Dental veneers on the rise

Media item: article on increasing demand for dental veneers

Date published: 12 September 2019

This page records the media item. The original article is the property of its publisher and is not reproduced here. What follows is an independent account of the same subject.

What is actually driving the demand

Cosmetic dental demand has risen sharply across the developed world since roughly 2015, and the causes are reasonably well understood.

Front-facing cameras and filters

The single largest driver. Before smartphones, most people saw their own teeth in a bathroom mirror at arm's length, occasionally. Now they see them magnified, lit unflatteringly, from angles nobody else ever sees, dozens of times a day — and next to filtered images of other people's.

Two things follow:

Filters and retouching routinely whiten and reshape teeth. A great many people arrive asking for a result that does not physically exist in the person they saw.
Front-facing camera lenses distort. They exaggerate whatever is closest, which at conversational distance is the middle of the face. The teeth you dislike in a selfie are not the teeth other people see.

The clinical literature has a term for the more severe end of this — appearance concerns amplified by editable self-images — and it is a recognised reason to decline treatment rather than provide it.

Video calls

A step change from 2020. Millions of people spent hours a day watching their own face while talking, which almost no one had previously done.

The uniform look, and its visibility

The very uniformity that photographs well — identical, opaque, brilliant white, all the same length — is precisely what reads as artificial in daylight. Natural enamel is translucent, slightly irregular, and varies in colour from the gum to the edge. Skilled cosmetic work reproduces that irregularity; conspicuous cosmetic work removes it.

Price competition and dental tourism

Which is the part that most warrants a warning.

Dental tourism for veneers

Overseas cosmetic dental packages — commonly Turkey, Thailand, and parts of Eastern Europe and Asia — are heavily marketed, often at a fraction of Australian prices. Some of the work is competent. The structural problems are not about the country.

The Australian Dental Association has a policy statement on exactly this — Policy Statement 2.2.6, Elective Overseas Dental Treatment — and its position is unambiguous: “Overseas elective dental treatment carries the risk of adverse oral and general health outcomes with long term problems which may be difficult to resolve on return to Australia.” It goes further than most professional bodies would on a consumer choice, holding that “Australian residents should only seek elective dental care in Australia” and that “Australian promoters of health services in overseas countries should be required to indemnify consumers for all adverse outcomes of such treatment.” It is worth being clear about what that document is: a policy position, not evidence. It carries no complication rates, because none are published.

What the price often conceals: many packages marketed as "veneers" involve crowns, not veneers. The difference is enormous, and it has been measured. Edelhoff and Sorensen, in The Journal of Prosthetic Dentistry in 2002, weighed the tooth structure removed by each preparation design and found that veneer and resin-bonded preparations removed approximately 3% to 30% of the coronal tooth structure, while approximately 63% to 72% was removed for all-ceramic and metal-ceramic crowns — a metal-ceramic crown preparation taking 4.3 times as much as a facial-surface-only veneer, and their overall conclusion that veneer preparations need “approximately one-quarter to one-half the amount of tooth reduction of conventional complete-coverage crowns.” In depth rather than weight, published veneer preparations run to around 0.6 mm on the buccal surface with a 0.3 mm cervical chamfer, and minimal-preparation designs to 0.3 to 0.5 mm. Three qualifications belong with those percentages and are almost always dropped: the study was in vitro, by gravimetric analysis, on typodont resin anterior teeth. It is the right order of magnitude for a front tooth, not a measurement of yours.

A crown, then, removes the whole outer surface of the tooth, and substantially raises the chance the nerve dies and root canal treatment is later needed. Twenty teeth crowned in a week in a young person with healthy teeth is a very large irreversible intervention, and it is frequently not described that way.

The specific risks:

Compressed timelines. Extensive work completed in a week leaves no room for the diagnostic phase, a trial in temporary restorations, or healing and reassessment. The trial stage is where changes are free, and it is the stage most often removed. The ADA makes the same point structurally: “Optimal ongoing oral health cannot be achieved in a single episode or short course of treatment and requires regular maintenance.”
No follow-up. Restorations need adjustment, review and maintenance. When something debonds or a tooth becomes painful three months later, you are in Australia and the practitioner is not.
Remedial work is expensive. Australian practitioners routinely see cases requiring root canal treatment, remakes or extractions afterwards, and fixing failed extensive work costs more than doing it well initially — sometimes far more. The ADA's wording is that such treatment “may also require extensive and costly repair procedures on return to Australia.”
Regulatory recourse is limited. AHPRA regulates practitioners registered in Australia. It has no jurisdiction over an overseas clinic, and pursuing a complaint or claim across borders is difficult and usually futile. The ADA notes one specific gap that patients rarely think to ask about: Australian dental practitioners “are required to have professional indemnity insurance. This may not be the case in overseas clinics.”
Records may be unavailable to whoever treats you next — in the ADA's words, “the records and complete details of treatment obtained overseas are unlikely to be available to those providing subsequent treatment in Australia.”
Insurance may not cover it either. The ADA records that “Complications to health from elective dental treatments ... obtained while overseas are not always covered by travel insurance and the treatments may not be covered by Australian health funds.”
Flying after some procedures carries its own considerations, particularly after surgery.

None of this means overseas care is inherently poor. It means the risk profile is different, the safeguards are thinner, and the failure mode is expensive and irreversible. Ask the same questions you would here: how much tooth is being removed, is this a veneer or a crown, is there a trial stage, what material, and what happens if it fails.

What is worth knowing before any veneer decision

Most porcelain veneers are irreversible. Enamel removed does not grow back; the tooth needs a veneer or crown for life.
They are not permanent — and the honest way to put that is in survival at stated time points rather than a lifespan in years, because no authority publishes a veneer lifespan. The published figures are: a 2021 systematic review in the Journal of Clinical Medicine pooling 25 studies and 6,500 porcelain laminate veneers found 10-year cumulative survival of 95.5% counting fracture, debonding, secondary decay and the need for root canal treatment together as failure; counted on their own, 96.3% for fracture, 99.2% for debonding, 99.3% for secondary decay and 99.0% for needing root canal treatment. Longer follow-up is thinner and less flattering: individual cohorts report 82.9% to 91% at 20 years, and one 73% at 15 to 16 years. Note two things about the best of those numbers — the most favourable cohort excluded heavy grinders and poor periodontal prognoses before treatment, and survival is not appearance: a veneer that was repaired or repolished still counts as surviving.
Failure is usually biological — decay at the margin or gum recession exposing the join. On the mechanical side, the same review found fracture the most common complication, followed by debonding, with both more common in the first years after cementation.
Untreated grinding breaks ceramic. A night guard is part of the plan.
Whiten first. Porcelain and composite do not lighten.
Orthodontics is often the better answer where alignment is the real complaint — it moves the tooth and removes no enamel.
Composite bonding is the reversible, repairable, cheaper alternative, and for a young patient it is usually the right first step because it defers the irreversible decision. It is also, honestly, the less durable one: pooled randomised-trial survival for resin composite laminate veneers is 88% (95% CI 81% to 94%) over roughly two to eight years, and in the cleanest head-to-head comparison — Mazzetti and colleagues' 10-year practice-based evaluation, 2022 — composite carried a hazard ratio of 4.00 (95% CI 2.74 to 5.83) for failure against ceramic, with annual failure rates of 4.1% versus 1.2% at ten years. That is the trade, stated in both directions.

The advertising rules that apply

Advertising a regulated health service in Australia may not use testimonials about clinical care, may not create an unreasonable expectation of benefit, may not be misleading including by omission, and may not offer inducements without stating the terms — section 133's own wording on the last of those is that an offer of a gift, discount or other inducement is prohibited “unless the advertisement also states the terms and conditions of the offer.” The same section prohibits advertising that “directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services”, which is the limb most relevant to a rising demand for elective work. AHPRA also publishes separate advertising guidance for cosmetic procedures, which is worth checking directly rather than taking second hand.

Before-and-after images are permitted but conditioned. AHPRA's guidelines warn that such images “have the potential to be misleading or deceptive” and “may cause a member of the public to have unreasonable expectations of a successful outcome”, and set out when they are “less likely to be misleading”: where “the images are as similar as possible in content, camera angle, background, framing and exposure”; where “the posture, clothing and make-up is consistent”; where “the lighting and contrast is consistent”; where “there is an explanation if images have been altered in any way”; and where “the referenced treatment or procedure is the only visible change to the person being photographed.” Those five are the conditions the regulator actually states.

Common questions

How do I tell from a quote whether I am being offered veneers or crowns?

Ask, in those words, and ask for the item numbers so the answer is on paper. The ADA's own plain-language distinction is the test: a crown is “created to fit over the natural tooth after it has been cut back”, while a veneer is “a thin shell of porcelain or white filling material ... which is glued to the front surface of the tooth”, and because veneers “are very thin”, “not much or no tooth structure has to be cut away from the tooth or teeth for the treatment to be completed.”

So the practical question is whether the tooth is being reduced all the way round or only on the front. Two further questions make it concrete: how many millimetres will be removed, against the published veneer figures above; and will the tooth still be usable without a restoration if you change your mind. A quote that will not answer either is telling you something. The two treatments also differ in timing — the ADA notes composite veneers are “usually completed in one appointment”, porcelain veneers need “at least two appointments”, and a crown “often takes two appointments” with a temporary crown between them.

Do veneers stain, and can I whiten them later?

They can discolour at the edges, and no, you cannot whiten them. Peroxide has no effect on ceramic or composite, which is why the sequence is always to whiten first. Pooled data put severe marginal discolouration at 2% (95% CI 1% to 10%), and one study found significantly more marginal discolouration among smokers. Composite is the more vulnerable of the two materials: the reported causes of composite veneer failure are surface roughness, colour mismatch and marginal discolouration, which is the visible-wear pattern rather than the breaking pattern.

The problem that catches people years later is the other direction. healthdirect lists it among the drawbacks: “your other teeth may become discoloured, no longer matching your veneers.” The veneers hold their colour while the natural teeth around them darken with age and staining — and whitening will lift the natural teeth but not the veneers, so the mismatch can be narrowed from one side only. Ask, before anything is made, what happens to the match in ten years.

I am in my twenties. Is it too soon?

It is the decision most worth slowing down, for one reason: enamel removed now cannot be put back, and a tooth prepared at 24 needs a restoration for sixty years rather than thirty. That is the argument for composite first — it removes less tooth, it is repairable, and it defers the irreversible choice without foreclosing it. The cost is durability, and the figures above state it honestly.

Two pieces of context. The ADA frames this work as “elective” treatment, and AHPRA's reasoning on unnecessary use is that encouraging it “can lead the public to buy or use a regulated health service they do not need and is not clinically indicated or provides no therapeutic benefit”, because “Any health intervention involves inherent risks.” And the pressure on younger patients has been recognised by advertising regulators: in the United Kingdom, restrictions in effect since 25 May 2022 prohibit cosmetic-intervention advertising directed at people under 18, including in non-broadcast media “where under 18s make up over 25% of the audience.” That is a UK rule with no standing in Australia, and we include it only because it shows a regulator elsewhere reached the view that this market needed an age boundary.

When one eventually needs replacing, can they just fit a new one?

Usually yes, and it is not quite a like-for-like swap. The ADA states the general principle without hedging: “Having a crown, bridge or veneer does not mean no treatment will ever be required again for the tooth or teeth.” What determines how easy the replacement is, is why the first one failed. The systematic review above found fracture the most common complication, followed by debonding, with both more common in the first years after cementation — an early debond on sound enamel is the best case, and a fitted replacement may be all that is needed. Composite has an advantage here, being repairable in the chair rather than remade in a laboratory.

The harder cases are the biological ones: decay at the margin, or gum recession exposing the join. There the tooth beneath has changed, so more may have to be removed, and a veneer can become a crown. One honest limit: we have not found a published figure for how much additional tooth structure a replacement typically costs, so treat that as a question for the practitioner who will do it rather than something anyone can quote you. Ask what a remake costs, and what the plan is if the tooth underneath is no longer suitable for a veneer.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

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