Congenital diseases and a New York State regulation. Help is here.

Knowledge of a little known New York State regulation and its insurance implications can be used to provide dental benefits to people who have congenital diseases or anomalies. An explanation of the regulation is provided, and some of the more common congenital diseases that may affect the dentition, such as amelogenesis imperfecta, dentinogenesis imperfecta, ectodermal dysplasia, cleft lip/palate and trisomy 21, are reviewed.

Managing Bariatric Patients in Dentistry.

Obesity is a growing issue across the world, presenting a range of challenges to society. Management of obese or bariatric patients in the dental environment has become more commonplace. This article considers an overview of obesity, reviews its dental impact and offers some solutions to minimising those challenges in the dental setting.

TB infection control recommendations from the CDC, 1994: considerations for dentistry. United States Centers for Disease Control and Prevention.

Between 1989 and 1992, reports of outbreaks and transmissions of tuberculosis in institutional settings prompted the Centers for Disease Control and Prevention to review the guidelines for TB infection control it had published in 1990. The CDC published an updated version of the guidelines in October 1994. This article gives dentists an overview of the guidelines' recommendations that are applicable to most outpatient dental settings.

Legal considerations in infectious diseases and dentistry.

Dentists, similar to other professionals subject to legal regulation, often have an overly simple view of the legal system. Communicable diseases present questions on the cutting edge of the law, and, as the previous discussion makes perhaps painfully clear, there is considerable uncertainty on many important legal points. Legal uncertainty is often a reflection of social or scientific uncertainty. Clear answers emerge less from the words of lawyers and judges than from the actions of professionals themselves, who ultimately set the standard of care. In any area of legal uncertainty, the dentist is best advised to adhere to the best scientific information available and to meet the ethical standards of the profession.

National Alliance for Oral Health Consensus Conference on Medically Necessary Oral Health Care: Legal issues.

This paper examines medical malpractice law as it applies to medically necessary oral health care. The basic legal concepts and reported cases involving medically necessary oral health care are reviewed. It is concluded that dental professionals and consumer advocates must advance their educational and legislative advocacy efforts so that health professional colleagues and the public will become aware of the importance of these services and insurers will routinely include coverage of medically necessary oral health care in their medical and dental policies. While failure to provide medically necessary oral health care can be violative of patient rights and legally actionable, medical malpractice litigation should always be the behavior modifier of last resort.

The ethical foundations of a duty to treat HIV-positive patients.

Unfortunately, those who commit the most egregious acts of HIV-related discrimination may not be motivated to change either by fines and sanctions, or by educational programs. Perhaps the best solution to dealing with the small, but significant, number of health care providers who discriminate against HIV-positive patients is the action of the majority. Most dentists are ethical and concerned health care professionals, who willingly care for patients with a wide array of medical problems. This majority must continue to serve as an example to those who refuse to care for HIV-positive patients, and must make it clear that such actions are professionally intolerable.

Confidentiality versus disclosure of a patient's infectious status.

Patients in health care settings have a legal and moral right to privacy, which includes confidentiality of all information related to the patient or gathered by the patient's health care team. Even so, the right to privacy is not total. Under certain circumstances, that right must yield to a state's fundamental right to enact laws to promote public health and to ensure public safety and welfare. Justifiably, dental health care team members are concerned with their health and with the possibility of being infected by a fatal disease such as acquired immunodeficiency syndrome (AIDS). The right to know patients' infectious status is growing with the mortality rate of the disease. However, as more health care workers learn of a patient's infectious status, that patient's privacy diminishes. Abiding by laws that enforce doctor-patient confidentiality while still fulfilling their obligations to their staffs and related third parties often proves difficult for dentists and physicians. Since the discovery of AIDS, believed to be caused by the human immunodeficiency virus (HIV), health care providers have been increasingly conscientious in maintaining these professional relationships.

The dentist, HIV and the law: duty to treat, need to understand.

An understanding of three areas of law--anti-discrimination, workplace safety and privacy and confidentiality--is helpful to dentists in meeting their responsibilities to treat HIV-infected individuals. This understanding also will assist in establishing a practice atmosphere in which HIV-infected patients will feel comfortable enough to fully disclose their condition and discuss treatment options with the care provider.

Murmurs, infective endocarditis and dentistry.

Patients with cardiac murmurs may have a predisposition to infective endocarditis, and the dental practitioner must be aware of this potential problem. This article reviews cardiac murmurs and how they are investigated by physicians to assess their significance. Practical advice is offered concerning the need to refer patients with a suspected heart murmur. The emergency and elective dental management of patients with heart murmurs is included, together with recommended regimens for antibiotic prophylaxis.

HIV and AIDS--the ethical dilemma central to many issues in HIV/AIDS revolves around individual good versus societal good.

Using patient advocacy as a point of departure, there are three possible ethical options where the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is concerned: a 'strict advocacy' approach, a 'moderate advocacy' approach and a 'no advocacy' approach. In South Africa, a 'moderate advocacy' approach is favoured in general.

[Legal and ethical considerations of emergencies in the dental office].

The dentist has the ethical and legal responsibility to anticipate emergency situations in correlation with the patient's medical status. He has the obligation to do all in his power to prevent emergencies from happening and to be prepared to manage any emergency that might occur. This article also discusses the importance of monitoring and documentation.

Infectious disease in dental practice--professional opportunities and obligations.

This article presents one author's view of the dentist's obligations to patients, to the community, to the profession, and to the principles of ethics in a highly troubling time of serious infectious diseases. It essentially is an optimistic view that, while the epidemic of AIDS will continue and tuberculosis may become a graver problem in certain health care settings, the dental profession possesses the education, ethical insights, and technical training needed to meet with grace and authority the challenges of practice in this era of infectious disease.

GOP lawmakers seek a second review of dentist's case.

AIDS: Reps. Charles Norwood of Georgia and Tom Coburn of Oklahoma are seeking a second Supreme Court review of the case of [name removed], a Maine dentist who refused to treat an HIV-positive patient. In 1997, the 1st U.S. Circuit Court of Appeals ruled that [name removed] had violated the Americans with Disabilities Act. The appeals court later reexamined the case on instructions from the Supreme Court. In their petition, Norwood, a dentist, and Coburn, a physician, argue that the 1st Circuit erred in its ruling and note that although universal precautions, such as face shields and latex gloves, may alleviate the direct threat of infection, these precautions cannot protect against needlesticks the dentist might suffer while treating the HIV-positive patient. The lawmakers are backed by the American Association of Forensic Dentists and Dr. Cary Savitch, a medical professor who disagrees with the theory that HIV is difficult to transmit. The Supreme Court is expected to decide in the near future whether it will hear the case.^ieng

The Supreme Court confronts AIDS: expanded coverage.

AIDS: The United States Supreme Court ruled that people with HIV infection may be covered under the Americans with Disabilities Act (ADA), even if they are symptom free. In [name removed] v. [Name removed] sued Dr. [name removed] for discrimination. [Name removed] refused to fill a cavity for [name removed], who is HIV-positive, unless the procedure was performed at a local hospital where he felt there would be better infection-control procedures. The First Circuit Court ruled that [name removed] did not present sufficient evidence showing that HIV transmission was riskier in a dental setting versus a hospital setting. [Name removed] then appealed to the Supreme Court. The Supreme Court ruled on June 25, 1998 that [name removed] was protected from discrimination under the ADA's definition of disability, due to her decision to not have children because of her HIV status. Therefore, [name removed]'s decision to not fill the cavity could be considered discrimination. The Supreme Court's decision allows for a broader interpretation of the ADA in future court cases, which may prove beneficial for other HIV positive people or for people suffering from various life threatening diseases. Other possibilities of how HIV might affect major life activities, and as a result, be covered under the ADA are discussed. Positive and negative comments regarding the Supreme Court's decision are also included.^ieng