JACD 71-4 - American College of Dentists

offices are now offering the ultimate
cosmetic makeover service of permanent
makeup tattooing. There are even dentists
who offer botox injections, justified as
dental treatment, because, and here
I am quoting from the advertisement,
“They reduce the muscle tension that
contributes to oral pain and damage with
the main side effect that you can lose
some of your wrinkles and refresh
your aging smile.” Now isn’t that clever
commercial marketing?
And, I can hear you thinking again,
“So what? Who cares if whiter, brighter
teeth is dentistry’s ubiquitous public
message today? At least it brings patients
into our offices. How is this message
demeaning to the profession of dentistry?”
Because it is a solely commercial
message. It is not a health care service
message. It is a cosmetic business service
message. And again you answer: “So
what? So is plastic surgery.” Well, tooth
whitening isn’t surgical unless it involves
veneers. When it is tooth bleaching and
the spa experience, it is directly analogous
to hair bleaching and cosmetics. It
is not surgery; it is cosmetology—plain
and simple.
Parenthetically, we are not even
sure of the long-term effects that tooth
whitening might have on the oral health
of our cosmetology clients. Do we know
what effect the bleach and heat used to
whiten teeth will have on pulpal tissues?
No. But many of us seem only too eager
to offer tooth bleaching as a commercial
dental service.
And what of the public’s attitude
toward dentists? How do they see a profession
that offers them cosmetology as
its most visible public service? Does the
general public embrace the notion that
oral health is part of their overall health,
and that you cannot be healthy without
a healthy mouth? Sadly, I think not.
Ever since the profession of dentistry
stood by while dental care for seniors
was omitted from Medicare, we have
Journal of the American College of Dentists
Today the loudest
message being
received by North
American society is
that dentistry is an
elective cosmetics
service which can
help you look younger
and sexier.
fought an uphill battle to convince
government, health insurers, and the
public that oral health is an essential
component of overall systemic health.
I think that we have been making
significant progress in this uphill battle,
most notably with the Surgeon General’s
Report on Oral Health and the resultant
National Oral Health Plan. But today the
loudest message being received by North
American society is that dentistry is an
elective cosmetics service which can
help you look younger and sexier.
There is no message about oral health
as a vital component of overall health
in the “bright smile and white teeth”
advertising campaign.
And again you are asking yourself,
“So what? This is the platinum age of
dentistry. Dentists’ incomes have never
been higher. Things have never been so
good for the dental profession! Why is
Graham complaining about cosmetic
dentistry? So what if the public sees us
as cosmetologists?”
Let me try to explain what is bothering
me. Put simply, our existence as a
profession of dentistry is dependent, in
the final analysis, on what the public
thinks of us. The public—that is, society—
affords us the privilege of being a
profession on the basis of its trust that
dentists put the oral health care needs
2004 ACD Annual Meeting
of our patients ahead of our own desires
to make money. Because of society’s
trust in us, we have the privilege of
educating dentists, licensing dentists,
and disciplining dentists, all with virtually
no societal—that is, no governmental—
oversight. We are, perhaps, the last real
true profession in North America.
But I believe that this privileged
status is in dire jeopardy. I believe that
we are in danger of convincing society
that we no longer deserve professional
status, because we have crossed over the
line between oral health professional
and dental businessperson, crossed
over that line to become full-fledged
businessmen and women, as dental
cosmetologists.
As an example of the way the
commercialization of dentistry could
cause its “de-professionalization,” we
need only reflect on the precipitous fall
of the pharmacist from professional
status. Until the 1960s, the pharmacist
was our society’s respected corner
druggist, trusted to give the public sage
advice about prescription and over-thecounter
medicines. Then, with the
corporatization of the corner drug store
into chain mega-stores filled with more
groceries and household goods than
medications, the pharmacist/druggist
was downgraded in society’s regard to a
slightly gentrified convenience store
owner. It is only during the past decade,
with the dual strategies of the pharmacy
doctorate degree and the strong
marketing by the drugstore chains of
the pharmacist as a newly minted
“medication counselor” that we have
begun to see even a modicum of professional
status returning to the pharmacist.
Could this happen to dentistry?
Could we miss our chance to apply
molecular medicine, tissue engineering,
and computer-assisted decision making
to the care of our future patients, sinking,
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