By Harvey N. Silverman, DMD, FASDA, FABAD
INTRODUCTION
Dental hygienists play a critical role in patient education, motivation, and long-term oral health outcomes. Yet despite their central position in patient communication, hygienists are often underutilized when it comes to educating patients about modern advances in elective cosmetic dentistry.
Recent developments in noninvasive aesthetic technologies now provide hygienists with an opportunity to become more effective clinical educators and facilitators of care—without increasing appointment length or introducing sales pressure into the hygiene visit.
This article outlines a concise, step-by-step protocol designed to integrate the EasySmile System into routine hygiene appointments. When properly implemented, this approach requires minimal chair time, enhances patient understanding of conservative cosmetic options, and creates a predictable, ethical profit center for the dental practice. With as little as 15 minutes of additional clinical time per day, practices can significantly increase net revenue while making cosmetic dentistry more accessible to a broader patient population. In clinical training programs conducted by the author, dentists and hygienists consistently report increased patient interest and acceptance when this step-by-step protocol is utilized.
THE PROTOCOL
1. Review the Dental History Update Form
Begin by reviewing the EasySmile Dental History Update Form with the patient. Highlight areas of aesthetic concern indicated by the patient using a yellow marker.
For a complimentary copy of this form, contact the author at [email protected]. This form was developed to identify cosmetic dental needs more effectively than conventional smile analysis forms while patients update their medical and dental histories. It serves as a professional communication tool that facilitates essential dialogue between the patient, hygienist, and dentist during the co-diagnostic process. It also removes any sense of marketing or sales often associated with conventional smile analysis forms.
2. Visual Confirmation With the Patient
Provide the patient with a mirror and ask them to point to the specific tooth or teeth referenced on the form. Clinicians should avoid assumptions regarding patient priorities; experience shows that patients often identify concerns that differ from practitioner expectations. This step provides critical information necessary for effective co-diagnosis.
3. Educate the Patient on New Options
Inform the patient that recent advances in dental technology—such as the EasySmile System—may offer a solution to their concerns. Emphasize the benefits of noninvasive cosmetic dentistry, particularly the preservation of natural tooth structure.
4. Determine Candidacy Using a Smile Preview Veneer
Candidacy can typically be determined in fewer than 5 minutes of chair time by creating a Smile Preview Veneer. Patients should be clearly informed that this preview is fully reversible to avoid any misunderstanding that it represents a permanent restoration. Where legally permissible, the dental hygienist may perform the following procedure:
STEP-BY-STEP PROCEDURE
A. Tooth Preparation
Ask the patient to observe with a mirror as a thin layer of separating agent is applied and allowed to dry. No bonding agent is applied. This step is critical, particularly in the presence of existing composite restorations, to prevent inadvertent bonding of the Smile Preview Veneer to any existing restorations.
B. Application of RBFM
Using the pinky finger (rather than the index finger or thumb), apply and adapt the appropriate shade of Resin-Based Foundation Material (RBFM) to the unetched tooth. Contact the author at [email protected] for feedback on whether your composite of choice qualifies as an RBFM suitable for this approach.
Clinical Tip: In most cases, previewing a single tooth is sufficient to demonstrate aesthetic potential, alleviate patient anxiety, save chair time, and provide a highly educational experience.
C. Incisal Third Adaptation
Gently adapt the RBFM to the incisal third of the tooth, maintaining minimal material on the incisal edge while removing any excess that flows onto lingual or interproximal surfaces. If any RBFM is left on the lingual you will create a labial-lingual lock and the Smile Preview Veneer will fracture when you are ready to remove it. This is a critical consideration.
D. Middle Third Adaptation
Using only the pinky finger, adapt the RBFM to the middle third of the tooth.
E. Gingival Third Adaptation
Finally, adapt the RBFM to the gingival third. Working in thirds as described improves adaptation and minimizes finishing and polishing requirements.
F. Contouring and Curing
Use a thin bladed plastic instrument to create interproximal line angles and to remove any excess bulk of RBFM at the gingiva. Unlike conventional composites that pull away from the tooth or stick to your plastic instrument, your EasySmile LifeLike Veneer RBFM should not.
Select the RBFM carefully; inappropriate material selection may significantly increase chair time and frustration. Contact this author if you would like feedback on whether your RBFM is appropriate for use with the EasySmile System.
Once a seamless gingival emergence profile is achieved, cure the Smile Preview Veneer.
G. Patient Evaluation
Have the patient evaluate the aesthetic result holding a mirror without the overhead light on as well as looking with a mirror in natural light, which is highly recommended and extremely helpful for patient evaluation purposes.
H. Patient Satisfaction Score
Ask the patient to rate their satisfaction on a scale from 1 to 10, with 10 representing the highest level of satisfaction.
I. Interpretation of Scores
A score of 8 or higher indicates that patient expectations have been met and that the patient is a candidate for the EasySmile LifeLike Veneer you just created.
J. Refinement When Needed
If the score is 7 or lower, identify necessary modifications. Additional RBFM may be added, or the preview veneer may be removed using a dental scaler and recreated. Removal is easy and atraumatic.
K. Contact Verification
Before removal, use dental floss to ensure contacts are not inadvertently splinted. If necessary, a thin dental saw may be used; with typical veneer thickness of approximately 0.1 mm achieved with the appropriate RBFM, separation is easily achieved.
L. Removal of the Preview Veneer
Remove the Smile Preview Veneer as described above.
M. Demonstration of Veneer Properties
Show the patient how thin yet durable the Smile Preview Veneer is. This can be accomplished by holding the Smile Preview Veneer and ask the patient to flex it while you are holding it. The veneer will be strong and will not fracture. Additionally, because dentin, enamel, incisal shades, as well as tints, and opaquers are not required, veneers may be fabricated as thin as 0.1 mm.
N. Laboratory Processing Discussion
Once the patient agrees they want to proceed with work, inform them that to further enhance veneer strength you will next laboratory cure the Smile Preview Veneer (done in your office with a microwave oven). Over more than 12 years of clinical use, minimal fractures or complications have been observed, with bruxism being the primary exception—readily minimized with appropriate occlusal therapy and night guards.
ADVANTAGES
Once proficiency is achieved, a Smile Preview Veneer can be fabricated in approximately 2 minutes. Depending on the practice’s fee structure, placing a single EasySmile LifeLike Veneer per day has the potential to increase a practice’s annual net income by 6 figures, with proportional increases for additional cases.
Over 2 decades of cosmetic dentistry training programs conducted by the author, approximately 80% of patients desire changes to the size, shape, or appearance of one or more teeth. This represents a substantial, often untapped, opportunity for hygienists to educate patients regarding conservative aesthetic solutions. This is how you can easily double your elective cosmetic dentistry services without any marketing or selling involved.
By opening up a dialogue using the Dental History Form, following up with the Smile Preview Veneer you will be well on your way to taking your cosmetic dentistry practice to the next level.
Where legally permitted, dental hygienists can create a custom, micro-thin, stain-resistant, and durable veneer in fewer than 5 minutes—allowing patients to preview outcomes before committing to treatment. If the hygienist cannot do the above, this can easily be performed by the dentist or an expanded dental function assistant.
OTHER CONSIDERATIONS
- Review legal guidelines regarding team-based incentive programs before implementation.
- Always capture before-and-after photographs as part of patient education.
- Identify and address functional concerns such as bruxism and excursive interferences.
- Practice the Smile Preview Veneer technique on a team member to gain familiarity and confidence.
SUMMARY
By shifting cosmetic dentistry education upstream into the hygiene appointment, practices can ethically expand elective services while preserving a patient-centered, conservative philosophy of care. The EasySmile System provides a predictable, reversible method for visualizing aesthetic outcomes—empowering patients to make informed decisions without pressure.
With more than 12 years of documented clinical use and consistently favorable clinician and patient feedback, this system offers a practical, scalable pathway for practices seeking to increase elective cosmetic dentistry while preserving tooth structure, chair time, and professional integrity.
Disclaimer: The EasySmile System and EasySmile LifeLike Veneers were invented by the author.
ABOUT THE AUTHOR
Harvey Silverman, DMD, FASDA, FABAD, is a nationally recognized leader in the field of aesthetic dentistry. He is the inventor and patent holder of the original OTC tooth-whitening system, helped refine and develop one of the original porcelain veneers, and has lectured worldwide on aesthetic dentistry, practice simplification, and team-based cosmetic protocols. Dr. Silverman has consulted for numerous dental manufacturers, pioneered same-day extreme makeovers starting in the 1980s, performed numerous on-site cosmetic dentistry boot camp programs, created the first dental spa in an allied health and beauty setting, and developed technologies that culminated in the EasySmile System.
He is a Fellow of the American Society of Dental Aesthetics and a Diplomate of the American Board of Aesthetic Dentistry. For more information on how you can expand your cosmetic dentistry program, contact Dr. Silverman at [email protected].
[Editor’s Note: Dr. Silverman is a regular contributor to Dentistry Today and this latest article is the first in a series of 3 articles on why elective cosmetic dentistry remains underutilized. These articles are intended to function as a complementary educational series addressing a persistent challenge in everyday dentistry: why elective cosmetic dentistry remains underutilized despite strong patient interest and major advances in conservative esthetic technology. Together, these articles move from how to implement to how to think, providing Dentistry Today readers with both a practical roadmap and a conceptual framework for integrating conservative, same-day cosmetic dentistry into everyday practice.]
