Emotional dentistry

Dr Sam Jethwa shines a light on why cosmetic dentistry is more than just about appearance and reveals
the role of the dental nurse in delivering aesthetic dental procedures

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Head dental nurse Lauren assisting on a smile makeover course (taken pre-COVID-19).


Dr Sam Jethwa BDS (Lon) MFDS RCS
(Edin) PgDip ClinEd provides advanced and
cosmetic dentistry at Bespoke Smile & The
Perfect Smile Studio, founded The Bespoke
Smile Academy for dentists, and is director
of communications at the British Academy
of Cosmetic Dentistry (BACD). For more,
visit https://bacd.com

When we talk about cosmetic dentistry,
referring to it as purely an aesthetic
procedure doesn’t quite do it justice.
Cosmetic dentistry could be described, in
my opinion, as ‘emotional dentistry’. That
is why there has been no decline in the
delivery or demand of cosmetic dentistry
following the impact of the pandemic. The
quest for an emotional change to one’s life,
does not simply disappear because there is
a pandemic, or the world is in lockdown –
and for the person involved, as soon as its
possible to make that change, they will – and
that is why we exist: to provide our patients

with the positive emotional change, that they
so desire.
I run clinics that are focused on
advanced and cosmetic care and there has
been little decline and have found a similar
level of uptake for cosmetic procedures,
possibly slightly more than usual since March
2020.

What are patients primarily
seeking?

All aspects of cosmetic dentistry are more
popular than ever. Our clinics are geared towards ultra-thin porcelain veneers,
cosmetic braces and Invisalign, along
with dental implants – we are seeing huge
demand for all treatments.

How important is good
communication when it comes
to cosmetic dentistry?

Communicating how cosmetic dentistry can
help patients is vital to increase awareness
and allow patients to explore a wide range of
treatments. The wider team is possibly more
important that the dentist themselves, as
we find our patient care coordinators, care
nurses, and hygiene therapists play a vital
role when communicating with patients.

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Employee of the month

What technologies and
equipment have changed
the way you deliver smile
makeovers?

My workflows for porcelain veneer smile
makeovers are tried and tested. Any
modifications to these protocols needs to
involve testing and auditing of results for
a lengthy period of time in order to ensure
quality control. However, 3D scanning
software has slotted in seamlessly into the
clinic, with workflows of their own. We can
now digitally scan all our patients to avoid
messy impressions, and this technology
means quicker turnarounds, too. We can also
predict movements of teeth for treatments
such as Invisalign and show patients the end
results before we start.

What is The Hand Sculpted
Trial Smile?

This is my secret weapon. The traditional way
to produce porcelain veneers for a patient’s
new smile is to send working impressions
to the laboratory who create the veneers
for the dentist to cement onto the prepared
teeth. With a handmade trial smile instead
of relaying the information to a laboratory
technician, the clinician creates in the
patient’s mouth, on the teeth themselves and
produces hand sculpted temporary veneers,
with no laboratory template. A thorough
understanding of dental aesthetics is needed
for this technique to be successful. It allows
patients to leave with the new design, and
test this for a period of time so they have
an input into the look, and bite before the
final porcelain is made. In our clinic, our
care nurses play a huge part in assisting the creation of the trial smiles, often guiding the
dentists and helping patient with decisions
on shape, colour, and proportion.

How important is minimally
invasive dentistry?

A key part of success long term is to ensure
enamel is preserved when placing veneers,
and minimally invasive dentistry is always
the goal. We have learnt how damaging
the natural tooth is not in the patient’s best
interests, and it becomes more and more
important when younger patients are seeking
cosmetic dentistry. It is important that as
dentists we explain to patients what the long-
term effect of their treatment choices are, not
just the short term.

Do you believe cosmetic dentistry offers opportunities for dentists and dental nurses to create their own USPs and unique skill sets?

Absolutely. In our clinic, our care nurses play a crucial role and are considered cogs that make the machine work. Without them, our workflows and patient journeys fall apart. From photography, impression taking to treatment coordinating, our team are involved in every aspect.

Is cosmetic dentistry well-suited as a platform for team members looking to progress their career?

Most definitely! Specific training on customer service, phone skills, business development, all helps to grow our clinical team individually in terms of their USPs and personal skill sets.

How important is for teams to stay up to date with the latest developments in the profession?

If the clinics want to stay ahead, it is critical that enhancements in technology are embraced by the practice. In our clinic, our nurses use the intra oral scanner, are able to set up imaging devices such as the cone beam CT and OPG and are skilled in providing nursing for implant dentistry, which involves 3D printed surgical guides. Staying up to date and moving with the times, really gives a team member that edge within the dental profession.

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Patient care coordinator Aimie with a patient celebrating his new smile

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Training academy coordinator Anup with trainee dental nurse Jessie.

What can dental nurses do to make themselves indispensable in an aesthetic-focused dental practice?

Show a true passion for learning, hard work, and be genuinely interested about the process of smile makeovers. Playing a role in the whole process from communicating the treatments, and understanding the clinical aspects, whilst supporting the patients and sharing their excitement.

What key skills do they require (implant dental nursing/photography/orthodontic
nursing etc)

Communication, communication, communication! Plus excellent infection control, awareness of CQC regulations, and a highly organised mindset. Efficiency we find is the key when working in a high demand cosmetic practice, and being proactive rather than reactive. It can be so rewarding for dental teams to be

given responsibilities and further training such as impression taking, radiography, photography, and specialist treatments.

How important is it to have a dental nurse who can communicate well with patients and walk them through their patient journey?

As mentioned above, this is so important when working around patients and a team where treatment plans involve a number of visits, a team of clinicians and dental care professionals. Care nurses are the port of call for patients, and are there to provide a trusting and caring channel of communication. Spending time learning and becoming a true expert care nurse in cosmetic dentistry will allow easy communication with patients where often many questions are asked as the treatments are more complex than usual.

How key is oral health education throughout the smile makeover process?

Success long term for smile makeovers is heavily related to how well results are maintained. We ask our patients to visit our hygiene therapist every three to six months or our periodontist where required, but oral health advice during the smile makeover process and afterwards is imperative to produce the best results. The whole dental team can play a part in this.

Does the BACD welcome dental nurses as members?

The British Academy of Cosmetic Dentistry (BACD) is always open to welcoming any dental care professional and we do find a number of dental nurses attend the BACD aesthetic dentistry theatre at The Dentistry Show each year.
The board of directors at the BACD is always looking at ways of collaborating with other academies and professional bodies to provide support and relevant education – and dental nurses are a key part of cosmetic dentistry now and for the future.

Why is aesthetic dentistry booming during a pandemic?

-> Greater time to attend visits whilst working from home or furloughed.
-> Virtual consultations making it easier to access advice and care from professional
dentists who usually would have long waiting lists.
-> More savings to spend on things like cosmetic dentistry. For those who have retained jobs, there have been fewer expenses in 2020, with limited travel and socialising.
-> It’s now or never. There is a sense of urgency because things that we enjoy are being
taken away from us as a result of the pandemic, so ‘if I don’t do it now, when will I?’
-> Limited socialising and mask wearing could be a good time to consider treatments that may involve visible appliances like braces.

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