I have always believed that one person’s time is never intrinsically worth more than another’s. Skill matters. Experience matters. Responsibility matters. But when the value of time becomes untethered from need and drifts instead toward expectation and status, something quietly distorts the relationship between professionals and those who depend on them.
Dentistry offers a small but revealing case study.
Consider something as mundane as toothpaste. Walk into any supermarket and you are confronted by a bewildering array of brands, prices, claims, and assurances. The implication is obvious: better health lies just one upgrade away. Yet strip away the packaging and the message dissolves. What actually matters in toothpaste is limited and well understood. A fluoride content of around 1,450 parts per million, safe abrasiveness, and basic plaque disruption. On these measures, Lidl’s own-brand DENTALUX performs as well as many far more expensive products. Dentists know this. Privately, most will admit that brand matters far less than brushing technique, duration, and fluoride contact time.
The extra money buys flavour, foam, reassurance, and marketing. It buys confidence, not health.
My own experience confirms this. I brush once a day, before breakfast, and I do not rinse the toothpaste away. I leave it on the teeth to work. This runs counter to the performative rituals many of us were taught, but it is increasingly recognised as sound practice. Fluoride remains in contact with enamel longer. Acid damage from breakfast is reduced. The result is protection rather than abrasion. In that context, more expensive toothpastes add nothing. In some cases they do less, irritating the mouth with aggressive flavouring or abrasives designed to create an immediate sensation of “clean”.
This matters because it exposes a wider pattern. When outcomes are slow, ambiguous, or difficult to measure, it becomes easy for authority to slide from evidence into performance. Gum disease is a perfect example. It is chronic, age-related, genetically influenced, and often irreversible. Management is possible; cure is not. Yet repeated hygienist visits are frequently presented as “preventive” or “necessary”, even when long-term improvement is unlikely. When improvement does not occur, responsibility is quietly transferred to the patient: the brushing was inadequate, the flossing inconsistent, the biology unfavourable. The intervention itself is never allowed to fail. Only the patient can.
This is guilt-based medicine. It replaces collaboration with moral pressure and turns health into a ritual of compliance. The mirror is brandished like a crucifix; warnings are delivered with solemn gravity; the patient is shown, not invited to understand. Authority is performed. Uncertainty is concealed. And, not incidentally, money changes hands.
My own experience with hygienist care sharpened this discomfort. As an NHS patient, repeated private hygienist visits were recommended — not by the dentist, but by the hygienist herself — at significant cost. When I later became a private patient, those recommendations quietly ceased. The clinical need had not changed; the financial context had. That is not proof of bad faith, but it is enough to erode trust. Preventive care becomes suspect when it appears and disappears with payment structure.
What is striking is how familiar this pattern is beyond dentistry. In many professions that combine expertise, moral authority, and private remuneration, claims for higher pay or greater provision are made without disclosing the full financial picture. Earnings, assets, and lifestyle choices remain invisible, while appeals are framed in terms of stress, responsibility, and underfunding. Without transparency, it is impossible to judge whether the claim reflects genuine need or the protection of an expanded way of life.
Most people, given time, live at the margins of their income. As earnings rise, so do expectations. Larger houses, newer cars, private schooling, frequent holidays — none of these are immoral. But once adopted, they harden into necessities. At that point, pressure for more money is often less about survival than about preserving a constructed standard of living. Downward adjustment becomes unthinkable. Responsibility flows outward. The listener is asked to sympathise without being given the information needed to judge fairly.
The ethical problem here is not wealth. It is asymmetry. Asymmetry of knowledge, of power, of risk, and of accountability. The professional speaks with authority; the client or patient bears the anxiety, the cost, and the blame when outcomes disappoint. When that authority is exercised without openness about limits, incentives, or uncertainty, it begins to resemble moral coercion rather than care.
This is why scepticism, in such contexts, is not cynicism but realism. To question whether an intervention is necessary, proportionate, or genuinely beneficial is not to reject expertise. It is to insist that expertise remain accountable to evidence, not insulated by ritual or reputation.
The toothpaste aisle reminds us of something easily forgotten: more expensive is not the same as better. Often it is merely louder. The same principle applies to professional life more broadly. When expectations, status, and income quietly replace need as the drivers of demand, social balance tilts. Those with authority ask more; those without it are expected to comply, trust, and pay.
If there is a corrective, it lies in restraint, transparency, and a willingness to say “enough”. Not every problem requires intervention. Not every risk demands action. And no one’s time, however skilled, is worth more simply because the system has learned how to charge for it.
Seeing that clearly is uncomfortable. But clarity, not guilt, is the beginning of ethical relationships — in dentistry, in professions, and in society at large.
