In 2017, while the age of bright, white cosmetic dentistry being everywhere we turn may be behind us, patients still want to look nice and feel confident in their smile. I practice in the Boston area, where the tendency is to be a bit more conservative with cosmetic enhancements.

how to have conversations about esthetic dentistry

Patients that ask for whitening often question if it will make their teeth “too white,” and those that want veneers or composite bonding question if their “friends will notice” under the assumption that it would be a bad thing. It’s my favorite environment to practice in; there’s nothing more gratifying than making teeth look natural and beautiful. Some of you may practice in areas that aren’t so closeted about their treatments, in a place where “too white” doesn’t exist.

I do a lot of cosmetic work in an area that is a bit too timid to ask for it. I’ve learned a few ways of approaching the subject in a comfortable, non-threatening, non-judgmental environment that may benefit the conversations you have in your practice. Here are three tips to approach an occasionally uncomfortable topic!

Indirectly discussing esthetics with patients

The first place I ask the question is on my intake paperwork. I have a question that simply says, “Are you happy with the look of your smile?” It’s amazing how simply asking the question can open up a whole world of information.

Discussing esthetics in the consult room

After patients let me know that they aren’t happy with the look of their smile from the intake form, it gives me the opportunity to inquire when we sit down together in my consult room. I review all the new patient paperwork myself with a new patient before bringing them to the treatment room, but this would work just as well if your assistant or another team member does it. If a patient says they aren’t happy with the look of their smile on the questionnaire, after reviewing several dental history questions, I ask them what it is they don’t like. Sometimes the answer is brief, like the shade, but sometimes there’s a great deal of information that comes out. I’m always amazed at how many patients are interested in improving their smile, but just haven’t been asked about it before. Many patients won’t bring it up on their own for fear of appearing vain.

Discussing esthetics through my dental assistant

When I bring a new patient to the treatment room, I begin with photographs. After taking my series of photos, my assistant then takes radiographs. During the time it takes her to finish a complete set of x-rays, I’ve gone back to my computer and uploaded and rotated/flipped the necessary images and they’re ready for viewing. Before I re-enter the room, my assistant puts a full smile photo up on the patient's monitor while she cleans up from the radiographs and asks the patient if there is anything in particular they would like to be sure I cover during today’s exam.

She doesn’t directly ask them about their smile, but while they are given the opportunity to see their teeth up close and personal, it jogs their memory or gives them the boost to discuss something they otherwise may forget. This is another fascinating moment for me in a new patient exam. While some patients look at it and say, “I’m good,” others will start pointing out gingival zenith discrepancies, shade issues, you name it. While most patients won’t arrive at an appointment ready to discuss gingival levels, a photo is worth a thousand words and is often the impetus to begin that discussion.

So if you aren’t sure where to start with discussing esthetics and smile enhancement, let the patient begin these conversations for you. Give them the tools they need to ask, and you’ll be amazed at the responses you start to get! 

(Click this link for more dentistry articles by Dr. Courtney Lavigne.)

Courtney Lavigne, D.M.D., Spear Visiting Faculty and Contributing Author -


Commenter's Profile Image Shawn S.
December 21st, 2017
Simple Clean and Useful article. Thankyou I will incorporate in my practice today.