Wanted: An Improved Public Message

During the last decade of the 20th century, dentistry often was cited in the upper tier of image polls conducted by groups such as the Gallup Organization. Dentistry fairly regularly was listed in the top 10, and often in the top five, of the "most trusted professions."

We have not seen the results of such a poll recently, but wonder if the profession would still find itself in the lofty positions described if a new poll was taken today. We do have concern that activities both inside and outside of the profession have been damaging the image that the profession enjoyed a few years back.

It may be that dentistry’s image has not suffered any more than that of other occupations and professions in this era of increased public scrutiny. The presence of the media during times of legislative, regulatory, or even legal scrutiny can raise the public’s awareness of the slightest misstep or question centering on an individual or the profession. However, with mid-year 2002 upon us, we believe that dentistry could benefit from an improved message to the public over the one that has been building over the past year. A continuation of some of the bad press that the profession has been experiencing of late dulls the positive image that is so important to a health care professional. Let’s examine our concern, reviewing a few of the danger signals in no particular order.

The organized profession has been extremely careful to avoid word and action that suggests self-interest on behalf of the profession. Service to the public has always been placed in front of any language or activity that suggests that it is self-serving to the interest of dentists. The lawsuits against CDA and ADA in the past 18 months, while not directly suggesting dentistry’s conduct is self-serving, nonetheless convey that spirit to the public. For example, language in lawsuits filed against the associations in regard to alleged amalgam toxicity accuse dentistry of fraud, apparently because of the profession’s long-standing defense of the safety of amalgam. There is an implication that dentistry’s defense of amalgam has been based upon economic self-interest, with the consequences of harm to the health of the public. These "public charges" in legal actions against the profession, while lacking science to support the claims, leave an unsuspecting public (and the media) to assume that, yes, the profession is defending the continued use of the material for economic gain.

While many members of the dental profession will recognize the "deep pockets" legal strategy being employed by the plaintiff legal counsel, we suspect the average member of the public may more readily be influenced by the emotional charge of "fraud" against dentistry. However, these legal assaults perpetrated from outside the profession are not the circumstances that concern us the most. They may be lengthy and costly; but, ultimately, science will be an important ally of the profession in the resolution of these challenges. The publicity generated contributes to the severity of the negativism of the messages being conveyed about the profession these days.

While the profession faces these legal accusations, there continue to be suspicions within the profession that some dentists who actively promote replacement of amalgam restorations do so for economic, rather than for the health-based or patient-requested cosmetic reasons often advanced as the rationale by these practitioners. On the global issue of amalgam, any way we analyze it, the profession faces an image problem based upon the notion sold to the public that economics too often is a more important consideration than the oral health care needs of the patient.

Despite the high level of notoriety surrounding the amalgam/mercury issue, the most serious messages leveled against dentists may be those seen in the print media aimed at what we shall refer to as the treatment-planning practices of some individuals in our profession. Recent media stories remind us of the article carried in Reader’s Digest in February 1997 that created quite a stir inside and outside the profession. These reports always have one thing in common: stories of unhappy patients who were offered expensive treatment plans that seemed to lack standardization of treatment philosophy from office to office. They conclude that many dentists present treatment plans that recommend excessive and unnecessary replacement of crowns and other restorations, overly promote cosmetic dentistry, and lack guidelines for their decisions, scientific or otherwise, that patients can understand.

There appear to be two results of these public airings. First, the question as to the honesty of many of our colleagues is raised. Second, many of the media investigators have knowledge that the incidence of caries has been on the decline and that we are in a period where there are fewer new dentists graduating and engaging in practice. Therefore, they conclude that practitioners can more readily mask their economic self-interests in establishing fees and treatment-plan philosophy during a period of high demand for their services.

Journalist Chris Pummer recently circulated a particularly damaging report to the image of dentistry on CBS.MarketWatch.com. His report was titled, "A Profession in Decay -- Dentists’ Business Practices Increasingly Suspect." He bases much of his report and his conclusions on personal experiences he had in interacting with members of the dental community. We will not attempt to evaluate or analyze his findings or his conclusions beyond stating that if his experiences are valid as presented, they portray a very negative image of dentistry. His remarks about dentists are at times scathing and will make ethical practitioners cringe at his characterizations of our profession and some of our colleagues.

The real wake-up call for our profession is best articulated by a few passages from his article. First, the author indicates that a consumer trying to determine if they’ve found a good dentist faces the complication that dentistry "lacks recognized standards of care." While we know that professional standards of care exist, Pummer passionately believes that standards do not exist. Or, he could be conveying a message that he and the consumer population have not been properly educated as to what they might be. He continues: "In other words, one dentist may suggest treating tooth decay with a new less-invasive technique called remineralization, another might recommend a deep filling, a third might suggest a crown and a fourth might say supportive bridgework also is in order -- and all four would have defensible positions in the eyes of the profession."

In making the latter statement, he does demonstrate that he possesses a decent level of education about the possible options for treatment -- a level of education that will probably help him convince other dental consumers that he just might be a well-informed critic about the dental profession.

Considered together, these concerns suggest to this observer that the profession, and particularly those of us who practice general dentistry, will need to spend more time in the future on patient education. Patients must be provided a better explanation of their options than many are apparently receiving. Due to the many variables that drive the management of time in the contemporary practice, many patients receive neither the education nor the opportunity to consider their options of treatment. They turn to what has become the accepted source for health care information for many people -- the media. Until the profession can reverse the public’s dependence on media-generated information by improving the level of patient education in our offices, the image of the profession will remain at a level that is less than optimal.

If our goal is to achieve an improved public message, improved patient educational efforts in the dental office that validate our commitment to good oral health will serve as the most important ingredient.