Medicine, Health Care and Philosophy

https://doi.org/10.1007/s11019-018-9834-1

SCIENTIFIC CONTRIBUTION

Consumer-driven and commercialised practice in dentistry: an ethical

and professional problem?
A. C. L. Holden1

© Springer Science+Business Media B.V., part of Springer Nature 2018

Abstract
The rise and persistence of a commercial model of healthcare and the potential shift towards the commodification of dental
services, provided to consumers, should provoke thought about the nature and purpose of dentistry and whether this para-
digm is cause for concern. Within this article, whether dentistry is a commodity and the legitimacy of dentistry as a busi-
ness is explored and assessed. Dentistry is perceived to be a commodity, dependent upon the context of how services are
to be provided and the interpretation of the patient–professional relationship. Commercially-focused practices threaten the
fiduciary nature of the interaction between consumer and provider. The solution to managing commercial elements within
dentistry is not through rejection of the new paradigm of the consumer of dental services, but in the rejection of competitive
practices, coercive advertising and the erosion of professional values and duty. Consumerism may bring empowerment to
those accessing dental services. However, if the patient–practitioner relationship is reduced to a mere transaction in the name
of enhanced consumer participation, this empowerment is but a myth.

Keywords  Dentistry · Consumerism · Commercialism · Ethics · Professionalism

A history embedded in the marketplace
Dentistry is a comparatively young profession. Whilst pro-
cedures on the teeth have been practiced since time imme-
morial, it is not until comparatively recently (in the last
100–120 years) that dentistry has formalised as a separate
and distinct profession to medicine. It is often assumed that
due to shared origins, many of the observations that are
made relating to the medical profession also apply to den-
tistry as well. This article will seek to question the validity of
this assumption and whether comments relating to the nature
of medical professionalism and the limits of professional
practice in the context of consumerism and commercialism
really do apply interchangeably to the dental profession.
Healthcare would seem to have always had pecuniary
driving-forces. Produced in the Assyro-Babylonian culture
in Mesopotamia circa 1700 BCE, the Code of Hammurabi
contained a fee schedule for surgical procedures. The rate
* A. C. L. Holden
alexander.holden@sydney.edu.au
1
Dental Ethics, Law and Professionalism, Faculty
of Dentistry, The University of Sydney, 2‑6 Chalmers Street,
Surry Hills, NSW 2061, Australia
of remuneration was linked to the success or failure of the
procedure; severe penalties applied to poor outcomes (Hal-
wani and Takrouri 2006). The question of the place of com-
mercial considerations in healthcare is not restricted to the
contemporary era. Plato recalls Socrates’ interaction with
Thrasymachus; “But tell me, your physician … is he a mon-
eymaker, an earner of fees or a healer of the sick?” (Plato
1997; 18). This is a question which seems to still trouble
many within society today. Within dentistry, the modern
dental professional is likely to be both. What effects does
this paradigm have for professionalism and professional eth-
ics? Does the inseparable association between the practice
of dentistry and commercial considerations create an unrec-
oncilable challenge?
Consumerism is the promotion of the rights and inter-
ests of consumers. Consumerism in the context of dental
practice is characterised by Weintraub to include the fol-
lowing; “Patients’ expectations for increased engagement
in their care and decision making, receipt of high-quality
care, esthetic outcomes, good value, and reasonable cost.”
(Weintraub 2017; 1025). Commercialism may be seen in two
different ways; firstly, as something that is in the spirit and
principles of commerce; or secondly, as being concerned
solely, or inappropriately with the maximisation of profit. In

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 A. C. L. Holden
this exploration, the tensions between dentistry as a caring
profession and dentistry as a business will be unravelled.
Assumptions of inherent values are too simplistic and fail to
consider the reality of how dentistry is provided.
Within traditional constructs of health professionalism,
the consideration of the patient to be a client or consumer
would imply the loss of the fiduciary relationship between
clinicians and those who they treat. The rise of the term
‘consumer’ to refer to an individual who is empowered, has
brought legitimacy to the use of this descriptor for those
accessing healthcare services, much the same way that the
term ‘client’ has also been adopted. When used to suggest
that someone seeking care is equal to their caregivers and
owed the right of respect and appropriate care, the terms
consumer and client are analogous the person traditionally
described as a patient. Where the common meanings of
these terms diverge due to commercial considerations, this
is where the clinician–patient relationship begins to be trans-
formed into a mere transaction, rather than one driven by
professional duty. Here, the consumer becomes less empow-
ered and the nature of dentistry as a professional endeav-
our is changed. This is contrary to some interpretations of
consumer-driven practice. Ideas that ‘the customer is always
right’ lead to those seeking care being stripped of their status
as individuals to be guided through accessing care, replacing
clinicians’ duty of self-effacement with notions of ‘buyer-
beware’. Where dentistry ceases to exist as a patient and oral
health-centred pursuit, balanced with, rather than dominated
by, business considerations; professionalism is surely at risk
of being damaged.
Richard and Daniel Susskind argue that the moral char-
acter and intention of those providing a service are of less
concern than the outcomes of services. The demand for reli-
able and effective outcomes have left character attributes
such as the effacement of self-interest to be less important
(Susskind and Susskind 2015). Therefore, dentistry provided
as a market service is unproblematic so long as the needs and
expectations of the consumer are met.
A criticism of this approach is that a disproportionate
focus upon outcomes is too narrow. The wider moral context
of those who provide a dental service and the environment
of the clinic may influence the outcomes in a way that lends
value to the norms of professional expectations. Market
norms and professional norms place different emphasis on
different values. The social contract within dentistry (Holden
2016) and healthcare places importance upon the primacy
of the principles of patient welfare, autonomy and social
justice (American Board of Internal Medicine Foundation
2005). Market norms do not value these attributes in the
same way as traditional notions of healthcare professional-
ism have. Nevertheless, there is a notable attrition of pro-
fessional norms within healthcare practice, which are being
replaced by market norms (Sandell 2012). This is highly
13
conspicuous within dentistry where commercial-focus is
increasingly common. The literature relating to the rise of
commercial forces within dentistry demonstrates that some
within the dental profession are uncomfortable with this
(Christensen 2004). The objection to the increasing reach
of markets and the erosion of professional norms derives
from the belief that certain services have intrinsic moral
value that is corrupted when treated in a commercial fashion.
Whether dentistry falls into the category of a service which
is morally corrupted when bought or sold is not obvious
upon first instance.
The rise of the health consumer has led to greater expec-
tation from those accessing services to be involved in shared
decision making. Historic failures of health professionals to
comprehend the legal and cultural requirements for valid
consent has seen a rise in litigation in cases of failure to
warn. Those who suffer harm as a result of their treatment
have the option of seeking legal help if errors are not ade-
quately managed and complaints processes accessible (Lup-
ton 1998). Despite the negative connotations this association
brings, consumerism has seen a shift in the clinician–patient
relationship to being one that is more egalitarian. Where
patient-centred strategies are adopted, the power within the
clinical relationship is more balanced and leads to a more
collaborative approach to the provision of care (Larkin
2011).
Is dentistry a commodity?
Dental care is most often provided as a commercial service
within private practice. Within public dental services, pro-
cedures are still paid for, just not by the end service user.
Even large public health systems such as the primary dental
care in the NHS system in the UK is provided in the main by
privately operating dental providers who hold contracts with
the public sector. In NHS dentistry, patients may be exempt
from treatment charges, but many are still required to pay a
portion of their treatment costs.
In considering whether dental care is a commodity, dis-
tinction might be made between the dental profession and
the surrounding dental industry. Dental care provided to
patients in the form of treatment and advice, and the ser-
vices provided by the wider dental industry to the dental
profession are very different in nature from one another.
Dental professional services are reliant upon extensive skills
and knowledge and are not tangible as property in the same
way as dental consumables, materials and equipment may
be. The objects used in the provision of dental treatment
are essential, but are an end to managing oral health needs,
rather than defining the provision of dental care itself. It has
been commented that the true value and nature of healthcare
Consumer-driven and commercialised practice in dentistry: an ethical and professional…
is the relationship that exists between the dental professional
and the patient (Pellegrino 1999).
This assertion may be challengeable from the perspective
of the dental consumer. In discussing the nature of profes-
sional status and practice, the analysis above may prove to
be correct; that there is a significant ontological difference
between selling a dental material in its raw form and the
technical and academic skill needed to successfully place
it. Despite this, many patients or consumers are unlikely to
attach the same value to this perceived dichotomy. Patients
who have dental treatment would likely perceive that they
have bought/purchased a filling, denture, crown or any other
intra-oral appliance. The given regularity of check-ups and
the scaling and polishing of teeth would likely to be regarded
as the same. Pellegrino states that these conceptions of
healthcare activities being indistinguishable from other types
of human activity are often held by those who are well, as
he states; “the young and those who have not thought much
about their own vulnerability and finitude” (Pellegrino 1999;
106). Pellegrino claims that when individuals or their fam-
ily members become sick, and need treatment and care, this
position of healthcare being a mere commodity to be trans-
acted is likely to be re-examined. This insight may apply
well to extensive or life-changing medical conditions or
treatment, but for elective dental treatment, this becomes dif-
ficult to apply. Within dentistry, the only treatments that defy
classification as elective procedures are; emergencies such
as trauma, uncontrolled bleeding, pain that is unmanageable
with analgesics and spreading infection. The nature of most
dental conditions is that they are chronic and asymptomatic
until their advanced stages; many treatments are likely to
be perceived as commodities, where patients might shop
around, negotiate on price or may simply not have the desire
to have treatment.
The nature of dental skills and knowledge conflicts with
the concept of being classified as commodities in them-
selves. Dental students gain their knowledge through a pro-
cess of sanctioned exposure to the dental profession. Society
allows unqualified students to dissect human bodies, handle
and administer prescription-only medications and provide
dental treatment to the public (albeit supervised). Therefore,
the development of skills and gaining of professional status
in dentistry is possible only with the permission of society.
Further to this, the skills taught to students have historic and
evidence-based foundations. To suggest that dental skills and
knowledge can be treated as commodities is to forget that
much research underpinning clinical practice is publicly-
funded, treatment provided by students is carried out in pub-
lic practice and in some cases, dental education is subsidised
by the state. The basis of modern dental practice is derived
from generations of knowledge created by predecessors and
their practice. The idea that this type of knowledge could be
proprietary is misguided; dentists are not the sole owners of
knowledge and skills relating to their practices. Furthermore,
these skills would not be permissible to be learned without
the sanction of society. This is only given on the basis of that
the training and development of dental students is clearly a
public good and with benefit to society (Pellegrino 1999).
Does the commercialisation of dental training affect this?
Some students pay a huge amount to access dental educa-
tion, with continuing professional education also being
increasingly treated as a commercial venture. Courses offer-
ing opportunity utilise cadavers to allow dentists to learn
facial injectables placement (such as botulinum toxin and
lip-fillers) seem to be a breach of the societal sanction; is
it possible to claim that such courses are designed with the
interests of developing dentists’ skills to help society? This
becomes especially pertinent when advertising for courses
may focus on ‘practice building’, where skills might be sug-
gested as methodologies for increasing practice revenue.
Similarly, courses aimed at taking practitioners overseas to
practice surgical techniques such as dental implant place-
ment are ethically problematic. Such courses often offer,
‘unlimited implants’ in ‘unlimited patients’; the opportunity
to gain practical experience in live patients is sold as a com-
modity. These patients may or may not require implants,
there is no focus from advertisements on the idea of help-
ing patients realise legitimate treatment needs. The focus of
these courses is upon the needs of the clinician to receive
as much clinical experience as possible, in order to expand
and bolster their practice’s earning potential, not to cre-
ate as much societal good as possible. Whilst the rise in
the expense of training to obtain core dental skills raises
concerns in some regards (for example, in the changing
demographics of those who may be attracted or inhibited
to undertake professional training), there is no fundamental
change in the societal sanction. Skills should still learned
primarily for the benefit of the public and taught in a manner
that reflects this. Courses offered and delivered with brazen
reference to increasing practice revenue and which treat the
opportunity to advance skills as business opportunities, fall
short of the societal sanction. In becoming commodified,
they lose their moral justification.
Arguments that dentistry cannot be a commodity because
of the nature of oral healthcare require re-examination.
Assertions that only the treatment of dental or oral disease
and the alleviation of suffering count as the ‘proper’ or pro-
fessional practice of dentistry fall flat. Definitions of oral
health are wider than those that consider general concepts
of health. Oral health, as defined by both the FDI (2016) and
the WHO (2012) include the ability to smile as being key
(the FDI evoking the attribute of confidence and the WHO
referencing psychosocial well-being). Based on this, it is not
congruent with the way in which dentistry and oral health
are perceived by society to exclude aesthetic or cosmetically-
focused considerations from the practice of dentistry. This is
13
 A. C. L. Holden
significant because it changes the nature of the patient–clini-
cian interaction. As stated, dentistry is commonly perceived
by the public to be a largely elective, consumable commod-
ity, where patients and consumers have extensive choice.
The business of dentistry
Healthcare does not exist naturally as a commodity. This
statement may cause confusion; dentistry exists as a busi-
ness, but that is not its prime function; or should not be. It
must be emphasised that running a poor business in den-
tistry is not ethical; patients expect to receive continuity of
good quality care. A practice that is shut due to business
failure is not one that can contribute to this endeavour. The
duality of the dentist as both healer and businessperson has
been highlighted as a perceived conflict of interest. Where
a clinician’s material well-being is linked to the quantity
of treatment that is provided, Wellie (2000) states that it is
inevitable that professional activity will be influenced by
economic considerations.
There has been acknowledgement within the courts that
the business interests of health professionals are not inher-
ently contradictory to the provision of services; it is only
when this becomes the sole purpose of providing treatment
that this raises criticism (Johnston 2015). The inclusion of
business considerations in the running of an efficacious and
patient/consumer-focused dental service is not in itself prob-
lematic, so long as these same business considerations do
not dominate. As the potential for profitability in dentistry
has been identified outside of the immediacy of dental pro-
fessionals, non-dental professional owned corporate bodies
have developed a business model that includes the provision
of dental care. The development of corporatized dentistry
has been of concern to many who feel that the ownership
of dental practices should be reserved for those within the
profession. The reality is that both corporate and independ-
ent dental businesses are potentially to blame for a rise in
predatory, market-driven practices. Dental professionals
are seldom slow to identify opportunity, and many have
adopted similar approaches as their corporate rivals. Within
this paradigm, professional ethics and moral duty have been
replaced by contract and tort law as the internal regulator.
Where strong corporate identity is attached to dental busi-
nesses, patients are encouraged to identify with the business
and brand itself, rather than with individual treating clini-
cians. For this reason, some practices will not book patients
into regular appointments with a particular dentist, rather the
patient ‘belonging’ to the practice as a communal pool. This
model similarly encourages individual clinicians to adopt an
attitude of patient problems being, ‘the company’s problem’.
The assumption of fungibility within dental care, providing
that the cost and quality of services are the same, may lead
13
to both patients and clinicians being considered commodi-
ties. Patients may be traded, bargained for and valued on the
basis of the potential profit their dental needs may deliver.
The standardisation of service provision is not restricted to
healthcare. Ritzer terms this phenomenon, ‘McDonaldisa-
tion’ stating; “the principles of the fast-food restaurant are
coming to dominate more and more sectors of American
life as well as the rest of the world” (Ritzer 2004; 2). The
premise of McDonaldisation is founded within hyper-ration-
ality; the idea that rational social action, based on calculated
understanding of the interaction between means and ends,
is manifested through political, economic and legal struc-
tures. Within business, this leads to a formalised and strict
methodology of practice (Weber 1970). A career in den-
tistry has traditionally been characterised by a high degree
of autonomy for clinicians. The development of bureaucracy
within dental practice organisations has the potential to draw
such free models of practice to a close (Scott et al. 2000).
The rise of corporate structures are attributed by some to
be due to the failure of Government to effectively control
spending on healthcare, leading to healthcare practitioners
to increasingly work in larger corporations with ownership
being within corporate firms or by insurance companies
(Starr 1982). Where this new organisational structure leads
to corporatized influences on activities, this has the potential
to override traditional drivers of professionalism. Some have
heralded this as the signifier of the end of the golden era
of medical professionalism (McKinlay and Marceau 2002).
A casual survey of the trade literature and publications of
professional organisations might well expose a pre-occupa-
tion within the profession with business. Courses that teach
dental professionals and their teams how to attract more
patients, sell more treatment and market a dental practice are
common and popular. Professionals may also be judged by
financial output, with employers monitoring the profitability
of individual clinicians and value being determined based
upon this measure. The depersonalisation of both patients
and professionals may occur to differing levels within dif-
ferent businesses, typically dependent upon the values held
by those who are ultimately responsible for determining the
culture and approach within organisations. Any healthcare
business should not forget its primary purpose; to empower
the consumers of healthcare to access treatment that they
need.
A problem that may arise from an over reliance upon a
commercial model of professional interaction is that the
health-consumer is empowered, not to be an equal partner
in the decision-making process, but to dictate completely
what he or she might want. The expectation from this
interaction is that the dental professional is simply there
as a facilitator of the transaction, not to question clinical
appropriateness. Furthermore, within this conceptualisa-
tion of the relationship between the patient and clinician,
Consumer-driven and commercialised practice in dentistry: an ethical and professional…
the patient and dental professional compete against one
another, with each participant trying to get from the other
the greatest amount, whilst relinquishing as little as pos-
sible. Ozar et al. (2002) summarise the ethos behind the
commercialised dental professional–patient relationship
well; “The dentist is concerned about the patient’s well-
being only as a means of improving his or her own” (49).
Here, the dental professional is bound by the obligations
of the market; he or she is no more obligated to the patient
than any other merchant and provider of services. It would
be hard to imagine that consumers of healthcare services
would be enthusiastic to accept such an interpretation of
the clinical relationship.
The role of the rational consumer may be played by most
individuals in making many commercial decisions. The
choice to purchase one brand over another, based on cost
and personal preference is an accepted part of daily life for
most. When this same expectation is applied to dental care,
with the dental patient being expected to make decisions
as to the best therapy for them based on risks and benefits,
costs and prognosis, the role of the rational consumer seems
to be more fraught. The average dental patient is most likely
able to comprehend these factors when laid out by a den-
tal practitioner in a comprehendible manner. Without the
translation of technical jargon into a format that is digest-
ible to lay-men and women, it is unlikely that patients may
be able to make an empowered choice relating to their care.
Patients are expected to control their behaviour in acting as
rational and well-informed consumers. The standardisation
of services may make the choice that exists between differ-
ent hyper-rationalised services to be one that is against their
own best interests with regards to quality of care (Waring
and Bishop 2015). Where the dental professional and the
patient are in competition to derive the greatest benefit from
one another, with the lowest personal expenditure, there is
no impetus for there to be appropriate information exchange
or transparent explanation. Valid consent is still protected by
tort law principles, but the ethical and professional obliga-
tion to gain this has become absent. There are clear tensions
between dental practices focusing solely upon measurable
aspects of care and the ability of dental professionals to pro-
vide high-quality, safe and appropriate services to patients.
The standardised and business-focused relationship between
dental professional and patient can be viewed as ethically
irrational as it does not permit individual interpretations of
human relationships. The corporatisation of services may
appear to give the dental patient greater choice, and may
superficially appear to be empowering, however, such an
environment limits the possibility that patients may have
genuine involvement in their care. This is due to increasing
standardisation, services are restricted in how personalised
and patient-centred they may be. Practitioners in heavily
regulated environments may find themselves de-skilled
in dealing with complex professional, ethical and clinical
dilemmas due to a lack of environmental dynamism.
Needs and wants in dental care
Dental businesses have to resolve the potential tension that
exists between patient wants and needs. We have already
identified that the nature of dental treatment often identifies
with patients as a commodity. The nature of cosmetic treat-
ment also being a legitimate part of oral healthcare means
that professionals are required to be as sensitive to what
a patient might want in addition to their needs. A quality
dental service cannot simply ignore the wants of patients
accessing care. The ultimate wants of patients can be met,
but the methodology through which this happens needs to
be observant of acceptable practice standards (Berkowitz
2017).
The legitimacy of patient or consumer wants is driven by
the social acceptability of smile enhancement as an act of
self-care. Care of the self, as described by Foucault (1990a,
b), has led to the acceptability of many procedures that have
traditionally been thought of as cosmetic, indulgent and out
of the primary purpose of dental practice. There is little
doubt that today’s consumer of dental services expects to
be able to access treatments that will enhance appearance
should they wish to do so. This in itself does not disman-
tle the professional nature of dental practice. Where this
becomes a threat to professionalism is where the professional
authority of the dentist is used to sell ‘wants’ to patients that
they did not previously have. The bold advertisement of rhet-
oric that suggests to consumers that they would live happier,
more fulfilled and confident lives if only they improved their
smiles, reveals the culturally and professional sanctioned
desire for a pleasing dental appearance. The rhetoric often
harnesses the worthiness of self-improvement and transfor-
mation to sell the idea that enhancement is accessible to all.
The drive to conform to societal normalcy is aided by dental
businesses offering specialist finance to assist consumers to
purchase their dental treatment. The transience of cosmetic
treatments is seldom part of the pitch in advertisements; as
Harris-Moore states, “In the battle for perfection a lasting
prize can never be won” (Harris-Moore 2014; 27).
The concept of the health consumer within the free-
market being empowered is over-stated. Free-markets are
only free in that they allow open competition and con-
sumption. The power given by this ability to purchase and
consume is precarious given the nature of commercial
practices that use professional authority and persuasive
advertising to push consumers into agreeing to treatment
(Harris-Moore 2014). Dentistry, as a commercial market,
is often guilty of creating and fuelling desire in consumers
for appearance-enhancing procedures (Christensen 2004;
13
 A. C. L. Holden
Welie 2000). It would be incorrect to categorically state
that patients don’t need to have these treatments where
desire has been created or encouraged, either by profes-
sionals or through advertising. Cosmetic enhancement is a
highly subjective matter; a patient with minor discoloura-
tion of their teeth may be more aware and concerned by
their appearance than a patient with a significant malocclu-
sion. It is professionally arrogant to suggest that induced
desires are always illegitimate. The neo-liberal orientation
of twenty-first century culture removes the stigma from
consciously and actively consuming advertising. Where
this may conflict with professional obligation towards
well-being is with regard to conspicuous advertising. If
this may seek to suggest that a dental professional will
look after oral health along with a desire for a pleasing
dental appearance, without fully referencing that in some
cases, these two things may be mutually exclusive.
The increasing dentalisation of society, through a normal-
ised practice of dentists creating treatment desires, seems
to fit well within model of attachment suggested by Zola
(1977). Along with other methods of attaching value to
medical intervention, Zola noted that the medical profes-
sion increased the reach of medical practice by expanding
from areas of medicine, what is deemed relevant to the living
of a ‘good life’. Certainly, those dentists who subscribe to
practices of active encouragement of desires within patients,
or plant seeds of concern where previously none existed,
would seem to be complicit in this definition of over-medi-
calisation. The health professions have always been fiercely
protective over what is considered to be the practice of
medicine and the allied disciplines. At one time, the idea of
dentists competing for patients through advertising or com-
petitive pricing would have been condemned by the profes-
sion. This attitude would appear to have largely disappeared
from the professional Zeitgeist. Instead, the preference for a
more business-focused concept has arisen, where competing
against one’s colleagues is seen by some as a necessary evil,
and by others as a fantastic opportunity to get ahead. Den-
tists are not just competing against one another; they now
have to consider the perceived threat of non-practitioners
carrying out tooth whitening, or other health professionals
placing facial injectables such as fillers and botulinum toxin.
It could be said that society is being de-dentalised by this
attenuation of the professional monopoly of certain dental
procedures. This is probably an incorrect conclusion; the
increase in the number of consumers seeking treatments that
enhance dental appearance would appear to be increasing.
Depending upon jurisdiction, heavier restrictions to non-
dentists practicing may or may not exist, but it is heavily
publicised that the dental profession believes that treatment
received from them is safer. Dental professionals are still
placed by society to be the greatest authority in discussing
oral health matters.
13
The commercial worth of having dentists endorse prod-
ucts has been effectively harnessed by those companies sell-
ing dental consumables such as toothpaste and toothbrushes.
Sensodyne found that by using advertising that used real
dentists, talking about why and how the toothpaste worked
and how it could help, sales increased markedly (The Semi-
otic Alliance). Similarly Oral-B claim that their electric
toothbrushes are worthy of consumer trust because; “Oral-
B has always been committed to providing innovations
in oral care. It’s just one of the reasons more dentists and
hygienists recommend Oral-B worldwide” (Oral-B 2018).
Colgate-Palmolive were sanctioned in the United Kingdom
for misleading advertising by the Advertising Standards
Agency because of disingenuous claims they made that
80% of dentists recommended their toothpaste (Derbyshire
2007). Toothpastes that treat certain oral issues, such as;
discolouration, sensitivity and plaque or tartar build-up, rely
on the use of experts (either real or perceived through use of
actors in advertising) to draw attention to a normalised issue,
so a solution may then be offered. The expansion of the role
of oral healthcare products can be seen by the expansion of
the product lines of many companies offering different tooth-
pastes and mouthwashes. These are all designed to tackle
different issues, accompanied by customisable toothbrushes
and with electric toothbrushes having a myriad of different
sized and shaped heads. These advertising strategies and
ever-expanding product lines of pharmaceutical compa-
nies reveal that the new highly commercialised relationship
between pharma, the health professions and consumers is
indeed applicable to dentistry (Conrad 2007).
Conclusion
Dentistry is capable of existing as both a business and a
healing profession. The development of cosmetic enhance-
ment into a legitimate part of dental practice should be
viewed with the knowledge that cosmetic interventions are
often the exemplars of commercialism in healthcare (Sulli-
van 2001). Harmonious existence of profession and business
is only possible if dentists can resist the temptation to use the
innate disparity in professional knowledge in skill that exists
between patient and dentist to a competitive advantage. If
patient needs are ignored in favour of expressed patient
desires and needs suggested and normalised by profession-
als, the future of dentistry as a professional endeavour is
threatened. This consideration requires a holistic approach;
the majority of dental professionals need to take a public
stance against overtly entrepreneurial practice, with those
that choose to resist becoming ever more perspicuous and
vulnerable to criticism. If most practitioners choose to adopt
a commercial approach to the provision of dentistry, there is
little choice but for the minority to conform to this as well.
Consumer-driven and commercialised practice in dentistry: an ethical and professional…
Regardless of arguments that relate to a higher moral sta-
tus, dentistry is clearly viewed to be a commodity by many.
However, this is not a consistent approach and is contextu-
ally dependent upon the type and manner of care being pro-
vided; patients may switch between consumerist and passive
behaviours (Lupton 1997). Regardless of whether treatment
is aimed at managing dental disease, or meeting aesthetic
needs or desires, dental practitioners should endeavour to
preserve the inherent virtue within the provision of dental
services. Whether treatment is to make patients well, or to
make them better than well through an enhancement, con-
sumers of dental care are still reliant upon the fiduciary
nature of treatment.
Dentistry has operated as a business for much of the mod-
ern era and is unlikely to deviate from this model anytime
soon. The challenge for society and the dental profession is
to ensure that the delicate balance between consumerism
and professionalism is maintained in a manner that enhances
the rights and status of those seeking care, but also protects
them from mercurial practice.
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