Interview: "I am on a crusade against overly aggressive cosmetic dentists"

Dental Tribune: Dr. Zuk, please would you introduce yourself to our readers by telling them something about your background?
Dr. Michael Zuk: I was born in New York City and moved to Canada as a child. I graduated from dental school in 1986 and set up practice with a classmate and a second friend from grade school. As a child, I enjoyed art and science, and wanted a career that would not be back-breaking work. I constantly work on inventions, like High Speed Braces for faster orthodontic treatment, dental marketing and assorted development projects. I am a consultant to several dental marketing programs and run a successful group dental practice in Red Deer.

Why and when did you decide to go into dentistry?
I always respected my dentist and felt it would be an honest career that would combine my interests in art and science. In high school, I decided the tooth business would be one of my top choices. I had no idea that dentistry would expand into such a revolutionary profession.

You are pursuing a treatment approach that combines cosmetic dentistry and orthodontics. Please could you describe the advantages of this combination in comparison with other approaches, and explain why you have devoted yourself to it?
In dentistry, it is sometimes difficult to combine different disciplines owing to the training. Most cosmetic dentists try to straighten teeth without braces, and most orthodontic practitioners do not think veneers are a top treatment for crooked, healthy teeth. I promote the use of composite rather than porcelain in combination with orthodontics, which is basically a hybrid that can take on some very challenging smile problems, such as people with crooked and worn teeth. This means a patient can be treated for a fraction of the cost of a full-mouth set of veneers. In addition, less enamel is drilled away. Shorter treatment times with braces make this idea more acceptable because wearing orthodontic braces can become a nuisance.

I have taken advanced treatment-planning courses and have found that almost every situation can be improved with some changes in tooth position and replacement of worn enamel.

You are known to be a critic of cosmetic dentistry, although you started out working as a cosmetic dentist yourself. Was there a key moment that caused you to change direction?
Once a very attractive young lady came in with a crooked tooth, and she insisted that I veneer it straight instead of refer her to an orthodontist. She looked like Penelope Cruz but I could not convince her to get braces so she left the office. At the time, I did not have the orthodontic training, but I knew people were turned off by the idea of years in braces so now we try to reduce the time to months, when we can, with modified styles of care and different goals.

I always had a healthy respect for tooth enamel and even in dental school I was afraid to drill away too much. As a cosmetic dentist, you are often trained to sacrifice healthy tooth material in order to use porcelain. Many teeth have been treated with root-canal therapy because the teeth were drilled away. Orthodontics also has its risks, so it is not that anything is perfectly safe but I think braces were made "uncool" partly by the heavy promotion of cosmetic veneer dentists and the dental labs. Training in both areas with many of the top practitioners in the world has helped me see that many of the treatment concepts are flawed and based on soft science. Making money for the dentist needs to be a distant second to saving patients money and giving them what they want.

The two professions dentist and author appear to have few aspects in common; yet, both are among your wide range of interests. Please could you explain what makes each one so appealing to you?
If you are serious about your profession, career or hobby, it is a natural step to document your ideas with a book. I have very strong feelings regarding central issues to the dental profession and since I do not enjoy speaking to crowds and getting bottles thrown at me, I prefer to use a book to get my points across. I know life is short, so if we want to make a difference we need to step up and say something. I have also written a children's book titled "Teeth Shouldn't Hurt," which was a fun and less controversial project.

You went public with your opinion about cosmetic dentistry, writing your book "Confessions of a Former Cosmetic Dentist." Are you on a crusade against cosmetic dentists?
I am on a crusade against overly aggressive cosmetic dentists. There are "big name" cosmetic dentists who are teaching impressionable young dentists to treat people with techniques that are damaging teeth and setting people up for a lifetime of maintenance and complications. I do not want to make people think veneers are bad, but some dentists overuse them because they do not know how to use other treatment methods or they simply are influenced by the high fees.

My staff was once threatened, a doctor tried to cut off my dental supplies and one even tried to get me kicked out of a course because of the book. Sometimes the truth hurts.

The book was even reported to my dental association as a violation against our profession by a local competitor. Apparently, they had forgotten about the freedom of speech! I asked my publisher to pull my book out of print for the time being, but there are still a few copies floating around. I may rerelease it once my association revises its "wall of silence" rules.

In your book, you coined new dental terms, such as "Veneer Nazi" and "Smilorexia." Would you please explain these terms?
I wanted to add shock value to my book and since these words were mentioned in the New York Times, I guess they worked. The Veneer Nazi is basically a brainwashed cosmetic dentist. It is a stereotype for a highly aggressive cosmetic dentist. I even spoofed the German movie "Downfall," in which Hitler saw the end of the cosmetic revolution. To lighten the message, I also hired the Seinfeld Soup Nazi actor to do a scene in which he plays a Veneer Nazi. Most cosmetic dentists are less veneer crazy than they were a few years ago, but there are still a few floating around.

"Smilorexia" means someone obsessed with getting the perfect smile at any cost. These people undergo repeated cosmetic surgery and stop looking natural, like the American television celebrity Joan Rivers. These people are easily taken advantage of by cosmetic dentists, but their level of perfection sometimes gets the dentist in the end, as they may never be satisfied.

What do you think is the current trend in cosmetic dentistry? Do you think cosmetic dentistry may be heralding in a new era of conservative treatment?
Certainly, the cat is out of the bag, and some of us have become more vocal against the old style of cosmetic dentistry. I discovered a dentist in the U.K. who has the exact same concerns that I have and he seems to be a fearless lecturer on the topic — which takes guts. The latest trend is cosmetic orthodontics, and the problem with this is that the training is usually very limited so I suggest that dentists really need to invest in a number of courses to cross-train for the difficult situations and not try to use the simplest treatment for everyone.

You are also known to be a collector of celebrity memorabilia. Do you have other dental mementos of famous people in your collection, except for the Lennon tooth and the Elvis crown?
The biggest boost in my celebrity has been buying a couple of teeth, but I am trying to use the attention to discuss the concerns I have, to develop some interesting projects, and have some fun. I am encouraging other dentists to work with me on their own collections because each tooth and celebrity has a story. For example, Elvis had toothache the day he died and could have overmedicated to try to get relief.

I am waiting for Tom Cruise to give me a call when his cap falls out and he wants to give me another gem for my collection. Those metal teeth Richard Kiel wore in his role as "James Bond's" Jaws would be cool too! I also have Julian Lennon's baby tooth, so that makes three celebrity teeth for now.

My wife and two children think my celebrity tooth hobby is a little crazy but that is understandable.

You have been practicing dentistry for more than two decades now. Are you still enjoying your job or have you ever thought about pursuing another career?
I was thinking it was time to look at retirement, but I have gotten a second wind and think it will be a few more years before I hang up the drill. I have always enjoyed marketing development and have helped dentists all over the world with ideas for years. It is easy for me to get a project completed by joining the dots: from a Beatle's tooth, to his DNA, to the "John Lennon DNA pendant" jewelry and "rot star" art prints of the molar, to writing a song "Love Me Tooth."

If you believe anything is possible, can work with people who know what they are doing and believe that what you have to say is as important as the other person then big things can result. Just look at the Kardashians. I think "keeping up with the molar" is more interesting!

Thank you for this interview!