Dentists' Perspectives on Commercial Practices in Private Dentistry.

BACKGROUND: Dentistry is predominantly provided in a commercial context in Australia. Despite this, little is known about how dentists navigate potential tensions that may arise between commercial and professional obligations in private dental practice. This analysis uses a qualitative approach to explore dentists' perceptions and attitudes toward the commercialized nature of private dental practice and how these affect their professional role in providing care. METHODS: Participants were recruited by advertising on social media, as well as through a professional association and a corporate dental group's graduate training program. Data were collected from participants through interviews and written reflections. The data were subjected to thematic analysis to reveal deeper meanings and linkages between different emergent themes. RESULTS: Twenty dentists who worked in private practice environments were recruited to take part. The analysis revealed the following themes within the data: dentistry devalued, commercial influences on professional behavior, the effect of advertising and competition on dentistry, ethical selling, and the impacts of commercialism on consumers of dentistry. CONCLUSIONS: Consumers of dentistry may only be superficially empowered by the commercialized context of private dental practice. Empowerment to decide which services to access and from whom does not address the inherent disparities that exist within the dentist-patient clinical relationship. Advertising and the active "selling" of oral health services are all designed to create dental consumers, not to empower them. While advertising might assist patients to understand available treatments, the primary objective of marketing is not health education. Increasing competition and consumer choice within dentistry may help to empower consumers of dental services but only if the dentist-patient relationship remains founded in altruistic intent, with the doctrine of "caveat emptor" (buyer beware) having no place within dentistry. KNOWLEDGE TRANSFER STATEMENT: This research provides novel insights into how dentists experience the commercial context of private dental practice and how this is perceived to be both beneficial and detrimental to the consumers of dental services. This work will help to guide policy development to address the commercial determinants of oral health generated by the nature of commercialized dental practice environments.

Private practice dentists' views of oral health injustice.

OBJECTIVES: There is a lack of research examining how dentists in private practice conceptualise the challenge presented by oral health injustice and how attitudes towards low-income patients might be influenced by the commercial nature of private dental care. This study provides insights into how dentists navigated the interactions between the commercial nature of dental practice and the provision of care to patients who either struggled to (or could not) afford the cost of self-funded care in private practice. METHODS: Participants took part in semi-structured interviews and were invited to keep an online diary of reflections. Thematic analysis was used to examine the data to extract and synthesise understanding of how practitioners conceptualised issues surrounding providing care for the disadvantaged and how this related to the economic realities of private practice. RESULTS: Twenty participants were recruited and interviewed from a variety of private practice environments and roles. This report focuses on one specific theme within the data that explored how participants viewed patients who received public dental care, as well as those privately funded patients who could ill-afford their treatment. CONCLUSIONS: The findings raise how neoliberal attitudes towards oral healthcare and dental disease may act as a social determinant of health and contribute to the sustaining of structural barriers and inaction towards oral health injustice. For low-income patients, practitioners distinguish between (a) those who are deemed to be deserving of professional care and the charitable endeavours of the profession, and (b) those who are not. There appears to be no overt professional obligation to actively work towards the amelioration of oral health injustice.

Dentistry and Oral Health in Online Media Sources: A Discourse Analysis.

BACKGROUND: This analysis examines the discourses within online media that relate to dentistry and oral health, contributing to developing understanding of the underlying social and political contexts that may affect the promotion of oral health. The increased mediatisation of society means that media representations of the dental profession and oral health are of increasing importance. METHODS: A search for online media sources relevant to dentistry and oral health was carried out using Google News. Discourse analysis was used to explore online media sources that discussed oral health, the dental profession and dentistry more generally. RESULTS: 171 articles were included, and three overarching discourses were identified from the selected online sources; 1) Power and Professional Status; 2) Advancement of Social Control and; 3) Neo-liberal Attitudes Towards Oral Healthcare. CONCLUSIONS: The theory of the social contract provides a conceptual framework to explore the relationship between the dental profession and society, the nature of this is discoverable through analysis of the discourses within online media. Within the sources examined, the dental profession frequently invokes neo-liberal discourses that place personal responsibility to be an important factor in preventative oral health. There was also frequent suggestion of a stronger link between oral and systemic health than is evidenced within the academic literature. Analysis of the media sources examined also suggests that the representations of oral health and dentistry also serve to reinforce the artificial separation of the mouth and the body, with dental services being separate from other healthcare activities.

Embarrassing Realities: the Portrayal of Dentistry in Reality TV 'Dentertainment'.

BACKGROUND: Dentists are not common subjects within reality TV. When presented in film, the overall impression has been reported to be negative. The British reality TV show 'Embarrassing Bodies' includes within its format, cases where complex and extensive dental treatment is presented. This analysis examines how these cases frame dentistry, as a rare example of the profession and its activities upon the small screen. METHODS: 14 dental cases from the show were located and transcribed. Semiotic and thematic analysis was used to explore the deeper and hidden meanings and signs within the cases. This developed understanding of the implications of the show upon the public presentation of dentistry, oral health and disease, patients and dental professionals. RESULTS: Five distinct themes were identified within the corpus of cases; Professional Values and Portrayal of Cosmetic Dentistry; The Presentation of Oral Health and Disease; Dental Physiognomy; Dentistry as Empowerment and Unequal Professional Relationships. CONCLUSIONS: 'Embarrassing Bodies' portrays a presentation of dentistry that focuses disproportionately upon restorative dental interventions, especially cosmetic dental therapies, in preference to preventative treatment. Dental disease is presented in a way that associates oral health conditions with dirt and as being caused by neglect and carelessness.

Professionalism by proxy: a case for the formal regulation of dental assistants in Australia.

Dental assistants are the most numerous member of the dental team in Australia, responsible for many clinical and non-clinical duties. Despite this, dental assistants are not registered and regulated in the same manner as their clinical colleagues within the dental profession. In this article, the authors argue that this is an unacceptable situation within the Australian dental context. In the examination of events within the profession both within Australia and overseas, it becomes apparent that this is an untenable position with regards to promoting the safety of the public. The current stance towards dental assistants is often perpetuated by a dental profession whose motives would not seem to be free from issues of professional dominance. Dental assistants may also be an essential division of the dental profession in providing culturally competent, economically viable and sustainable oral healthcare to those communities that are traditionally difficult to access.

Consumer-driven and commercialised practice in dentistry: an ethical and professional problem?

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 paradigm is cause for concern. Within this article, whether dentistry is a commodity and the legitimacy of dentistry as a business 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.

The future of failure to warn in dentistry after Montgomery: reflections from Australia.

The switch from the standard of the reasonable professional, to that of the reasonable patient in cases where it is alleged that a health professional has not imparted sufficient information to allow the gaining of valid consent, has created anxiety and confusion within the dental profession. The ruling in Montgomery v Lanarkshire Health Board is relatively young; there have been insufficient subsequent cases to truly allow a deep exploration of the real changes that the case will bring to the way dentistry and other health activities are provided. One way that light may be shone onto the significance of Montgomery is to examine the development of the law in this area from Australia. Australia and the UK share a common history and while each legal system is independent from the other, they hold significant influence upon each other's destiny. This article seeks to shed light on the true relevance of Montgomery to dentistry in the UK through examination of the Australian position towards the gaining of valid consent which has enjoyed somewhat of a head-start in this area of the law.

Reflections on the encouragement of altruism in dental education.

Dental ethics and professionalism are often relegated to being taught on the coat-tails of other disciplines, if they are taught at all. The assumption that students develop professionalism as a by-product of other learned competencies in dentistry is well documented to be false, and yet, little has been done in many institutions to deal with this. This article seeks to propose that altruism should be championed in dental education and that traditional learning through the preaching of professional codes is not the appropriate way to achieve this. The environment of dental schools needs to be challenged and reformed so that altruism is promoted. If we fail to address declines in altruism in the dental profession, then damage to the professional status of dentistry is inevitable and the ability to fulfil the profession's social contract with society will be inhibited.

Paradise Lost; the reputation of the dental profession and regulatory scope.

In their recent article in this Journal, Affleck and Macnish (BDJ 2016) state that when questionable, private behaviour of dental professionals does not directly affect patient care or safety, the General Dental Council should have no interest in disciplinary action. They argue that the private affairs of dental professionals have no bearing upon their professional practice. This article is a response to this conclusion in which I examine the relationship between professional and private matters within the context of social media. I also demonstrate that regulatory action in response to behaviour which damages the reputation of the dental profession is more than just appropriate, but also essential in order to preserve the profession's relationship with society. While valid to a point, I find that Affleck and Macnish's view on this issue is too narrow and to fully appreciate the ethical quandaries within this issue, we must adopt a more holistic perspective of the nature of professionalism.

Self-regulation in dentistry and the social contract.

This article looks at the General Dental Council (GDC) and dental regulation from the perspective of social contract theory. Self-regulation is a requirement for the dental profession to exist within such a contract with society and this article seeks to examine the effects of the GDC upon the social contract. The GDC maintains that it is independent of the dental profession and while this may be true when discussing impartiality, the existence and purpose of the GDC is intrinsically intertwined with the dental profession. This article will show that the GDC has acted in a manner that has a negative impact upon the social contract between the dental profession and society and that for the dental profession to maintain its status and ability to place patients first, the GDC needs to re-evaluate its role and attitudes.

The ExTORTion of dentistry--is litigation and over-regulation best for our patients?

This article examines the current trends within UK dentistry for increased litigation and regulation. The law of tort when applied to dental negligence falls short of attaining justice for patients in a way which is focused on their best interests. It also has the effect of causing demoralisation and encouraging defensive practice. The introduction of a no-fault compensation scheme, such as that found in New Zealand, may be a solution to this issue, but this would come with questions around how it could be funded. The current system of high litigation and regulation, which shows no signs of relenting, seems to be in no-one's best interests. Therefore there is a real need to consider and propose alternatives that may break the continuum of increasing trends.

Justice and NHS dental treatment--is injustice rife in NHS dentistry?

In this article the issue of injustice in NHS dental care is examined using the philosophical principles of non-ideal theory. The causes for this injustice in this context are examined as well as how injustice may be perpetuated within the NHS dental system. The focus upon targets that the current system supports contributes in shifting the focus of healthcare provision from being patient-centred to that of financial gain. This leads to a drop in quality of care and to dissatisfaction within the dental workforce. This article aims to examine this perversity and how this further contributes to injustice.