Image Citation: The White Tusk
Written by Gloria Yao ‘28
Edited by Yusef Lateef ‘28
Botox, rhinoplasty, or facelifts are what often come to mind when the term cosmetology is brought up. Yet, does dentistry ever come to mind? In reality, while a main priority of studying teeth is to ensure oral health, dental procedures are no longer singularly confined to fillings of cavities or analysis of gum disease. Cosmetic dentistry is expanding its presence in both public health and social circles and dental procedures now include teeth whitening, veneers, and smile makeovers, marketing teeth as symbols of prestige and aesthetics. At the same time, the rise in cosmetic dentistry also brings along complex dental public health implications that span biological, psychological, ethical, and socioeconomic dimensions, raising the question of who deserves oral healthcare access and whether this field is expanding outside of health to beauty.
A scoping review by Doughty, Lala, and Marshman highlights these multifaceted impacts, examining 57 papers that reveal emerging themes in cosmetic dentistry. For example, the growing expectations of patients, ethical dilemmas in marketing, and the iatrogenic risks tied to invasive procedures (1) indicate that cosmetic dental procedures are not merely aesthetic—they carry psychosocial and biological risks. Thus, the increasingly commercialized nature of dentistry raises concerns about public health governance. The rapid growth of this field has led to an increasing need for structured training, policies, and ethical guidelines to safeguard patients while meeting the public's demands. As cosmetic dentistry continues to expand, the need for a balanced approach is essential, especially given its unique blend of healthcare and aesthetic service, where patient expectations must be effectively managed against potential risks.
The appeal of cosmetic dentistry is a symbol of a broader societal issue: the intersection of oral health and socioeconomic status. Cosmetic dental treatments, especially procedures such as teeth whitening, veneers, and orthodontics, are often priced out of reach for lower-income individuals, stressing the disparity in access to dental care as a whole. In “Social Inequalities in Dental Health,” Petersen highlights how financial means often determine access to dental care, leaving those from lower socioeconomic backgrounds with fewer opportunities for preventative treatments (2). The disparities are particularly evident in childhood, where children from affluent families generally receive better dental care, setting them on a path toward good oral health, while those in economically disadvantaged settings often face higher levels of untreated dental issues. This divide begins early, and over time, these inequalities widen the gap in both oral health outcomes and social perceptions associated with appearance and hygiene.
Society’s emphasis on appearances has increasingly created a perception that bright, white, and perfectly aligned teeth signify status and success. This creates pressure for many to pursue costly cosmetic dental procedures to maintain a certain image, even if it means financial sacrifice. This problem expands into the general problem of public health care systems in the US where the overlap between health and cosemtology is blurred. In fact, dental professionals are increasingly pressured to navigate the ethical territory between marketing to aesthetic desires and prioritizing essential oral health.
Reports from organizations such as Public Health England also reemphasize these concerns, noting that socioeconomic status is a critical determinant of dental health. Public Health England highlights the importance of accessible education in helping individuals across socioeconomic backgrounds to maintain oral hygiene independently, without signficiant monetary sacrifices (3). Programs like Dental Buddy provide resources to educate children, especially those in underserved communities, on how to take care of their teeth, with an aim to establish lifelong healthy habits. Ensuring that all children, regardless of economic background, receive foundational oral health education is crucial to bridging the gap in oral health outcomes and empowering individuals to take preventative measures as they age.
However, adults from lower-income backgrounds continue to face challenges, often with limited access to dental care. With nearly 40% of adults not attending regular dental check-ups, community outreach, and preventive services are essential to help them prioritize oral health. Increasing access to affordable products like fluoride-rich toothpaste and promoting awareness about cost-effective oral hygiene solutions can help close these gaps. Additionally, some employer health plans now cover preventive and even cosmetic dental procedures, which could offer an opportunity for broader access to dental care beyond traditional public health services (4). However, such plans are not universally available, and the cost of high-quality cosmetic dental care remains prohibitive for many individuals.
The aesthetic nature of cosmetic dentistry complicates the public health challenge. As procedures like teeth whitening and veneer application become increasingly accessible, there’s a growing sense that these procedures are not merely optional but necessary to “fit in” with societal standards. For example, younger generations are particularly influenced by social media, where idealized beauty standards often promote the importance of a perfect smile. The heightened focus on appearance perpetuated by media and societal expectations can create psychological stress and lead people to prioritize aesthetic treatments over other essential health needs.
As the pursuit of cosmetic dental procedures gains momentum, public health must address the implications of a system that risks prioritizing appearance over accessibility. A more regulated approach could help ensure that people are fully informed about the potential health implications and realistic outcomes of cosmetic procedures. Additionally, public health campaigns emphasizing the health aspects of oral care rather than just aesthetics could provide more balanced messaging to counteract societal pressures.
At this point in time, awareness, research, and policy can create pathways to make both essential and cosmetic dental care accessible, guaranteeing that the rising cosmetic trend aligns with equitable and ethical healthcare practices. Addressing the complexities surrounding cosmetic dentistry will require an interdisciplinary approach between dental professionals, policymakers, educators, and community leaders. As the dental landscape balances aesthetic desire with genuine public health needs, it’s important to keep in mind the goal of oral health: to create equitable dental care to all.
References
Doughty J, Lala R, Marshman Z. The dental public health implications of cosmetic dentistry: a scoping review of the literature. Community Dent Health. 2016;33(3):218–24. doi:10.1922/CDH_3881Doughty07
Petersen PE. Social inequalities in dental health: Towards a theoretical explanation. Community Dent Oral Epidemiol. 1990;18(3):153–8. doi:10.1111/j.1600-0528.1990.tb00042.x
Oral Health Foundation. Oral health and socioeconomic inequalities [Internet]. Available from: https://www.dentalhealth.org
Taylor HL, Sen B, Holmes AM, Schleyer T, Menachemi N, Blackburn J. Does preventive dental care reduce nonpreventive dental visits and expenditures among Medicaid-enrolled adults? Health Serv Res. 2022;57(6):1295–302. doi:10.1111/1475-6773.13987
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