Principles

Ethics could be considered to be a moral code, giving a set of principles to guide behaviour. All of us who belong to the healing or caring professions are expected to look after our patients in their best interests, at all times. This is the obligation that society places on us, in return for the trust it places in our hands.

The doctor/patient relationship is underpinned by some fundamental principles, the first of these being ‘beneficence’ – that is, doing good and acting in the patient’s best interests – and ‘non-maleficence’ – that is, doing no harm. This principle dates back to the Hippocratic oath, which also includes the exhortation Primum est non nocere, ‘First and most importantly, do no harm’. This is further supported by a secondary principle of reserving more extreme measures to treat the more extreme conditions.

The two words ‘aesthetic’ and ‘cosmetic’ appear to be very commonly used in surgery and dentistry and are often interchangeable. ‘Cosmetic’ comes from the Greek word cosmeticos and generally implies temporary, superficial or reversible. ‘Aesthetic’ comes from the Greek word aestheticos and is concerned with the perception, the philosophy or the structure of beauty. With its deeper meaning, the term ‘aesthetic’ may appear to be favoured by the medical profession.

We live in an age where various cultural and social expectations associate beauty and appearance with attractiveness, youth, success and status.¹ Added to this, in the presence of a rapidly increasing amount of readily available information, the people who are seeking cosmetic procedures have rising demands and expectations. They may also see themselves more as consumers than as patients. Because aesthetic dentistry may be perceived as an issue to do with their ‘wellness’, they see it as their ‘right’ to have it done.

Procedures

As dentists we have a problem and an ethical dilemma when faced with patients requesting cosmetic treatments that are purely elective and optional, merely in order to enhance the smile or appearance. This is especially the case when it is in the absence of any disease or functional disability or deficiency. The fact is that many procedures may involve considerable and irreversible harm to the existing biological tissues. It has been shown²