FROM THE DIARY OF A DENTAL ETHICIST

Bleaching Strips

One of the most challenging tasks, so I have found, is to explain to dental students the concept of a profession. Not that I have to convince them that they will be true professionals once they graduate. Most of them think they already are – kind of. The challenge is to get them to think critically about that label. What does it mean to be a professional? In the classic sense of that term? How do professions differ from other occupations? Fashion designers, hair stylists, the soap industry – to mention just a few?

The other day, I was lecturing to my first year students about the profession of dentistry. They had been assigned the task of composing a class code of ethics and I had reviewed all six drafts. They were really quite good and I was pleased with their idealism. Of course, as an educator and philosopher I had to challenge them on a number of items. What’s the value of a class code of ethics? Are they really ready to abide by it as well as discipline they own ranks? How do they intend to protect vulnerable patients in practical terms. Are they in school to compete, get ahead of one another, or to jointly get ready for the relief of patients’ oral health needs?

For a few minutes I manage to elicit some responses from the class, but only by asking direct and challenging questions from them. They don’t have any questions for me. I need to remind myself that it’s Thursday afternoon late. Their brains have had to accommodate four days of intensive course work already and it’s 4:30 pm. Another 15 minutes, and I end class, wishing them good luck with the composition of the final version of their class code of ethics.

They have one more session to go, but it’s optional. The “Rep” from Crest will bring pizza and soda, in exchange for 30 minutes of their time. Dental school is expensive. These students must budget tightly. I figure most will stay for a slice of pizza or two, and then slip out. Unfortunately (for them) the pizza is delayed. If they want it they have to sit and listen to the Crest Rep. As far as I can tell, they all do. He shows the Crest webpage, specially designed for dental professionals, with lots of scientific info as well as case studies to prepare for boards. Fifteen minutes pass; the pizzas have arrived, but the soda is still missing.

So the Rep switches to the second topic on his agenda: the latest whitening agent developed by Crest. Whitening is in demand, he explains. Half of all the toothpaste sold to clients has a whitening agent. A survey has revealed that 50% of all adults want their teeth to be whither! But only 5% of all adults obtain bleaching treatment from their dentists. Why not more? Crest figures that the methods available (i.e., bleaching trays) are too cumbersome. Something easier must be developed and they have done it: bleaching strips. While he is explaining the design of the strips, I am doing some quick calculations. 50% of all adults in the US – that’s roughly one hundred million people who want whiter teeth. Crest sells the strips for $20 to the dentist, the Rep goes on; but the dentist sells it to the patient for about $50. I calculate: if the net profit is about $45, that boils down to a total of $ 4.5 billion. They need two sets of strips, one for the maxilla, one for the mandibula, the Rep explains. That makes it $9 billion. The acquired whiteness will last about 6 months. In my mind, that doubles the potential profit to $18 billion.

That’s eighteen billion dollars, net profit, annually, to be made off patients’ vanity! Only 30 minutes earlier I had tried to convince the students that patients have medical needs that render them vulnerable towards dentists, the only people who are capable of relieving their pain and suffering. A true professional distinguishes him- or herself by not capitalizing on that vulnerability. Patients may not be talked into treatments they don’t really need, merely to make a profit. Up comes the Crest Rep who tells them that there’s $18 billion to be made off the vanity of those same patients – of should we call them clients; at least that would be more honest? Suddenly my quiet students become very interested. The soda has long arrived, but never mind; they want to know more about these magical strips. How exactly should they be used? How effective are the strips really? Four vita shades on average?! Does he have samples for them to try?

No, unfortunately, he does not have samples. But he has a satchel for each student, filled with other goodies. I get one too. Information about Crest, lots of toothpaste – with whitening agent of course; a small pack of coffee. The cynic in me can’t resist: “Makes sense, coffee stains your teeth; that explains as well why there is only coke to go with the pizza.” $18 billion dollars per year! I chew my pizza and wonder whether I have chosen the right profession.

JW