There has recently been a lot of discussion in the news about the dangers of cosmetic surgery, sparked this time by the news that thousands of women had received faulty breast implants. As usual, these news items are followed by discussions in newspapers and magazines about what makes people so dissatisfied with their normal healthy bodies that they are willing to risk a surgical procedure with all the possible complications that entails.

I would agree that this is confusing.  It surprises me that so many people undergo cosmetic surgery to alter parts of their body that are not in any way abnormal. Most of these people seem to assume that the (sometimes major surgical) procedures are completely safe and without complications, and although to doctors who have been through many surgical consent forms it seems incredible that anyone could believe any procedure is without risk, it is unsurprising when these ‘treatments’ are advertised on TV and in glossy magazines just as if they were the latest new eye shadow or nail varnish.

However, the thing I have been more surprised about is the even greater number of people who undergo cosmetic treatments on their teeth. Many of these procedures are designed to straighten teeth, and some involve not only braces which exert pressure on the teeth to move them into different positions, but also sometimes surgery involving a general anaesthetic to remove healthy teeth with the aim of improving the cosmetic appearance of the person’s smile.

What is even more surprising and concerning is that these procedures are often carried out in children and teenagers. They have almost become so standard that it is becoming unusual for people this age to have naturally spaced and naturally coloured teeth. Their parents are quite happy to encourage this and to pay a lot of money for it as well in some cases – I suspect the same parents would be horrified if their 13 year old daughter wanted breast implants or a tummy tuck or liposuction.

These cosmetic dental procedures are not without risks. A brief glance through dental journals, or patient advice leaflets or even wikipedia will tell you there are risks of demineralization while wearing fixed braces and risks of damaging teeth during these procedures, and although the risks may be small they do exist. Many treatments take place over several years and involve many X-rays or even CT scans as well. It is also not inconceivable that, just like the breast implants, further down the line we may find out that some people were treated with substandard equipment which has caused damage, or that moving teeth around may cause an ongoing weakness.

On holiday a few years ago I chipped a molar tooth, which I left alone at the time as it wasn’t painful, then around a year ago the same tooth chipped a bit further – I went to see a dentist about it and when I arrived I was given a questionnaire to complete. Some of the questions were about past medical history and covered important facts for a dentist to be aware of, such as allergies and any previous treatments. However the form then moved on to questions asking if you were happy with the cosmetic appearance of your teeth. This is surprising – if a patient comes to see their GP with a breast lump, for example, we do not ask if they are happy with the size and shape of their breasts, we just treat the clinical problem; if they come with an ear infection we do not ask if they are happy with the appearance of their ears or if they want an otoplasty procedure, we just assess what treatment is needed.

I explained that I wasn’t unhappy with my teeth and just wanted to know if there was anything I should be doing to stop any further breaking. I was relieved that the tooth was OK and I felt lucky not to have experienced any other problems so far and want to keep it that way, rather than risk complications from unnecessary cosmetic procedures.

Perfectly (and, some would argue, unnaturally) straight and white teeth have now almost become the norm and going through cosmetic surgical procedures to obtain them has now become so acceptable that people do not question parents organising these cosmetic procedures for young children. Meanwhile, the newspapers are full of articles suggesting that the root cause for all these cosmetic surgery disasters we read about is that people are judged for their looks and are expected to have an unnaturally ‘perfect’ body as modelled by celebrities who have had extensive surgery. Are we not just one step ahead when it comes to cosmetic dental procedures? Have they become so ubiquitous that many people with nothing wrong with their teeth feel they look unacceptable and unattractive without these interventions? Thirty years ago these dental procedures were rare – in thirty years time from now will it be unusual to see someone with a normal, non-reconstructed body?