asking for veneers, so the marketing, the extreme makeover shows, those things have really educated the public," Morris says. "When I watch those shows, I always want to tear up; you can see it's a life-changing event for the people. It's made it OK."

That's one reason why Morris has done extreme smile makeovers in the community for the past three years. The first two years, she held a contest to pick a "deserving person who didn't have money but needed a great smile." One winner was a mother of 18 children, and another was disabled. The proceeds went to the Sarasota Winefest. This year, she auctioned off veneers and raised $40,000 for the event.

Dentists have intensified their marketing efforts to reach patients. When Morris graduated from dental school in 1985, advertising was taboo. "If you marketed, you were a quack. That was the old-school idea of professionalism," she says.

Today, a presence on the Internet and visibility in the community are a necessity. So, it seems, are the ever-present before-and-after ads that show real patients flashing their newly perfect smiles. "I don't care how good I am and how much I've learned, if I can't get that out to the public, I won't have the patients," Morris says. "You have to constantly figure out ways to separate yourself from the rest."

The increased marketing for cosmetic and reconstructive dentistry allows the public to avoid wasting time trying to find the appropriate doctor, who can deliver these procedures in a timely, comfortable and predictable manner, says Koval. "Previously people thought of dentistry as, 'If it's not broken, don't fix it,'" she says. "We as a society have evolved to be more proactive and preventive with our health."

Dr. Richard W. Valachovis, executive director of the Washington, D.C.-based American Dental Education Association, says dental schools are doing little to teach future dentists how to market themselves. "Like others, dentists have become more aware of issues related to marketing," he says, noting that practices nationwide are hiring advertising and marketing firms. "It's not coming from the dental school."

When Sundeen began advertising in the late 1980s, he started with a small ad in SARASOTA Magazine "to let people know we were there; we had their interest at heart." At that time, most dentists had only a line in the yellow pages, he says. But over the years, Sundeen's ads have become more like jewelry ads, with smiling customers wearing pearls, than the "old-time dentistry approach." Now, his wife, Annie, serves as his director of marketing and public relations. "In most of the offices that I know, the marketing and PR person is probably related to the dentist," he says. "Who else do you trust the most with getting the message out and representing you?"

While print-media options have grown, Sundeen and other dentists believe a presence on the Internet is probably most important. Patients use the Internet to find information about certain procedures and to see before-and-after shots.

The increased marketing means patients have to be more proactive in choosing a dentist with the educational background and knowledge to perform the services correctly, says Dr. Nicholas Davis, a California cosmetic dentist who serves as president of the American Academy of Cosmetic Dentistry. "There are people who profess to be cosmetic dentists who may not have a lot of training," he says.

One problem is that anyone can say he or she is a cosmetic dentist. There's no degree in cosmetic dentistry, although doctors can earn accreditation through the American Academy of Cosmetic Dentistry, based in Madison, Wis. Some local doctors, including Morris, Koval and Sundeen, take courses and teach at the Las Vegas Institute for Advanced Dental Studies, a top post-graduate dental teaching center founded in 1995 that offers seminars to strengthen dentists' clinical and management skills. LVI also understands the power of marketing-its national marketing campaign for graduates includes a 30-second TV commercial during Extreme Makeover, ads in magazines including People, InStyle and O-The Oprah Magazine, and an in-flight segment on Continental Airlines flights.

Davis says consumers must ask dentists about their education, examples of their work ("that doesn't mean a book dentists buy of others' work") and ask to speak to satisfied patients.

Every dental practice to some degree does cosmetic dentistry, he adds. Common entry-level aesthetic procedures include bleaching and the use of tooth-colored resin or porcelain, instead of metal, for fillings.

Dentists find it hard these days to separate cosmetic work from the rest, because they say most procedures have some aesthetic component. Even extreme makeovers aren't completely for looks, Sundeen says. Fixing a smile may be a self-esteem issue, or it may be because teeth have deteriorated so badly or because a patient is looking to enhance a first impression.

Even when Morris is helping a patient with a common problem, like facial pain from problems caused by TMJ, she uses cosmetic restoration. It's aesthetic but also functional. "Hopefully someday we won't even need to use the word 'cosmetic,' because everything will be cosmetic," she says.

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