Putting a price on a smile

The advertising of dental services divided dentists in a survey in Australia. PHOTO: GETTY IMAGES
The advertising of dental services divided dentists in a survey in Australia. PHOTO: GETTY IMAGES
Until around the 1980s, professionals like lawyers, doctors and dentists didn’t advertise their services. Advertising was considered brash and vulgar and was against the rules of many professions.

Only dignified, simple notices about where to find practitioners and the services they offered were acceptable.

In the 1980s in New Zealand and elsewhere, professional organisations’ rules against advertising came to be considered anti-competitive. Now if you google Dentist in Dunedin you get a page of claims to provide quality, caring, safe, high-tech, personal, relaxing care.

Independent dentists and dental chains compete by showing pictures of happy people with great teeth. Murray Thomson from the University of Otago and his colleagues Alex Holden and Lee Adams investigated what Australian dentists think of this commercialism in dental practice.

They interviewed 20 dentists in private practice, including those who owned practices and those who didn’t. Some of the dentists then kept a diary of their thoughts about commercialisation, and some had a second interview about a month later.

Many of the dentists in the study felt dentistry was devalued by commercialism. They felt dentistry should be a high-status occupation like medicine. Apparently in Australia there are many “$99 dentists” who do standard treatments for $99. The dentists in the study felt that advertising, especially on price, reduced the prestige of the profession and was “a bit crass”. They assumed cheap services must not be good quality.

The study participants were concerned about dentistry being seen as a provider of products rather services, with this being less prestigious. This reflect traditional British views about trade: Jane Austen fans will remember the Bingley sister’s disdain for Elizabeth Bennet’s uncle who was ‘‘in trade’’. The dentists worried about dentistry being “sold as a supermarket item”. Some worried that dentistry was being seen as primarily an optional cosmetic service to produce a great smile, rather than an essential health service treating oral disease.

Some of the dentists felt commercialism had benefits for patients, made them more empowered to make their own decisions, and ensured high quality treatment because dentists need to keep their patients happy. However the authors were concerned about ‘‘over-treatment’’, that is, advertising creating demand for unnecessary services. They point out that if commercialised practices such as over-selling are the norm, patients would be unlikely to complain about them.

The research seems to describe dentistry at a cross-roads. Is it a commercial endeavour, increasingly organised in corporate chains, providing services to people with mostly healthy teeth who want to have great smiles? Some of the dentists in the study expressed some discomfort about this future.

Or is dentistry a profession which provides healthcare to people who need it? The oral health of many New Zealanders, especially Maori, Pacific and low-income New Zealanders, is shockingly bad, with many people having no functional teeth at all, and people regularly ending up in intensive care from infections from untreated teeth. If this is to be addressed, it seems like to require a different funding model, and a different focus to dentists’ efforts.

- Pauline Norris is a research professor at the Centre for Pacific Health, Va’a O Tautai, and CHeST: the Centre for Health Systems and Technology, in the University of Otago Division of Health Sciences.


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