Jack Ringer, D.D.S., started solo practice about 35 years ago, and had an interest in aesthetics from the get-go.
Adhesive technology for bonding, colored resins and thin shells of porcelain for veneers had made their debuts in the specialty. But there weren’t many educational opportunities at the time, so Dr. Ringer started associating with people who had the same interest and began learning.
Today, Dr. Ringer has a thriving cosmetic dentistry practice in Anaheim Hills, Calif. He’s an accredited fellow and past president of the American Academy of Cosmetic Dentistry (AACD), cofounded the Orange County Academy of Cosmetic Dentistry, and spends about a third of his time teaching and mentoring others in aesthetic dentistry, as a faculty mentor for the Spear Institute in Scottsdale, Ariz., and he lectures for various organizations and study groups nationally and internationally.
Dentists are in an ideal position to offer patients more than fillings and crowns. In fact, dentists can make one of the most profound impacts on a person’s attractiveness by aesthetically enhancing teeth, he says.
And what’s cool about cosmetic dentistry, according to Dr. Ringer, is that compared to other cosmetic subspecialties that address soft tissue, dentists work with hard tissue, which tends to offer more predictable outcomes, with less pain and downtime.
The Aesthetic Channel asked Dr. Ringer to share his insight for how dentists can best incorporate aesthetics into practice. Here’s what he had to say.
The Aesthetic Channel: What is the scope of your aesthetic practice in dentistry?
Dr. Ringer: Dentists are pretty limited as far as what they can do in facial aesthetics. We’re more confined to the oral cavity.
In some areas in the U.S., there are some minor procedures that dentists are allowed to do in cosmetics, like using Botox [Allergan] or fillers. Where I am in California, dentists aren’t allowed to do that for aesthetic purposes. We can do Botox for therapeutic reasons, but not to eliminate wrinkles or anything like that.
When it comes to the teeth and mouth, intraorally, I can do almost anything, as far as changing their shape, position, size and color. When it comes to the soft tissue, I would defer to specialists in those areas. In my type of practice, I work very closely with these people.
I think for any dentist or doctor, you should understand your limitations and skillset.
The Aesthetic Channel: Is your philosophy that cosmetics is part of dental practice?
Dr. Ringer: Yes, I think it’s a part of every dental practice, but dentists who offer it need to be skilled in aesthetics. Cosmetics is more of a want, than a need, but just because it’s a want, doesn’t mean it’s not as important to a patient.
The Aesthetic Channel: How has aesthetic dentistry evolved in your practice?
Dr. Ringer: The biggest thing that has happened in the last five to 10 years is more predictability in placing dental implants. But, at the end of the day, aesthetics are what the restoration looks like on top of the implant. Changes in that aspect include more sophisticated ceramics, better optics and new high-tech [computer-aided design/computer-aided manufacturing] CAD/CAM manufacturing of restorations. Everything is going digital.
You can design and actually mill the restoration on the CAD/CAM system. Though, aesthetically, milling alone — at least at the level of aesthetics that I demand — isn’t good enough for the front teeth. You still need a human to do the fine aesthetic changes, customization and characterization.
The Aesthetic Channel: What are considerations for dentists who want to offer cosmetic services?
Dr. Ringer: Again, cosmetics is more of a want than a need. When they go to dental school, dentists learn how to treat the need. So anybody that wants to excel in the aesthetic world needs to take extended training.
There’s no board certification in dentistry for cosmetics in dentistry. But there are programs out there. They’re not through dental schools. They’re at private facilities that have dentists who are highly skilled and world-renowned who put on programs.
There’s one group called the American Academy of Cosmetic Dentistry. It’s the largest organization in the world that focuses on comprehensive cosmetic dentistry. And they have a credentialing process. As of today, it’s really the only barometer out there that a patient and other dentists can look at that shows the dentist is skilled in the field of cosmetic dentistry. Organizations like the AACD offer programs and hands-on opportunities and didactic courses to teach dentists how to elevate their skill set in cosmetics.
Another consideration: If you’re trying to develop a practice that focuses on aesthetic dentistry, then I believe the environment needs to reflect that. It should be a practice that shows nice aesthetic cases — not pictures of duck hunting on the walls. In my practice, the staff that I hire, if they don’t have really pretty teeth, I will correct that for them. I think you should practice what you preach.
When it comes to investing in the practice, there’s lots of technologies out there, but the most important things are to learn aesthetic techniques and practice them and work with other disciplines. Then, purchase technology for whatever it is that you want to focus on.
It’s pretty competitive. As a result of that, cosmetic dentists need to set themselves apart from other dentists. You can do that by getting credentialed by the AACD, as well as keeping up with the latest technologies.
The Aesthetic Channel: Is there anything you would do differently if you were to open a cosmetic dentistry practice today?
Dr. Ringer: When I started practice, we didn’t have managed care or corporate dentistry. It was a whole different ballgame when it came to overhead and costs of running a practice. If I was a youngster today, and I wanted to get into cosmetic dentistry, I would still do the training, but I wouldn’t start a solo practice. It’s too expensive. I would be in a private group practice of dentists who do the same thing.
A degree in dentistry costs an average of $350,000, just for tuition. For the dentist who comes out of school and wants to start a practice, that will cost another half a million dollars. What ends up happening is a lot of dentists are coming out of school and can’t afford to jump into practice, so they work for corporate-run, factory-like production practices. Those who want to excel in aesthetics should rather reach out to and look for practices that do more private, less production line cosmetic work.
The Aesthetic Channel: What is the impact of aesthetics on the bottom line?
That’s the reason a lot of dentists want to do it: it’s very, very profitable. When a patient comes in for cosmetic dentistry and has eight teeth done on his or her front smile, it is far more profitable than if I’m seeing eight patients and doing one tooth at a time. Your overhead is less when you’re doing a big case, versus a bunch of little cases.
Plus as we all know when it comes to more elective things in our lives — a Mercedes versus a Toyota — there’s a higher markup. And those dentists who are more highly skilled and have a better reputation can command a little higher fee because they know that they’re providing a better result for the patient.
For me, aesthetics offers a much better quality of life. Don’t forget, there are very few patients on this planet that want to go to a dentist. But, with cosmetics, they’re coming in because they want to.
To me, this is not a job. This is fun. I never want to retire. And it affords me a good living.
