Lately, we’ve been seeing a lot more tweets like this one:
Veneers are a cosmetic treatment. They may be done for practical reasons – to restore a chipped or discolored tooth, say – but their main purpose is to improve appearance.
Braces and other orthodontic treatments  improve appearance, too, but that’s not their main purpose.
Orthodontics is concerned with occlusion: how the teeth come together. While mildly misaligned teeth may be covered up with veneers, more significant malocclusion – literally, coming together badly – can contribute to a variety of problems. For instance, crowded, crooked teeth can make it hard to brush and floss well, raising the risk of tooth decay and gum disease. An uneven bite can spur clenching and grinding, TMJ dysfunction, headaches, pain, gum recession, tooth sensitivity and increased risk of fracture. It can even spur problems with speech, digestion, breathing, snoring and sleep apnea.
Ortho helps prevent such problems through correcting the bite. A more attractive smile is a happy side effect of successful treatment, whether with traditional metal brackets or removable appliances. Seldom is tooth removal necessary.
Placing veneers, on the other hand, requires removing natural tooth structure – as much as 30% per tooth! – to fit the composite or porcelain shell. Meantime, alignment problems may persist. If there’s crowding, say, or teeth slightly twisted due to a narrow dental arch – veneers will not completely iron them out, so to speak.
So why promote them as an “alternative” to braces?
It’s certainly not because they’re cheaper for the patient. Veneers have a lifespan of about 10 years, at which point they must be replaced. At over $1000 a pop, their lifetime cost is many times the cost of a single course of orthodontic treatment.
But from a dentist’s perspective, they’re relatively quick and easy to do. The patient gets instant results – an immediate makeover. If it looks good, they’re happy. And repeat business is assured.
If you wanted to get really cynical about it, you could say
$ = i + g/t
where i = intention, g = greed and t = time. It’s not that dentists are deliberately out to make a fast buck off you. Rather, most just seem beholden to the conventional wisdom they were taught in dental school: that each tooth can be treated in isolation from the rest of the body. Taking this kind of compartmentalizing view, it’s easy to lose sight of potential consequences, especially when economic concerns loom large. It becomes easier to go with all sorts of procedures – easier, say, to justify the use of toxic mercury amalgam fillings or to urge immediate extraction and implant rather than taking a more conservative approach and trying to save a diseased tooth.