[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.

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.

[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.

Can Dentistry Have Two Contracts with the Public?

The social contract is an implicit agreement between parts of society and society as a whole. Since the Middle Ages, the learned professions, recently including dentistry, have had a covenantal relationship with the public based on trust, exchanging monopoly privileges for benefiting the public good. Unlike commercial trade in commodities, professional relationships are grounded in ensuring an adequate level of oral health to all. A second contract is emerging where dentists relate to society as business operators, exchanging commodity services for a price. Recent actions by the Federal Trade Commission and the U.S. Supreme Court make it unlikely that dentistry will be able to enjoy only selected aspects of each contract while avoiding obligations that it finds unfavorable.

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.

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.

How we view complainants; an ethical dilemma?

UNLABELLED: All too often, those patients who complain are thought to be unreasonable. Healthcare professionals often feel that patients do not have an understanding of the pressures and hardships that they struggle with on a day-to-day basis. When a patient complains, it is seen by the professional complained about as a wholly negative event, leading to loss of confidence and leaving that professional feeling demoralized. Often complaints are due to a breakdown in communication. Sometimes a patient is unhappy with a treatment charge or simply there is a perception that he/she has been poorly treated. The General Dental Council and Primary Care Trusts (and now their successors) take a dim view of dental practitioners who deal with complaints poorly. This article sets out to offer a different perspective on complaints, so that the complaint system can be used to build trust between dental professionals and patients, instead of instilling demoralization and fear of litigation into those on the receiving end of a complaint. CLINICAL RELEVANCE: This article is relevant to all dental professionals as complaints are an inevitability of practice.

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.

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.

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.

Consent in dentistry: ethical and deontological issues.

In Italy, consent for health treatment, aside from being an ethical and deontological obligation, constitutes an essential requirement for any medical treatment according to articles 13 and 32 of the National Constitution and also in accordance with the Council of Europe's 'Convention on Human Rights and Biomedicine'. An essential requirement for the validity of consent is that clear, exhaustive and adequate information be provided to the patient himself: the practice of informed consent is a communicative relationship in which the patient can express doubts, perplexities and clarification requests to the dentist. Furthermore, dental treatment has specific peculiarities: the relationship between dentistry and aesthetics, the concomitant presence of pathologies requiring different treatments, the elongated care process and the establishment of a trustworthy relationship and familiarity with the patient represent important aspects in the configuration of the dentist-patient relationship and in the process of acquiring informed consent. The dentist must offer correct information on diagnosis, prognosis, the therapeutic perspective and the likely consequences of therapy, alternative therapy and refusal of therapy, as well as eventual commitments for the period after treatment. Particular consideration must be given to minors and patients of unsound mind: the dentist's approach to these patients needs to be clear and appropriate to the person's age and understanding ability, even if the decisional power for sanitary treatment may be in the hands of a third person.

How do I comment ethically on the work of colleagues?

Patients are entitled to know about their dental and oral health, and practitioners have an ethical duty to inform them on an honest and factual basis. If this can be done without denigrating one's colleagues in any way, both patients and practitioners can benefit. As professionals, our first obligation is to place the well-being of our patients ahead of our own interests. First and foremost and for patient autonomy, we must give patients complete and truthful information regarding their current oral health status. When asked to comment on another dentist's treatment, it is not unethical or unprofessional to remember that the burden of proof regarding faulty or bad treatment s demanding and a prudent dentist must exercise great caution before making comments about other dentist's treatment. Uninformed and unjustifiable criticism is disparaging and can lead to unpleasant consequences for the unwary professional. Comprehensive and accurate records would be needed by both dentists to support their clinical judgement, if this case ever resulted in a complaint.

Living in limbo: Ethics and experience in a conversation about persistent oral lesions.

This case report presents a conversation that the authors had with a patient who is suffering from oral lichen planus and oral cancer. The reason that the authors approached the patient for an interview was to find out why he decided to enroll in an experimental study related to his oral cancer. The patient reported that it was "the waiting" that led him to enroll in this study--that is, the pressure of waiting for oral cancer to reemerge was simply unbearable, and enrolling in this experimental study enabled him to take a more proactive approach to his illness. The authors view this "waiting" as a "limbo experience" and reflect on the implications of this limbo experience for dental ethics and research ethics.

Culturally diverse patients and professionalism in dentistry.

A case is considered in which the father of an adult patient from another culture requests that only limited care be provided his daughter. Additional indicated treatment was declined. The patient appeared to defer to her father as a cultural norm. Various ethical principles and the conflicts among them are considered in light of cultural competency.

Why stories matter. Applying principles of narrative medicine to health care ethics.

Narrative medicine seeks to improve clinical effectiveness through narrative training in reading and writing. Stories give meaning to experience and encourage communication between doctors and patients by honoring the basic human need to recognize and be recognized. Learning how to receive and tell stories, practiced through close reading, group discussion, and written response, may also facilitate ethical reflection and inquiry.