Perception or Reality?

For many years, leadership in the dental profession has taken great pride whenever results of public opinion surveys have shown dentistry to receive high marks in public esteem. For example, a review of our files confirms that a poll conducted in the late 1980s by the Gallup Organization rated dentistry as the second most highly respected profession in America. That report, which was utilized by the Select Program of the American Dental Association and the American Association of Dental Schools to attract highly qualified individuals to careers in dentistry, noted that dentists were rated higher in terms of honesty and ethical standards than physicians, clergy, or lawyers.

If one can place any validity in opinion polls, the times have been changing. In 1998, when the same poll was conducted covering 25 professions, Dentistry ranked fourth. Given that it is an "opinion" poll, a drop of two places over 10 years is probably not significant. Considering that dentistry had been ranked higher than the clergy and physicians a decade ago, what might have been most significant about the 1998 poll is that clergy (second) and physicians (third) now ranked ahead of dentists.

However, the 1999 poll is the one that gives us the most disturbing reason to reflect on our public image. Twenty occupations not previously listed in this poll were included to bring the number of professions in this ranking to 45. In this ranking, dentistry dropped to ninth. Physicians and clergy also lost some ground, but only to fourth and sixth, respectively. In this poll, nurses, veterinarians, and teachers, which were among the newly added professions, placed above dentistry. Even taking that into consideration, dentistry has lost four places since the 1980s. It seemed ironic to see that police, despite scandals in New York and Los Angeles, were still one notch above dentists at eighth. Perhaps that ranking will decline in the next poll!

Background information on this poll, both past and present, indicates that image is based upon honesty and ethical standards. Organized dentistry has always placed great importance on its Code of Ethics. Many of our colleagues over time, by word and deed, have demonstrated their support of our professional standards, encouraging others to follow their lead. However, the results of these most recent Gallup polls are certainly no surprise to many colleagues, some of whom have sometimes complained bitterly that dentistry has been experiencing a decline in adherence to professional ethical standards.

This latest Gallup poll does raise the question as to whether it is a valid monitor of a downward trend in the adherence to professional ethics by dentists in the past decade. Is public opinion too heavily influenced by the emotions of media events to be reliable, leading to the perception that dentists as a professional group are less ethical than in reality they are? For example, is public opinion swayed more by emotional television reports tending to be critical of dentistry on topics such as waterlines (the dentists’ "Dirty Little Secret"), the amalgam controversy, and deaths of children under sedation or anesthesia? It does need to be said that on the positive side, dentistry has done a great deal to continue to earn public trust through activities such as prevention and infection control practices. However, an observation here is that the perception of dentistry’s image is probably more easily shaped by negative emotional issues than by positive professional efforts.

We have had discussions with many dentists and nondentists regarding honesty and ethics in society at large. There seems to be general agreement that there was a negative trend in the past decade. Has a decline in dental ethics been any more significant than, or merely reflective of, a decline in ethical behavior society? We don’t have the answer to that question, although our belief is that changes in dentistry only mirror those in society at large.

Finally, let’s consider two trends in dental practice that help to shape the attitudes that patients develop about dental health professionals. If we fail to properly educate patients about their dental benefits, do some individuals lose trust or believe that we have done something wrong if their plan denies or reduces benefit payments? And, what about the significant marketing of cosmetic dentistry? We have seen opinion pieces by nondentists who have expressed the attitude that the aggressive marketing of cosmetic dentistry is nothing more than a vehicle for economic greed by some practitioners.

These trends, coupled with the exposure to negative "dental issues" in the media, may help to explain why dentistry’s public image has appeared to fall in the last decade. It seems that all of these influences together have reduced the public’s perception of dentistry’s public image. And, perception becomes reality.

Public opinion polls such as those conducted by the Gallup Organization may not have great value or validity. Their importance or the scientific process used to develop them could be questioned. But for a profession that has traditionally taken pride in its ethical standards, the 1999 Gallup poll, without question should, as a minimum, serve as an important wake up call.