My History of Aesthetic and Cosmetic Dentistry

Dr. Ross Nash

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I graduated from North Carolina State University in 1970 with a Bachelor of Science degree in textile technology and went to work for DuPont in a nylon yarn manufacturing plant in Martinsville, Va, as a process engineer. Nylon is a polymer, much like the ones we use in dentistry. In this job I was able to learn a lot about how polymers (plastics) work. In 1972, I accepted a job with Ciba Geigy Chemical Company in Charlotte, NC, where my family lived. I was hired as a dye colorist, or chemist, in the textile fiber dye division. It was my job to develop dye formulations for the customer to achieve specific colors on textile fabrics with Ciba Geigy’s dyes. In this job, I learned a lot about color (hue, value, chroma, etc). I believe the knowledge I gained in both of these jobs helped me later when I became a dentist.

I was introduced to many dentists and found that I had some traits in common with them. They were technical, like me, but they were also involved in what I call a “helping profession” and were able to directly improve the lives of others through their work. These things attracted me, so I applied to dental school and was lucky enough to be accepted at the University of North Carolina School of Dentistry. In 1974, at the age of 27, I entered dental school and graduated with a DDS degree in 1978.

In just a few short years, I grew a busy practice in Charlotte. I was providing preventive services, placing amalgam restorations, performing crown and bridge procedures, delivering dentures, and providing many other services in a normal general practice. I was enjoying my career.

But something happened at that time that changed the face of dentistry and changed me personally. Light-cured composite resins came on the scene. In these early days of my practice, the new light-cured composites changed everything. The materials could be hardened on command rather than having to wait for the chemical cure. Manufacturers developed dentin, enamel, and incisal shades that would allow layering to create aesthetic restorations that mimicked the actual appearance of natural teeth, rather than just tooth-colored fillings as before. We eventually discovered that we could, indeed, bond to dentin, as well as enamel. Posterior composites strong enough for occlusal function were produced. We found that we could use composite resin to cover the entire facial surface of the teeth, and direct composite resin veneers came into use.

My previous background in resins and colors helped me realize the huge potential with these materials, and I wanted to learn all I could about them. The only way to learn about them at that time was to attend seminars provided mostly by manufacturers who wanted dentists to know about their new products. A few dental schools were providing courses on these innovative materials. I traveled wherever I could to attend seminars on these subjects. I studied and learned from many of the pioneers in this field of dentistry who were using these materials before they were in common use. It was my desire to know what materials I could use to provide our patients with the health and function that we are responsible for as doctors and the aesthetics they were looking for.

Dr. Ross Nash’s first practice in Charlotte, NC, in 1980. Nash in 1980.
Nash’s second location in Charlotte in 1988. Nash with Dr. Larry Rosenthal and Dr. Arun Nayer.
Nash with Dr. Karl Leinfelder. Nash with Bob Ibsen, founder of DenMat.

We found that we could etch the internal surfaces of ceramic restorations and bond them to teeth with composite resins, and our choices expanded further. Pressed and milled ceramic materials gave us enough strength for function. Aesthetic inlays, onlays, and crowns for posterior teeth entered our routine treatment plans. Anterior aesthetics that challenged one to determine which teeth were natural or restored became common. Thin veneers with no need for aggressive tooth reduction gave our patients options for elective cosmetic treatment.

Zirconia oxide, a ceramic whose strength is equivalent to many metals, gave us the opportunity to replace metal foundations for crowns and fixed bridges with a material that does not alter the aesthetic value of the layering porcelain. Requests from dentists to dental ceramists for porcelain fused to zirconia oxide are common today. Full-contour zirconia oxide crowns with no surface layering allow for the use of this high-strength material on functional surfaces.

It seems each year brings us new and better materials and procedures to enhance our dental treatments. Assisted direct composite resin veneers using premade facings have given more dentists the ability to create direct veneers with predictable results. CAD/CAM technology is providing same-day services for many restorations. Diode lasers have become affordable for every dentist, and tissue treatment can be performed predictably and easily. Hard-tissue lasers allow expanded procedures that include bone and tooth structure removal. Minor tooth movement with removable appliances can be accomplished quickly to enhance aesthetic or cosmetic treatment and allow for more conservative tooth preparation. And the list goes on.

Over the years, I built a general practice that is focused on aesthetic and cosmetic treatment, and I plan to spend the rest of my career in this exciting field. The rewards I receive go far beyond money. When I am able to help a patient with health and function, I feel rewarded as a doctor. But when I can help them with their self-esteem as well, I am rewarded as an artist. Today, we have excellent composite resins and high-strength ceramics that can be used in almost any restorative or elective cosmetic process.

In the early 1980s, I began lecturing, publishing, and consulting with manufacturers of these innovative new dental materials and procedures. In the late 1980s, I built a large operatory for live-patient demonstration programs and a conference room for small seminars in my office in Charlotte.

In 1990, I met Debra Englehardt when I was attending the ADA annual meeting in Seattle. She was presenting on the program and a host for another speaker. Debra was a dental practice business consultant and owned a company called Debra Englehardt and Associates. After graduating from college with a Bachelor of Arts in theater arts education, she took a job as a dental assistant. She became an office manager and then a practice consultant. She opened her own consulting business in 1985.

We fell in love and were married in 1995. After she moved from Seattle to Charlotte, I asked Debra to manage my practice. In the first year, she helped me computerize my practice, improved my systems, and doubled my net income. In the second year, we built a new office with 6 operatories and a lecture hall for seminars. Together, we created the Nash Institute for Dental Learning, where we provided seminars for dentists and team members. I focused on clinical courses for direct, indirect, and full-mouth aesthetic and cosmetic dentistry. Debra added the practice management courses for these types of dentistry.

The Nash Institute expanded in 2005. We moved to a larger facility with more teaching space and began offering courses for a larger number of participants. In 2007, we opened a general practice in Huntersville, NC, a suburb of Charlotte. In 2010, we closed the larger facility and relocated the Nash Institute to our office in Huntersville. Today, we have a beautiful lecture and teaching hall, along with 6 operatories for the dental practice and hands-on courses.

At 72, I have no plans to retire, and I intend to continue in this rewarding field for the rest of my life. I want to continue to share with my colleagues and learn from others in the profession.
Interview by Ed Matthews of SB Logic.

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