Aprudent person thinks twice before writing about the Internet. For a start, the Web is a fact of everyday life, no longer an exotic technological wonder. It’s been explained, explored and exploited ad nauseam. Moreover, I realize that many of my readers know a lot more about the subject than I do. Undeterred by mere prudence, however, I’d like to offer a few personal thoughts on what this remarkable technology can mean to the practice of dentistry, for better and for worse.

First, let’s clear away some of the near-mystical nonsense that surrounds the "information superhighway." I find it helps to think of the Internet as no more than an advanced kind of telephone system—a vast, efficient and impersonal mechanism carrying millions of individual conversations. ("Internet" and "World Wide Web" are not synonymous, but for simplicity I’ll follow the common practice and use the terms interchangeably.) For most of us, most of the time, the conversation is between a human (us) and a robot (a computer at the other end), but it’s a dialog nonetheless.

Clicking on a link puts one call on hold and dials another one. A search engine is like a really well-indexed directory. Electronic mail is analogous to a fax message, transferred automatically in a machine-to-machine conversation, to be read or discarded at your convenience. One notable difference is that your Internet "phone" (that is, browser) normally is set up for outgoing calls only: Web sites can’t interrupt your dinner to sell you a cemetery plot—at least not yet.

I don’t want to press the telephone analogy too far, but I do think it’s important to recognize the essential neutrality of the Internet. It doesn’t create, maintain or validate the information it carries. If you dialed a wrong number, would you ask for medical advice from whomever picked up the phone? Certainly not. Why then do we invest the phrase "found it on the Internet" with so much more authority than "heard it on the phone"?

One reason, of course, is that a staggering amount of reliable, up-to-date, detailed knowledge can be tapped almost instantaneously via the Internet—if we know where to look. As dentists, we use the net daily:

– to learn about new products. In addition to the manufacturers’ and distributors’ own sites, third parties provide some very useful critical reviews and side-by-side comparisons.

– to investigate specific conditions and therapies. Massive, well-indexed resources such as MEDLINE give access to abstracts of the dental and medical literature, providing reasonably current information on a broad range of topics.

– to read full journal articles. Abstracts are fine research tools, but there’s no substitute for the actual article when you need in-depth information. More and more journals—including JADA—are now available online, as well as in printed form, usually with full text and sometimes with figures. (By the way, I hope you will try out this new addition to ADA’s Web site, and give us some feedback on how it works for you.)

– to order and pay for supplies and equipment. Online ordering is a great convenience, particularly when suppliers combine logical, reliable order-entry software with superior follow-through. But, vendors, beware of "Internet Rapture": the best Web site in the world is no substitute for responsive person-to-person service.

– to communicate with patients. More of our patients now want us to use e-mail either as a primary or a backup form of communication. It’s a convenient way to send out reminders, to confirm appointments and to disseminate news. Many practitioners also have their own Web sites, an idea that you may want to investigate. Your site doesn’t need to be flashy or expensive to be useful: your address, specialty, phone number, office hours and perhaps a map are what prospective patients are looking for. And again, don’t neglect traditional communication channels in favor of the Internet.

– to keep in touch professionally. We spend our careers in a struggle against isolation, stagnation and obsolescence. To help us, Web sites are maintained by the ADA, National Institute of Dental and Craniofacial Research, Bethesda, Md., and most of the specialty and subspecialty groups. Coupled with more traditional media, these provide an excellent way to stay abreast of current trends, issues and developments in the profession.

It doesn’t take long to discover that not all Web sites touching on dental matters are created equal. Some are directed toward professionals, others to the general public, and still others to special-interest groups. Some are operated in a highly responsible manner, not unlike a scientific journal, with editorial and peer-review processes in place to ensure that the information you receive is accurate, current and useful. At the other extreme, bulletin boards and chat rooms allow absolutely anyone to say absolutely anything. In between, one can find all shades of opinion—reasoned, unreasoned and malicious—along with a dazzling array of misinformation. The ADA works hard to make accurate and up-to-date information available to all the media, including Web sites, but unfortunately, fiction always seems to spread faster than fact.

Many of these sites, even the crazy ones, have their uses, but it is essential to know who’s at the other end of the line! Is it one of the "trusted" sources? Then you can probably treat the information as factual, subject to stated limitations. A personal opinion? It’s as reliable as the source, no more. An advertiser? I think we all know how to interpret advertising, electronic or otherwise. A fringe group? Pay attention, and become aware of the currents of misinformation and bad advice that can undermine good dentistry.

As far as information goes, the Internet is a great equalizer. Our patients are every bit as smart as we are, and they now have access to essentially all the same information resources. The problem, of course, lies in the interpretation of raw information. Patients are going to search the Internet, too, but they may have difficulty judging the reliability of what they find. How should we react when a patient brings in a Web page advocating some obscure technique or miracle cure, and demands that we explain why we’re not using it? Tempting as it may be, a blunt rebuff probably is not the right approach.

For one thing, you may have been presented with a nugget of new and useful information, in which case you should learn from it. More usually, though, you’ll need to explain that Web sites aren’t all equally reliable, much less balanced, and that you don’t admit techniques into your practice until you have been convinced by scientific evidence. You also might direct the patient to some trustworthy sites as a starting point for further reading. A well-informed patient is a powerful ally, and we never should discourage responsible independent inquiry.

Today’s wired world offers dentistry a wealth of new capabilities and opportunities. It also is forcing us to re-learn a very old lesson: let the seeker beware.