Don’t feel bad if you don’t know the answer. I am amazed at how often I have to give an answer to people who work in dentistry. There are really two ways to answer: the short way and the long way.
The Short Way
The official definition from the American Dental Association is this:
“Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.”
In my opinion, this definition does more to confuse the issue rather than help it. I myself like the “dumbed down” definition you can find on Wikipedia.
A prosthodontist is a dentist who specializes in prosthodontics, the specialty of implant, esthetic and reconstructive dentistry. Prosthodontists specialize in the restoration of oral function by creating prostheses and restorations (i.e., complete dentures, crowns, implant retained/supported restorations). Cosmetic dentistry, implants and temporomandibular joint disorders all fall under the field of prosthodontics.
Prosthodontics is one of nine specialties that the American Dental Association recognizes (just like Orthodontics and Oral Surgery). To be a prosthodontist a person has to have at least three years of additional training beyond dental school in an accredited program. So, in the same way that a hygienist learns more during their training than a dental assistant and a dentist learns more than a hygienist; a prosthodontist (or any other specialist) learns more than the general dentist in an organized and regulated way.
Before I get into the long answer, let me make one point clear. There is NO specialty known as Esthetic or Cosmetic dentistry, nor are there any formal, accredited programs which focus solely on that in their curriculum.
The Long Way
To learn more click on any of the sentences below.
Prosthodontists have more training than general dentists do. There, I said it. It is a fact and one that I choose not to apologize for. I spent four extra years at one of the most prestigious hospitals in the world under the tutelage of four leaders in dentistry getting that training and I don’t mind tooting my horn a little about it.
When someone graduates from dental school they usually have been seeing patients for the previous two to three years. During that time they are required to complete a certain minimum number of fillings, crowns and bridges, dentures and partial dentures. They are also required to perform pediatric dentistry, oral surgery and root canals. I know that in my personal case I did not feel completely prepared to enter into private practice when I graduated and it was one of the primary influencing factors in my choosing to seek additional training. When I graduated from dental school I had made 4 dentures, 2 partial dentures and about 30 crowns and bridges. I did not place nor did I restore any implants. At the end of my four years of prosthodontic training I was making 4 or more dentures a month (on average), several partial dentures a month, had prepared and restored hundreds of units of crowns and bridges (including several full-mouth rehabilitations) and had restored over 500 implants. In addition to this I had fabricated many ears, eyes and noses for people who had lost those structures to injury or cancer. In short, my experience in dental school was laughable compared to my experience during residency.
One also spends considerable more time “hitting the books” during a residency than during dental school. I’ll use one example to demonstrate my point. In dental school, you have one class that dealt with occlusion (how the teeth and jaws function as a unit) for a semester. There was one textbook and you simply read the book and listened to a few lectures on the subject. At the end you took a test and you passed or you didn’t. As a resident, I had two years of formal seminars that dealt directly or indirectly with occlusion. Typically I was required to read 150-250 pages on the subject EVERY WEEK. In addition to this I had to constantly explain how and why I was treating a patient this way or that with the 4 instructors looking over my shoulder at every step of the way.
Like I mentioned above, there is no such specialty known as cosmetic or esthetic dentistry. When someone advertises that they provide these services or that their practice is devoted to this type of dentistry, it is just that, advertising. No dentist, regardless of their skill or lack thereof, intentionally tries to do “ugly” dentistry.
So, what is an esthetic of cosmetic dentist?
Typically this is an individual who has made a decision to perform procedures for individuals for the purpose of altering the size, shape and color of the teeth to make them more pleasing to the (patient’s) eyes.
How does one become an esthetic or cosmetic dentist?
No one has to do anything other than graduate dental school to advertise that they “specialize” in cosmetic or esthetic dentistry. There are no regulated standards and there are no accredited programs which teach only esthetics. Having said that, a (very) large percentage of the continuing education courses that dentists are required to take to renew their licenses deal with esthetic dentistry. I find that one of the most telling things with respect to these courses is the fact that they are taught, more often than not, by prosthodontists.
In today’s world of continuing education you either attend a meeting to hear someone speak or you pay money to attend an “institute” somewhere for a weekend crash course in whatever subject you wish. Two of the biggest names today in the arena of cosmetic/esthetic dentistry are Frank Spear and John Kois. Each has been extremely successful lecturing to local, national and international study groups and have taught tens of thousands of dentists their ideas on just how to perform esthetic dentistry. In addition to their lecturing, each has an institute in Washington state to which countless dentists travel to learn from the masters in both lecture and hands on format. It is no accident that both these doctors are prosthodontists and that much of what they teach in their courses are condensed and simplified concepts that one would learn during the course of a prosthodontic residency; concepts of occlusion (how the bite works), head and neck anatomy and physiology, the science of the materials used to make crowns, bridges and veneers and many other principles that are at the heart of cosmetic dentistry.
Ask anyone who has graduated from dental school who are the most overworked people in the institution. If they don’t answer “the prosthodontic residents,” then just remind them about how much time those poor souls spent in the laboratory making restorations and prostheses for patients. You know when your dentist says something like, “now we’ll send this to the lab and your crown (or denture, etc., etc.) will be back in a few weeks”? Prosthodontists are required to know how to do the things that the lab would do when your gag-eliciting impressions are sent away. Prosthodontists have to know how to make crowns, to cast the metal, to wax the teeth, to layer the porcelain of those beautiful veneers, to process the acrylic of those perfect fitting dentures, and so on. Not only do they have to know how to do those things, they are required to have an intricate understanding of the chemistry of those materials and how they are manipulated to function properly in your mouth. This understanding is a BIG distinguishing feature of the prosthodontist in that the deeper understanding makes us extremely picky and critical of what is given to us by the laboratory, what materials are used and how these things fit and function for you.
This high standard was the primary motivating factor for me to choose to have a technician work in my office full time. I wanted to be able to oversee the designing and making of everything that I place in my patients’ mouths so that I have full confidence in the quality of the work. I often spend time in the lab working along side Henry to ensure that my standards are met. Thankfully he is just as obsessed with “getting it right” as I am.
Some dentistry is simple and straight forward. Some dentistry is complicated and takes thought, care and planning to make it “work.” An example of simple dentistry would be a filling or a single crown. With a filling, most of the tooth is still there to let the dentist know how much material should be used and how it should bite against the adjacent teeth. The same is true for a single crown. All the other teeth are around it to give the doctor and idea how it should “fit” in its surroundings. Dentistry becomes progressively more complicated when there are fewer and fewer teeth to guide how things should “fit.” The most extreme example would be a person with no teeth at all. In order to have a happy patient, a doctor must know how to make something fit the gums that doesn’t cut or put too much pressure in places and doesn’t fall out easily. The doctor has to know where to put the teeth so that the patient doesn’t talk funny, doesn’t bite their tongue or cheek, doesn’t develop pain in the jaw joints and is able to eat food normally. As I mentioned before, when I was a dental student, there was little time devoted to teaching us how to handle these complicated situations with any real proficiency. As a prosthodontic resident I was seeing this type of patient every day, five days a week, 8-10 times a day. Not only were my patients without teeth, sometimes they were without parts of their jaw(s). In all these cases I was taught how to manage the situation in a way that would allow to have a replacement that was comfortable, functional AND esthetic.
That is what a prosthodontist is; a dentist with vast amounts of experience, book smarts and clinical skill, who understands how to reconstruct teeth that are missing or beyond repair, who understands what materials are used to make the replacement, who understands how to make the replacement and is able to do so in a way that is more than just pleasing to the eye, but is comfortable and properly functioning.
All patient photos shown on this web site depict treatment that I (myself) have provided. I do not use stock photographs of work that someone else has done.