Inside Dentistry
September 2007
Volume 3, Issue 8

From the Editor

Gerard Kugel, DMD, MS, PhD

Dear Readers,

This month, Inside Dentistry addresses what might very well be one of the most sensitive issues that we’ve covered in our feature presentations. In “Dissecting the Debate Over the Ethics of Esthetic Dentistry,” we acknowledge that necessary dentistry can now be esthetic dentistry and that the two are no longer mutually exclusive. We also acknowledge that unnecessary esthetic dentistry—often called elective dentistry—is becoming more commonplace because patients are demanding that our profession provide it. Finally, we acknowledge that the hardest thing for dentists to do as healthcare providers is determine the right thing to do, especially when being pushed by patients, grappling with business/financial considerations, and balancing needs vs wants in the context of what it means to provide care and do no harm—or at least do as little harm as possible.

No One Answer. Neither the publishers, the author, my esteemed colleagues, nor I can make a firm judgment about what is unquestionably right, what is ultimately ethical, or what is most appropriate under any given circumstance. Rather, by exploring the issues affecting esthetic dentistry, as well as their dimensions, we hope to provoke your thoughts on the matter in such a way that you personally reflect upon your own beliefs and practices in order to establish your own high standards for patient care.

Gatekeepers of Our Patients’ Best Interests. We have a responsibility to provide our patients with as much research- and evidence-based information as possible about the treatment options available to them. When presenting them with their options, we should review all of them. Given everything that patients see in the media today, an ethical issue can arise when dentists are looking at tremendous financial reward if they do what the patient wants, but which might not necessarily be best for him or her. Even if it’s not what patients want, they need to know what alternative you—as the healthcare provider—consider to be in their best interest. Even when pushed by a patient to do what we may not feel is best, it is still our responsibility to make the final decision. I have told patients that I will not be able to do their treatment, rather than compromise myself and my beliefs.

Know What You’re Doing So You Can “Do No Harm.” Many patients today are requesting porcelain veneers; I recently had a 24-year-old woman in my practice who was having problems with a veneer case that had been placed only a month earlier. Five of the eight veneers that had been placed had debonded, with no composite cement left on the teeth. I called her dentist to discuss the situation, as well as to ask why the veneers were done in the first place because the teeth seemed healthy and the preoperative photos the patient brought in gave no indication that veneers were necessary. The dentist stated that the patient wanted veneers and that he decided to do the case even though he questioned the need. I fixed the case and worked with the original dentist to keep the patient happy. The lesson learned from this case is that although esthetic dentistry is a very important part of our practices, we are the ones that must make the final treatment decision, and if we choose to do the case we must have the skill set to make it work.

We hope you enjoy this issue and find that it stimulates reflective thought and relevant dialogue with your colleagues about today’s esthetic dentistry and its implications for our profession and our patients. We encourage you to send us your feedback at letters@insidedentistry.net. As always, your thoughts, opinions, and reactions are our motivations to continually enhance our clinical content and coverage of today’s topics of interest. Thank you for reading and, most of all, thank you for your continued support.

With warm regards,

Gerard Kugel, DMD, MS, PhD
Associate Dean for Research
Tufts University School of Dental Medicine

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