Content uploaded by William Murray Thomson
Author content
All content in this area was uploaded by William Murray Thomson
Content may be subject to copyright.
In toda
y
's societ
y
, most people have the desire to look thei
r
best, since ph
y
sical appearance pla
y
s an important role in
a
n individualʼs self-esteem and success. It is human nature
to attribute positive personalit
y
characteristics to attractive
individuals, and such
p
eo
p
le receive favourable treatment
in a variet
y
of situations (Sarwer et al, 2004). There is also
e
vidence that being ph
y
sicall
y
attractive has other benefits.
Even children consider attractiveness a more important
c
riterion than intelli
g
ence in the selection of friends (Clark
a
nd A
y
ers, 1988), and this attitude often continues into
a
dulthood. There is ample evidence that attractive applicants
a
re more likel
y
to receive
j
ob offers than their less attractive
p
eers (Cann et al, 1981; Hamermesh and Biddle, 1994; Biddle
a
nd Hamermesh, 1998); this is es
p
eciall
y
true for women
(
Marlowe et al, 1996
)
. Attractive individuals also tend to earn
m
ore (Hamermesh and Biddle, 1994), and are more likel
y
to gain promotion (Biddle and Hamermesh, 1998). Even in
s
ituations where we would like to think that our a
pp
earance
is of no consequence, research suggests that, whether we like
it or not, our appearance reall
y
does seem to matter (Sarwe
r
e
t al, 2004).
T
he quest for an improved appearance has recentl
y
become s
y
non
y
mous with cosmetic intervention, involvin
g
various health professionals in fields such as plastic surger
y
a
nd dermatolog
y
. For an increasing number of people, an
“
upgrade” in appearance also involves cosmetic dentistr
y
.
A
n “enhanced smile” not onl
y
ma
y
make one look
y
oun
g
er,
but it is also associated with positive attributes such as good
hy
giene, health and success (Priest and Priest, 2004).
Dentistr
y
's image in contemporar
y
fiction and popula
r
c
ulture has undergone a profound change in recent
y
ears
(
Mandel, 1998), havin
g
been
p
ro
p
elled out of the "a
g
e of
a
mputation" and into the "age of augmentation" (Golub-
Evans, 1994). This has been largel
y
due to the widespread
use of dental adhesive technolog
y
introduced in the 1950s
(
Buonocore, 1955). It has been
p
ro
p
osed that dentists will
c
ontinue to experience a growing demand for their services,
largel
y
on the strength of patients' desires for better-looking
s
miles (Christensen, 2002b). This ma
y
be (at least in part)
a
ttributed to the influence of the media on social norms and
e
x
p
ectations
.
Investigations into the impact o
f
the mass me
d
ia on societ
y
h
ave shown that it affects a wide variet
y
of areas, including
m
ental health (Christakis et al, 2004), child development
(
Si
g
norielli, 1990), attitudes toward eatin
g
habits (Thom
p
son
a
nd Heinberg, 1999; Becker et al, 2002), sexual attitudes
a
nd behaviours
(
Zuckerman and Zuckerman, 1985; Ward,
2002), violence among children (Felson, 1996), and suicidal
tendencies
(
Gould and Shaffer, 1986
)
. It is therefore not
unreasonable to assume that the media ma
y
have a simila
r
impact on
d
entistr
y
. In
d
ee
d
, in a recent US surve
y
,
d
entists
c
ited media coverage as the main reason for the increase in
d
emand (b
y
an average of 12.5 percent over the previous five
y
ears, with some dentists re
p
ortin
g
an increase of almost 40
A
B
S
TRA
C
T
T
he popular mediaʼs influence on social norms with respect
to
p
eo
p
leʼs a
pp
earance is likel
y
to have
p
la
y
ed a
p
art in the
r
ecent growth of cosmetic dentistr
y
.
Aims
T
his stud
y
was designed to investigate the manner in which
the popular media have affected the perception and deliver
y
of aesthetic dentistr
y
in New Zealand.
M
et
h
o
d
s
A
nationwide surve
y
was posted to a random sample of
6
00 general dental practitioners (GDPs) requesting socio-
d
emographic details and information on the t
y
pes of aesthetic
d
ental
p
rocedures
p
rovided and the demand for those.
I
nformation was also sought on GDPsʼ awareness of television
p
rogrammes and realit
y
“makeover” television shows (such
a
s “Extreme Makeover”) covering issues related to aesthetic
d
entistr
y
, together with the impact of such programmes (and
that of different
p
rint media) on their
p
atientsʼ
p
erce
p
tions of,
a
n
d
d
eman
d
f
or, aesthetic
d
entistr
y
.
R
esu
l
ts
T
he response rate was 81.2 percent. A ma
j
orit
y
of participants
p
erceived an increased demand for tooth whitening (77.8
p
ercent) and veneers (54.8
p
ercent) subse
q
uent to the airin
g
of those television programmes, with 85.2 percent reporting
p
atients mentioning “Extreme Makeover” in relation to
a
esthetic dentistr
y
. Some 56.8 percent believed that patients
h
ad higher aesthetic expectations subsequent to the airing of
that
p
ro
g
ramme. An increased demand for tooth whitenin
g
w
as reported b
y
more female than male GDPs, and also
b
y
y
ounger practitioners and those who were practising in
l
arger centres. Similar patterns were observed with respect to
G
DPs recommendin
g
tooth whitenin
g
for
p
atients. Womenʼs
m
agazines were ranked b
y
GDPs as having the highest impact
on patientsʼ perceptions of aesthetic dentistr
y
.
C
onclusio
n
T
he popular media (especiall
y
television) appear to have
h
ad an im
p
act on the demand for various aesthetic dental
p
rocedures in New Zealand
.
I
NTR
O
D
UC
TI
O
N
Dentistr
y
has evolved over the past 50
y
ears from being
p
rimaril
y
a health service to a h
y
brid profession (Mandel,
1998; Christensen, 2002a), whereb
y
not onl
y
pain and
oral disease are treated, but elective aesthetic services are
increasin
g
l
y
bein
g
p
rovided (Morle
y
, 1999; Priest and Priest,
2
004), often at the request of the patient. Social pressure due to
changing norms ma
y
be the driving force behind this aesthetic
r
evolution, fuelled b
y
the media's portra
y
al of beaut
y
.
T
he impact of the popular media on cosmetic dentistr
y
ANNA H THEOBALD
,
BENEDICTA KJ WONG
,
ANDREW N QUICK AND W MURRAY THOMSON
New Zealand Dental Journal 102, No. 3: 58–63; September 200
6
S
EPTEMBER 200
6
N
EW ZEALAND DENTAL
J
OURNAL
verifiable
cpd paper
58
P
eer-reviewed article. Received Novem
b
er 2005. Revised text
accepted April 200
6.
articles
31038 Sept 06 Dental 1 .indd Sec3:5931038 Sept 06 Dental 1 .indd Sec3:59 9/4/06 12:04:27 PM9/4/06 12:04:27 PM
p
ercent for aesthetic dental procedures) (American Academ
y
of Cosmetic Dentistr
y
, 2004). However, media ex
p
osure ma
y
n
ot alwa
y
s portra
y
dentistr
y
in a positive light: a recent surve
y
conducted b
y
the Australian Societ
y
of Orthodontists (ASO)
h
ighlighted the negative impact of a current affairs television
p
ro
g
ramme on the
p
ublicʼs
p
erce
p
tion of orthodontic treatment
(
Australian Societ
y
of Orthodontists, 2004). Thus, the mediaʼs
influence on dentistr
y
can be both positive and negative
.
T
o date, little is known of the demand for aesthetic dentistr
y
in New Zealand. This stud
y
aimed to investigate the manne
r
in which the
p
o
p
ular media (such as television and
p
rinted
m
e
d
ia) have a
ff
ecte
d
the perception o
f
, an
d
d
eman
d
f
or,
a
esthetic dentistr
y
in New Zealand
.
M
ETH
O
D
A
nationwide postal surve
y
of 600 New Zealand general
d
ental practitioners was carried out between April and June
2
005. The sample was randoml
y
selected from the 2003
New Zealand Dental Re
g
ister (with
p
ermission from the
D
ental Council of New Zealand). Specialist dentists were
e
xcluded from the sampling frame prior to drawing the sample.
The stud
y
was approved b
y
the Universit
y
of Otago Ethics
C
ommittee.
T
he followin
g
information was
g
athered: socio-demo
g
ra
p
hic
d
etails; the t
y
pes of aesthetic dental procedure practised;
the current demand for aesthetic dental procedures among
p
atients in different age groups; the dentists' awareness of
current affairs television
p
ro
g
rammes and realit
y
makeove
r
television shows (that is, programmes in which volunteers
undergo a range of cosmetic and surgical enhancements aimed
a
t dramaticall
y
improving their appearance) covering issues
r
elated to aesthetic dentistr
y
, and the impact such programmes
m
a
y
have had on their
p
atients; and dentists' o
p
inions of which
t
y
pes o
f
printe
d
me
d
ia appear to have the greatest e
ff
ect on
their patients' awareness of aesthetic dentistr
y.
F
or reporting purposes, respondents were grouped b
y
g
ender, number of
y
ears in
p
ractice (0-14, 15-30 and 30+
y
ears), and site of practice (“ma
j
or cit
y
”, “provincial cit
y
”
a
nd “other centre”). Locations classified as “ma
j
or cities”
included Auckland, Hamilton, Christchurch, Dunedin, Porirua,
Upper Hutt, Lower Hutt, Wellington, North Shore, Waitakere,
Manukau and Pa
p
akura. Locations classified as “
p
rovincial
cities” included Whangarei, Tauranga, Rotorua, Gisborne,
H
astings, Napier, New Pl
y
mouth, Wanganui, Palmerston
North, Masterton, Nelson, Blenheim, Kaikoura, Timaru and
I
nvercar
g
ill. The remainin
g
locations were classified as
“o
t
h
er”
.
P
articipation incentives were offered in the form of seven
p
rize hampers, generousl
y
sponsored b
y
several dental suppl
y
companies. Prize winners were randoml
y
selected from those
w
ho com
p
leted and returned the surve
y.
T
he surve
y
questionnaire was posted with a covering lette
r
e
xplaining the stud
y
ʼs purpose, and a freepost envelope was
included for returning completed forms. One month later, a
s
econd wave of forms was sent to the 2
9
0 dentists who had
n
ot
y
et responded. This was accompanied b
y
an amended
covering letter.
T
he surve
y
responses were entered into an electronic
d
atabase, and then anal
y
sed using the Statistical Package fo
r
the Social Sciences (SPSS; Version 13.0; www.s
p
ss.com).
A
ssociations between categorical variables were tested fo
r
s
tatistical significance using the Chi-square test, with the
a
lpha level set at 0.05. Multiple logistic regression was used
to control confoundin
g
and derive ad
j
usted odds ratios
.
R
E
SU
LT
S
D
escri
p
tion of sam
p
le
O
f the original random sample of 600 general dental
p
ractitioners, 47 were outside the sampling frame, eithe
r
because the
y
were retired or deceased, or because thei
r
q
uestionnaires had been returned due to incorrect address
d
etails. The 449 questionnaires returned from the remaining
5
53 general dental practitioners
y
ielded a response rate of
81.2 percent. The socio-demographic characteristics of the
p
articipants are summarised in Table I. Respondents were
n
ormall
y
distributed relative to their a
g
e and number of
y
ears
s
ince qualif
y
ing. Their mean age was 46.5
y
ears (s.d. 11.8),
a
nd the mean number of
y
ears in practice was 23.2
y
ears (s.d.
11.5). There were more males than females, at 76.6 percent and
23.4
p
ercent res
p
ectivel
y
. Just under half the sam
p
le had been
in practice for 15 to 30
y
ears, and almost 60 percent practised
in a ma
j
or cit
y
. The proportion of females was greater among
those who had been in practice for 30 or fewer
y
ears
.
A
est
h
et
i
c
d
enta
l
p
roce
d
ures
A
ll participants reported offering at least one t
y
pe of
a
esthetic dental procedure. A further breakdown of the
a
esthetic dental procedures offered according to different
p
ractitioner characteristics is
p
resented in Table II. Unless
otherwise indicated, onl
y
statisticall
y
significant differences
a
re described. There was a gender difference for implant
r
estorations, with more males than females offering these.
T
ooth whitenin
g
and veneers were offered b
y
a lar
g
e
r
p
roportion of practitioners who had spent fewer
y
ears in
p
ractice. With the exception of orthodontics, aesthetic dental
p
rocedures were offered b
y
more cit
y
-based practitioners than
b
y
those in smaller centres
.
T
oot
h
w
hi
ten
i
n
g
Most of the participants (97.0 percent) reported that thei
r
p
atients asked for tooth whitening, while 37.9 percent of
d
entists reported recommending professional tooth whitening
to their
p
atients. Partici
p
ants re
p
orted the hi
g
hest demand
f
or tooth whitening procedures among their 31-40-
y
ear-old
p
atients (52.0 percent), followed b
y
those aged 41-50
y
ears
(
32.4 percent). When asked about their preferred method of
T
able I. Practice characteristics b
y
gende
r
G
ende
r
(row
p
ercenta
g
e)
M
a
l
e
F
e
m
a
l
e
T
o
t
a
l
(column
percentage
)
Y
ears
i
n pract
i
ce
a
0
to 14 68
(
61.3
)
43
(
38.7
)
b
111
(
24.7
)
1
5 to 30 147
(
71.7
)
58
(
28.3
)
205
(
45.7
)
31 or more 115
(
98.3
)
2
(
1.7
)
117
(
26.1
)
Practice settin
g
Ma
j
or cit
y
192 (72.2) 74 (27.8) 266 (59.2
)
P
rovincial cit
y
78 (86.7) 12 (13.3) 90 (20.1
)
O
ther 74 (79.6) 19 (20.4) 93 (20.7
)
T
o
t
a
l 344
(
76.6
)
105
(
23.4
)
449
(
100.0
)
a
Information not supplied b
y
16 individuals
.
b
p<0.00
1
The impact of the media
–
T
HE
O
BALD ET AL
5
9
31038 Sept 06 Dental 1 .indd Sec3:6031038 Sept 06 Dental 1 .indd Sec3:60 9/4/06 12:04:31 PM9/4/06 12:04:31 PM
tooth whitening, 66.8 percent of GDPs preferred using take-
h
ome tra
y
s, 21.1 percent preferred in-surger
y
whitening, and
the remainder had no preference for either method. Females,
cit
y
-based or
y
ounger practitioners were more likel
y
to offe
r
tooth whitenin
g
to their
p
atients.
Reality makeover television programmes
S
ome 77.8 percent of GDPs perceived an increased demand
f
or tooth whitenin
g
subse
q
uent to the airin
g
of realit
y
makeove
r
television programmes such as “Extreme Makeover”. The
f
indings relating to those programmes are presented in Table
I
II. Nearl
y
all respondents were aware of “Extreme Makeover”
a
t the time of the surve
y
, althou
g
h onl
y
three-
q
uarters had seen
the programme. Respondents reported becoming aware of it
through their patients (52.8 percent), friends and famil
y
(50.0
p
ercent), or colleagues (23.6 percent; multiple responses were
p
ermitted to this item, and therefore the percentages do not
a
dd u
p
to 100
p
ercent). Over half believed that their
p
atients
m
a
y
now have higher aesthetic expectations of their dental
treatment after viewing such programmes, while more than 85
p
ercent have had patients mention that particular programme
w
ith res
p
ect to dental aesthetics. Tooth whitenin
g
and veneers
w
ere the aesthetic dental procedures that were reported to
h
ave had a substantiall
y
increased demand since the airing
of such programmes
.
A
higher proportion of female GDPs reported having
w
atched “Extreme Makeover” and having perceived a greate
r
d
emand for tooth whitening, and this was also true of more
r
ecent graduates (who also reported having more patient
e
n
q
uiries as a result of the
p
ro
g
ramme). Practitioners in ma
j
o
r
c
ities were also more likel
y
to perceive an increased demand
f
or tooth whitening among their patients than those from othe
r
c
entres. Those who had watched “Extreme Makeover” were
m
ore likel
y
to
p
erceive hi
g
her aesthetic ex
p
ectations amon
g
p
atients, and an increased demand for tooth whitening, veneers
a
nd crowns and bridges. After controlling for age, gender and
location of practice using logistic regression, those who had
w
atched “Extreme Makeover” were more likel
y
to perceive
a
hi
g
her demand for veneers (Odds Ratio 2.6; 95
p
ercent
c
onfidence interval 1.6, 4.5) or for tooth whitening (OR 2.7;
95 percent CI 1.5, 4.6); gender and practice location were no
longer significant predictors, although age was, with olde
r
p
ractitioners less likel
y
to
p
erceive a hi
g
her demand for eithe
r
c
osmetic procedure
.
C
urrent affairs television programmes
T
his section of the surve
y
was based on a s
p
ecific e
p
isode
(
“Straight Talk”) of the current affairs programme “60
Minutes”. It examined the issues of orthodontic extractions,
e
arl
y
treatment and functional appliances. More than one-
T
able II - Aesthetic dental procedures offered, b
y
practitioner characteristics (brackets contain percentages
)
Typ
e o
f
p
rocedure o
ff
ere
d
Tooth whitenin
g
Veneers Aesthetic crowns Implants Orthodontic
s
G
ende
r
Female 94
(
89.5
)
91
(
86.7
)
94
(
89.5
)
44
(
41.9
)
a
19
(
18.1
)
Male 310 (90.1) 288 (83.7) 316 (91.9) 189 (54.9) 67 (19.5
)
Y
ears
i
n pract
i
ce
0
to 14 106
(
95.5
)
a
97
(
87.4
)
a
106
(
95.5
)
59
(
53.2
)
22
(
19.8
)
1
5 to 30 191
(
93.2
)
185
(
90.2
)
191
(
93.2
)
114
(
55.6
)
43
(
21.0
)
31 or more 97
(
82.9
)
89
(
76.1
)
105
(
89.7
)
54
(
46.2
)
19
(
16.2
)
Practice settin
g
Ma
j
or cit
y
246 (92.5) 233 (87.6) 247 (92.9) 148 (55.6) 43 (16.2
)
P
rovincial cit
y
78 (86.7) 73 (81.1) 80 (88.9) 45 (50.0) 23 (25.6
)
O
ther 80 (86.0) 73 (78.5) 83 (89.2) 40 (43.0) 20 (21.5
)
A
ll combined 404 (90.0) 379 (84.4) 410 (91.3) 233 (51.9) 86 (19.2
)
a
P
<0.05
T
able III - Watching of “Extreme Makeover” and subsequent demand for aesthetic dental procedures, b
y
practitioner characteristics (brackets
c
ontain percentages
)
H
ave watched Have had related Perce
i
ved h
ig
her Perce
i
ved h
ig
her Perce
i
ved h
ig
her
“E
xtreme Makeover
”
pat
i
ent enqu
i
r
i
es pat
i
ent expectat
i
ons pat
i
ent demand for pat
i
ent deman
d
tooth wh
i
ten
i
n
g
for veneer
s
G
ende
r
Female 90
(
85.7
)
a
92
(
87.6
)
65
(
61.9
)
82
(
86.3
)
a
56
(
59.6
)
Male 252
(
73.7
)
287
(
84.4
)
186
(
55.2
)
237
(
75.2
)
166
(
53.4
)
Y
ears in
p
ractice
0
to 14 94
(
84.7
)
a
100
(
90.1
)
a
61 (55.0) 90 (87.4
)
a
6
2 (
6
0.2
)
a
1
5 to 30 171 (83.4) 181 (88.3) 125 (61.3) 159 (80.7) 119 (60.1
)
31 or more 66 (57.4) 84 (74.3) 58 (52.3) 60 (61.2) 35 (37.6
)
Practice settin
g
Ma
j
or cit
y
212 (79.7) 227 (86.3) 153 (58.4) 203 (82.9
)
a
142
(
58.9
)
P
rovincial cit
y
67 (74.4) 78 (86.7) 52 (58.4) 61 (74.4) 43 (52.4
)
O
ther 63
(
69.2
)
74
(
80.4
)
46
(
50.5
)
55
(
66.3
)
37
(
45.1
)
A
ll
co
mb
i
ne
d
342 (76.5) 379 (85.2) 251 (56.8) 319 (77.8) 222 (54.8
)
a
P
<0.05
S
EPTEMBER 200
6
NEW ZEALAND DENTAL JOURNAL
60
31038 Sept 06 Dental 1 .indd Sec3:6131038 Sept 06 Dental 1 .indd Sec3:61 9/4/06 12:04:31 PM9/4/06 12:04:31 PM
third of respondents were aware of the programme (Table
I
V
)
, but fewer than half of these had watched it, while others
h
ad become aware of it mainl
y
through colleagues (16.7
p
ercent) or patients (13.1 percent). The data which follow
a
re based on the 184 who were aware of this programme.
Just over half (50.6
p
ercent) believed that it was harmful to
orthodontics, but most (94.4 percent) believed that it was not
h
armful to their own practice. Since its airing, 45.8 percent
r
eported having related patient enquiries; 23.3 percent
r
eported an increase in their own awareness of functional
app
liances; 16.7
p
ercent re
p
orted an increased
p
rovision of
f
unctional appliances; and 10.2 percent reported a decrease
in the number of orthodontic extractions. Moreover, 40.4
p
ercent reported greater resistance to orthodontic extractions
in their
p
atients, while 44.0
p
ercent believed that the
p
rogramme was biased. While there were no significant
d
ifferences b
y
gender,
y
ears in practice or practice location,
a
greater percentage of practitioners who offer orthodontics
w
ere aware of (and had seen) the programme, and the
y
also
r
e
p
orted havin
g
more related
p
atient en
q
uiries (Table IV).
Moreover, a greater percentage o
f
practitioners in ma
j
or cities
r
eported increased awareness of functional appliances afte
r
the programme was aired. Practitioners in provincial cities
w
ere more likel
y
to have become aware of the
p
ro
g
ramme
through their colleagues
.
P
rint m
ed
i
a
P
ractitioners were asked to rank various com
p
onents
of the print media (from 1 to 5, lowest to highest impact)
a
ccording to their perceived impact on patientsʼ perceptions
of aesthetic dentistr
y
. Womenʼs magazines were deemed to
h
ave the hi
g
hest im
p
act (mean = 3.9), followed b
y
g
ossi
p
m
agazines (3.5), health/fitness magazines (3.5), and aesthetic
d
entistr
y
brochures (3.4). Current affairs magazines (2.7) and
n
ewspapers (2.7) were rated as having the lowest impact.
Nearl
y
all participants (90.1 percent) believed that television
h
as a
g
reater im
p
act than
p
rint media on the demand fo
r
a
esthetic
d
entistr
y
. No
d
i
ff
erence in opinion was note
d
b
y
gender or practice setting, but a significantl
y
lower percentage
(
83.6 percent) of practitioners with 30+
y
ears in practice
s
hared this o
p
inion than their
y
oun
g
er counter
p
arts (where
the proportions b
y
length of time in practice were as follows:
1–14
y
ears, 94.5
p
ercent; 15–30
y
ears, 90.6
p
ercent).
D
I
SCUSS
I
ON
T
his stud
y
has found that the
p
o
p
ular media have a
m
easurable impact on dental practice and GDPsʼ perceptions
of the publicʼs expectations and attitudes towards aesthetic
d
entistr
y
. However, before the findings can be discussed and
p
laced in context, it is necessar
y
first to examine the issue
of their
g
eneralisabilit
y
. This, in turn, is de
p
endent u
p
on
the representativeness of the responding sample. At ove
r
80 percent, the response rate was high b
y
modern standards
(
Locker, 2000), and the proportion of female respondents
(
23.4
p
ercent; 95
p
ercent CI 19.5
p
ercent, 27.3
p
ercent) was
s
imilar to the 25.5 percent of female dentists in 2003 (Dental
C
ouncil of New Zealand, 2004). Together, these suggest that
the sample was representative of practising dentists in New
Z
ealand, and that the findings ma
y
be generalised to that
p
o
p
ulation with confidence
.
Aesthetic dental procedures
A
ll practitioners reported offering at least one aesthetic dental
p
rocedure, with onl
y
orthodontics offered b
y
a minorit
y
of
r
espondents. Implant dentistr
y
was offered b
y
j
ust over half, with
m
ore male practitioners than females doing so. This supports the
f
indings of Reid et al (2005), who noted a similar difference.
A
lmost all of the different t
yp
es of aesthetic dental
p
rocedures
—
a
nd tooth whitening and veneers in particular—were offered
m
ore extensivel
y
in large cities than in provincial cities or othe
r
locations, perhaps due to cit
y
patients being more appearance-
c
onscious, and the practitioners adapting their service mix to meet
this ex
p
ressed demand. The exce
p
tion was orthodontics, and this is
p
ossibl
y
due to orthodontic specialists being largel
y
concentrated
in the ma
j
or cities, thus requiring practitioners in provincial towns
a
nd other locations to provide a more extensive range of treatment
o
p
tions, includin
g
orthodontics. That more recent
g
raduates
w
ere more likel
y
to offer and recommend procedures such as
tooth whitening ma
y
be due to their older counterparts being less
p
repared to embrace the new age of aesthetic dentistr
y
(possibl
y
d
ue to their having been trained in an era where the primar
y
focus
of treatment was to eradicate disease
)
.
T
able IV - Awareness of “Straight Talk” and subsequent related patient enquiries, b
y
different practitioner characteristics (brackets contain
p
ercentages
)
Aware of “
S
trai
g
ht Talk” Have seen “
S
trai
g
ht Talk” Have had related patient enquirie
s
G
ende
r
Female 44
(
41.9
)
18
(
37.5
)
24
(
54.5
)
Male 140 (40.9) 69 (45.7) 58 (42.0
)
Y
ears
i
n pract
i
ce
0
to 14 48 (4
3
.2) 2
3
(44.2) 2
3
(47.9
)
1
5 to 30 92 (45.1) 36 (37.1) 42 (46.2
)
31 or more 38
(
32.8
)
24
(
54.5
)
14
(
37..8
)
Practice settin
g
Ma
j
or cit
y
114 (42.9) 54 (43.9) 48 (42.9
)
P
rovincial cit
y
39 (43.8) 15 (37.5) 18 (47.4
)
O
ther 31
(
33.7
)
18
(
50.0
)
16
(
50.0
)
T
yp
e of
p
ractitione
r
Does not offer orthodontics 127
(
35.1
)
a
55
(
38.7
)
a
47
(
37.6
)
a
O
ffers orthodontics 57 (67.1) 32 (56.1) 35 (61.4
)
A
ll
co
mb
i
ne
d
184 (41.2) 87 (47.3) 82 (45.8
)
a
P
<0.05
The impact of the media
–
T
HE
O
BALD ET AL
61
31038 Sept 06 Dental 1 .indd Sec3:6231038 Sept 06 Dental 1 .indd Sec3:62 9/4/06 12:04:32 PM9/4/06 12:04:32 PM
Where patient demand is concerned, the age group with
the hi
g
hest re
p
orted demand for tooth whitenin
g
p
rocedures
w
as patients aged 31 to 50
y
ears old (the “bab
y
boomers”).
A
US stud
y
also reported that this age group had the greatest
d
emand for cosmetic dental procedures (American Academ
y
of Cosmetic Dentistr
y
, 2004). Furthermore, it has been
d
escribed as comprising the largest target market for aesthetic
d
ental services, being both more concerned with retaining a
y
outhful appearance and able to pa
y
for such care (Priest and
P
riest, 2004
)
.
Television and the perceived demand
f
or aesthetic
d
entistr
y
F
emale
p
ractitioners and those with fewer
y
ears in
p
ractice
w
ere more likel
y
to have watched realit
y
makeover television
p
rogrammes such as “Extreme Makeover”. Those who had
w
atched such programmes were also more likel
y
to perceive
a
greater demand, suggesting that the greater awareness
a
mon
g
females and
y
oun
g
er dentists had been at least
p
artl
y
influenced b
y
television.
While there are man
y
positive spin-offs from greater media
coverage of aesthetic dentistr
y
through realit
y
makeove
r
television
p
ro
g
rammes, there are also some ne
g
ative
consequences. Patients' expectations ma
y
be unrealistic, as
the transformations depicted in these programmes are often
p
ortra
y
ed as instant, and treatment appears to be homogenous,
r
egardless of the patient's individual needs. For example,
s
everel
y
mali
g
ned teeth are often seen to under
g
o “instant
orthodontics” to enhance smiles without the waiting time
of conventional orthodontics (Spear, 2004). Our findings
s
uggest that the demand has significantl
y
increased for tooth
w
hitenin
g
and veneers (and it is no accident that these are the
two main treatment modalities used in such programmes).
S
ubsequentl
y
, dentists ma
y
be placed under greater pressure to
give in to patientsʼ demands when the expressed need for such
p
rocedures among patients does not correspond to the clinical
indications for treatment. This can
p
lace the dental
p
rofessional
in a quandar
y
: is it ethical to provide what the patient demands,
irrespective of what is best for them, or ought one to refuse
treatment, or refer the patient to someone who will meet thei
r
d
emands (and thereb
y
risk losin
g
oneʼs
p
atient)?
C
urrent affairs television programmes
O
ur stud
y
indicates that
j
ust over half of the practitioners
w
ho were aware of the
6
0 Minute
s
p
ro
g
ramme “Strai
g
ht Talk”
believed it to be harmful to orthodontics, and almost as man
y
believed it t
o
be biased. A small number believed that it was
h
armful to their practice. An Australian surve
y
of orthodontists
conducted in September 2004 investigated the effects of the
s
ame
p
ro
g
ramme, and re
p
orted that three-
q
uarters believed that
the programme was harmful to the specialit
y
of orthodontics,
w
hile more than one quarter believed that their own practice
a
lso suffered (Australian Societ
y
of Orthodontists, 2004).
These estimates considerabl
y
exceed those of our stud
y
, but
the ASO stud
y
surve
y
ed onl
y
orthodontists. Moreover, the
p
rogramme was aired in both countries in August 2003, but
m
ore time had elapsed (20 months) before the New Zealand
s
tud
y
than before the ASO surve
y
(12 months). Nearl
y
half
(
40.4
p
ercent) of the surve
y
ed GDPs re
p
orted an increased
r
esistance to ortho
d
ontic extractions subsequent to the
p
rogrammeʼs airing, indicating that some members of the
p
ublic were affected b
y
it. This suggests that the media are
p
owerful in influencin
g
p
ublic
p
erce
p
tions, and em
p
hasizes
the need for the profession to take leadership in raising public
a
wareness of the evidence on controversial dental issues, and
in
g
au
g
in
g
p
ublic o
p
inion on such issues.
The print media
Women's magazines were ranked as having the highest
im
p
act on
p
atients'
p
erce
p
tions of aesthetic dentistr
y
,
f
ollowed b
y
gossip magazines. Since it has been shown that
m
ore females request aesthetic dental procedures (American
A
cadem
y
of Cosmetic Dentistr
y
, 2004), this ranking is hardl
y
s
ur
p
risin
g
. While most of our
p
artici
p
ants believed that
television has a greater impact than the print media in this
r
egard, a smaller proportion of practitioners with 30+
y
ears
in practice shared this view. This viewpoint ma
y
reflect the
increasing role of (and differential exposure to) television
a
cross
ag
e
g
rou
p
s
.
CO
N
C
L
US
I
O
N
F
emale
p
ractitioners and those with fewer
y
ears in
p
ractice had perceived a greater demand for various
a
esthetic dental procedures, and were also more likel
y
to
offer them. Cit
y
-based practitioners were also more likel
y
than their more rural counterparts to do so. We conclude
that the
p
o
p
ular media (es
p
eciall
y
television) a
pp
ear to
h
ave ha
d
an impact on the
d
eman
d
f
or various aesthetic
d
ental procedures in New Zealand, affecting mainl
y
tooth
w
hitening and veneers
.
A
C
KN
O
WLED
G
MENT
S
T
he authors would like to acknowledge and thank Henr
y
S
chein Regional, Shalfoon, Oral-B, Gunz Dental, New Zealand
D
ental Su
pp
lies, Oraltec, BD, Arthur Hall Orthodontics and
H
ealthcare Essentials for sponsoring the prize incentives,
a
nd ProudMouth Caring Dentistr
y
for generousl
y
funding
the postage costs. We would also like to thank Mrs Wilma
Neilson for her time and assistance. Finall
y
, all respondents
a
re thanked for takin
g
p
art.
R
EFEREN
C
E
S
A
merican Academ
y
of Cosmetic Dentistr
y
(2004). North American
S
urve
y
: The state of cosmetic dentistr
y
. htt
p
://www.aacd.com/media
/
r
eleases/2004 percent20National percent20Surve
y
.pdf
A
ustralian Societ
y
of Orthodontists (2004). ASO Member Surve
y
–
2
004.
Australian Society of Orthodontists Newsletter
September
r
2
004, 1
3
.
Becker AE, Burwell RA, Gilman SE, Herzog DB and Hamburg
P
(2002). Eating behaviours and attitudes following prolonged
e
xposure to television among ethnic Fi
j
ian adolescent girls.
B
riti
sh
J
ournal of Psychiatry 180: 50
9
-514
.
Biddle JE and Hamermesh DS (1998). Beaut
y
, productivit
y
and
d
iscrimination: law
y
ersʼ looks and lucre.
J
ournal of La
b
or Economics
1
6: 172-201
.
Buonocore MA (1955). A simple method of increasing the adhesion
of acr
y
lic materials to enamel surfaces (abstract). Journal of Dental
R
e
s
earc
h
34: 74
9.
C
ann A, Siegfried WD and Pearce L (1981). Forced attention to
s
pecific applicant qualifications: impact on ph
y
sical attractiveness
a
nd sex of applicant biases.
P
ersonnel Ps
y
cholo
gy
34: 65-75
.
C
hristakis DA, Zimmerman FJ, DiGiuseppe DL and McCart
y
C
A (2004). Earl
y
television exposure and subsequent attentional
p
roblems in children.
P
e
d
iatric
s
113
(
4
)
: 708-71
3
C
hristensen GJ (2002a). The tooth-whitening revolution.
J
ournal of
the American Dental A
ss
ociatio
n
133: 1277-127
9.
S
EPTEMBER 200
6
NEW ZEALAND DENTAL JOURNAL
6
2
31038 Sept 06 Dental 1 .indd Sec3:6531038 Sept 06 Dental 1 .indd Sec3:65 9/4/06 12:04:40 PM9/4/06 12:04:40 PM
C
hristensen GJ (2002b). Are prosthodontics a vital part of dentistr
y
?
J
ournal of the American Dental Associatio
n
133: 647-648
.
C
lark ML and A
y
ers M (1988). The role of reciprocit
y
and proximit
y
in
j
unior high school friendships.
J
ournal of Youth an
d
A
d
olescence
1
7: 403-11
.
Dental Council of New Zealand (2005). 2004 Workforce Anal
y
sis.
Wellington: Dental Council of New Zealand.
Felson RB
(
1996
)
Mass media effects on violent behaviour. Ann
ua
l
R
eview of Sociolog
y
22: 103-128
.
Felton DA
(
2004
)
. Do no harm
(
editorial
)
.
J
ournal of Prostho
d
ontics
1
3
(
2
)
: 71-72
.
G
olub-Evans J (1994). Unit
y
and variet
y
: essential in
g
redients of a
s
mile design.
C
urrent
O
pinions in
C
osmetic Dentistr
y
2: 1-5
.
G
ould MS and Shaffer D (1986). The impact of suicide in television
movies. Evidence of imitation.
T
he New Englan
d
Journal of Me
d
icine
315: 6
9
0-6
9
4
.
Hamermesh DS and Biddle JE (1994). Beaut
y
and the labor market.
A
m
e
ri
ca
n E
c
onomi
c
R
e
vi
ew
8
4: 1174-
9
4
.
Locker D (2000). Response and non-response bias in oral health
s
urve
ys
.
J
ournal of Public Health Dentistry 60: 72-81
.
Mandel I (1998). The image of dentistr
y
in contemporar
y
culture.
J
ournal of the American Dental Associatio
n
12
9
: 607-613
.
Marlowe CM, Schneider SL and Nelson SE
(
1996
)
. Gender and
a
ttractiveness biases in hirin
g
decisions: are more ex
p
erienced
mana
g
ers less biased?
J
ournal of Applie
d
Psychology 81: 11-
2
1
.
Newton JT, Daven
p
ort-Jones L, Idle M, Patel M, Setchell A et al
(
2001). Patients' perceptions of general dental practitioners: The
influence of ethnicit
y
and sex of dentist.
S
ocial Behaviour an
d
P
ersonalit
y
2
9
: 601-606
.
Morle
y
J (1999). The role of cosmetic dentistr
y
in restoring a
y
outhful appearance.
J
ournal of the American Dental Association
1
30: 1166-1172
.
P
riest G an
d
Priest J (2004). Promoting esthetic proce
d
ures in the
p
rosthodontic practice.
J
ournal of Prostho
d
ontics 1
3
: 111-117
.
Reid D, Leichter JW and Thomson WM (2005). Dental implant use
in New Zealand in 2004.
New Zealand Dental Journal
101: 12-16.
l
S
arwer DB, Magee L and Clark V (2004). Ph
y
sical appearance
a
nd cosmetic medical treatments: ph
y
siological and socio-cultural
influences. Journal of Cosmetic Dermatology 2: 2
9
-3
9.
S
ignorielli N (1990). Children, television, and gender roles. Messages
a
nd impact.
J
ournal of A
d
olescent Health Care 11: 50-58.
S
pear FM (2004). The esthetic correction of anterior dental mal-
a
lignment: conventional vs. instant (restorative) orthodontics.
J
ournal of the Californian Dental Associatio
n
32: 133-141
.
T
hompson JK and Heinberg LJ (1999). The media's influence on bod
y
image disturbance and eating disorders: we've reviled them, now can
w
e rehabilitate them?
J
ournal of Social Issues 55: 33
9
-344
.
Ward LM (2002). Does television exposure affect emerging adults'
a
ttitudes and assumptions about sexual relationships? Correlational
a
nd experimental confirmation.
J
ournal of Youth an
d
A
d
olescence
31: 1-15
.
Z
uckerman DM and Zuckerman BS (1985). Televisionʼs impact on
c
hildren. Pe
d
iatric
s
75: 233-240
.
Anna H Theobald, BDS (Otago)
Benedicta KJ Won
g
, BD
S
(
O
ta
g
o)
Andrew N
Q
uick, B
S
c, M
C
hD
(S
tell
)
W
. Murray Thomson, BDS, MComDent (Otago), MA
(
Leeds
)
, PhD
(
Adel
)
D
epartment of Oral Science
s
S
chool of Dentistr
y
T
he Universit
y
of Otago
P
O Box 647
D
unedi
n
C
orresponding author: Murra
y
Thomso
n
E-mail: murra
y
.thomson@stonebow.otago.ac.nz
The impact of the media
–
T
HE
O
BALD ET AL
63
31038 Sept 06 Dental 1 .indd Sec3:6631038 Sept 06 Dental 1 .indd Sec3:66 9/4/06 12:04:43 PM9/4/06 12:04:43 PM
