Like most things, our ability to have a good whinge about things is vastly amplified by the channels of social media.

It is easy to let this depression and anxiety get to us, and then it somewhat becomes self-fulfilling. Having accepted that dentistry is “over” and that patients want easy, cheap, fast, we can focus on providing that, which incidentally, then attracts the patients that want easy, cheap and fast.

Often I get asked if there is any point trying to do better 

Upon questioning however, most people will reveal that there is a part of their life where they don’t care about easy, cheap and fast. Frequently someone asking if anyone values quality anymore will have an unpronounceable (unless you are Swiss) hand made watch with “complications”. Or maybe they are into gaming and have an incredibly expensive hand made computer.

Such things are not sensible of course but are emotional purchases made with enthusiasm.

While it is often not seen as such, the enormous emotion that is attached to dentistry, is I think, a hugely positive thing. We often are drained by our patient’s emotions and anxieties, but this is also the very thing that makes a fair chunk of the population want something more than fast, cheap and easy. Not a majority for sure. But certainly a large minority that is significant in terms of chair time. Probably Pareto at work.

This is compounded by the fact that many dentists really do want to do good work. They get frustrated when the environment they work in does not allow them to do work that they are proud of. When their fees do not allow them to use a lab that they are proud of. When they cannot afford to do that one extra try in that would make a big difference to the outcome.

Perhaps a lot of us are artisan’s at heart and denied that chance, and forced to work just for money, we become bitter and cynical, and start whinging on social media.

Which brings us to a subject about which there is significant denial. Upon which we refuse to discuss the elephant in the room.


We all know something that was expensive that wasn’t that good. This leads to the maxim that just because something is something is expensive, doesn’t mean that it is good. Dental laboratories might be an example of this. We all have a horror story of paying big money for terrible service or a horrendous result.

This does not prove the opposite

This does not prove that excellence comes cheaply. And again this can be illustrated by dental laboratories. As we work our way up the quality scale, it becomes impossible to find a cheap one.

Sure a big production lab might do something that fits routinely. But the finer details are missing. And if you think they aren’t, it’s probably just because you haven’t seen the finer details of exceptional work. Or perhaps don’t want to see them.

And as dentists, we are not immune. Efficiency can gain us some time. But eventually, the time available puts a limit on our excellence. For a certain fee, increasing the quality of our output results in us receiving a lower income.

Some of us will trade away some of our income for a while for personal satisfaction, but at some point, doing excellence and going broke results in us becoming bitter and cynical and having a good whinge on social media.

It is difficult to escape that the limits of the quality of work we produce, are set by our fees. This increase in quality is either paid by the patient, or by the dentist in reduced income.

It is good to keep in mind that those that are at a different stage to us usually didn’t get there in a single step. So we should not be tempted to go home and try to emulate those that inspire us in a single moment.

Which brings us to the two legged race of quality and fees. Neither can get far ahead of the other, and usually quality has to go first.

You usually need to increase quality first before you can increase the fees to go with it. The steps of each should be small and frequent rather than large and shocking. As you take these steps, you may well be walking away from some of your original patients and gaining a new audience.

If you are in a situation where you have no control over your fees, then the only way to increase quality is to accept that the payment will have to be satisfaction, not money. And that if it continues for too long, you may become bitter and cynical.

Thankfully, dentistry is not just an emotional business for dentists, but also for quite a few patients.

Say hello to the elephant.