What is emotional dentistry?

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emotional dentistry
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The concept of ‘emotional dentistry’—the connection between a patient’s smile and their mental wellbeing—may be catching on, but some experts advise caution is needed. By John Burfitt

The connection between a person’s smile and their self-esteem has in recent years earned its own category. It is known in some dental circles as ‘emotional dentistry’.

In the article ‘Emotional dentistry and dental photography for treatment planning’ in the Journal of Dental Research and Practice, Saudi Arabian dentist Dr Basma Raza-ur Rahman defines emotional dentistry as ‘analysing and considering the full face of the patient into the new smile so that it looks natural’. The article also claims, ‘The art of Emotional Dentistry is similar to the skill of an architect, interior designer or sculptor.’

Emotional dentistry has also been described by the US practice Georgian Dental as ‘the practice of understanding the emotional connection between a person and their smile, with the dentists playing a key role in helping create a smile the patient can be proud of’.

According to the results of a Bupa study published in Dentistry Today, the state of a person’s smile ranked as a major concern among 2000 participants. The study revealed 42 per cent of people said their smile was the first thing they would change about themselves and more than one third admitted they were embarrassed by their smile.

Additionally, 81 per cent of people stated they believed their teeth look unattractive in photographs and around 50 per cent felt pressure to have a perfect smile.

Dr Fadi Yassmin of Sydney’s FY Smile has been working in cosmetic dentistry for 30 years and has noticed more patients are willing to admit feeling inadequate because of their smile in recent years. With some patients, he claims dealing with the issue of their smile can be, “like a therapy session. Once you show them what is possible through various techniques like Digital Smile Design, a lot of the baggage that they have been carrying unlocks and that’s when you see the emotions released,” Dr Yassmin says.

“But standards have also been raised so patients are expecting an emotional response, like when they tell us they have not smiled for 10 years and the impact that has had on them. When it is all done correctly, a better smile can indeed transform them.”

In her article, Dr Basma Raza-ur Rahman also writes that those who are ashamed of their teeth are ‘more depressed, withdrawn and lacking in confidence’. The claim is also made in an article by US health and lifestyle finance company Ameritas, which claims people who don’t like their smiles often struggle with depression.

According to Associate Professor Roy Judge at the Melbourne Dental School, these claims about emotional dentistry deserve our attention.

“In many respects, she (Dr Basma Raza-ur Rahman) is right as the way patients are perceived by others is, of course, very important and that has been inherent in our teaching for quite some time,” he says. 

“The way dentists assess teeth, the smile, tooth proportions, and then onto delivery of veneers and crowns, that train of research and literature has been around for many years.”

And yet, with the increase in aesthetic dentistry, he believes wise guidance is required from practitioners as to how aspects of emotional dentistry are handled.

Once you show them what is possible through various techniques like Digital Smile Design, a lot of the baggage that they have been carrying unlocks and that’s when you see the emotions released.

Dr Fadi Yassmin, FY Smile

“With emotional dentistry, the perception of happiness comes from having a smile that’s socially accepted, and we need to remember part of the population does not see things the same way everyone else does,” he says.

That’s when what might be possible body dysmorphia needs to be assessed. “Part of our job is to identify those patients and provide appropriate care that clearly outlines what the care plan is, as sometimes their perceptions are so different.

“It might be a case that no matter how much work is done to that smile, they’re never going to be happy and that’s a bad outcome for all. That’s when important conversations have to be had, by a range of health care professionals.”

The focus on the concept of emotional dentistry, A/Prof Judge adds, is part of the important emphasis on patient-centred care.

“The emotional impact of the work we do is all part of the conversations we need to have as we want to have a positive outcome for the patients.”

Those conversations, he stresses, must include the risk analysis of any work on the smile.

“It’s so important clinicians and patients have honest discussions about the positives as well as the potential issues that may arise so you have an informed patient with realistic expectations, and yet they feel supported along their chosen path.”

While Professor Alex Holden, the head of Specialist Services at Sydney Dental Hospital & Oral Health Services, believes aesthetic dentistry plays a vital role within dentistry, he’s less convinced about the connection between a smile and a person’s mental wellbeing.

“The idea of emotional wellness being connected to your smile makes me wonder, as I don’t think there is a huge number of people walking around whose emotional and mental state is solely connected to their smile,” he says.

Commenting on the article by Dr Basma Raza-ur Rahman about emotional dentistry, Professor Holden says, “This promise you can solve people’s depression through dentistry is completely unrealistic and the reality is, people who are depressed before their dentistry are typically depressed after their dentistry, because dentists are not psychologists nor psychiatrists.”

Professor Holden agrees the issue of emotional dentistry highlights the importance of effective communication, so the practitioner understands what a patient’s expectations are, and the patient is reassured about the reality of what outcomes can be expected.

“Smile design is nothing new, but the advances in the digital age with computer modelling showing what can be achieved with certain treatment are so significant,” he says. “It also adds an important degree of predictability into things, so good patient-centric care is always guiding the dental plan.” 

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