Sir, Dr Kelleher is right to be concerned about over-prescription of veneering techniques.1 Over-prescription of any treatment modality is inappropriate. Criminal damage is criminal damage and should be dealt with accordingly. He is also right to emphasise the potential for composite resin based solutions for anterior teeth aesthetic issues.

Dr Kelleher is, however, wrong, and in a sense abusing privilege himself, to continue to polarise discussion by over-demonising veneer provision. Ceramics are generally more aesthetic and longer lasting than composite resins. There is a much more interesting discussion to have about ceramic veneers than just condemning them. How well can they be done? How long can they last and what are the factors that contribute to this?2 I have placed and otherwise observed veneers that have lasted 15 years and more and then some do not last nearly so long. I do see them gradually develop stress fractures, sometimes mimicking abfraction and stress breakdown in natural tooth tissue. If appropriately provided they work well, rarely displace and the levels of patient satisfaction can be very high.

For example I placed a veneer on my daughter's UL2 eight years ago. She is very happy with it and she is aware that it is a 'repeat prescription' treatment. I suspect it will last at least another ten years.

If Dr Kelleher is really so concerned about enamel 'hacking' he could be much more concerned at the catastrophic iatrogenic damage done to inter-proximal surfaces of adjacent teeth during routine dental treatments. Dentists are very poor at preparing inter-proximal cavities for restoration without damaging the adjacent tooth. Some research3 suggests that this occurs in up to 70% of inter-proximal preparations. There seems to be a conspiracy not to acknowledge this. At least with inappropriate veneering the culprit can be identified. With inter-proximal enamel damage it can take several years for caries to develop within the un-cleansable iatrogenic cavitation and is very unlikely to be associated with the dentistry that caused it.

Opinion posturing and position taking is important for the profession to discuss and understand itself and its impact, but it should be relevant and proportionate. I suggest that elective enamel preparation in veneer preparation is the tip of the iceberg in the damage that operative dentistry really causes. The easy target of elective criminal 'bad' cosmetic surgery detracts from serious discussion about the total damage that is caused by the honest intention of 'good' routine dentistry.