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.

[Dentists' Knowledge of Ethical Questions Regarding Dental Medicine - A Survey of Dentists from Saxony, Saxony-Anhalt and Thuringia (Germany)]. / Zahnmedizinethische Kenntnisse in der Praxis ­ eine Befragung von Zahnärzten aus Sachsen, Sachsen-Anhalt und Thüringen.

Background: Subjects regarding ethical questions in dental medicine are only slightly touched in the study of dental medicine or in the working regulations of the dentists' association. However, dentists are confronted with these matters in everyday working life. The empirical study at hand collects current data regarding the ethical knowledge about dental medicine in the practical experience of dentists in Saxony, Saxony-Anhalt, and Thuringia. Methods: The tool used in the survey was a structured questionnaire. Out of 600 randomly chosen and contacted dentists from Saxony, Saxony-Anhalt, and Thuringia, 290 replied (response rate: 48.3%). The anonymised assessment took place between June and November 2013. Results: Dentists frequently encounter ethical questions regarding dental matters. The dentists interviewed in the study are in favour of a participative relationship between patient and dentist. Simultaneously, the patient's health is predominantly seen as the good of higher value than his or her self-determination. The dentists show competent knowledge of ethical dental subjects, although increased uncertainties could be observed in more complex situations, e. g. considering contact with patients who are HIV-positive. Conclusions: Questions dealing with dental ethical questions do play a major role in the daily professional life of dentists. In order to further support and strengthen dentists in their individual dental ethical competence, we see a need for advanced training and further education regarding questions and problems in the area of ethics in dental medicine. Also, these topics should become a component in the curriculum of the study of dental medicine.

The Dangerous Specter of Addiction A Cautionary Tale.

The literature is equivocal: dentists are either as susceptible to substance abuse or somewhat more susceptible than the general public. Most of us have suspected at one time that a colleague was troubled by excessive alcohol consumption or prescription pain medications. We often sit on the sidelines, waiting for an ideal opportunity to help, wary about offering unsolicited advice or invading the privacy of a colleague. When the problem is confronted and intervention begins, we hold our breath, yearning for a healthy outcome but dreading the worst. This brief memoir describes the first author's real-life attempts to support a colleague (with the help of a psychologist, the second author) at various intersections of treatment. The moral challenge of professional confrontation is explored. Suggestions on how to intervene with friends, colleagues, and loved ones are offered.

How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland.

BACKGROUND: Overtreatment (or unnecessary treatment) is when medical or dental services are provided with a higher volume or cost than is appropriate. This study aimed to investigate how a group of dentists in Switzerland, a wealthy country known to have high standards of healthcare including dentistry, evaluated the meaning of unnecessary treatments from an ethical perspective and, assessed the expected frequency of different possible behaviors among their peers. METHODS: A vignette describing a situation that is susceptible for overtreatment of a patient was presented to a group of dentists. The vignette was followed by five options. A questionnaire including the vignette was posted to 2482 dentists in the German-speaking areas of Switzerland. The respondents were asked to rate each option according to their estimation about its prevalence and their judgment about the degree to which the behavior is ethically sound. RESULTS: 732 completed questionnaires were returned. According to the responses, the most ethical and the most unethical options are considered to be the most and the least prevalent behaviors among dentists practicing in Switzerland, respectively. CONCLUSIONS: Suggesting unnecessary treatments to patients seems to be an ethically unacceptable conduct in the eyes of a sample of dentists in Switzerland. Although the respondents believed their colleagues were very likely to behave in an ethical way in response to a situation that is susceptible to overtreatment, they still seemed to be concerned about the prevalence of unethical behaviors in this regard.

The Francis Report--dento-legal implications.

This article explores the potential implications of the Francis Report for members of the dental team from a dento-legal perspective. It looks at the broad recommendations in light of the existing ethical environment in which dental registrants work and asks what is new and what the recommendations will actually mean for dental professionals in practical terms. Clinical Relevance: The fundamental recommendations of the Francis Report, namely, that those who provide care should put patients' interests first and be open about outcomes and performance, are not new concepts. A breach of these ethically based expectations may, however, create grounds for legal proceedings, which is clearly a significant point for all members of the dental team. It is therefore important to be aware of what is expected of those providing clinical care.

The Implications of the New GDC Standards for Dental Professionals.

This article is about the publication by the General Dental Council in 2013 of the Standards expected of those members of the dental team who are registered with the Council, on each of their Registers, and discusses the implications of the new Standards for dental professionals.

Moral Communities and Moral Leadership.

The American College of Dentists is embarking on a multiyear project to improve ethics in dentistry. Early indications are that the focus will be on actual moral behavior rather than theory, that we will include organizations as ethical units, and that we will focus on building moral leadership. There is little evidence that the "telling individuals how to behave" approach to ethics is having the hoped-for effect. As a profession, dentistry is based on shared trust. The public level of trust in practitioners is acceptable, but could be improved, and will need to be strengthened to reduce the risk of increasing regulation. While feedback from the way dentists and patients view ethics is generally reassuring, dentists are often at odds with patients and their colleagues over how the profesion manages itself. Individuals are an inconsistent mix of good and bad behavior, and it may be more helpful to make small improvements in the habits of all dentists than to try to take a few certifiably dishonest ones off the street. A computer simulation model of dentistry as a moral community suggests that the profession will always have the proportion of bad actors it will tolerate, that moral leadership is a difficult posture to maintain, that massive interventions to correct imbalances through education or other means will be wasted unless the system as a whole is modified, and that most dentists see no compelling benefit in changing the ethical climate of the profession because they are doing just fine. Considering organiza-tions as loci of moral behavior reveals questionable practices that otherwise remain undetected, including moral distress, fragmentation, fictitious dentists, moral fading, decoupling, responsibility shifting, and moral priming. What is most needed is not phillosophy or principles, but moral leadership.

Emerging Dental Specialties and Ethics.

This paper discusses ethical dimensions related to the formal recognition of emerging dental specialties. It explores several issues related to the potential emergence of several new dental specialty areas. There are good reasons that dentistry should open the door to these new specialties, and patients would benefit. The ethical considerations for and against formal acceptance are examined.

State Dental Boards and Public Protection: Fulfilling the Contract.

Dental boards are agents of the state, sworn to protect the public. They combine the skills of professional training with responsibility to ensure that patients receive safe and effective care. They can play a vital role in ensuring that the profession does not invite more regulation by working to maintain the public's trust. Two cases are presented illustrating that one's perspective can cloud the sense of what is right and that it is wrong to pass ethical responsibilities on to others.

What Contract? With Whom? For What Purpose?

The central point in the U.S. Supreme Court upholding the Federal Trade Commission's action against the North Carolina State Board of Dental Examiners was that they acted without proper supervision from the State of North Carolina in curbing commercial activity: issuing cease and desist orders to teeth-whitening businesses, for example. It appears unlikely that the law of the land will allow professions to enforce and may substantially limit a profession's voice in defining nearby commercial activity. The line between professional services and commercial ones is not clear. Vending whitening agents, as drug stores do, is commercial but may not be professional. Providing such services in the dental office certainly should be professional, but is also certainly commercial. As dentistry becomes more overtly commercial in nature, it is likely that the profession will have less say over defining and enforcing oral healthcare practices.

The dilemma of reporting suspicions of child maltreatment in pediatric dentistry.

This study examined the factors that lead specialists in pediatric dentistry to suspect child abuse or neglect and the considerations that influence the decision to report these suspicions to social services. Focus group discussions were used to identify new aspects of child maltreatment suspicion and reporting. Such discussions illuminate the diversity of informants' experiences, opinions, and reflections. Focus groups included 19 specialists and postgraduate students in pediatric dentistry. We conducted video-recorded focus group discussions at the informants' dental clinics. All sessions lasted approximately 1.5 h. We transcribed the discussions verbatim and studied the transcripts using thematic analysis, a method well-suited to evaluating the experiences discussed and how the informants understand them. The analysis process elicited key concepts and identified one main theme, which we labeled 'the dilemma of reporting child maltreatment'. We found this dilemma to pervade a variety of situations and divided it into three sub-themes: to support or report; differentiating concern for well-being from maltreatment; and the supportive or unhelpful consultation. Reporting a suspicion about child maltreatment seems to be a clinical and ethical dilemma arising from concerns of having contradicting professional roles, difficulties confirming suspicions of maltreatment, and perceived shortcomings in the child-protection system.

Computer simulation of dental professionals as a moral community.

Current empirical studies of moral behavior of healthcare professionals are almost entirely focused on self-reports, usually collected under the assumption that an ethical disposition characterizes individuals across various contexts. It is well known, however, that individuals adjust their behavior to what they see being done by those in their peer group. That presents a methodological challenge to traditional research within a community of peers because the behavior of each individual is both the result of norms and a contributor to the norms of others. Computer simulations can be used to address this methodological challenge. A Markov replicator model that runs on an Excel spreadsheet was used to investigate a community with four agent types in the dental community: devious practitioners, ethical practitioners who avoid involvement in the poor ethics of others, ethical practitioners who accept it as part of their professional responsibility to challenge colleagues who act unprofessionally, and those who enforce ethical standards. A panel of leaders in the profession independently estimated parameters for the model and criteria for a possible distribution of agent types in the community. The simulation converged on distributions of the agent types that were very similar to the expectations of the panel. The simulation suggests the following characteristics of such moral communities: The structure of such communities is robust across a wide distribution. It appears that reduction in unethical behavior is more sensitive to the way ethical practitioners interact with each other than to sanctions the enforcement community imposes on unethical practitioners, and that large external interventions will be short lived.

Knowledge, attitudes and practice of healthcare ethics and law among dental graduates at the RV dental college, Bengaluru.

OBJECTIVE: To assess knowledge, attitudes and practices among the dental graduate in relation to healthcare ethics and law. MATERIALS AND METHODS: A cross-sectional study design was employed using a self-administered questionnaire. A 15 item questionnaire about law and ethics was devised; tested and made available to all levels of graduates including teaching staff, postgraduates and intern at dental college in Bengaluru. A total of 116 graduates participated, with a response rate of 96.5% (n = 112). RESULTS: Seventy-six percent of the participants said that they are legally bound to treat all the patients who approach them for the treatment. Nearly 32% of the participants have mentioned the various other reasons for the rejection apart from the reason like HIV+, poor patients and patients with the contagious disease. CONCLUSION: The study points to the need for appropriate training among graduates including the professional staffs and other graduates, and to devise means to sensitize them to issues of law and ethics in the workplace.

Decision dilemmas and opportunities for the new graduate dentist.

Career options for new graduate dentists are changing because of economic and management challenges in traditional practice, the growing trend toward group practice models, enormous educational debt load and lifestyle expectations of the millennial dentist. While new dentists learn to survive and adapt to an evolving profession with many pitfalls, they also have the opportunity to shape the future of our profession.

Professional responsibility and patient retention: alerts for the new dentist.

Getting to know your patients, well beyond recognition of their specific chief dental complaint, is most important in operating a successful and satisfying practice. In addition to the clinical findings and pertinent history alerts, a good understanding of the person being treated can go a long way toward cementing lasting and rewarding doctor-patient relationships. Almost all new patients to the practice are welcome. However, an occasional "difficult" patient can be identified. This is the patient who you will not be able to satisfy, who cultivates misunderstandings, is unfairly over demanding, wastes office time in innumerable ways and eventually causes great frustration for the dentist. These patients may leave the practice in an unpleasant termination. Concerns of litigation arise, and one must also consider the waste of economic and emotional currency, as well as any other negative repercussions that may result. The dentist should become skilled at early identification of potentially risky, disruptive and problematic persons seeking treatment.

Patients who make terrible therapeutic choices.

The traditional approaches to dental ethics include appeals to principles, duties (deontology), and consequences (utilitarianism). These approaches are often inadequate when faced with the case of a patient who refuses reasonable treatment and does not share the same ethical framework the dentist is using. An approach based on virtue ethics may be helpful in this and other cases. Virtue ethics is a tradition going back to Plato and Aristotle. It depends on forming a holistic character supporting general appropriate behavior. By correctly diagnosing the real issues at stake in a patient's inappropriate oral health choices and working to build effective habits, dentists can sometimes respond to ethical challenges that remain intractable given rule-based methods.

Dental ethics and emotional intelligence.

Dental ethics is often taught, viewed, and conducted as an intell enterprise, uninformed by other noncognitive factors. Emotional intelligence (EQ) is defined distinguished from the cognitive intelligence measured by Intelligence Quotient (IQ). This essay recommends more inclusion of emotional, noncognitive input to the ethical decision process in dental education and dental practice.

The ethics of charity dental clinics.

The Ben Massell Dental Clinic is part of the Jewish Family & Career Services in Atlanta, Georgia, which provides a wide range of health and social services on a sliding-fee basis. A fixed location, comprehensive service, and a clinic with full regular hours is an obvious benefit to patients. This structure also provides advantages to dentists who wish to donate their professional expertise without disrupting their offices and without the need to create a new logistic and management structure. Such a regular clinic also provides continuity of care in a charity setting.