Article
Dentistry, traditionally regarded as a noble profession, has undergone significant changes in recent decades. These transformations have shifted the field from a profession centred on patient care to an industry driven by market forces and profit maximization. It is important to highlight this trend, delineate the hallmarks of a profession versus an industry, and discuss the potential difficulties these changes pose to dental practitioners. Ultimately, in the authors' view, dentistry is best maintained as a profession to safeguard the quality of patient care and uphold ethical standards.
Hallmarks of a profession
A profession is typically characterized by specialized education and training, a commitment to serving the public good, and adherence to a code of ethics. Professionals are expected to place the welfare of their patients above personal gain. In dentistry, this has historically meant prioritizing patient care, prevention, and education over financial considerations – putting the patient's interests first. The key features include the following.
Education and training
Dentists undergo extensive education, including undergraduate studies, dental school, additional postgraduate training and continuing professional development. These rigorous processes help to ensure a high level of expertise and competency.
Ethical standards
The dental profession is governed by strict ethical codes that emphasize patient welfare, confidentiality, and informed consent. Professional bodies such as the General Dental Council (GDC) in the UK, and similar bodies in other countries, uphold and regulate these standards.
Patient-centred care
Traditionally, dentists have focused on providing personalized care tailored to individual patient needs. This involves building long-term relationships and emphasizing preventive care to maintain oral health.
Hallmarks of an industry
An industry, on the other hand, is characterized by its focus on profitability, efficiency, and market competition. The primary goal is often financial gain, which can sometimes overshadow the commitment to serving the public good. The key features of an industry include the following.
Profit maximization
Industries prioritize financial performance and return on investment. This can lead to cost-cutting measures, standardization of services, and an emphasis on highmargin procedures.1
Efficiency and scalability
Industries strive for efficiency and scalability to maximize profits. This can result in the commodification of services, where patient care is delivered in a more standardized, less personalized manner.2
Market competition
Industries are driven by competition, which can spur innovation, but also lead to aggressive marketing and sales tactics.3
The shift in dentistry
The shift from a profession to an industry in dentistry is evident in several trends.
Increased emphasis on profit
There is a noticeable increase in the emphasis on profitability within dental practices. Dentists may face pressure to meet financial targets, potentially leading to overtreatment or the prioritization of high-revenue procedures over essential, but lesslucrative care.4
Marketing and sales pressure
Aggressive marketing and sales tactics are becoming more prevalent. Patients are increasingly viewed as consumers and dental services are marketed similarly to other consumer goods. This shift can undermine the trust-based patient–dentist relationship.5,6
Standardization of care
To achieve efficiency, some dental practices may standardize care protocols. While this can lead to consistency in treatment, it can also result in a one-size-fits-all approach that may not adequately address individual patient needs. Currently, this can be seen with treatments such as composite bonding or orthodontic-related treatments, which some patients purchase online, often where the attainment of consent may be lacking and/or without proper patient assessment and logical treatment planning.
Social media influence
The rise of social media has significantly impacted dentistry from both the perspective of patients and dentists.6 Dental practices and individual dentists increasingly use social media platforms to promote their services, often highlighting cosmetic procedures. Patients are also influenced by treatment outcomes proposed by various dental sites and posts on social media.6 This can create a focus on trend-driven treatments, sometimes at the expense of necessary, fundamental dental care or preservation of healthy tissues.7 In an article published in The Times on 19th August 2024, titled ‘Why dentists are the new social media stars,’ author Phoebe McDowell traced this trend, in part, to the influence of Invisalign.8 This would suggest a notable impact of industry forces on the public image of dentistry, alongside possible conflicts of interests between industry and the profession with its potentially compromising consequences.9 The article focuses on the rise in cosmetic dental procedures allied to this trend, therefore further shaping public perception of dentists.
Elective and cosmetic treatments
There is a growing emphasis on elective and cosmetic treatments, driven by social media trends and the desire for a perfect smile. Procedures, such as teeth whitening, veneers, composite bonding and orthodontics are heavily marketed and promoted online, influencing patient preferences and expectations.10
Medico-legal implications
The shift towards an industry model also brings significant medico-legal implications.11 Dentists are at an increased risk of litigation and regulatory challenges, particularly when elective and cosmetic treatments do not meet patient expectations or lead to complications. Additionally, the pressure to meet financial targets may lead to ethical and legal breaches, such as unnecessary procedures or failure to obtain proper informed consent.
Challenges for dental practitioners
This shift of dentistry from a profession to an industry poses several challenges for dental practitioners.
Ethical dilemmas
Dentists may face ethical dilemmas when financial targets conflict with a patient's best interests. The pressure to increase productivity and profitability can lead to difficult decisions about treatment recommendations.
Loss of autonomy
Dentists may experience reduced professional autonomy, with reduced control over treatment decisions, schedules and practice policies. This can affect job satisfaction and the quality of patient care.
Quality of care
The emphasis on profitability and efficiency can compromise the quality of care. Time constraints and standardized treatment protocols may prevent dentists from providing the comprehensive, patient-centred care they were trained to deliver.
Patient trust
The commodification of dental services can erode patient trust. When patients perceive that financial incentives drive treatment recommendations, they may become sceptical of their dentist's motives. This may result in complaints or concerns being raised.
Pressure to conform
Social media and advertising trends can create pressure on dental practitioners to conform to market demands, focusing more on cosmetic and elective procedures rather than essential dental health care. This can shift the focus from treating disease and promoting oral health to fulfilling cosmetic desires.
Conclusion
The shift from dentistry as a profession to an industry represents a fundamental change with significant implications for dental practitioners and patients alike. While the drive for efficiency and profitability can bring benefits, such as lower costs and greater access to care, it also raises concerns about the quality of care, ethical standards and the nature of the patient–dentist relationship. It is essential for the dental community to navigate these changes carefully, ensuring that the core values of the profession, commitment to patient welfare, ethical integrity, and the provision of high-quality care are not compromised.
It is imperative that dentistry remains firmly rooted in its professional foundations. The trend towards industrialization, while beneficial in some respects, poses risks that could ultimately undermine the trust and quality of care that are the hallmarks of the profession. Dental practitioners must advocate for a balanced approach that embraces necessary innovations and efficiencies while steadfastly upholding the ethical and patient-centred values that define the true essence of dentistry.