By David Lurye, D.D.S.
From the Spring 2016 Journal of the Colorado Dental Association
I was sharing an Uber (a first for me) on the way from my hotel to the O’Hare airport recently. I shared the car with three dentists from “back east.” They were telling me about how wonderful a presenter was at a meeting they attended, and how he did a computer mock-up showing “ideal,” Hollywood smiles for people, regardless if it fit in with their occlusion. Being inquisitive and respecting occlusion, I asked them what they do with that info. They told me that they present it to their patients to get the “emotional sell” so that the patients want the smile so badly they are willing to have whatever done to the rest of their teeth to achieve it.
A few of the prime questions that the American College of Dentists (ACD) asks on their wallet cards that ran through my mind during my Uber experience were:
- Have you presented alternatives?
- Is it in the best interest of the patient?
- Is it what you would want for yourself?
I pressed my car-mates for more info. I then asked if they would have all their teeth prepped for veneers or crowns to achieve that “Hollywood” smile. They all answered with different variations of “no.” “Troubling” doesn’t quite describe my feelings about this, but I am sure I’m not alone.
Last fall, I was proud to be part of a collaboration between interested dental students at the University of Colorado School of Dental Medicine and board members of the ACD Colorado chapter. Following this meeting, a new chapter of the Students Professionalism and Ethics Association (SPEA) was born.
The concept of SPEA (at the time of inception called the Student Professionalism and Ethics Club (SPEC)) was established in 2007, when students at the University of Southern California met with their ethics professor to discuss how they could become more proactive in promoting ethics at their school. The years 2006 and 2007 remain sad years in U.S. dental school history, when cheating scandals at two separate schools made front page news in many papers across the country. A survey done shortly thereafter, published in the Journal of Dental Education, found that a whopping 75% of students admitted to cheating on exams (August 2007, Vol. 71:8, pp. 1027-1039). Obviously, a crisis was brewing in schools, and this forward-thinking group of students had the presence of mind to help protect the reputation of not only their schools but their soon-to-be career path. The American Student Dental Association (ASDA) started working on a white paper on this topic at the time (available at www.asdanet.org), which was published in 2009.
Shortly after SPEC was formed, ASDA, ACD and the American Society of Dental Ethics passed a resolution encouraging the establishment of organizations similar to SPEC at every dental school. In 2011, with help from the ACD, a strategic plan for this group was laid out, and SPEC was officially renamed SPEA. SPEA has since then been partnered with ACD to promote ethics at the student level and beyond.
Depending on where you are in your career, you may be reading this and thinking to yourself, “so what?” “What’s this got to do with me? I’m not a student.” Fair question.
For those of you who weren’t practicing back then, or were practicing but have conveniently forgotten, there was a 1997 Reader’s Digest article about dentists’ honesty. In the article, the author visited 50 dental offices in 28 states as a “mystery shopper.” Prior to his investigation, he engaged a panel of four dentists, including his own dentist, to assess the health of his mouth and the cost of necessary treatment. All of them determined that one tooth needed a crown. The visits to 50 different offices, however, were very telling. He received recommendations for no treatment all the way to a dentist stating that he needed all teeth veneered or crowned at a cost of $30,000, which would translate to $50,000-$60,000 in today’s economy.
Gordon Christensen, in a landmark article he wrote in 2001, discussed the decline of the dentist’s credibility, noting a Gallup Poll showing their ranking among the profession had fallen below nurses, physicians and veterinarians (JADA Aug. 2001, Vol. 132:8, pp. 1163-1165). In Gallup Polls, dentists were the third most trusted professionals in 1995. We slipped to ninth in 2001 and came in as a dismal sixth in 2009. Dr. Christensen’s article cited commercialization and self-promotion, excessive treatment and fees, providing service only when it’s convenient, and refusing to accept responsibility when treatment fails prematurely.
This is nothing new. Actually, it was going on long before ACD was formed. Pierre Fauchard (1678-1761), for whom the Pierre Fauchard Academy is named, denounced quackery and fraud perpetrated by dental charlatans and their exploitation of dental patients. In 1920, the founders of the ACD were fighting back against “hucksterism” and the “snake oil salesmen” of their day.
SPEA isn’t waiting around to start practicing, but is grabbing the bull by the horns and examining ethical issues that can come up in school or in the day-to-day practice of dentistry of their soon to be colleagues and peers.
As one student at our school wrote, “I have a long history in dental hygiene, and have seen a wide range of ethical dilemmas in my career. Our SPEA chapter at the University of Colorado School of Dental Medicine will allow me to share my experiences with fellow students and continue learning professional and ethical behavior in all situations. Practicing ethically has always been a passion of mine, and meeting with like-minded professionals will be a fun and rewarding experience.”
Another wrote, “during my fourth year at CU, a faculty member and board member of ACD asked if I was interested in starting a SPEA chapter. This idea sparked my interest due to the passion I have for the profession, not just as my chosen career, but also as a means to provide care for others in need. As students, we encounter many ethical obstacles and often hear of dentists abusing their position of trust. This not only impacts the public’s perception but also personally offends me. As a soon-to-be dentist, I am privileged to provide the highest quality care possible to my patients and spread the passion I feel to my peers. I hope that SPEA will encourage other students to do the same, and foster future opportunities to continue a pursuit of high standards of quality and ethical conduct.”
It’s my hope that ACD and other professional organizations that have helped or will help this local SPEA chapter will keep the fire burning for not only practicing dentistry to high technical standards, but also maintaining the highest ethical standards, so dentistry can rise back to the top of the trust-meter with the public.
Dr. David Lurye is the chair of the American College of Dentists in Colorado.
