On the Cusp of Scrutiny -- Again

Too often, the well-meaning, well-intentioned, responsible dental professional is placed in an uncomfortable defensive posture in the media and in his or her practice. Despite their efforts to inform their patients, provide exhaustive informed consent, utilize treatment protocols and materials that they believe are safe for patients and for management by their staff, dentists are made to look uninformed and insensitive.

Well-informed dentists know that some of their colleagues may be guilty of the shortcomings mentioned above. That is a given. What is unreasonable is that in an effort to placate consumer advocates, individuals in the public arena, who should know that the majority of dentists uphold contemporary standards of patient education, nonetheless allow themselves to be badgered into actions or words that suggest that the entire profession is guilty of the deficiencies under scrutiny and must be punished like a petulant child until all of its members are brought into line. The net result is to raise unnecessary concerns among the public about their safety when considering dental treatment.

It isn’t easy to take actions or comments to reporters about issues of public concern, particularly if an issue erupts quickly or blindsides an individual who must respond to critical questioning. That is why leadership in organized dentistry must be exposed to spokesperson training from time to time so that when under pressure they will be better able to respond to hard inquiry. Sometimes it only takes a few ill-chosen "off the cuff" words to give an eager reporter an opening that inflicts damage that takes considerable time and effort to repair.

In this observer’s opinion, general dentists as a group took a heavy hit in the press as a result of a special order of business placed before the Board of Dental Examiners in early December. A report of some of the discussions at that meeting subsequently carried in the Los Angeles Times and by the Associated Press were patently unfair to the well-educated, caring general dentists who currently do an outstanding job of providing education and informed consent to their patients.

The issue under discussion was the safety of dental amalgam, the controversy that seems to have no end. Our purpose here is not to raise amalgam as an issue for extensive discussion, but to show how an emotion-based issue backed the Board of Dental Examiners into words and action that placed dentistry in a very poor light. It is not clear exactly what revisions in the BDE Fact Sheet on Dental Materials will occur as a result of actions taken by the board or how recommendations that were incorporated in the board action will be enforced or carried out. In our review, we noted a variance between a preliminary reporting of the board actions and the press reports that immediately circulated. We will await the specifics that are distributed by the board before reaching any conclusions about the impact of the new guidelines.

However, what we object to most strenuously are two items incorporated into the press reports that stand out. The first was the following:

"But the board also voted to include in both publications (the quarterly newsletter and the revised materials fact sheet) the array of toxic chemicals used in alternative fillings -- made of porcelain, ceramics, and resin -- despite objections from the mercury-free advocates that none are as dangerous as mercury."

We are concerned that the phrase "array of toxic materials" in the dental office sends the wrong message about dentistry. The term array is defined as "an impressively large number." It is also doubtful that the Board of Dental Examiners or any other agency will be able to provide an objective scientific assessment of the relative toxicity of these materials in the near future. In that regard, we recently read a referenced article in Oral Care Report, Vol. 9, No. 3, 1999, edited by Chester Douglas, professor of oral health policy and epidemiology at the Harvard School of Dental Medicine and School of Public Health.

He concluded, "As yet, there is little comparative data on the safety of the numerous agents (dental restoratives). Hence, the World Health Organization has called for an extensive postmarket surveillance on all dental materials so that risks can be assessed and practitioners can take the relevant precautions to protect both themselves and their patients. At present, the most thorough review of existing studies, reported by the Oral Health Division of the World Health Organization, concludes that composites and glass ionomers are not superior to traditional dental amalgam in their safety. They appear to be less effective for large restorations in stress-bearing areas, though they have the obvious advantage of being tooth-colored."

The news report also stated that one dentist board member "read a list of hazardous materials used in practicing dentistry, ranging from the latex in dentists’ gloves to the triethylene in resin fillings." He went on to say, "There are quite a few. It would be good to look around our offices and see what’s there." To this we wonder, what have dentists been dealing with for quite some time with MSDS’s, OSHA guidelines, hazardous waste disposal, etc., etc.? This comment suggested that the average dentist is not well-informed about the number of dangerous materials in his or her office and has heretofore been insensitive in caring whether he or she is endangering patients or staff. We believe that even the average dentist is better informed than the critical comments suggest. Since it doesn’t directly deal with the amalgam issue under discussion, the latter statement ("It would be good to look ...") should not have been made. What is the purpose of depicting the general dental practice as a supermarket of toxic hazardous materials?

We are all for efforts to improve the quality and safety of care in the dental office. But we are against any efforts or comments subject to public scrutiny that impugn the integrity of dentists that are doing their very best to uphold accepted standards of care. It is not appropriate to appeal to the emotions of the public by appearing to question the practices of an entire profession with public statements that, at best, are irresponsible.