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References

Da Rosa Rodolpho PA, Donassollo TA, Cenci MS, Loguérico AD, Moraes RR, Bronkhorst EM 22-Year clinical evaluation of the performance of two posterior composites with different filler characteristics. Dent Mater. 2011; 27:955-963
Beck F, Lettner S, Graf A, Bitriol B, Bauer P Survival of direct resin restorations in posterior teeth within a 19-year period (1996–2015): a meta-analysis of prospective studies. Dent Mater. 2015; 31:958-985
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The commoditization of choice

From Volume 43, Issue 7, September 2016 | Page 605

Authors

F J Trevor Burke

DDS, MSc, MDS, MGDS, FDS(RCS Edin), FDS RCS(Eng), FFGDP(UK), FADM

Professor of Primary Dental Care, University of Birmingham School of Dentistry, St Chad's Queensway, Birmingham B4 6NN, UK

Articles by F J Trevor Burke

Article

As a presenter at hands-on composite meetings, I take the opportunity to ask my audience about the materials that they use. On many occasions in the recent past, when I asked this question, I was astonished to hear that a sizeable proportion did not have any choice regarding the materials that they used! Having been a dental practice principal myself for many years, I realize that a delicate balance often has to be struck between carrying out good dentistry and making sufficient ‘profit’ for the practice to be viable, given that the practice owners are responsible, not only for their own salary, but also for the livelihoods of all of the practice team. However, when the decision regarding the procurement of materials is made purely on cost and not made by the clinician treating the actual patient sitting in his/her chair, there is surely a massive dilemma for the clinician, and indeed strong moral and ethical issues are brought into the equation. Such matters are made even more acute when the decision to purchase a given material is made by an accountant or book-keeper with no knowledge of dentistry other than its profitability. Can this ever be justified? In my view no: yet this is happening up and down the UK on a daily basis and possibly in other parts of the world. Dentists affected by such a regimen must feel hot under the collar every time they use a material which is not optimal for the job, yet they are under pressure to keep themselves employed (in this era when jobs are relatively scarce) rather than to complain to the practice owner(s) or the chief executive of a corporate, if that is who they are working for. The alternative is to purchase the materials of their choice – and I know that some actually do this – but, given that many are already being paid a low rate for the job, they feel disinclined to do so.

The ethical responsibility for clinicians to carry out treatment for patients to the best of their ability lies at the heart of being in a profession. All dental students are reminded of this at graduation but, when they leave the ivory tower, their decision-making may fall into the hands of an unscrupulous employer. The dental students are all taught about evidence-based dentistry, and, as a result, we all know that some dental materials perform better than others1 although it may be difficult to determine that from the literature due to the heterogeneity of reported clinical studies and the fact that many systematic reviews use Randomized Controlled Trials which are scarce in restorative dentistry.2 Notwithstanding such difficulties, it is beholden to the clinician to use materials which perform optimally. The ethical dilemma is when this is not allowed within the practice. Surely the time has come for employers of associate/assistant dentists to realize that they are making sufficient ‘profit’ from their employees and to exercise their moral and ethical responsibility to patients as opposed to shareholders (where these exist) and to use materials which have an evidence base demonstrating their effectiveness, which is generally not the case for own-label materials.3,4 In some instances there may be a further conflict when the practice owner also owns a materials' supply company. It is the clinician rather than the employer who is likely to face a patient complaint or a General Dental Council case if and when treatment expectations are not met because of premature failure due to a substandard material. The choice of material for use in a given clinical situation must be brought back under the control of the clinician, rather than choice becoming a commodity, as it seems to be for some clinicians in the UK.

This Comment could have been called the Uberization of Choice, but the wonderfully original Martin Kelleher thought of the term before me! Readers will, I am sure, enjoy reading his thought-provoking Guest Editorial in this issue. His message and mine concur, in all dental matters, we must not allow procurement of materials – indeed of anything – to shift from a clinical to a financial decision.