Aesthetic, Essential, and Ethical
Bernard Touati, DDS, MS
While discussions on materials and techniques presented in dental conferences and publications have evolved over the years, one subject that has recaptured the interest of the profession is ethics. Before clinicians lecture on this topic with any degree of credibility, they must first ensure that the rules they espouse to their colleagues have already been applied to themselves. When such a gap exists, the message is apt to be poorly received. Ethics cannot exist without dignity and respect toward others.
Ethics applies not only to the representation of slides, data, and results in professional publications but more importantly to the treatment of each patient. It is imperative to preserve the natural tooth structure, to prevent the devitalization or extraction of a tooth without jeopardizing the future of the existing dentition and/or supporting tissues, and without overtreating the patient. The moral obligation of a clinician is to explain -- and also to provide -- the most effective treatment options for a patient, options that could be performed without hesitation on one's self or family members. Unfortunately, the only way to be knowledgeable of these alternatives -- apart from university education and congresses -- is to actively seek them through dental journals and magazines. These sources are continually updated and contain valuable information on novel materials and techniques, as well as reports of scientific trials and clinical applications performed with these innovations. Ethical treatment, whether it be through the use of established modalities or experimental techniques, is initiated only when informed consent has been obtained from the patient.
Not only must a given treatment be ethical, but it must be essential as well. These concerns may be influenced by societal and demographic factors, and must be determined on a patient by patient basis. Although tooth whitening, for example, has evolved into a necessary treatment in the Western hemisphere, it might be regarded as a purely elective procedure in the East. The prospect of performing less treatment may appear financially limiting -- if the need for dental care is reduced, then how is one to maintain a livelihood in this profession? As patients' life expectancies are raised by environmental, medical, and technological advances, however, greater numbers of teeth will require continual treatment, provided they have not been iatrogenically mistreated previously.
It is similarly mandatory that any form of treatment today be aesthetic. Volumes of literature have been generated to establish the efficacy and longevity of aesthetic materials and procedures, which can be performed with success and predictability if these prerequisites are followed by the attending clinician. The Talmud states "We don't see things as they are; we see things as we are." Wouldn't it be more productive for us to continually refine our own sense of ethics before looking to direct energy elsewhere?
*Editor-in-chief of PPAD, private practice, Paris, France
**Head of Ronald E. Goldstein Center for Aesthetic Dentistry, Hadassah Medical Campus, Hebrew University, Jerusalem