Cosmetic dentistry remains popular and unregulated.

Dentists feel your pain.

They know the psychological effects caused by the hideous whine of a drill sandblasting tooth enamel and can sympathize with the

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nauseating taste of bubblegum fluoride.

But Bonnie Rae DeBilzan can probably relate to

such discomfort better than most. Except it isn't a dentist's office giving her a sense of foreboding these days. It's a courthouse.

The former Santa Fe dentist was scheduled to appear April 7 in District Court for a hearing on a personal injury lawsuit filed by two former patients. The postponed hearing caused another lull in a case that has seen six judges and nearly three years pass. Despite the delays, lawyer Greg Chase-who represents plaintiffs Keitha Leonard and John Geldersma-says the "case is very close to being ready to go to trial."

Chase also represents former DeBilzan patients in two other pending lawsuits, part of a wave of litigation filed against DeBilzan (whose lawyers EW Shepherd and Nicole Charlebois did not respond to interview requests) for allegedly performing inadequate (and costly) cosmetic dental work [Cover story, April 28, 2004: "Licensed to Drill

"

].

Nearly three years have passed since DeBilzan, who could not be reached for comment, became ensnared in a web of bankruptcy proceedings and lawsuits. During that time, little has changed about how the New Mexico Dental Board regulates cosmetic dentistry.

The New Mexico Regulation and Licensing Department, which oversees the state Dental Board, issues general practice and specialty practice dental licenses. But a gray area exists that allows general practitioners to conduct specialized procedures-like the "full-mouth reconstruction" at the core of the DeBilzan lawsuits-without additional certification.

That's because such procedures are considered cosmetic dentistry, which utilizes procedures from specialized fields, but isn't considered a specialty.

"Legally you don't need any additional training," says Robert Hall, executive director of the American Academy of Cosmetic Dentistry (AACD). "There is no legal standard that says you have to do X, Y and Z in order to do cosmetic dentistry."

New Mexico requires general practice dentists to take 60 hours of continuing education credits every three years. That requirement-and the increasing popularity of cosmetic dentistry-has allowed for the emergence of training centers like the Pankey Institute in Florida and the Las Vegas Institute (LVI) in Nevada. More than 20 New Mexico dentists (including four in Santa Fe) are listed as LVI alumni.

Dr. Richard Parker-who operates the Dental Design Studio in Santa Fe-has taken at least 12 LVI courses, which he says translates into more than 200 continuing education credit hours a year.

"Essentially anybody can call themselves a cosmetic dentist," Parker says. "That's where people get into trouble because they don't necessarily have the training to do those procedures."

LVI has a solid reputation within the dental community for its "hands-on" approach, but it isn't without controversy. Business courses such as "Achieving Extreme Success" and "Creating a Niche Practice" have caused some consternation in the dental community.

"What happens is that you have well-intentioned, good general practitioners who are taking on projects because they're being told by salespeople that there's money to be made," says Dr. Paul Balderamos, a Santa Fe prosthodontist. Then again, training at institutions like LVI is better than no training at all.

"I think it's helped dentistry because the work that is being done is being done better," says Dr. Phillip Cook, an Albuquerque prosthodontist who served as a consultant to the state Dental Board in reviewing DeBilzan's case work.

Marty Zase, president-elect of the AACD, says the key to success lies in the personal responsibility of an individual dentist.

"If people took a three-day course and suddenly set themselves up to be experts it would be wrong," Zase says. "But that's not the norm. What's routinely happening is that people are taking courses, getting better and providing better services for their patients."

Hall says the best safeguard a patient can have is to do their homework.

"A full-mouth reconstruction can cost you more than a very nice car," he says. "You wouldn't just walk onto the lot and pick the first one. You'd want to know what the car's performance was, what Consumer Reports said about it and so forth."

And when there are concerns, Cook says, "patients have to be more vocal" about them.

"There are many, many good general practitioners in this state who can do advanced work in an excellent way," Cook says. "Unfortunately, there have been a few that have kind of given us a black eye because of their lack of training or lack of thoroughness. The good thing is there's very few of them."

Parker, however, believes the problem may be more widespread. "I know of several clients here in Santa Fe where similar kinds of things happened, they just didn't get the exposure that [DeBilzan's] clients did," he says.

DeBilzan, who holds a California dental license, has applied to take the Florida dental exam. On Feb. 10, she appeared before the Florida Board of Dentistry; her application was then approved on a 6-4 vote.