Best of "Modern Cosmetic Dentistry"

A smile makeover shouldn’t feel like a leap of faith, and it definitely shouldn’t end with a surprise you didn’t sign up for. We sit down with Dr. David Esham, a credentialed cosmetic dentist with 25 years of experience, to talk about what modern cosmetic dentistry is supposed to be: clear planning, better communication, and technology that helps you see the destination before you start. 

We walk through how to choose a cosmetic dentist with confidence, from patient reviews and before-and-after photos to credentials and the vibe you get during a consultation. Then we get practical about the technology that changes the experience for patients, including virtual consultations, fast digital scans that replace messy impressions, and digital planning that lets us adjust tooth shape, length, and shade with far more precision. If you’ve ever wondered what “digital dentistry” actually means for your comfort and your results, we spell it out in plain English. 

We also dig into next-level planning tools like merging a CBCT 3D X-ray with a digital scan, especially for implant cases and All-on-4 or All-on-6 treatment where alignment and fit matter down to the millimeter. Finally, we connect all of that tech to the bigger goal: minimally invasive cosmetic dentistry. When planning is accurate, we can often use additive, enamel-preserving approaches that improve aesthetics without grinding teeth down, helping patients avoid the long-term “tooth death spiral.” 

If you’re considering veneers, bonding, whitening, Invisalign, or implants, hit play and take notes on what to ask and what to look for. Subscribe, share this with a friend who’s researching a new smile, and leave a review with your biggest cosmetic dentistry question so we can tackle it next.

Transcript

Speaker 0:01

Welcome to getting your dream smile with cosmetic dentistry. This is where we discuss how patients get what they want in a smile while being totally informed. Whether it is force combiners, bonding, lightning, or disline, you'll find out what is best for your situation. Everything you should know, where and who to speak, and all the costs involved. Stay tuned.

Speaker 2 0:25

Welcome back to Getting Your Dream Smile with Cosmetic Dentistry. This is where we discuss and help patients get what they want in a smile while being totally informed. Whether it's forced in veneers, bonding, whitening, or invisalign, you'll find what is best for your situation. Everything you should know, where and who to see, and all the costs involved. Stay tuned. My name is Sabrina Chan, your host for today. I work with Dr. Eshom to inform the public about the best ways to achieve your best smile with cosmetic dentistry. Our podcast discusses the benefits and what you need to know as a patient about cosmetic dentistry. Today we'll be talking with Dr. David Eshom, who has been practicing cosmetic dentistry for 25 years as a credentialed cosmetic dentist from the American Academy of Cosmetic Dentistry. Dr. Eshom loves sharing his recommendations when it comes to getting a great smile in the most minimally invasive way. And today we'll be discussing what modern cosmetic dentistry is and what it should be. Let me introduce to you all Dr. David Eshom.

Speaker 1:21

Thank you, Sabrina. That's such a nice introduction.

Speaker 2 1:24

Of course.

Speaker 1:25

And u I'll just make a small correction of the introduction. Sabrina used to work with me before she went to dental school. And now she's coming back on after her first year break. And she's nice enough to do this podcast with me. And she's done so many good ones. I asked her if she if she'd be willing to um come in and do this one. And so we are all honored to have Sabrina here in between uh dental school years uh to do this, and and I'm so proud and impressed with this young lady. So can't wait for her to get to graduation. But that will that will come soon enough. Soon. So any, just so you know about Sabrina, how special she is.

Speaker 2 2:03

Thank you.

How To Choose A Cosmetic Dentist

Speaker 2:04

So, yes, we're going to talk about modern cosmetic dentistry and and different aspects of that. But before we get into that, I want to remind the audience about what they should be looking for in a cosmetic dentistry as they look to enhance their smile. And one of the things that they should be looking for is the uh doctor's reviews, because those are reviews who tell you a lot about how the doctor treats his patients and whether the patients are happy with their smiles at the end. You also should uh be able to see the doctor's case pictures. So that you should should should be able to see on their website or their Instagram or whatever it is, the before and after. So you get an idea of what you can expect from them. And then also look at the the doctor's experience level, and especially if they're credentialed, because the American Academy of Cosmetic Dentistry credentials cosmetic dentists. And sure there are some that are not credentialed that are very good, but most of them have that AACD uh credential uh after their name. And then when um when you're if you decide and then go ahead and do a consultation, you should have a feeling of how the doctor communicates with you and um how you feel. It's kind of like it's kind of like dating to a certain dental dating, I should call it maybe. And that you should have a vibe, you should have a good feeling about them and in terms of how they communicate and whether um they can make you happy with their smile based on what they say during that consultation and how much time they take with you. And then the last thing that we're addressing today uh about choosing a cosmetic dentist is the technology and what technology they might use. And so that's what we're gonna mainly talk about today. But before we get to that, Sabrina, any questions or additions to what I just said?

Speaker 2 4:00

Yeah, well, I think one thing that was interesting that you said was, you know, seeing the work of the doctor is really important. It's almost kind of like online shopping where you want to see it on these different models, see what it looks like rather than just, you know, oh, I want this piece of clothing. You want to see what it cases that you know could look like on your teeth. And I think that's really important because everyone has different teeth, everyone's gonna have a different case, but knowing what you could potentially look like is both inspiring and it could help you get an idea of what to expect when you go into that dentist's office. And then jumping off of that, you talked about technology, which I think is really important, especially nowadays where technology is booming. So, what sort of technology is part of modern cosmetic dentistry?

Digital Scans Replace Goopy Impressions

Speaker 4:44

Well, there are different aspects of it, but a lot of it is in the way you contact the office too. Um, you know, can you text them? Um, is there a an option to do a virtual consultation? And so we do a lot of that here in our office. And it's in for patients that come and travel to us from out of state and out of the country, you know, that is particularly handy. And so that's one thing that you could look for. Um, the the other thing is um, you know, do they have do they do things digitally? Meaning now instead of having to put that goopy stuff in our mouths to make models, and you know, I I've been practicing for a lot and a lot of a lot of years, and I had to do that for a lot of years, but I'm so thankful now that my patients don't need to go through that, nor does do my um assistants have to pour up the models in stone and all that. Now we can just do a digital scan of your teeth. It takes about five minutes, and then I have a model that kind of goes in and out, and I can turn it around and look at it any which way I like, and um, that lets me do things without having to have uh a big office with all kinds of models in it. So, so um digital technology in that way with scanning. And then from that scan, whenever we're gonna do a cosmetic uh case, we we work it up digitally also. So in the past, we had to actually put wax on teeth and build the teeth up and make the edges exactly the way we were gonna think, uh thought we do them. But now we can actually just paste um these templated type uh teeth on the patient's uh digital model and then move it around so that it gives them that characterization and individualization that um most people desire. And so those two things really, really help a cosmetic dentist and a cosmetic dentist should have access to them if you're getting the most up-to-date cosmetic dentistry. Now, Sabrina, you're working with digital things at dental school, right? Yeah, it's really what comments do you have about that?

Speaker 2 6:57

Well, I've had the experience of both non-digital with the the goopy things and then scans. So we did impressions on each other, and that that was fun, but it was also not fun as the patient, you know, getting the goopy stuff in her mouth. And then we also worked on digital scans, and those are so much faster. You could see a lot more of what you need to fix with yourself, with your teeth right in front of you. You can move it around, you can see so many different things with the digital scans in comparison to just, oh, if you show the patient, yeah, these are your teeth in, you know, in setting in the alginate, it's kind of like, okay, I can see that I have an impression, but I can't really see what my teeth look like zoomed in. And even when I get my scans here at, you know, Dr. Asham's office, I see, wow, like, okay, I need to fix that little part of my teeth. And I think that's important for the patient to see as well, not just to help the dentist themselves, but for the patient to educate themselves and to understand, oh, maybe I haven't thought about fixing this part of my smile, but now I want to fix that part of my smile because I can see it so blown up. So I think that's what is really important about the technology and the comfortable comfortability of it for the patient.

Speaker 8:09

Yeah. And then, you know, but on top of that too, you know, it's nice to see it, and then you can change it almost instantly without having to go through a large process of doing what we call analog type of impressions, which is the goopy impressions. So yeah, so that's so nice to have that.

Speaker 2 8:27

And then also for the patient, it takes faster, right? You know, you can wax it up or quote unquote wax it up on the technology and can show it to them right away, right?

Digital Wax-Ups And 3D Printing Progress

CBCT Merging For Implants And All-on-X

Speaker 8:37

Yeah, it actually gets printed, which is really nice. So it's uh just like you know, they're they're doing printed toys in that. Now we have printed dental models, and then we're working even towards printing porcelain veneers or or printing crowns. We're not there yet, and we're not trusting of those materials yet, but they're not too far away. And probably in the next six to nine months, we'll have some studies on some of those printed porcelain and printed printed composite uh crowns. So that'll be nice. The other thing we we do uh that you should look for in digital is you can take these scanned models and then you can merge them with what we call a CBCT, and that's a three-dimensional x-ray of your teeth and bone. And so you can take those teeth and bone, which kind of looks like a skeleton, and then you place your scanned model on top of that, and then instantly you have what you've proposed as the patient's smile actually in their face. And so that's really, really neat in order to get things exactly right. And that comes in particularly handy when you're doing a thing that we call all on X, which means all on either four implants or all on either six implants, where you're replacing every your patient's teeth that uh in one day. And so if you can work all that up with the digital scan and the CBCT, then that patient can have their teeth in a day. And you've probably seen commercials for that. And then that's kind of what we're doing now. But to see it on the face and then move it accordingly so it fits within their lips and it is in proper alignment with their eyes, that is really, really phenomenal in terms of technology. And and most cosmetic dentists should have that, should have that type of uh ability.

Speaker 2 10:39

Is there also, you know, the option for virtual smile designs as well that patients can see?

Speaker 10:46

Absolutely. You know, the the I kind of skipped ahead to that very detailed technology, but one of the things we do um with our patients when they're here for our consultations, and which you know could be done at the cosmetic dentist that you choose, is we actually place the teeth in their mouse on their face. It's called the cosmetic imaging. And then that way the patient can see the teeth that the cosmetic dentist is proposing right in their mouth. And when we do it here in the office, I actually tell the patient, it's fine if you don't like it, because that just gets us a little bit closer to what you do like. And so when I show that to them and they think they're too light, then we can instantly darken them and then see if they like that on their face. And then we know the appropriate shade that gets them there. If the teeth are too big or too long, we can change them right in that imaging too. And then that way they get to see what these teeth we're proposing look like in their face before we've even touched their teeth. And then that gives patients the confidence to know that the cosmetic dentist is working in the right direction. And then from there, to make the patient more comfortable, we take that imaging and then we put it back on that scanned model. And then when the patient comes in for their treatment, we actually make their temporaries look just like that imaging and just like that scan. And then they get to see it again in their mouth as temporaries. And in our office, we give them a whole week to kind of get used to it, talk with it, see the shade, have their family members and loved ones comment on it. And then we do an approval process of their temporaries, making sure they like the length, the shade, and the shape. And if they do, then we take a digital impression of that again. No goopy stuff. And then we use that as our blueprint to make their finals. And then the last step of that is when they're when they come in to have their finals placed, we take one tooth off of the temporaries, and then we take the one tooth off of the permanents, and we put that in their mouth and make sure it lines up, uh, you know, in alignment, in length, and then also in shade. And so the patient sees that we're doing exactly what we had planned from their accepted temporaries. And so that give gives patients confidence that we did exactly what we had planned and they are getting exactly what they approved. So all those steps with technology really, really help the outcome and the communication and the security the patient has to know they're getting the smile that they want.

Speaker 2 13:34

That's awesome. I mean, the whole idea that I get from modern technology is that now you just get closer and closer to what the patient wants. Everyone is happy. You get to do a job that both the patient is proud of and you are proud of. And that helps both you feel confident as a patient in the that you feel like you're in the right cosmetic dentist, and the cosmetic dentist feels happy with your reaction to their results.

Speaker 14:01

Exactly. We're as a cosmetic dentist, we did this in an analog way, which was more difficult in the past. But now we're doing it in a digital way. So we're walking them through the different steps of what they would look like with cosmetic dentistry, and then eventually getting to that final result that is not a surprise. And I can tell you uh that's how cosmetic dentists get a bad name is when they don't go through these steps and they just put these white chiclet teeth in somebody's mouth that they the dentist feels looks good, and then the patient looks at and is in is shocked.

Speaker 2 14:39

Yeah.

Speaker 14:40

So using technology to let the patient walk through what their change is gonna be really, really enhances the whole process of cosmetic dentistry.

Non-Invasive Additive Smiles And The Tooth Death Spiral

Speaker 2 14:49

For sure. I mean, right there, you just answered one of my questions, which was how does modern technology improve cosmetic dentistry? But I guess one question that I can ask you is how does modern technology allow you to create a smile that is non-destructive and aesthetic for the patient?

Speaker 15:07

Wonderful question. And thank you for asking. Of course. You're so sharp. Um, thank you for letting me get to that. You know, what I specialize in here is not just cosmetic dentistry. I specialize in minimally invasive cosmetic dentistry, which 90% of the time is non-invasive, meaning we don't take any of our two structure away. And I couldn't really do that without the technology we just talked about earlier in their podcast. We use a digital model to have the patient's teeth as they are, and then we enhance the teeth superficial to those teeth and longer. Usually they need their teeth longer, longer than their teeth. So we're doing everything additive. And then we can blend that additive arch form from the two front teeth, which are the two most important teeth in their smile, off to the sides, to the side view of their smile, so they have a nice broad smile. And then we know exactly what the thickness of the material is that we're putting on their teeth, and that blends with each other to make it look like your natural teeth, just enhanced. So it's all non-invasive cosmetic dentistry is all additive. And then to explain what you know, why how it's so different is that when someone would get porcelain veneers in the past, you couldn't just put a porcelain veneer on their tooth without touching it because it would look too big. So what all dentists learned how to do before this non-invasive technique is they had to grind the teeth down a certain amount so that when you put the porcelain back on, it looks like were their teeth before. And then now we don't have to do that. Now, not all dentists know how to do this method, but you should look for one that is either minimally invasive or non-invasive, because a majority of the time you don't have to have your teeth ground on to get a better smile.

Speaker 2 17:15

I see. So what I'm getting from you is that with the technology, you can see that you can have enough material or you have enough space to put the material on top of their additional teeth to make them have a cohesive and have it all form fit in with the adjacent teeth.

Speaker 17:31

Mean meaning with this, you can't just do one tooth. You need to do maybe a minimum of four. And and then a lot of patients, because they want a nice color, you might have to do 10 teeth. But if you have them all built outward, so to speak, in the right proportions, they don't look buck or they don't look funny or they don't look too big. And then that way that they get a great smile without grinding their teeth. And it kind of reminds me of a patient that I have that you know she has done very well in her life uh with husbands and with her own work. And so that she owns horse, horse, uh, uh racehorses. Um, she has a big charity where she's saving a saving a lot of animals and she helps the you know Navy SEAL. And so she's very she has a lot of money, she's very philanthropic, but she wanted her teeth improved. But even though she had all the money in the world to do it, she never wanted to do it. And then when her and I met, and I told her we could do it without grinding on her teeth, she was all for it because she just couldn't see taking away good tooth structure to have a better smile. But if you take that barrier away and you could have a good smile without grinding on her teeth, then all of a sudden that's something she wanted to do. And that's the way a lot of people feel because everybody has thought in the past the only way to get a nice smile is with porcelain banaires. And with porcelain banaires, your teeth get ground down to teepees in order for them to be placed right. And so it's just nice to see that this woman valued her teeth so much that she'd rather go around with a bad smile than have her teeth ground on. And then she was so joyful and happy when I told her, well, we can give you that smile without grinding on your teeth.

Speaker 2 19:31

I think that's so exciting because it opens up so many options for patients to get the perfect smile and the teeth that they want now. Because I think before, you know, if they're scared about grinding down your teeth, they won't want to change your smile. But now looking for the right cosmetic dentist who will search to preserve your smile, to keep your enamel is super important. And now there are options and dentists that will help you get the smile that you want without taking away tooth structure. And I think one thing that we talked about in dental school that I learned this past year was the whole implant cycle where, you know, you have you start taking away tooth structure, it's gonna that whole reconstruction might fail, then you're gonna have to go to the next invasive option. After that, is oh, I have to take my tooth out, then I have to get an implant. It's this whole cycle. So I learned that you definitely do want to avoid taking away any unnecessary tooth structure and to conserve as much as possible. Yeah. And so that's why I think you know, bioclear and minimally invasive cosmetic dentistry is so important.

Speaker 20:34

Warm injection molding that adds to your teeth. And you're exactly right. I I I kind of call that the the tooth death spiral.

Speaker 2 20:42

Oh yeah.

Speaker 20:43

The tooth death spiral, because first it starts with a filling, and then it needs a crown, and then it needs a root canal, and then it needs a new crown, and then the tooth breaks and the root it breaks down the root, you gotta take the root out, but so if you never start that spiral by never taking anything away from your tooth, you avoid that, all those things that all our patients kind of do not like about dentistry. And they're fearful root canal extractions, implants, you know, they take all that whole possibility away.

Speaker 2 21:12

For sure.

Key Takeaways And How To Follow Up

Speaker 21:13

Well, that's all right. So I'm gonna have you, because you're a dental student, Sabrina, you're gonna summarize, you know, in a few sentences, you know, what our audience should remember about this last podcast.

Speaker 2 21:25

All right. So I guess one way to summarize is first what is important in a cosmetic dentist. And so Dr. Asham talked about, you know, the experience of the cosmetic dentist. Do they are they credentialed? I think that's super important. Can you see their cases, you know, their technology, um, and then how do you feel with the consultation? So those are main points that we want to get across to our audience. And after that, what is modern cosmetic dentistry? Modern cosmetic dentistry kind of incorporates technologies such as you know, virtual scans, which is way more comfortable. For the patient, it takes less time. You get to see your teeth right in front of you, and you get to see what it's like to have your new smile kind of digitally right there on top of you. And then from there, you can have your CBCT, which is more advanced technology for implants. And then also just the virtual smile design, which is something so simple as taking a picture of you and then putting nice new teeth in front of that picture. So you can kind of get a gist of what your smile could look like. And I think that in itself is so important because obviously you're going through a huge reconstruction of your teeth. You're going to want to know what it looks like, but there's no real way of knowing what it will look like until you get it. But these little technologies that we have now and that cosmetic dentists have will allow you to see what your teeth could look like and get you more comfortable to the result that you want to get. And then obviously it's super important to remember that there aren't just invasive cosmetic dental procedures like porcelain veneers. Obviously, porcelain veneers are very nice. And if that's what you want, then that you should go for it, right? But there's another option, you know, with bioclear or just composite veneers that can help you get the smile that you want without taking away tooth structure. And technology helps us with that by allowing us to see how much tooth structure can we add on without making it seem too bulky or too chunky if that's something that you fear. Um, but overall, cosmetic dentistry is going in a direction that is with technology and that will help save your teeth. So it's not only good for your looks, but it's good for your overall health.

Speaker 23:35

Fantastic. You you hit it right on the head, Sabrina. Great job. Perfect. Yeah, just know that your smile can be enhanced without that having to grind on your teeth, and that we want to use technology to to do that. And I imagine our audience who's watching us on a pod or listening to us on a podcast or watching us on YouTube, they're very techno technologically advanced. And so um they they would want to go some that someone has that same kind of attitude.

Speaker 2 24:03

For sure. Well, I mean, if you have anything else to say, but this was so fun to do this podcast again. I really enjoyed being back here with Dr. Eshom. He always has so many great things to share to the audience. So be sure you're taking your notes and looking for the right cosmetic dentists. But other than that, thank you so much for tuning in to Getting Your Dream Smile with Cosmetic Dentistry. Be sure to tune in to us on Spotify, on YouTube, Google, whatever it is that you like to listen to, and give us a thumbs up. But other than that, thank you so much for listening to us today.

Speaker 24:37

Thank you, everybody.

Speaker 1 24:38

Bye. Thank you for tuning in to Getting Your Dream Smile with Cosmetic Dentistry with Dr. David Eshom. Be sure to subscribe to our podcast to be notified about future episodes. Click the link in the description to fill out a form if you have any questions on cosmetic dentistry or your smile that you want us to answer. See you next episode.