Jos VM Welie, Melissa Simpson & Gary H Westerman*
Creighton University Center for Health Policy and Ethics, Omaha, US

The Troubled History of Dental Advertising
Part 1: Definitions and Statistics


Introduction

Advertising by dentists is one of the ethically most sensitive issues. It is covered in many codes of dental ethics from around the world. The American Dental Association’s (ADA) devotes almost half of the text of its code to this one issue and every year new statements are added. Why are the ADA and other professional dental associations so focused on dental advertising?

In a series of four short articles, we will try to shed some light on this question. The series is based on the American experience with advertising by dentists, but the authors are convinced the lessons to be learned are applicable to many other countries as well. In this first article, we will define advertising and provide some statistics. In the second article, the history of advertising will be reviewed, leading up to the (in)famous 1977 Supreme Court decision that lifted the ban on advertising in the US. In a follow-up article, the legal consequences of that decision will be analyzed. In a fourth and last article, we will reflect on the ethics of advertising and provide some guidelines.
 

Some Definitions

This series of articles is concerned with advertising by dentists. To advertise literally means “to turn (someone’s mind) towards (one’s services or product).” A dental advertisement is not effective if it merely brings a news item to a patient’s attention, which is what an announcement literally does. A successful dental advertisement actually redirects the patient’s mind towards the advertising dentist.

Consider the following example of an announcement, commonly found in the Yellow Pages. This notice may lead parents seeking a dentist for their five year old daughter to visit Dr. Doe. But it may also turn away patients, particularly adults. Either way the notice is effective. The primary objective of this notice is not to draw ever more patients to the dentist. Rather, this notice informs patients and makes it easier for particular categories of them (e.g., children) to find the right provider (e.g., a pediatric dentist).
 

Trust the Delicate Touch of an Artist to Make Your Smile Magnificent Dr. John Doe, DDS and Associates 2500 Center Ave tel: 450-4500 For patients who worry about AIDS: We are serious about sterilizing instruments !

On the other hand, the second notice would not at all be successful if it turns away patients. This notice is not aimed at informing patients such that they can find the dentist best able to meet their oral health care needs, even if it means visiting someone else than Dr. Doe. All patients would like a dentist who is an artist and can provide a magnificent smile (not all patients want a pediatric dentist). And all dentists strive for optimal esthetics (but not all dentists want to treat children). Rather, than informing patients, this advertisement lures patients with such glowing terms as “artistry” and “magnificence.” And if that doesn’t work, there is always the scare tactic. First remind patients about that dreadful disease called AIDS and then imply that other dentist are not always meticulous about sterilization.

The principal difference between advertisements and announcements has long been known and established. For example, the 1927 ADA Code of Ethics, specifically distinguished between advertisements and announcements. While advertisements were categorically prohibited, announcements were allowed, provided that no outstanding or prominent features were used dissimilar to those used by colleagues.

Unfortunately, the distinction between announcements and advertisements nowadays is often overlooked. Consequently, opponents of a commercial model of dentistry end up prohibiting any and all public notices, whereas dentists merely desiring to inform patients about their specialty or change of address end up advocating all forms of advertisements. The International Code of Medical Ethics categorically prohibits all self-advertising. All advertising and self-promotion by dentists is prohibited in Germany. Until recently, the General Dental Council in the United Kingdom also prohibited all forms of publicity. In order to allow for announcements, nowadays it allows a dentist to “use publicity or advertising” but only if it is “legal, decent, honest and truthful and has regard for professional propriety” (General Dental Council: Maintaining Standards § 7.1). But what exactly does that mean? The Hong Kong Dental Association probably said it best in its Principles of Ethics for Dental Practitioners: “No dentist should attempt to draw undue attention to himself ... The general rule should be that information is limited to assist the public in obtaining dental services” (art. 2). In other words, announcements are allowed, advertisements are not.
 

Some Statistics
 
Since the early 1980s, both announcements and advertisements by dentists are allowed in the US. A cursory review of the Yellow Pages of most telephone books shows that most dentists limit themselves to announcements. But advertisements now have become widespread as well, from telephone books to newspapers, public benches to radio, and glossy pamphlets to the internet.

Prices of single advertisements in the US West Yellow Pages varies depending on the readership and population of the area for which the book is printed. But the costs greatly exceed the expense of an announcement in the Yellow Pages where the dentist’s name simply appears in the alphabetical listing.

Newspaper advertising can become quite costly as well. One time advertisements in a typical regional US newspaper run $40.00 to $80.00 per square inch (≈ 6.5 cm2).

Local radio stations quote advertising fees at around $100.00 per 30 - 60 second spot, depending on supply and demand. An advertisement should be played three to four times a day, as it takes the consumer that many times before they react to an ad. So, an effective radio advertisement costs $1,200.00 to $1,500.00 per week.

Of course, Internet rates vary depending on which service is chosen. As an example, The Dental Directory at “http://www.teeth.com” will carry a personal web page with the dentist’s biography, photos, logos, and real audio for $55.00 per year. A personal E-Mail address can be procured with them for an additional $45.00 per year.

These numbers make clear that the cost of advertising can become quite considerable. On average, advertising expenses account for $5,230 per year about 1.2 % of a dentist's gross billings (American Dental Association - Survey Center: Survey of Dental Practice: Annual expenses of Operating a Private Practice, 1997).

Acknowledgement

This is the first article in a series of four that was originally prepared for the newsletter of the Nebraska Dental Association. It is reprinted, with minor revisions, with the permission of the NDA.

* All three authors are affiliated with Creighton University. Jos VM Welie, MMedS, JD, PhD is an Associate Professor at the Center for Health Policy and Ethics and the Department of Community and Preventive Medicine. Melissa Simpson, JD, recently graduated from Creighton University School of Law and was a Research Assistant at the Center for Health Policy and Ethics. Gary H Westerman, DDS, MS, holds the Dr. Oscar S. Belzer Endowed Chair and is Professor and Chairman of the Department of Community and Preventive Dentistry, as well as a Faculty Associate at the Center for Health Policy and Ethics.

Contact address:

Dr. Jos VM Welie
Center for Health Policy and Ethics
Creighton University
2500 California Plaza
Omaha, NE 68178, USA
email: jwelie@creighton.edu