CDA Journal Volume 31, Number 10 Journal october 2003 departments 733 The Editor/Ethics, Trust, and Image 737 Impressions/ADA Sessions Heads to San Francisco 771 New Products/Product Listing 790 Dr. Bob/Dogs of Distinction features 749 EMERGENCY MEDICINE IN PEDIATRIC DENTISTRY: PREPARATION AND MANAGEMENT The contemporary dentist must be prepared to manage expeditiously and effectively pediatric dental emergencies. Stanley F. Malamed, DDS 757 SERUM MEPIVACAINE CONCENTRATIONS AFTER INTRAORAL INJECTION IN YOUNG CHILDREN This study leads researchers to conclude that 3 percent mepivacaine should not be used when relatively large volumes of local anesthetic must be administered to small children. Katherine L. Chin, DDS, MS; John A. Yagiela, DDS, PhD; Christine L. Quinn, DDS, MS; Kent R. Henderson, DDS; and Donald F. Duperon, DDS, MS 765 A PREDICTABLE PRECISION CAST FOR MULTI-UNIT SCREW-RETAINED IMPLANT PROSTHESIS: RATIONALE AND TECHNIQUE This article describes a technique derived from the premachined cylinder luting technique with the goal to predictably fabricate a highly precise master cast. Lambert J. Stumpel, III, DDS; Walter H. Haechler, MDT; and Edmond Bedrossian, DDS The Editor Jack F. Conley, DDS Ethics, Trust, and Image raditionally, dentistry has reached an agreement that seeks to been the beneficiary of a improve communication and collab- strong public image. Much oration that will lessen the complexi- of that reputation was at- ty in the payment of dental claims, tributed to the influence of ultimately enabling more-effective a strong Code of Ethics. service to patients. TwiceT in the past decade, we commented in Item: On June 29, the CDA this column on results of public opinion Board of Trustees adopted a plan polls conducted by the Gallup Organization that will help to revitalize the role that showed dentistry placing in the top and importance of the Code of five professions based upon public percep- Ethics in the future of the tions of trust and respect. Based solely upon California Dental Association. memory, the most recent of those polls that We believe that each of these we personally reviewed placed dentistry be- reports and actions is interrelat- tween second and fourth out of all profes- ed in explaining where den- sions surveyed. tistry’s image might presently be In recent years, many events have con- and where we might move it in tributed to an assault on that image. It is the future. easy to identify media activity that has The reference to a Gallup poll survey negatively affected the profession’s image. that measured dentistry’s image in compar- Legal matters involving use of amalgam ison with other professions, appeared in a and Proposition 65, and the ongoing ef- midyear dental newsletter. While we were Many forts of the anti-fluoridationists to under- not able to either confirm the date of the mine dentistry’s preventive efforts are just poll or validate its accuracy, we were not events have a few of the specific issues the media has surprised by this ranking and believe that communicated to the public. it shows that dentistry’s public image is contributed There have been some recent reports probably not as strong as it was a few years to an assault and events that offer a reality check for the ago. We have already listed some of the profession. They provide an opportunity to public issues that probably have negatively on dentistry’s reflect on our current and future efforts to influenced public opinion. There are also improve dentistry’s image. the individual surveys by journalists such image. Item: A recent Gallup poll shows dentistry as one commented on here in July 2002 ti- falling from No. 2 to No. 8 in public opinion tled “A Profession in Decay — Dentists’ when evaluating all professions with regard to Business Practices Increasingly Suspect” honesty, integrity, and trustworthiness. that not only damage the public image of Item: A different Gallup poll dated Aug. the profession but, realistically, point to 18, measuring the image of 25 business and abuses that have been occurring in some industry sectors, found the health care indus- dental practices. try, of which dentistry is a small part, next to In an effort to validate the preceding last in terms of positive image. Gallup poll results, we encountered the Item: On Aug. 20, it was announced that results of a different Gallup poll that eval- the American Dental Association and Aetna uated the public image of 25 business and OCTOBER.2003.VOL.31.NO.10.CDA.JOURNAL 733 The Editor industry sectors in the United States. The Another potential cause of patient dis- health care industry sector rankings were satisfaction and distrust arises out of the alarming. Out of 25 sectors, the only one marketing of cosmetic dentistry. Unlike with a lesser image was the oil and gas in- reparative restorative dentistry, periodontal dustry. You name it — automobile indus- therapy, or endodontic therapy that may try, banking, legal, education, sports, etc. resolve discomfort and restore function, — they all have had a better reputation cosmetic procedures such as bleaching are than the health care industry in each of elective. Elective procedures, particularly if the past three years, according to this they bring only short-term satisfaction, are public survey. far more likely to bring about dissatisfac- A potential Admittedly, dentistry is a very small tion and distrust. This will occur if patients segment of the health care industry, believe that the treatment was neither a cause of patient which includes medicine and hospitals as need nor want, that they were pressured by dissatisfaction the major players. However, we believe the dentist to “purchase” the treatment in that some key factors related to all mem- the first place, and the treatment is evalu- and distrust bers of this sector — namely rising costs ated by another dentist a relatively short and the relationships of dentists and term later with a recommendation to re- arises out of the other health care providers with the insur- place or repeat (i.e., bleaching). Therefore, marketing of ance carriers and benefit plans, may ex- our opinion is that some of the less tradi- plain this group’s unenviable position in tional, newer forms of therapy “marketed” cosmetic the eyes of the public. in dental offices today, if they fail, or fail to Some business practices of insurance live up to the expectation of the patient, dentistry. carriers resulted in the recent ADA legal are more likely to result in a lack of trust, action against some major carriers and are thus reducing the image of the profession part of a problem that has often alienated in general. patients from their dentists. Also, the fail- The ADA agreement reached with ure of many practitioners to educate their Aetna provides hope that in the future, patients about the benefits of their plan greater communication, education, and and to properly manage the claims for understanding can guide the relationships treatment they render, further strains rela- between dentist, patient, and third par- tionships with patients who believe that ties. With time and education, there their benefit plan will cover all of their should be much less opportunity for pa- needed dental treatment. When insuffi- tients to lose trust in their dentists as a re- cient communication between dentist and sult of a misunderstanding of their insur- patient occurs, and patients receive an un- ance benefit programs. expected billing for services or less than Finally, we look forward to seeing a re- anticipated benefits, the result is mistrust newed focus on ethics within the profes- and resentment — not necessarily with sion. The CDA board has taken a very their employer or dental plan, but with small step forward. The task force appoint- the dental practitioner or staff who failed ed to carry out this review has a large re- to properly inform them of what their fi- sponsibility. Bringing ethical principles nancial responsibility would be. Many and values back into the forefront of dental colleagues fail to recognize that it is their practice decision-making in the 21st centu- responsibility to educate patients about ry will be a major factor in helping to re- benefit plans. No one else has that re- store the public image of the dental profes- sponsibility today. sion to previous levels. CDA 734 CDA.JOURNAL.VOL.31.NO.10.OCTOBER.2003 Impressions ADA Session Heads to San Francisco he American Dental Association opportunities designed to enhance the com- will host its 144th Annual munity of dentistry. Session, Thursday, Oct. 23, More than 180 scientific programs are through Sunday, Oct. 26, 2003, planned for the Session. This year’s pro- at the Moscone Center in San gram offers C.E. options for every member t Francisco. The 2003 Session fea- of the dental team — dentists, hygienists, tures a variety of continuing education pro- dental assistants, business managers, busi- grams, technical exhibits, and networking ness assistants, and dental technicians. The OCTOBER.2003.VOL.31.NO.10.CDA.JOURNAL 737 scientific program provides participants ADA Annual Session attendees will with the education needed to enhance their have the opportunity to earn more than professional knowledge and clinical skills. 30 C.E. units and select from more than These in-depth sessions will present the lat- 25 hands-on workshops. In addition, the est developments in dental-related subjects following specialized programs are such as endodontics, esthetic dentistry, con- available: ADA Women’s Health and servative operative dentistry, and finance. Leadership Program, Two-Day Esthetic Forum, Technology Day Program and Exhibits, and the Team Building Program. ADA Session Highlights Session attendees will also have the opportunity to extend their educational ADA/Sonicare Distinguished Speaker Series opportunities beyond the classroom.