Awareness and practice of Revised Code of Dental Ethics and Consumer Protection Act among dental practitioners in Andhra Pradesh: A cross sectional study.

BACKGROUND: Given the imperative for dental practitioners to be familiar with the existing ethical principles and laws governing their practice, this study aimed to evaluate awareness and practice of the dentists (code of ethics) regulations 2014 and consumer protection act 2019 among dental practitioners in Andhra Pradesh state, India. METHODS: A cross sectional study was conducted among 384 dental practitioners in Andhra Pradesh state, India. A questionnaire consisting of 25 items was used to assess awareness and practice of the dentists (code of ethics) regulations and consumer protection act. The data collected were analysed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. RESULTS: Only 53(13.8%) dental practitioners in the study were aware that the dentists (code of ethics) regulations had been revised in 2014. About 190 (49.5%) practitioners were aware of the precise period for mandatory preservation of patient records. Most dental practitioners (278, 72.4%) accepted commissions in the form of gifts or cash from laboratories, radiologists, or pharmacists and 306 (79.7%) dental practitioners used unregistered dental lab technicians as employees in their practice. Furthermore, 297 (77.3%) practitioners were found to provide or sell drugs to patients in their clinic/office. The new regulations under consumer protection act 2019 were unknown to 194 (50.5%) dental practitioners. CONCLUSIONS: The present study indicates that the awareness of dental practitioners towards the dentists (code of ethics) regulations 2014 and consumer protection act 2019 is inadequate. It highlights the need for training programmes and curriculum changes with a focus on ethical and legal issues in clinical dental practice.

Difficulties experienced by dentists and orthodontists regarding ethical issues when announcing the diagnosis of a rare oral disease: a qualitative study in Marseille, France.

PURPOSE: It is traditionally considered that breaking bad news to patients does not represent a cause for concern for dental professionals. However, there are situations where they will be confronted with this task, as in the case of rare dental diseases. Little information is available regarding the feelings of healthcare professionals on this subject. There are no qualitative studies that explore how a diagnosis of oligodontia is announced to patients by dentists and orthodontists. The aim of our study is to explore the difficulties and ethical issues experienced by dental health professionals when they have to announce a diagnosis of oligodontia to a patient and their family. METHODS: This study relied on a qualitative research method using focus groups of dentists and orthodontists and a thematic analysis procedure. RESULTS: The difficulties experienced could be summarised within five topics: organisational difficulties, difficulties with the management of dental treatment and with the administrative management associated with this anomaly, difficulties with the content of the announcement, and relational difficulties. These could be grouped in two categories: practical difficulties and ethical difficulties. CONCLUSION: This survey allowed us to understand the difficulties encountered by dentists and orthodontists when announcing oligodontia. The participants felt uncomfortable with this task and were under stress. They reported difficulties in delivering the medical information and in adapting to the message. It is essential that dental professionals develop skills in medical communication.

Repercusiones en la deontología española ante el auge de las clínicas dentales low cost / Repercussions in Spanish deontology in light of the rise of low cost dental clinics / Repercussões na deontologia espanhola diante do boom das clínicas dentais de baixo custo

Resumen: El cambio en el modelo asistencial odontológico en España ha supuesto la proliferación de grandes franquicias dentales o clínicas dentales low cost. Este tipo de establecimientos suelen realizar la captación de pacientes mediante agresivas campañas de publicidad, establecen financiaciones de los presupuestos directamente con entidades bancarias y rebajan los presupuestos inicialmente marcados. En los últimos años, la Comisión de Ética y Deontología del Ilustre Colegio Oficial de Odontólogos y Estomatólogos de Aragón ha comprobado un notable aumento de las reclamaciones de pacientes procedentes de este tipo de clínicas. Uno de los casos más llamativos ha sido el cierre de la franquicia iDental, que dejó a miles de personas sin terminar sus tratamientos odontológicos. Se pretende realizar una puesta al día de las repercusiones deontológicas que estas clínicas tienen en la deontología dental de la Comunidad Autónoma de Aragón.

Abstract: The change in deontological health care model in Spain has led to the proliferation of huge dental franquises or low cost dental clinics. This type of settings generally engages customers by aggressive advertising campaigns, establishing financing with banks and reducing the agreed initial budget. In the last years, the Ethical and Deontological Commission of the Official College of Dentists and Stomatologists of Aragon has noticed a significant increase of claims by patients attending this type of clinics. One of the most striking cases has been the closing of iDental, which led thousands of patients without finishing dental treatment. This study pretends updating the deontological repercussions that these clinics have in the Autonomous Community of Aragon.

Resumo: A mudança no modelo assistencial odontológico na Espanha implicou na proliferação de grandes franquias dentais ou clínicas dentais de baixo custo. Estes tipos de estabelecimentos habitualmente realizam a captação de pacientes mediante agressivas campanhas publicitárias, estabelecem financiamento dos orçamentos diretamente com instituições bancárias e abaixam os orçamentos inicialmente apresentados. Nos últimos anos, a Comissão de Ética e Deontologia do Ilustre Colégio Oficial de Odontólogos e Estomatólogos de Aragão comprovou um notável aumento de reclamações de pacientes procedentes deste tipo de clínica. Um dos casos mais chamativos foi o encerramento da franquia iDental, que deixou milhares de pessoas sem terminar seus tratamentos odontológicos. Se pretende realizar uma atualização das repercussões deontológicas que estas clínicas têm na deontologia dental da Comunidade Autônoma de Aragão.

Conocimiento y aplicación de los principios bioéticos en alumnos de posgrado de Odontología / Knowledge and application of bioethical principles in postgraduate Dental Students

Resumen La bioética ha sido agregada formalmente, desde 2008, a la malla curricular de la carrera de Odontología en el Ecuador. También se han creado documentos que rigen el accionar ético del odontólogo frente a distintos dilemas que se pueden presentar durante su actividad clínica. Esta investigación busca describir el nivel del conocimiento y la aplicación de los principios bioéticos en los profesionales de salud oral. Se utilizó un método de investigación cuantitativo, descriptivo y transversal, mediante una encuesta estructurada, aplicada a estudiantes de posgrado en el área odontológica. Los datos fueron procesados y analizados de forma descriptiva y correlacional. Los resultados obtenidos, resaltaron la presencia de cinco niveles de conocimiento sobre principios bioéticos. Entre estos, en los grupos de mayor porcentaje de conocimiento sobre los principios bioéticos se destacó la aplicación del principio de no maleficencia en su práctica clínica. Se reveló desconocimiento sobre la teoría: muchos desconocen los principios bioéticos básicos del correcto accionar del profesional de salud oral. Sin embargo, se ha demostrado un creciente cambio con respecto a la aplicación de estos principios.

Abstract Bioethics has been formally added, since 2008, to the curricula of dentistry courses in Ecuador. Documents have also been created that govern the ethical actions of the dentist in the face of different dilemmas that may arise during their clinical activity. This research seeks to describe the level of knowledge and application of bioethical principles in oral health professionals. A quantitative, descriptive and cross-sectional research method was used, by means of a structured survey, applied to postgraduate students in the dental area. The data were processed and analyzed in a descriptive and correlational manner. The results obtained highlighted the presence of five levels of knowledge of bioethical principles. Among these, in the groups with the highest percentage of knowledge about bioethical principles, the application of the principle of non-maleficence in their clinical practice was highlighted. Lack of knowledge about the theory was revealed: many are unaware of the basic bioethical principles of the correct action of the oral health professional. However, a growing change has been demonstrated with regard to the application of these principles.

Resumo A bioética tem sido formalmente acrescentada ao currículo dos cursos de odontologia no Equador desde 2008. Também foram criados documentos para reger as ações éticas dos dentistas quando confrontados com diferentes dilemas que podem surgir durante sua atividade clínica. Esta pesquisa procura descrever o nível de conhecimento e aplicação dos princípios bioéticos nos profissionais de saúde bucal. Foi utilizado um método de pesquisa quantitativa, descritiva e transversal, por meio de uma pesquisa estruturada aplicada a estudantes pós-graduados na área odontológica. Os dados foram processados e analisados de forma descritiva e correlacional. Os resultados obtidos destacaram a presença de cinco níveis de conhecimento dos princípios bioéticos. Entre estes, nos grupos com maior porcentagem de conhecimento de princípios bioéticos, foi destacada a aplicação do princípio de não maleficência na prática clínica. A ignorância da teoria foi revelada: muitos desconhecem os princípios básicos de bioética da ação correta do profissional de saúde oral. No entanto, uma mudança crescente tem sido demonstrada com relação à aplicação destes princípios.

Developing and validating a questionnaire to Measure Ethical Sensitivity of Freshly Graduated Dentists.

OBJECTIVE: To develop an instrument for assessing the ethical sensitivity of freshly graduated dentists.. METHODS: This instrument development study was done at Sardar Begum Dental College, Peshawar, Pakistan, from September 2014 to April 2015. The instrument developed was the Dental Ethical Sensitivity Scale in accordance with the guidelines for the development of educational instruments. Data was obtained from freshly graduated dentists through the instrument containing vignettes related to three domains of ethics; beneficence, autonomy and confidentiality. Content validity index and Angoff's method were used to determine the validity and cut-off passing score respectively. Reliability analysis comprised internal consistency and test re-test. RESULTS: Of the 138 house officers approached, 107(77%) responded. Of them, 37(34.5%) were males and 70(65.4%) were females. The overall mean age was 23.7±1. 1 years. Overall, 51(47.6%) subjects were ethically sensitive whereas 50(46.7%) were partially sensitive and 6(5.6%) were insensitive. The CVI for the instrument was 0.8; cutoff score was 83%; internal consistency was 0.63; and test re-test reliability was 0.71. Relation between ethical sensitivity, gender and class attendance of the participants was insignificant (p>0.05 each). CONCLUSION: Dental Ethical Sensitivity Scale was found to be effective in providing a valid and reliable assessment instrument for measuring ethical sensitivity of freshly graduated dentists.

Cosmetic dentistry: A socioethical evaluation.

Cosmetic dentistry is a divisive discipline. Within discourses that raise questions of the purpose of the dental profession, cosmetic dentistry is frequently criticised on the basis of it being classified as a non-therapeutic intervention. This article re-evaluates this assertion through examination of ethics of care of the self, healthcare definitions and the social purpose of dentistry, finding the traditional position to be wanting in its conclusions. The slide of dentistry from a healthcare vocation towards being a predominantly business-focused interaction between clinician and consumer conflicts with traditional notions of dentistry as a profession. Whilst it is undeniable that cosmetic dental treatment particularly lends itself to the commercial paradigm, this is not exclusive to this area of professional practice. The cultural basis of dental appearance and the potential of the dental profession to exert coercive pressure upon the public to undergo treatment that is based upon social norms is discussed. This essay concludes that cosmetic dentistry is undeniably part of the professional purpose of 21st Century dentistry. However, the caveat that may be placed upon this, is that this status is conditional upon the professional conduct of dental practitioners remaining resilient to commercial practices not compatible with professional obligations.

Competency model for dentists in China: Results of a Delphi study.

OBJECTIVE: With the increasing awareness of the importance of oral health, patients have an increasing need for integrated care from dentists. In China, the dentistry examination consists of two parts: a practical skills examination and a comprehensive medical examination; to date, no assessment methods that are based on specialized dentistry competencies, unlike the United States, Canada, and other countries, have been established. Therefore, the purpose of this study was to construct a competency model for dentists in China in order to guide the development, admission, training and assessment of dentists. METHODS: Using a literature review, focus group interviews and in-depth personal interviews, a dentist competency index was developed with an expert consultation questionnaire. A panel of 20 specialist experts was chosen from ten national medical universities to carry out two rounds of Delphi expert analysis, using the boundary value method to filter the indicators and the Analytic Hierarchy Process to calculate the weights of the primary indicators. RESULTS: Two rounds of Delphi results showed that the expert authority, enthusiasm, and coordination coefficients were high. Constructs of the competency model that included seven primary indicators and 62 secondary indicators determined the weight of each index. The seven primary indicators included the following: clinical skills and medical services, disease prevention and health promotion, interpersonal communication skills, core values and professionalism, medical knowledge and lifelong learning ability, teamwork ability and scientific research ability. CONCLUSION: In conclusion, the use of the Delphi method to construct an initial model of Chinese physician competency is scientific and feasible. The initial competency model conforms to the characteristics and quality requirements of dentists in China and has a strong scientific basis. The dentist competency model should be used in the National Dental Licensing Examination in China.

Ethical issues and dentists' practices with children with intellectual disability: A qualitative inquiry into a local French health network.

BACKGROUND: The provision of dental care for children with intellectual disability raises many ethical questions. OBJECTIVE: The aim of this qualitative study was to explore approaches to dental treatment in an anxious child with intellectual disability and the ethical dilemmas that ensue. METHODS: Semi-structured interviews were conducted between February and May 2012. A clinical scenario was used to establish a starting point for a discussion of the clinical approach and lead to an ethical reflection. Four topics were discussed: first contact with the patient, information, attitude towards the patient and outcome from the practitioner's viewpoint. The coding procedure used thematic content analysis. RESULTS: Most practitioners fetched the patient from the waiting room personally, greeted them, gave them special attention, and either began the consultation at once, or used distraction to relax the patient. Verbal language and tell-show-do were most often used to provide information. Anxiety and pain were evaluated using parental assessment and standardized scales. A reassuring attitude was adopted. An ethical dilemma arose if the patient refused care or had to be restrained. Practitioners reported sacrificing ethical values (patient autonomy, beneficence and non-maleficence) when making a clinical decision. CONCLUSIONS: There is a wide range of practices but no consensus. This study shed some light on the different perspectives of dentists, most of whom adopted a utilitarianist viewpoint. In this context, ethical reflection is necessary to avoid a detached attitude or, worse, abuse. Further study would enrich this reflection.

Gifts from orthodontists to general dentists.

OBJECTIVES: To determine how often general dentists receive gifts from orthodontists, the value and number of the gifts they receive, and how they perceive the motivation behind the gift. MATERIALS AND METHODS: This was a questionnaire-based study. A questionnaire was constructed and tested for validity and reliability. An electronic version of survey was sent via email to 1300 general dentists. RESULTS: The validity and reliability of the survey was confirmed. Two hundred fifty-four valid responses were received (20%). Eighty-five percent of responding general practitioners reported that they received gifts from an orthodontist. Almost 100% reported that they referred patients to orthodontists. About one-third of the responding general practitioners reported that their office provided orthodontic care. There were statistically significant correlations between the number of annual patient referrals the general practitioners reported making and the number and value of the gifts they received from the orthodontists. Female general practitioners reported receiving a higher number of gifts of greater total value than male practitioners. General practitioners who reported providing orthodontic treatment did not differ from those who did not in the number of referrals they made annually and the number and value of the gifts they received. Quality of care was the most common reason general practitioners reported for their referral to an orthodontist. Forty-four percent of the responders reported that they received discounted orthodontic treatment. CONCLUSIONS: General practitioners refer patients to orthodontists and receive gifts from them. The number and value of the gifts reflects the number of referrals they make.

Ethical dilemmas among dental professionals in Davangere city- a cross-sectional survey.

To determine the ethical problems faced by dental practitioners, a cross-sectional survey was conducted in Bapuji Dental College and Hospital, College of Dental Sciences and private dental clinics in the city of Davangere. A questionnaire with close-ended questions on eight scenarios was administered to the 135 study participants. In the case of scenario 1, 81.4% of the participants said that the doctor had violated the principle of truthfulness. As for scenario 2, less than 50% of the participants replied that the doctor had breached ethical principles. In case scenario 3, 93% felt that the doctor should have taken the physician's opinion before extracting a tooth. Most dental practitioners faced ethical dilemmas because of the lack of awareness, and there is a need to introduce certain programmes to promote knowledge of ethics.

Código de ética odontológico brasileiro / Brazilian Dentistry code of ethics

O Código de Ética Odontológica (CEO), desde a sua instituição pelo Conselho Federal de Odontologia em 1976, vem sofrendo modificações (1984, 1991, 2003, 2006, 2012). É uma construção da categoria profissional odontológica que busca orientar a conduta dos cirurgiões dentistas no que diz respeito aos aspectos éticos de sua prática profissional. Na prática odontológica são frequentes as atitudes que demonstram desrespeito aos princípios bioéticos. Apesar de já na primeira versão do CEO o paciente ser referido como ôa razão e o objetivo de toda a ciência odontológicaõ, a leitura do código atual leva à conclusão oposta. O CEO configura-se como um instrumento de proteção dos profissionais, criado por estes para estes, com uma postura muito mais corporativista do que se deseja admitir. Nesse contexto, o objetivo desse trabalho é fazer, através de uma revisão de literatura, uma análise do Código de Ética Odontológico Brasileiro por meio de diferentes visões. Concluiu-se que o CEO é limitado ao resolver problemas éticos novos e complexos. Deste modo, são necessários estudos periódicos tendentes a atualizar os textos normativos e este deve ser de conhecimento obrigatório do profissional, não podendo, em momento algum, alegar ignorância ou má compreensão dos preceitos estabelecidos.

The Dentistry Code of Ethics (DCE), since its establishment by the Federal Council of Dentistry, in 1976, has undergone modifications (1984, 1991, 2003, 2006). This regulation seeks to guide the conduct of dentists with regard to ethical aspects of their professional practice. In dental practice, there are frequent actions that show disrespect to bioethical principles. Although already in the first version of the DCE the patient was referred to as ôthe reason and goal of all dental science,õ reading the current code may take to the opposite conclusion. The DCE was developed by dentists for their own protection, and therefore it has a more corporative aspect than one wants to admit. This paper was dedicated to analyze the Brazilian Dental Code of Ethics through different views, throughout literature review. It was concluded that the DCE is limited to solve new and complex ethical issues, thus studies are needed to ensure the regular update of legal texts. This set of principles must be known by any professional, since they canÆt plea ignorance or miss understanding of the established precepts at any circumstances.