I had someone ask about a dentist who wasn’t on good terms with their state dental board, and thought I’d comment about this. Consumers need a little background to evaluate this issue fairly.
There is often a degree of tension between cosmetic dentists and the rest of the dental community. And that tension mounts if the cosmetic dentist is accredited and begins to make that known. It’s rooted in a “turf war.” I would guess that 95% or more of dentists are attracted to dentistry because they have a technician mentality. They’re trained to fix things. Dentistry to them is a matter of looking for what is “broken” and then fixing it. These people have very little appreciation for esthetics in dentistry. They think that esthetics is “no big deal” and furthermore, they have all the training they need to be able to deliver cosmetic dentistry. So they are upset with dentists who focus on cosmetic dentistry, especially if they make claims such as being “accredited,” because that label implies that the “non-accredited” dentist somehow isn’t good enough. They want to have their share of the cosmetic dentistry business, as there is a strong demand for these services.
And these non-accredited general dentists can be very good people. They just see the world of dentistry very differently. They also tend to have authoritarian personalities. Their attitude toward patients reflects the attitude that is strongly inculcated into dental students at dental schools: the dentist is trained to know what is best for the patient. They think that the approach of the cosmetic dentist, who, because of the nature of cosmetic dentistry and a different personality type will spend a great deal of effort listening to the patient to find out what the patient wants – they tend to view that approach as pandering to the patient and demeaning to the profession. They think it isn’t professional for the dentist to give up that role that says, “I know what is best for the patient.”
So it isn’t difficult for jealousies and hard feelings to develop between general dentists and cosmetic dentists. In fact, the American Dental Association, through it’s internal political processes, has enacted a code of ethics that prohibits cosmetic dentists from letting the public know that they are accredited. The ADA also refuses to grant specialty status to cosmetic dentistry. Even though it takes years of training after dental school for a cosmetic dentist to get really good at it, it will never become a specialty because of this very attitude I’ve told you about. Maybe 95% of dentists think that esthetics is no big deal. So there’s this ADA ethical guideline that encourages state boards of dentistry to prohibit any advertising that makes any claim that some dentists have extra qualifications in cosmetic dentistry. And a number of state boards have adopted this provision. The problem they have in enforcing it is that the Federal Communications Commission has ruled against some state boards that have tried to enforce it because it is an infringement of free speech. Accreditation in cosmetic dentistry is a legitimate credential. The examination is very difficult. Failure rates for the examination have sometimes approached 60 and 70 percent. The boards have tried to claim that announcing accreditation “deceives the public” because cosmetic dentistry isn’t a specialty that is recognized by the ADA. But the FCC has decided that claiming accreditation is legitimate. This is very frustrating to some dental boards. So when a dentist doesn’t “toe the line” on this issue, sometimes dental boards, since they are legally restrained from acting on their true feelings, they can go hunting for technical violations and really make life miserable for the dentist.
An example is a recent rule from the Alabama dental board that no dentist in that state can publicly say that he or she is any better than any other dentist. When I hear things like that I want to say, “Yes, let’s hear it for mediocrity!” This type of rule is directed squarely at cosmetic dentists and implant dentists. Both fields require extensive additional training, but the ADA refuses to grant them specialty status. But can you imagine telling a supermodel like Pamela Anderson that if she wants a new smile the dentist on the corner is just as good as anyone? Of course not. We all know what Pamela Anderson is going to do. She’s going to try to find out who is the best, and she is going to fly there and have her teeth done. And we all know that there is a best, and that 99% of dentists wouldn’t be able to deliver the beautiful smile that she wants. But the Alabama dental board wants us to not talk about that. And they’re doing this under the guise of “protecting the consumer.” But clearly they’re really just protecting their power base. We all know that.
So consumers, just be aware that this is going on. And dentists, step carefully. Dental boards wield a tremendous amount of power. Often, they do what they want, and there are no checks and balances. When a dentist crosses them, you need to know that they are investigator, prosecutor, judge, and jury all rolled into one, and rarely does any court or legislature act to rein them in when they get oppressive. The FCC, fortunately, has stepped in to check their power.
Remember that it wasn’t that long ago that dentists weren’t even permitted to advertise. It was the FCC in the late 1970s that came in and put a stop to that muzzling of free speech.
– Dr. Hall
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