J.R. Schmitt tipped me off to a fascinating article published in 1997 (!) about a “de-marketing strategy” for the use of general anesthesia in dentistry in the UK:

De-marketing: Putting Kotler and Levy’s Ideas into Practice, by Steven Lawther, Gerard B. Hastings, and R. Lowry

(Be patient – you have to zoom and scroll to read the full paper, but it’s worth it.)

It seems that many dentists were putting patients under general anesthesia when it wasn’t strictly necessary and despite the known risks. Children were particularly likely to be put under. Older dentists were more likely than younger dentists to recommend general anesthesia. And there were regional hot spots: if a certain practice had invested in the expensive equipment required, they were more likely to use it (of course).

The authors conclude that the best way to change the culture is to create a collegial environment and gently change dentists’ minds. The authors cautioned that those at the “sharp end” of clinical practice, who engage in “wet-fingered dentistry,” would bristle at the idea of being told what to do by central authorities. So: no sudden billing changes or other mandates. The authors also did not see a role for patient education. I’d love to hear what others’ think of the article — and if anyone knows if this practice of general anesthesia in dentistry has indeed ebbed in the UK.