The May issue of The Atlantic included an article about dentistry. The author Ferris Jabr discussed “the truth” about the profession, that “it’s much less scientific — and more prone to gratuitous procedures — than you may think,” as the headline of the online version of the article stated. He provided examples where dentists over-treated patients, honing in on one extreme case, and the article exuded a message that there is no standard of care with which we practice as a profession. While various elements of this article caused an uproar in the dental community, it shows one picture of how the public may view dentistry. As dental professionals, this is an issue we should diligently address.
The article touched on multiple points around science in dentistry, practitioner accountability, ethics and values. The author also discussed a lack of evidence-based dentistry practice.
As a dental student, I have been instructed in methodology backed by research. My dental curriculum requires that we take a class called “Evidence-Based Dentistry” in order to matriculate with our DDS degree. I see clear ways our profession strives to use evidence-based practices. It is true, though, that more research can always be done, specifically in the case of dentistry.
The combination of rapid advancements in scientific knowledge, the slow growth of the body of dental researchers, and the uneven distribution of research funds and involvement in research by dental schools are hurdles to overcome in the practice of evidence-based dentistry. Despite these challenges, however, members of the dental profession are working daily to keep up with new technologies and improve the body of dental knowledge.
In this constant pursuit of knowledge, we also must hold ourselves accountable for our mistakes. The ASDA Code of Ethics states that “ethical and professional behavior by dental students is characterized by honesty, fairness and integrity in all professional circumstances.” This includes owning up to any professional errors. It also states that “students should conduct a thorough discussion with every patient” and “treatment plans should be determined according to patient needs as opposed to unmet requirements of the student.”
In order to develop strong relationships with our patients, we should provide all of their options for dental treatment. Jabr points out that many patients simply expect to accept the dentist’s opinion of the treatment plan without question. This directly conflicts with the ASDA Code as well as the ADA Code of Ethics, which states, “The dentist should inform the patient of the proposed treatment, and any reasonable alternatives, in a manner that allows the patient to become involved in treatment decisions.” As practitioners, we should ensure that we routinely present all available options for treatment to our patients and encourage their input.
Presenting the pros and cons of different treatment options can be a difficult skill to learn as a new student in dental school. A patient may be able to fix their tooth in the short-term with a composite filling. However, a crown might provide a better result in terms of esthetics and longevity. Helping a patient determine the treatment they prefer involves a complex discussion of the patient’s values, oral health goals and their finances. Despite the time constraints imposed on practicing dentists, it is integral to take the time to have this discussion.
There is a lot of wisdom to be gained from the lessons of the past. Our profession should turn to the future and use past problems like those that Jabr describes as learning experiences to ensure mistakes are not repeated. While insurance audits and state dental boards can keep dentists in check from malpractice, cooperation from the entire dental community is required if we are to be a self-regulated profession. Be accountable for over-treatment, and take the time to accurately educate your patients on their treatment options.
~Isabel Pennings, Creighton ’20, ASDA Contributing Editor