Q & A with Dr. Ronald Goldstein
Whether they’re looking to brighten their smiles, boost their confidence or appear younger, patients choose cosmetic dental care for many reasons. Modern dentistry offers a wide variety of treatment choices including bonding veneers, all-ceramic crowns, whitening, orthodontics and implants. In many cases, a combination of these techniques is utilized to deliver the best results.
Ronald Goldstein, DDS
Author of the best-selling book, Change Your Smile, Clinical Professor at the Georgia Regents University School of Dentistry, Adjunct Clinical Professor of both Boston University and the University of Texas, practicing dentist at Goldstein, Garber & Salama in Atlanta, Georgia
To learn more about this growing field, we’ve interviewed the “Father of Cosmetic Dentistry” and practicing dentist, Dr. Ronald Goldstein of Goldstein, Garber & Salama, an HDC affiliate in Atlanta, Georgia. Dr. Goldstein is the author of the best-selling book, Change Your Smile, which is now in its fourth edition and has been read by millions worldwide. In addition, he is a Clinical Professor at the Georgia Regents University School of Dentistry and an Adjunct Clinical Professor at both Boston University and the University of Texas.
Q: What do you think of minimally invasive cosmetic dentistry (MICD) and what impact will it have on the future of cosmetic dentistry?
A: I have been at the forefront of minimally invasive cosmetic dentistry for my entire career. We are taught in dental school that above all, we must “do no harm” to patients. This means that whenever possible, we avoid potential damage to both gingival and pulp tissue, and always consider not only the short term improvement to patients’ smiles but also their lifetime of dental restorations. This is a great question, especially with speculation on the overuse of cosmetic dentistry. I write for several consumer magazines, and one of my more recent articles addresses the question “Are We Over-Laminating America?” No doubt the porcelain veneer restoration has been overused—in many situations not for the patients’ benefit, but the dentists’. I have seen full crowns used in an entire mouth when orthodontics would have been a much better option. It’s important for dentists to better educate patients as to what will be best in their situation. This is also why I wrote and continue to update Change Your Smile. Informed patients are the best patients and are more likely to accept conservative esthetic treatment plans for improving their smiles.
Q: Change Your Smile helps patients navigate their understanding of cosmetics dentistry. What is the best way for dentists to take advantage of Change Your Smile?
A: When I undertook rewriting the fourth edition of Change Your Smile, I remembered what so many dentists in my courses asked me to try to do: lower the cost of the book so they could afford to put it in the hands of their existing and new patients. Fortunately, my publisher, Quintessence Publishing, did just that. They lowered the cost to under $20 for 30 or more books. Now dentists can afford to give a $20 gift to their patients as an inexpensive way to educate patients about problems and treatments, as well as to offer realistic cost ranges for each treatment. Unfortunately, magazines with articles on cosmetic dentistry typically include specific fees for each treatment rather than a range. The cost of a procedure, however, depends on many factors such as difficulty of the procedure, patient problems, dental and medical history, expectations and dentist qualifications, including technical and artistic expertise. Many dentists have written to tell me they experienced increased patient treatment plan success when the book was given in advance.
Diastema Closure Before & After
Before - This young lady wanted to have the space between her two front teeth closed, but did not want to go through orthodontic treatment as advised. As a compromise, the four maxillary anteriors were bonded as an immediate smile makeover.
After – The patient was very pleased at her one-appointment result. Note - Cosmetic contouring was also done on the lower incisors to make them appear straighter.
Q: For patients with limited financial means, what are your recommendations for the types of cosmetic work that are most appropriate?
A: The simplest and most economical treatments are bleaching, cosmetic contouring and bonding. These three procedures can dramatically improve smiles in a relatively short period and frankly, almost everyone could improve their smile using one or more of these. It’s helpful to find out up front if patients have financial problems. This will give you and your patients realistic expectations on what treatment can be performed. A good treatment coordinator should be able to politely determine, even during the initial phone calls, what patients are looking for. I’ve seen patients with comprehensive treatment plans they couldn’t afford, when all they want is their front teeth to look better. It’s important to never judge their ability or desire to have the best treatment. Rather, understanding your patients’ needs and expectations, as well as desires, helps you to determine the right approach to take legally and ethically in providing them choices. Hopefully, at least one plan will be within their ability to actually have the treatment done. If not, long-range plans with segmented cosmetic dentistry may well be accepted as compromises.
Q: When it comes to the costs of cosmetic dental treatment, does a conservative-therapy approach add to or reduce the overall treatment costs?
A: I practiced for 22 years with my father before he passed away. He was a wonderful but conservative dentist, so I got my philosophy from him. Now three of my children are dentists, and they also lean in that direction. It’s important to consider patients’ feelings about being conservative measured with restoration longevity, ultimate costs and time involved. That is exactly why in each chapter of Change Your Smile and with each cosmetic treatment, I give a comparative view of the advantages and disadvantages, longevity, cost, maintenance required and other information so patients can make an informed, educated decision. This becomes even more important if patients choose an alternate compromise treatment plan that you feel will not provide the same esthetic or functional result as your ideal plan. Also, it’s important to make extensive notes in the folder on why your patient rejects your ideal treatment plan in favor of a compromise plan.
Q: What do you feel is the optimal method to whiten teeth?
A: The technique we use in our office has been effective for the past 25 years. First, patients should be examined to ensure bleaching will be effective; in many instances, it won’t be, so I recommend those patients hold off rather than wasting their money. If they are good candidates, then I recommend an in-office bleaching appointment to start off with using a high concentration hydrogen peroxide and special bleaching light with adequate protection for the gum tissue. Then we provide custom-made bleaching trays and supply patients with a bleaching material that varies in strength depending on what we think will work best for each patient. This is based on the type of enamel, the stains, color and health of the tooth that can be determined after studying the x-rays. The patient will bleach for four to six weeks, and then we evaluate progress using photographs taken along the way.
Cosmetic Contouring Before & After
Before - This woman was unhappy with her crooked, worn and chipped teeth.
After – After a one hour, painless procedure, her teeth were reshaped and her smile was transformed.
Q: What is the best way to explain implant procedures to a patient?
A: I don’t think there is one “best” way because it depends on the patient. The most successful offices have a good understanding of the psychological make-up of each patient. So if the dentist is not good at this type of analysis, a good treatment coordinator, dental hygienist or even the dental assistant should be the one to spend time with patients initially. Look at who referred the patient. Patients referred by other satisfied patients may already be convinced and ready to get started. However, patients using the internet and your website may have already done considerable homework. With these patients, your approach needs to be scientifically-based (or fact-based) and cover all the advantages of your recommendations. I like to ask these patients what they want to know and then build my presentation from there.
The hardest type of patients to explain implant procedures to are the shoppers. They already know — or think they know — everything there is to learn, and they just want your opinion about their treatment to compare with the other offices they have visited. Your role here is to point out the specifics your office offers, from the professional advantages to the ease of the procedure, warranties available and the specific finances. Chances are your treatment plan will differ from other offices, and you must be ready with back-up graphics and even video to let them know why your plan is better.
Bottom line, patients are different and you need to avoid classifying them until you have the initial conversations, or certainly until you gather input from your staff. The most important person is your treatment coordinator. Our treatment coordinators can spend 30 minutes to an hour on the telephone with new patients explaining procedures and discussing options.
Q: Do you have any suggestions for dentists wanting to increase their patient acceptance rate of implant-based treatment?
A: Yes, first create a plan of action to make your entire office “implant friendly.” Create a comprehensive master plan — first on paper. Then discuss it with your office team. Use your plan to cover segments such as staff, office and educational aids.
Make sure the reception room has sufficient promotional material on implants, and try to make them specific to the office, including the doctor’s experience plus patient testimonials. Also consider making a video of patient testimonials and the doctor’s comments to run periodically. Patients really appreciate seeing and hearing their doctor speak about not only the benefits but the limitations, and being up-front and honest about implants.
Second, re-educate your staff, especially your hygienists, who will no doubt be the first to observe missing teeth in patients. Focus on mentioning new research about the success rate of implants, health benefits and quality of life issues. With patients who have removable appliances, discuss the health benefits of better mastication with fixed crowns or implants. Finally, consider mailing out a personal newsletter, or even a purchased one, to patients periodically as a way to inform them about implants.
Q: What is your opinion of digital impressions?
A: We have worked with digital impressions in my office and are impressed with the ease of capturing images of teeth prepared for inlays, onlays, veneers and crowns. I also like the ability to digitally see if I have enough room for my final restorations by taking a digital bite. We can quickly make adjustments at the preparation stage rather than later finding out there was not sufficient space throughout for proper crown thickness. With this technology, there is a learning curve, so both assistants and dentists need to be prepared to make the digital impressions at first. Later, the assistant should be perfectly capable of making the digital records.
Dr. Goldstein has been featured on: CNN, CBS, ABC 20/20, NBC Today Show, Fox, PBS, Discovery Health, Vogue, Elle, Allure, New Beauty, People, InStyle, Glamour, Town & Country, Redbook, Cosmopolitan, Men’s Health, Prevention, Forbes, Robb Report, Time, Wall Street Journal, USA Today, Changing Times, Atlanta Magazine, Harpers Bazaar, Shape, Consumer’s Digest, Atlanta Business Chronicle, Health, Bottom Line Personal, Departures, Women First, Family Circle, New York Times, Kiplinger’s, Muscle & Fitness, Newsweek, The Atlanta Journal, Miami Herald, Honolulu Star Bulletin, Chicago Tribune, The Baltimore Sun, The Charlotte Observer, Houston Chronicle, New York Daily News, WTBS, WOR TV, CNN International, hundreds of other radio, TV stations and newspapers both US and international.
Diastema closure photos courtesy of Ronald Goldstein, DDS. Cosmetic contouring photos courtesy of Change Your Smile, Quintessence Publishing Company, Author - Ronald Goldstein, DDS.
Ronald Goldstein, DDS Author of the best-selling book, Change Your Smile, Clinical Professor at the Georgia Regents University School of Dentistry, Adjunct Clinical Professor at both Boston University and the University of Texas, practicing dentist at Goldstein, Garber & Salama in Atlanta, Georgia