Doctors and dentists can face complaints about pushing cosmetic treatments

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By Rita Zeidner
Special to The Washington Post
Tuesday, May 18, 2010

When Carla Morelli made an appointment for a routine checkup at the Kentlands Dental Care in Gaithersburg, she didn't request a cosmetic consultation. But that didn't stop clinic staffers from offering up beauty advice.

First to weigh in was the hygienist who cleaned her teeth. After telling Morelli how much prettier she would look if she got her teeth straightened, she urged her to consider being fitted for Invisalign, clear plastic braces that would slowly move her teeth into place.

"Until she told me, I never knew there was a problem with my smile," recalled Morelli, 39, owner of a Gaithersburg financial services consultancy. She pulled down her lower lip to expose a slight buckling of her front bottom teeth.

After telling the hygienist she wasn't interested, Morelli said, she forgot about the incident until a follow-up visit last year, when several other staffers approached her about Invisalign. One said the braces would prevent her teeth from spreading and head off more-serious mouth and gum problems.

Morelli briefly considered making the investment, which averages $5,000. But because no dentist she had seen elsewhere had told her she needed braces -- nor, in fact, did the dentist she saw at Kentlands -- she began to get annoyed. Rather than a patient getting advice, she felt like a customer being pressured.

"The staff just seemed programmed to talk about Invisalign," she said.

She became even more irritated when several of her own employees said they had been pressed to look into Invisalign while having their teeth checked at Kentlands, the only nearby clinic that takes the insurance offered through Morelli's firm. (It is not related to the similarly named Kentlands Dental and Orthodontics group, which is also nearby.) The clinic also advertises the product on its Web site, on its recorded on-hold message and in a flier posted on a street-facing window.

A blurry line

Concerns such as Morelli's may become a common theme among consumers, as elective cosmetic treatments are increasingly available from the same providers whom patients turn to for medical advice.

Plastic surgeons are still the doctors most commonly associated with purely cosmetic treatments such as Botox injections, facelifts and tummy tucks. But similar elective procedures -- which generally aren't covered by insurance -- are being offered by a wide variety of specialists. Many dermatologists, who treat patients for skin cancer and other diseases, also promote treatments to smooth wrinkles, lighten age spots and remove hair. Otolarnygologists, who care for patients with conditions of the ear, nose and throat, commonly perform nose jobs, brow lifts and eyelid surgery.

Teeth whitening, veneers and Invisalign, along with more painful and costly gum surgery, are among the treatments many dentists and periodontists promote for adults as part of a "smile makeover."

Of course, just because a treatment has cosmetic benefits doesn't mean that it isn't medically beneficial or that it won't be covered by insurance. Breast augmentation, for example, may be covered by insurance following a partial mastectomy, but not if you're healthy and just want to increase your cup size. Similarly, insurance may pay for surgery if your droopy lids are getting in the way of your vision, not if you simply want to look younger.

Patients who don't demand to know why a particular treatment has been recommended risk unexpected out-of-pocket expenses, inconvenience and unnecessary pain, said Kenneth Greer, a professor at the University of Virginia School of Medicine and the recently retired chair of the school's dermatology department. "I would never say doctors are deliberately misleading patients," he said. "But like with many things in life, it's caveat emptor."


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