FINAL PODCAST

Teeth Talks is a podcast discussing controversial dental topics. The hosts introduce Dr. Shabnam Chehwani, an experienced dentist. They discuss the popularity of veneers, which are often confused with full coverage porcelain crowns. The hosts highlight the importance of considering the risks and costs associated with veneers, and the need for proper dental care. They explain the difference between composite and porcelain veneers, and the preparation involved in each. The hosts also mention the reasons why people opt for veneers, such as improving teeth appearance and correcting dental issues. They caution against getting veneers without proper assessment and maintenance. They address the trend of "turkey teeth" and the risks of getting dental procedures done overseas without informed consent. Overall, they emphasize the importance of thorough assessment and informed decision-making when considering veneers. Welcome to Teeth Talks, guys, where controversial and age-old topics in the dental scene are explored, dissected, and conclusions are extracted. The hot topic which has taken the world of dentistry by storm, capturing the attention of many and changing people's lives, beneath, is for the good or for the worse. We are your hosts, Ali Chehwani and Sina Zainalabhadeh, who will navigate us through this insanely hot topic that has people traveling as far as overseas countries to seek a changeover in their looks. Thanks, Ali. Our program for this topic will be complemented by our guest who works in the field of dentistry. She graduated from the Bachelor of Oral Health at the University of Sydney in 2009 and further pursued dental education, acquiring a Bachelor of Dental Science at Charles Sturt University. She is a practicing dental clinician, Managing Director of Two Dental Practices, and possesses a background in education as a clinical educator at the University of Sydney and Charles Sturt University. Her experience of nearly two decades renders her a veteran of the dental field. We are honored to welcome to our podcast none other than Dr. Shabnam Chehwani. Dr. Chehwani, welcome to our podcast and thank you for joining us today. Thank you, guys. Hi, Ali and Sina. That is a really strong and very kind introduction. Thank you so much. Yes, the topic of veneers. This is a really good relevant topic to cover as it is trending really strongly in today's social world. The veneer fever, as I call it, is all over social media, especially from what I've seen on TikTok, where people are recording literally their entire journey from the moment they are departing the country to having their teeth ground down and crowned. This is actually a false little representation of the term veneer itself. You guys know that the veneer is the surface of the tooth, whereas these lovely people are getting their entire teeth crowned. The nickname that I've come across a lot is turkey teeth, so these really large, unnatural-looking, very uniform and winding white teeth. They're actually, in fact, full coverage porcelain crowns and not veneers. It'll be nice to discuss this with you guys and also differentiate between what is and what it should be. Thank you, Dr. Shaywani. We can most definitely agree that this matter is of urgent consideration as there are patient horror cases involving veneers, some of which we'll be exploring today. It is also important to remember that this treatment is very expensive, which drives a lot of people overseas to seek it at a cheaper rate. Additionally, it seems to be a quick solution to achieve that aesthetic desire. However, quick and easy doesn't always guarantee longevity and quality. Wouldn't you agree, sir? Certainly, 100%. I can agree with that. From our background thus far in our educational pursuit, we can say that the bigger the problem, the bigger the considerations needed to actually address it. It's not wise to jump into a treatment that suddenly fixes a big problem such as a complete aesthetic makeover. When enough publications are being made regarding sales of veneers and patient complications of post-operative treatment, you'd assume the claims are starting to get raised. Yeah, for sure. As Dr. Shaywani has already mentioned, we'll be discussing the use of composite and porcelain veneers. I'll also be briefly laying out the main points to be discussed today. What's important to know about it is, as mentioned, there are basically two types of veneers used, one being of composite and another being of porcelain, each typically pertaining to a specific type of treatment approach. The approaches are conventional veneers, which are also referred to as CVs, and then our minimally or non-prepared veneers are also referred to as MPVs. Each of these treatments is distinctively different, characterized by their own preparations and risks, while CVs are commonly carried out with the use of porcelain and composite, porcelain more so. As such, great intro on this topic. Conventional veneers is typically divided into composite or porcelain, where the true structure is reduced to prepare for the build-up of the veneer. Composite veneers is then completed through remodelling of the suit anatomy by sculpting of the dental material onto the suit in order to achieve the desired outcome. On the other hand, porcelain veneers are made up of ceramic or zirconium material through lab manufacturing, of which the crowns are placed onto the prepared suit. Typically, a very strict consideration is taken and approximately 0.3 to 1 millimetre of thickness is adopted. Generally speaking, this is considered more invasive for the veneer treatment as compared to MPVs. MPVs is where a minimal approach is taken, meaning more of the original suit is preserved. A clear retainer is then made via compressions or digital scanning, of which a retainer is then placed into the patient's mouth and the material is applied onto the suit's structure, and polishing is done at the end, using dental materials. So, I guess these veneers are very hard to go through the process of achieving them, although there has been a massive drive for this, and there's various reasons for a lot of patients that have opted for this. These examples include wanting to improve their aesthetic appearance, the big influences from social media personalities, having dyslexic teeth due to severe staining and age of the patient relative to that, abnormal tooth development, they want to have their teeth corrected due to malformation, and patients who have had teeth trauma in the past who would require this form of treatment. Although veneers can also have pre-requirements for dentists who may require specific considerations for individuals and may be hesitant to actually do the treatment. These examples or situations include patients who grind their teeth, patients who have ongoing poor oral hygiene care at home, or they have conditions where they have insufficient tooth structure. So, the quality and the quantity of the enamel on the tooth is sufficient. Looking into this information, Dr. Chewani, is there any other information we have missed from this, and what would be the common choices for why people want veneers in Australia? Yeah, you're absolutely right, Ali. So, there's a lot of reasons or factors that are not really particularly considered for. For example, when you mentioned those who grind their teeth, so you can't just put veneers on patients because they'll just basically shear them off, you know, if they have an underlying clenching or grinding happening, or patients who have poor oral hygiene because it'll predispose them to secondary decay and things like that. So, a real thorough assessment, initial assessment has to be done on patients prior to embarking on a big aesthetic journey like that. Reasons that I, in private practice, have seen as to why patients want to go ahead with veneers, I find there's mainly three main reasons. One is particularly to the colour of teeth. So, obviously, everybody wants whiter and brighter teeth, right? So, the whiter the better. So, we sort of go through initials of bleaching with them and if they can actually achieve the desired white outlook. But a lot of people have this Hollywood perception of white, which is the artificial looking, you know, porcelain bleach-shading that they want to go after. The second main reason is the shape of teeth. So, in the aesthetic world, the longer and more rectangular teeth, they have a more desirable consideration for aesthetic outcomes. They are a lot more considered as aesthetically pleasing by people, or unusual per se. So, patients want longer and bigger rectangular teeth as a result to what they have. And then, finally, the third reason I find is a lot of patients who have little gaps between their teeth, or in dental terminology, we call them diastemas. They prefer, rather than going through an orthodontic journey, to close the gaps and maintain the health of their teeth. Quick fix, like you said, quick, but it may not necessarily be good quality and longevity in that regard. Definitely interesting to get the clinical perspective in regards to the news. So, our main area of concern for the new treatment is the recency of the term turkey teeth, as Dr. Shenhuang already mentioned. The term has been developed internationally by pain personality stars, which naturally draws worldwide attention and praise, especially for such an appealing makeover that's borderline one financial decision away, or sort of thing. Turkey teeth are defined, as Dr. Shenhuang already mentioned, unnaturally large, ultra-wide, very uniform, and often rectangular shaped, which will explain why they're so sought after. So, not just in Turkey, this may implement that many individuals are going to other countries for cheaper dental services. Although there are many hidden consequences that social media influences overlook, this includes that the needs are not a lifelong treatment, most definitely, and that healthy teeth may be lost, introducing the risk of sensitivity. Great points there, Sinar, and it's good to understand, I guess, the implications and what we see about turkey teeth and what the TV sort of puts out there as well. Also, to add to that, in certain countries, services are also completed by clinicians without proper informed consent, where the patient may lack understanding of significant risk or adverse outcomes of the procedures. Patients are also inclined to go to these countries for a quick holiday and a financially favourable fix. A major consequence of getting these procedures done overseas is the lack of a regular maintenance or recall program with the dentists there, as patients will then come back to their home country and reside there. Patients will also need to leave the dental chair, being appropriately informed of their responsibility in maintaining optimal oral health at home, and this will help with reducing the risk of veneer failure, any cavitation, and any infections. Dr. Shehwani, would you say you agree on this as well? Yeah, absolutely. The misconception where people get these crowns with the veneers done, and then they think, okay, that's it, I'm set for the rest of my life, and I wish things in life were permanent, but I think that is the biggest miscommunication where people don't understand that, unfortunately, nothing in life is permanent, and that applies also to the dentists that are making them to composite veneers. So, maintenance is a huge aspect, if not one of the most important things, post-cementation or fabrication of these veneers. Now, Dr. Shehwani, what would, I guess, a patient come into their appointment for obtaining veneers? So, let's say I come into your clinic, and I've gone, hey, I'm interested in getting veneers, and we've booked an appointment for a chat, what would be the initial step, and then right up to the end as well? Yeah, I wish it was that simple, you just walk in and go, yep, put some veneers on me. So, you're basically looking at having to give the patient dental clearance, so from a team perspective, no cavities, no other issues, you know, no need for any other restorative work, and also periodontal clearance, so that, you know, the gum's nice and healthy, the foundation is at all points so that you can support such expensive aesthetic work to be done. So, patients would come in, they'll have their checkup, consultation, etiol, etiol examinations, you'll have their x-rays updated, bite wings, or an OPG if you need to, you do your general treatment, clean, any underlying restorative work that needs to be done, so the foundation's nice, strong, healthy, then we have the discussion of actually why do you want the veneers, right? Is it a congenital defect of the teeth? Is it the shade? Is it the shade? It's something that's got to have a long-term positive impact on your dental health, so the worst of the situation is when young patients come and they just want to ground tooth away because they want to look like some Hollywood photo, you know, or a TV news presenter, so we try to avoid encouraging unhealthy habits and irreversible damage to teeth like that, but yeah, so you need to, you know, have all the periodontal and the dental clearance, and then from there on, we can have a discussion as to, you know, what pathways, what material you want to go through. So, those are some really good, I guess, points there to understand how a patient would come through with one of the veneers and what process they'll go through. Let's also distinguish an important difference between the risk of a new treatment as a general concept and the risk of getting those treatments done overseas. Generally speaking, I guess the following may occur. Patients may experience the sensitivity due to the enamel being shaved off. Another risk is irritation of the gums if the veneer is fitted improperly or incorrectly. This can also accelerate the risk of, I guess, progression for gum disease. The veneers can also chip, crack, or completely fail from de-bonding off that tooth surface, which basically means that they'll detach off the tooth. This can also provide a pathway for bacterial infiltration and increasing the risk for them to having tooth decay and then feeling needed. There's also an increased risk from overseas treatment due to differences in clinician education, clinician skill, choice of materials used, and obviously the material can be of lower quality. That comprehensively covers one side of it. Now, on the other hand, dental treatments overseas may be characterized by the following risks. Excessive shaving of the tooth structure, which is characteristic of what happened overseas, means 30% of reduction in healthy tooth structure, which is completed, or up to two-thirds of their load-bearing structure. Lost justice is the porcelain crown. This can then cause severe irritation or sensitivity for the patient, where good oral hygiene hasn't been undertaken. Teeth will be extracted. Consider this also, there may still be a gap between the veneer and actual tooth for bacterial infiltration. With excess removal of the natural tooth structure, bacteria in the profession is much closer to the pulp, therefore more rapidly reaching it. What this can result in is a dead tooth with risk of infection, again, risking the need for extraction. Let's also keep in mind that dental treatment overseas may not always be covered by insurance policies in Australia, meaning that patients may need to return to try and resolve the issue if not proceeding with corrections from clinicians in Australia. Furthermore, dental regulations that we see may not always be in the patient's favour, so some countries may allow for invasive treatments and use of lower quality materials. Dr. Shehwani, can you tell us about your experiences of your own patients or patients of other practitioners relating to veneer treatment, perhaps starting off with the cases that are good outcomes, then moving on to the failed treatment cases, the more finalised? Yeah, so they say the best cases are the ones that you're in touch with, right, because there's no harm, no drama. So the example of good cases that I've come across are those, I think, who know what they want. When they know, it just makes it so much easier in terms of meeting their expectations. It's patients who come and they say, they come with a photo of, you know, a Hollywood star, and they say, I want to look like this person, and that's what makes it really difficult. So I find that those who know what they want, it makes it a lot easier to transition to, especially patients who already have a history of existing veneers and they just need to be replaced. You know, it's a lot easier to work with a foundation that you have. So to have a positive outcome is you need to just have all the expectations laid out and obviously what you can achieve and what you can't achieve, and this is where your informed consent plays a huge role. Failed cases, the only failed cases that I can really relate to are those where veneers and crowns don't even fail. It's when you don't meet their expectations that's when it becomes a failed outcome, because they're not happy ultimately, yeah. So it's meeting their requirements and their desires essentially. So it's really good to also understand the information, our experiences, our opinions as well, but at the end of the day, we also need evidence to support our discussion. We will delve further into treatment cases by exploring journal articles. So there's an article by Miyagi and Advice Begun, where it publishes systematic review being the highest level of evidence developed. It has provided us with a collection of studies focusing the outcomes for CBs and MPBs. They reviewed four articles of relevance that highlight the key findings on the outcomes of the veneers. Overall, they found that MPBs have a higher success rate across linings than CBs, although both treatment types are risk for fractures or chips, and both treatment variants require a thorough oral hygiene routine from the patient to ensure adequate longevity. Dr. Keller also published an article on the dental procedure of veneers in Turkey by some practitioners, and as Sina said, basically practitioners will reduce their percent of healthy sound structure while the two-thirds of their load vary. How and what are the possible consequences of this, Dr. Shehwani? Yeah, it's really heartbreaking when you see such amount of healthy tissue structure gone because of family damage, right? So as long as you have a clinician who knows what they're doing with their minute, but ideally minimal conservative reduction, at the same time, you want to get the best possible outcome. Unfortunately, this is where patients confuse veneers with crowns, but even when we commence crown work, we do not reduce that much healthy tissue structure. You should never, ever, ever do reversible damage. Now, the risks are primarily risk of pulpitis, so inflammation of the nerve, and also this may be irreversible hypersensitivity, which then essentially leads to the tooth requiring root canal treatment, if not multiple teeth, and this is basically the end of life for the tooth. So, to add to that, Dr. Shehwani, can you please elaborate on the longevity, the lifespan, and maintenance for veneer treatment? Absolutely. So, as long as you have a dentist who's done conservative, minimal preparation, your longevity basically is, for a composite, up to five years. Five to seven years before they're stained and need repair or refurbishment, and for porcelain, ideally we stay up to 10 years before things like a little bit of fracture in porcelain or debonding occurs. So, they can still fail as a result of dental decay if the patient has poor oral hygiene, but ideally, those are the main reasons, and for a lifespan, yeah, you're looking at about five to 10 years. The wealth of knowledge that we've experienced today is astonishing and remarkable. We'll just finalize by saying, from our educational background and experience, we can't stress the importance of maintaining optimal oral hygiene. We can also wholeheartedly agree that patients should do their own research, consult with their dentist, and gather information from other clinicians to develop a better understanding and consideration of benefits and risks associated to make a well-informed decision. There is an abundance of resources available with Keeper of Access to become more informed on veneers. We hope that you have taken some important learnings from this episode, and very importantly, we sincerely thank Dr. Shea Wiley for taking the time out of her day to be a part of our discussion. She has made very valuable contributions for us all to learn from. Thank you, guys. Thank you very much, guys. Until next time, guys, be keen for our podcast and follow us on our show socials. Thank you.