Advertising and dentistry

Dentistry in Australia has always been a business, because it has always been predominantly a self-regulated and private practice based health profession with limited government funding.

The issue of advertising and ethics has been a longstanding and contested space in dentistry in Australia. In 1911 dentist and Victorian Dental Board member George Philpotts said:

‘our present state of dentistry is selfish, it is only available to the wealthy.’

Advertising was common – with large signs outside a practise displaying the name, fees and perhaps a testimonial, or a display case of denture and gold work in a window near the practice entrance or advertisements in daily newspapers.

Recent debate on compassionate release of superannuation has revolved in part around how some dental practitioners are marketing the use of this scheme to their patients and the broader community. Many older dentists now bemoan the loss of professionalism and point to deregulation changes that opened dentistry up to allow advertising under the guise of improving competition for the benefit of patients.

But were things always so rosy?

In the early 1880s in the Australian colonies, anyone could call themselves a dentist, and a dentist was generally just someone who could extract teeth and make dentures. Apprenticeship style training was common, with apprentices indentured to practising dentists for periods of up to five years. However many could not afford to be indentured, or perhaps lived in regional areas where it was not possible to be an apprentice, and so they just learned the skills necessary to practice some form of dentistry.

There were early attempts in Victoria to regulate the practice of dentistry, with a bill first introduced to parliament in 1882, which failed due to higher priorities at the time – predominantly railways and land development. The inability of government to prioritise oral health has clearly been an ongoing political issue that continues to the present day.

Some of the founding fathers of dentistry (and they were all men) continued to push for a Dental Act in Victoria, in part to raise the social status of dentists and to acquire the mantle of respectability worn by the medical profession. This early group formed the Odontological Society of Victoria, and barred themselves from advertising by signboard, showcase or in the press, to distinguish themselves as ethical dentists from those who advertised and were therefore commercial dentists. This set the stage for a longstanding battle about who could be a dentist, and what ethical dental practice looked like.

The battle between these ‘ethical dentists’ and those who wanted to advertise continued until the Dental Act of 1927 in Victoria, which gave the Dental Board powers to control the practice of dentistry through regulation, although it took until 1933 for advertising regulations to be finally put in place. Despite these regulations, many dentists continued to push the boundaries of advertising, a situation with clear parallels to the present day.

There were other commercial practices related to advertising that were common at the time which called into question the ethical conduct of dentistry. Cash order companies operated by supplying credit notes or cash orders to facilitate commercial transactions and were commonly used in dentistry. The lender charged the patient a commission of 5-10%, and the dentist paid a further 5% to the lender. This meant the dentist only received 95% of the face value of the cash order, but at least they were paid – which was an important consideration for many dentists. This practice was perceived as reducing dentistry to a mere commercial venture and allowed a form of advertising by default, because the cash order companies had lists of participating dentists that they could market to potential patients. The Victorian dental board had wanted to take action against these practices as early as 1915. Since there was often a business arrangement between the dentists and lender, it essentially made the lender a third party. This was the mechanism that eventually made the situation illegal after 1933.

This history highlights the ongoing and unresolved tension about whether dentistry is a health profession or a product. The proliferation of courses marketing ways to improve sales technique - under the guise of ethical marketing or case acceptance - highlights the role of dentist as a salesperson. And in one part, this is a necessity. In order to build trust and rapport, patients need to ‘buy-in’ to their dentist, yet this has the potential to be exploited due to the significant information asymmetry that exists between dentists and patients.

Despite what we may think, dentistry in Australia has always been a business, because it has always been predominantly a self-regulated and private practice based health profession with limited government funding. What we are seeing play out now is merely a variation of what we have seen over the past 140 years.