Cosmetic Dentistry in the Instagram Age: An Honest Conversation

This is the final piece in my series on minimally invasive dentistry at BDS Dental. The first four articles have been about how we think about clinical care — when to drill, when not to, how to rebuild worn teeth, and what’s quietly damaging your teeth in the meantime. This one is about cosmetic dentistry, which is where most of the difficult conversations I have with patients tend to land.

It’s also where the gap between the minimally invasive philosophy we work to at BDS and what patients sometimes arrive expecting is at its widest. So I want to use this article to explain how I think about it, what I’m happy to do, what I try to talk patients out of, and where I draw the line.

The patients arriving with a screenshot

The most common version of this conversation starts with a patient who has seen something on Instagram, TikTok, or similar. A specific smile. A particular shade of white. The very even, uniform look that’s become the unofficial signature of a lot of modern cosmetic dentistry.

I understand why this happens. Social media gives people a fixed idea of how they’re meant to look, and dentistry is one of the more visible parts of that. I don’t have a problem with people wanting to improve their smile — that’s a completely legitimate thing to want, and helping people feel more confident about how they look is one of the most rewarding parts of my job.

What I do have a problem with is the assumption that the only way to get there is irreversible, destructive dentistry such as crowns or veneers. Because in the majority of cases I see, it isn’t.

Where minimally invasive cosmetic dentistry shines

There’s a technique called edge bonding which I want to introduce here properly. It’s exactly what it sounds like — we bond small amounts of composite onto the edges of the front teeth to even them out, close small gaps, lengthen teeth that have shortened with age or wear, or refine the shape. The materials and techniques are very similar to the wear-restoration work I described in part three of this series. The difference is the intent: edge bonding is purely cosmetic. There’s nothing clinically wrong with the teeth — we’re refining what’s already there.

Crucially, edge bonding usually involves little to no drilling of the underlying tooth. We’re adding, not subtracting. So in terms of the long-term health of your teeth, it’s about as conservative as cosmetic dentistry gets.

The other tool in the minimally invasive cosmetic toolkit is whitening. Done properly, professional whitening is reversible and doesn’t damage the teeth. It’s almost always the first thing I’d suggest if a patient is unhappy with the colour of their smile. Whiten first. See how you feel. Then we can have the conversation about whether you still want anything else.

In a lot of cases, the answer at that point is no, actually this is enough. Which is exactly the outcome I’m hoping for.

“Minimally invasive” doesn’t mean “reversible”

One quick clarification, because patients often conflate these. Some people assume that if a procedure is described as no-drill or minimally invasive, it must be reversible — that you can have it removed if you change your mind.

That isn’t quite right. Edge bonding, for example, doesn’t involve drilling your teeth — but if you wanted it removed, the only way to do that would be to drill it off. So while it’s far less destructive than veneers, and far more conservative than crowns, it’s not something you can simply un-do.

I make sure patients understand this before we start. The choice is yours either way, but it should be made with eyes open.

Where I push back — and where I won’t go

I don’t refuse cosmetic work in any blanket way. If a patient wants something purely cosmetic and we can deliver it through minimally invasive means — bleaching, edge bonding, conservative composite work — and they understand what’s involved, I’ll do it. I’ve got the skills, and I enjoy the work.

But there are situations where I’ll try to talk patients down to something less invasive than what they came in asking for. The most common is when a patient has read about veneers and wants veneers, and what they actually need to achieve the look they’re after is whitening, perhaps with a bit of bonding to refine the shape. If that’s true, I’ll say so, and I’ll usually push to start there. The veneer option is still on the table if they’re not happy after, but most of the time we don’t get there.

Orthodontics is another great way to deliver a real aesthetic uplift — particularly when the main issue is the position of the teeth rather than their colour or shape.

There are also cases where I’ll decline cosmetic work outright. The biggest one is when a patient comes in with existing dental disease — active decay, untreated gum problems — and tells me they’re not interested in dealing with it; they just want me to make their smile look better. That’s not a conversation I’ll continue. Beautifying a mouth that has untreated disease isn’t dentistry, and I won’t do it. I’ll always offer to help the patient sort out the underlying health first, and if they’re up for that, we can have the cosmetic conversation properly afterwards.

Of course, I’ll always continue to look after such patients to the best of my ability — but I’ll do so while never providing treatment I don’t feel is in their best interests.

The other situation that makes me cautious is patients with what I’d describe as unrealistic expectations of what cosmetic dentistry can achieve. Most people don’t fall into this category — most patients I meet have a perfectly sensible idea of what would make them happy. But occasionally someone comes in for whom the whole of their self-image is tied up in this one piece of work, and the result they’re hoping for isn’t realistically deliverable. I’m careful with those situations. If I can’t honestly tell a patient I’ll meet their expectations, I’d rather not start the treatment.

The “would you do that to your daughter?” test

A useful test I think about in cases like these — and one I owe credit for to Professor Martin Kelleher, who coined the phrase in the 1990s — is the daughter test. Would you do this to your daughter?

That sounds glib, but it isn’t. It’s a useful gut-check. When a patient sits in front of me asking for a course of treatment that would involve drilling away large amounts of their natural tooth structure for purely cosmetic reasons, the daughter test forces me to ask whether I’d recommend the same thing to someone I love. If the answer is no, that tells me something. Sometimes the answer is yes, this is the right call for them. But quite often it isn’t, and the daughter test is what makes me say so out loud. (It doesn’t have to be a daughter, of course — it could be a mum, a sister, anyone you love.)

The metal-filling question — same logic

There’s one specific question I get more than almost any other, and it sits in the same territory. Can you take all my metal fillings out and put white ones in instead?

My honest answer, when the existing fillings are sound and there’s no decay underneath them, is almost always I’d advise against it right now. Here’s why.

If we drill out a perfectly serviceable filling to replace it with a tooth-coloured one, there is a real biological cost. Even with all the care in the world, we’re removing tooth structure that didn’t need to be removed. There’s a small but real risk that the nerve doesn’t take kindly to that — gets heated up, gets inflamed — and the tooth ends up needing a root canal a few weeks or months later. Then a crown. Then a more complicated history overall.

So I’ll have the conversation with the patient directly. I’ll ask: “How would you feel if we did this, and a year from now this tooth needed a root canal and a crown — would you feel it was just one of those things, or would you feel like an idiot for having had it done when it didn’t need to be?” Most patients, when I put it that way, take the point. We agree to leave the sound fillings alone and replace them with something tooth-coloured if and when they actually need replacing. That way, no healthy tooth is sacrificed unnecessarily.

I do still see the occasional patient who really wants the metal out regardless. I’m wary of those situations, and I think the reason is honest enough to put in print: it tells me they haven’t really bought into what we’re about, and I’m cautious about taking responsibility for irreversible work on a patient I’m not sure I’m aligned with. I won’t refuse outright, but I’m not chasing that work.

For what it’s worth, I don’t use dental amalgam any more, even though we still teach it at King’s. It’s a long-lasting, cheap material — but it’s not minimally invasive, and it doesn’t look good. When new work is needed, we use bonded composite or another tooth-coloured option.

Why the dental industry isn’t always honest about this

I’ll be candid for a moment about the industry context. Much of dental marketing — both the marketing dentists do, and the marketing to dentists by suppliers and trainers — pushes towards high-value cosmetic work. Veneers, crowns, implants. Big-ticket cases. The economics of running a dental practice push in that direction. Every dentist wants to feel they’re doing the right thing by their patients, and most are. But the reality is that running a dental practice is incredibly expensive — and becoming ever more so — and the financial incentives in modern dentistry don’t always align with the most conservative clinical decision. That’s not a comfortable thing to say out loud, but it’s true.

This is part of why minimally invasive dentistry hasn’t fully landed in the profession yet, even though it’s now formally taught and has its own department at King’s. The classroom message is one thing. The day-to-day commercial pressure is another. The dentists I most respect are the ones who are genuinely able to carry this philosophy into their day-to-day practice and hold true to its principles.

That’s what we try to do at BDS. We’ve been trying to do it for more than two decades, ever since Harris built the practice around this approach back when it was genuinely unusual. The fact that he was a prosthodontist by training — a specialty focused on replacing missing teeth, the end result of the ultimate failure of minimal intervention — and chose to push minimally invasive thinking anyway, still strikes me as the most telling thing about this practice.

Closing the series

That’s the end of the series. Five pieces, all on different aspects of the same underlying philosophy: do the minimum necessary, preserve as much natural tooth as we can, and have a longer, more honest conversation with the patient about what they actually need rather than what would be the most lucrative thing for us to sell them.

If anything in these articles has resonated — whether it’s the question of whether all your fillings really need replacing, the possibility of rebuilding worn teeth without crowns, the Diet Coke habit you’d quite like to address, or the cosmetic work you’ve been considering — please do come in and have a conversation with us. A consultation isn’t a commitment to treatment. Sometimes the most useful thing I can tell a patient is that they don’t need anything done at all. That’s a perfectly good outcome, and it’s one I’m happy to deliver.

Thanks for reading along.

Dr Ellie Bergin is a partner at BDS Dental and a clinical teacher at King’s College London. To book a cosmetic consultation or a second opinion on treatment you’ve been offered elsewhere, contact the practice here.