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.

Consumer-driven and commercialised practice in dentistry: an ethical and professional problem?

The rise and persistence of a commercial model of healthcare and the potential shift towards the commodification of dental services, provided to consumers, should provoke thought about the nature and purpose of dentistry and whether this paradigm is cause for concern. Within this article, whether dentistry is a commodity and the legitimacy of dentistry as a business is explored and assessed. Dentistry is perceived to be a commodity, dependent upon the context of how services are to be provided and the interpretation of the patient-professional relationship. Commercially-focused practices threaten the fiduciary nature of the interaction between consumer and provider. The solution to managing commercial elements within dentistry is not through rejection of the new paradigm of the consumer of dental services, but in the rejection of competitive practices, coercive advertising and the erosion of professional values and duty. Consumerism may bring empowerment to those accessing dental services. However, if the patient-practitioner relationship is reduced to a mere transaction in the name of enhanced consumer participation, this empowerment is but a myth.

[Compensation of moral harm caused by poor quality of dental care]. / Kompensatsiia moral'nogo vreda, prichinennogo v rezul'tate nekachestvennogo okazaniia stomatologicheskoi pomoshchi.

The study presents a review of the legislative regulation of compensation for moral damage in case of poor medical dental care and judicial practice according to the types of civil cases for 25 years as well as the main tendencies of existing court dental practice and the long-term trends.

Contract care in dentistry: sense-making of the concept and in practice when multiple institutional logics are at play.

In 2009 contract dental care was introduced into Sweden's Public Dental Service under a programme called Dental Care for Health (DCH). Previous research has revealed a possible dilemma whereby dental care professionals had the role of insurance agent foisted upon them, as they were assigned the task of 'selling contracts'. Using qualitative interviews, this study explores how these professionals make sense of contract dental care today. Drawing on the concepts of occupational and organisational professionalism, in combination with the institutional logics perspective, we discern that dental care professionals are entangled in multiple rationalities when reasoning about and dealing with DCH. A professional logic comes into play over health issues and preventive care, while market and corporate logics are present in relation to selling contracts and taking responsibility for the financial aspects of DCH, all of which creates tensions in these professionals. Overall, dental care professionals in the welfare sector respond both to an organisational and an occupational professionalism.

Could Ethical Tensions in Oral Healthcare Management Revealed by Adults with Intellectual Disabilities and Caregivers Explain Unmet Oral Health Needs? Participatory Research with Focus Groups.

BACKGROUND: Cognitively impaired patients often present poor oral health status that may be explained by ethical tensions in oral healthcare management. This participatory study explored such tensions among adults with intellectual disabilities and with caregivers. The second objective was to specify, with caregivers, the points that should be developed in a future study among dentists. MATERIALS AND METHODS: Three focus groups involving adults with intellectual disabilities, family caregivers and professional caregivers were organized in France in 2013. RESULTS: The thematic content analysis identified discrepancies between experiences and expectations, which were particularly marked for the dentist's competence and attitudes, the dentist's role in decisions, the dental care management and the French socio-political context. CONCLUSIONS: These discrepancies could partly explain multiple attempts to find the 'right' dentist or the fact that care was abandoned, and could at least contribute to oral health needs being unmet.

Review of the peer review process.

Discussions of dental law, ethics, and risk management often center around what a dentist should do to reduce the risk that an upset, litigious patient will seek out an attorney to address the problem. There is a very useful option for the dentist and patient to pursue that eliminates the adversarial stance associated with a lawsuit. The peer review resolution process has been shown to be a positive, professional way to end certain dentist-patient confrontations, and the results normally are upheld in most jurisdictions.

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.

[Is there room for improvement in the field of dental ethics?]. / La déontologie des chirurgiens-dentistes doit-elle évoluer ?

INTRODUCTION: Dental ethics, enforced by the Dental Board, are defined in the Code of Conduct for dentists included in the French Public Health Code. Dentist-patient relationships are changing, while scientific progress advances more rapidly than dental ethics. Are dental ethics still adapted to the practice of dentistry? METHODS: This study was based on the Institut BVA "The French and patients' rights" survey conducted in September 2013, together with a systematic review of the literature using the Medline, Legifrance, Lexisnexis, and Elnet.fr databases and the Paris Descartes University medical library website. RESULTS: Five essential principles were identified and a total of 210 articles were included. The results indicate that there is room for improvement in pain management, respect of human dignity, information and consent concerning healthcare, and free choice of a practitioner. CONCLUSION: Dental ethics have evolved, but further improvement is required to adapt the dentist-patient relationship to scientific progress and the patients' expectations. To ensure a truly informed choice, this article shows that dental ethics cannot vary in response to surveys or fashions, as dental practice must remain essentially based on an ethical approach that cannot be rigidly defined in a code of professional conduct.

Do Patients and Dentists See Ethics the Same Way?

The most common approach to ethics in dentistry and bioethics generally is through principles. To be effective, principles must be interpreted in particular situations, and the skill of interpretation requires many years of practice with feedback. The opinions of 91 dentists and 54 patients regarding multiple potential actions and justifications for these actions were gathered for eight dental ethics cases. The summary responses of dentists and patients have been integrated as feedback in an online ethics education exercise that individual dentists can use (see www.dental ethics.org/idea). The dataset of responses was also analyzed for general findings. It emerged that patients and dentists agree to a substantial extent on the average approaches, but they differ systematically on certain of the details. Some ethical issues stimulated a narrow range of responses while others, especially those of a nonclinical nature were regarded as ambiguous and are thus good candidates for future ethics training. A factor analysis revealed a five-dimension structure underlying dental ethics. Patients are most apt to view dentistry using a lens of oral health outcomes while practitioners prefer to stress the process and the technical dimensions of practice. The largest area of difference was patients' much greater interest in dentists assuming an active role as patient oral health advocates with their colleagues.

What about the dentist-patient relationship in dental tourism?

Dental tourism is patients travelling across international borders with the intention of receiving dental care. It is a growing phenomenon that raises many ethical issues, particularly regarding the dentist-patient relationship. We discuss various issues related to this phenomenon, including patient autonomy over practitioner choice, patient safety, continuity of care, informed consent and doctor-patient communication, among other factors. In particular, patients partaking in medical tourism should be informed of its potential problems and the importance of proper planning and post-treatment care to guarantee high-quality treatment outcomes.

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.

Minors' request for confidentiality.

Dentists must be cognisant of what the law requires and how they are expected to respond. When the law does not address an issue, the dentist would need to weigh the circumstances and consequences and do what he/she thinks is ethically appropriate and acceptable. The need to maintain confidentiality of any information given to us in our professional capacity is paramount. Patient autonomy and their absolute right to confidentiality must be ensured in almost all but the most exceptional circumstances. Patients have the ethical and legal right to expect a health professional to keep confidential the information provided during the course of their care. Disclosure of patient information is only permitted with the patient's consent or if there is an overwhelming public interest in disclosure as prescribed by the law.

Developing an ethical framework for short-term international dental and medical activities.

The popularity of volunteering to provide charity health care in third-world countries has increased dramatically in recent years. While there are advantages to both those being helped and to volunteers, there are also ethical issues that need to be addressed. A framework for analyzing the ethical impact of such service is presented which continues 27 principles that should be addressed.

A student's perspective on the ethics of international charity dental care.

A senior dental student describes the deep sense of personal satisfaction from participating in a weeklong charity dental care trips to the Dominican Republic. Care, primarily consisting of extractions, was provided to individuals living in conditions that encourage dental disease at the same time the availability of oral healthcare services are essentially nonexistent.

Dental school volunteerism.

Student Community Outreach for Public Education, SCOPE, is a student-led community outreach program at the University of the Pacific that provides leadership opportunities, service experiences, and a chance to understand the oral needs of all Americans. The organization and activities of the program are detailed, along with a description of the type of individuals served. The complex range of motives for community service and the relationship between the private system and the safety-net system are explored.

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.

A look at international, short-term service trips: challenges from a dental ethical perspective.

Although professionals helping those in need in other countries is a noble endeavor, it is not without its ethical challenges. Those in the medical field are just beginning to explore these issues. In this paper, the five-principle structure of the ADA Code is used to explore some of the not-so-obvious problems that may come in the wake of charity care in international contexts. Issues surrounding respect for autonomy include informed consent, adequate health history, and cultural sensitivity. Sometimes the difficulty of working conditions increases the possibility of causing harm, and follow-up care may be lacking or inadequate. The duty for beneficence may have different meanings in other cultures than it does in the United States. Standards for justice or fairness may not be the same in other countries, and bringing American benefits to a segment of a local population may disrupt indigenous standards. Issues can also arise around veracity due to communication problems and alternative ways of counting benefits and harms.

Standard of care: the legal view.

The standard of care is a legal construct, a line defined by juries, based on expert testimony, marking a point where treatment failed to meet expectations for what a reasonable professional would have done. There is no before-the-fact objective definition of this standard, except for cases of law and regulation, such as the Occupational Safety and Health Admintration (OSHA). Practitioners must use their judgment in determining what would be acceptable should a case come to trial. Professional codes of conduct and acting in the patient's best interests are helpful guides to practicing within the standard of care. Continuing education credit is available for this and the following article together online at www.dentalethics.org for those who wish to complete the quiz and exercises associated with them (see Course 22).