COVID-19: ¿cuál es el rol ético del odontólogo ante esta pandemia? / COVID-19: what is the ethical role of the dentist in face of this pandemic?

Introducción: Para un buen profesional de la odontología es necesaria la ética en todas las actividades que realice. La ética establece lo que es y debe ser, buscando siempre el bien y no hacer el mal o causar daño, y el odontólogo debe tener una serie de cualidades y aptitudes con el fin de llevar a cabo todo el tratamiento que amerite el paciente de manera correcta, honesta y responsable sin escatimar esfuerzos para devolverle su salud oral. La COVID-19 es una enfermedad que se ha convertido en pandemia y está afectando al mundo de manera importante. Entre los más afectados se encuentran los profesionales de la salud que arriesgan sus vidas por sanar al enfermo. Dada la situación actual, a los odontólogos se les presenta la duda si atender a sus pacientes en este periodo cumple o no con los principios éticos de la profesión. Objetivo: El objetivo del presente artículo fue realizar una revisión sistemática de la literatura con el fin de identificar el rol bioético del odontólogo ante la pandemia de COVID-19. Material y métodos: Para realizar la recolección de la literatura se compilaron artículos de diferentes bases de datos: PubMed, Cochrane, Nature y Lilacs producidos entre los años 2012 y 2020 con las palabras clave: ética, odontología, pandemia, COVID-19 y bioética en los idiomas español, inglés y portugués. Resultados: Se localizaron 70 artículos, de los cuales se escogieron finalmente 10 correspondientes a los criterios de búsqueda. Los artículos presentaron homogeneidad sobre el rol del odontólogo en la situación actual y coinciden en la búsqueda de alternativas y métodos de atención lo más seguras posibles, dando prioridad a quienes requieren atención de urgencias (AU)

Introduction: For a good dental professional, ethics is necessary in all the activities performed. Ethics stablish what is and what should be, always looking for the good and not the bad, the dentist should have a series of qualities and skills in order to perform every treatment that the patient needs in a correct, honest and responsible way without sparing efforts to give them back their oral health. COVID-19 is a disease that has converted into a pandemic affecting the world in an important manner. And, between the most affected are the health providers and professionals that risk their lives to heal the people suffering this disease. Given the current situation, dentists have been found in doubt regarding if treating their patients in this period meets or not the ethical principles of their profession. Objective: The objective of this article is to perform a systematic review of literature in order to identify the bioethics role of the dentist in face of the COVID-19 pandemic. Material and methods: To carry out the collection of literature the procedure included compiling different articles from the databases: PubMed, Cochrane, Nature, and Lilacs produced between the years of 2012 and 2020 with the key words: ethics, dentistry, pandemic, COVID-19, bioethics in the languages of Spanish, English and Portuguese. Results: 70 papers were located from which only 10 were chosen meeting the searching criteria. The papers presented homogenous results about the role of dentists in the current situation and the all agree in the search of alternatives and methods of care that are as secure as possible, giving priority to those who are in need of urgent care (AU)

Bioética do cuidado na clínica de ensino: aprendendo com pacientes / Bioethicsof the care in the teaching clinic: learning with patients

O estudo buscou compreender práticas de acolhimento de pacientes em uma clínica de ensino odontológico.Trata-se de um estudo de caso único e holístico, com abordagem qualitativa. Foram realizadas entrevistas abertas com 20 pacientes, guiadas por um roteiro com temas problematizadores que procuram ligar princípios bioéticos a dispositivos subjetivos do cuidado: conceito ampliado de saúde e doença, intersubjetividade, corresponsabilidade e qualidade de vida. As práticas discursivas analisadas mostraram que o vínculo entre estudantes e pacientes da clínica de ensino se estabelece em uma construção mediada pelo longo tempo da formação. A corresponsabilidade está relacionada às construções intersubjetivasnocuidado e tem como atores do processo osestudantes e os pacientes. Ao afirmarem sentirem-se livres para opinar sobre seus tratamento também expressam uma postura de reduzida autonomia, pois consideramque não sejanecessário fazê-lo. Como reflexo da fragmentação do cuidado nas clínicas de ensino, muitos silenciamentos emergem destas relações de poder e cuidado. Acredita-se que é clara a importância de práticas que se desvinculem de funções estritamente técnicas e invistam nos processos de fala e escuta, incansavelmente buscando empatia e vínculo como as tecnologias de saúde mais potentes para o tratamento, pois reafirmam a autonomia das pessoas na construção de seus itinerários de cuidado e a dignidade humana como valor central da prática de saúde (AU).

The study aimed to understand welcoming patients practices in a dentistry teaching clinic.It is a holistic single-case study with a qualitative approach.Twenty patients were interviewed following anopen-ended script containing problematizing topics trying to connect bioethical principles tosubjective devices of care: expandedconcept of health and illness, intersubjectivity, co-responsibility, and quality of life.The discursive practices analyzed showed that the bond between students and patients of the teaching clinic is established in a construction mediated by the long training time.Co-responsibility is related with the intersubjective constructions in the care, being the actors of the process both the students and the patients.When claiming to feelfree to give an opinion on their treatment, they also express a position of reduced autonomy, as they consider that it is not necessary to give it.As a reflection of the fragmentation of the care in the teaching clinics, much silencing emerges from these relations of power and care.It is believed that that the importance of practices that unlinkthemselvesfrom strictly technical functions and invest in the speaking and listening processes is clear. In an untiring search for empathy and bond as the mostpowerful health technologies for the treatment, they reaffirm the autonomy of the people in the construction of their itineraries of care and human dignity as a core value of the practice of health (AU).

Decisão diante de conflitos bioéticos e formação em odontologia / Decision-making in the face of bioethical conflict and training in Dentistry / Decisión frente a conflictos bioéticos y formación en odontología

Resumo O objetivo deste estudo é relacionar concepções sobre ética com a capacidade de tomada de decisão de estudantes no estágio inicial do curso de odontologia. Trata-se de pesquisa qualitativa, dividida em duas etapas: na primeira, 62 participantes responderam a um formulário on-line com duas perguntas sobre concepções de ética; na segunda, 59 deliberaram sobre duas situações de saúde envolvendo conflitos bioéticos. As respostas passaram por análise textual discursiva, por meio da qual se verificou que a maioria dos estudantes compreende a ética como orientação individual nas condutas sociais e profissionais. Essa concepção restrita de ética aparece também nos exercícios de tomada de decisão. Conclui-se que o ensino de bioética deve contemplar o papel de contextos singulares na tomada de decisão, enfatizando o respeito à vida, e não apenas o tratamento de doenças. Tal ensino, inserido de maneira transversal na formação, valoriza o cuidado centrado nas pessoas.

Abstract This study aims to understand the relationship between conceptions of ethics and decision making in situations of bioethical conflict in practices of first-year dentistry students. Holistic case study with a qualitative approach was carried out, in two steps: in the first, 62 participants answered an online form with two questions about conceptions of ethics; in the second, 59 deliberated on two health situations with bioethical conflict. Discursive textual analysis was performed. Results show that students understand ethics as individual guidance in social and profession conduct. In training, students' restricted conceptions of ethics are amplified in the decision-making exercises in the face of bioethical conflicts. The role of singular contexts is an element for the decision-making in learning that includes respect for life and not just the treatment of disease. The topic of bioethics, thus transversalized in the formative process, values people-centered care.

Resumen El objetivo de este estudio es relacionar concepciones sobre ética con la capacidad de toma de decisiones de estudiantes en la etapa inicial del curso de odontología. Se trata de una investigación cualitativa, dividida en dos etapas: en la primera, 62 participantes respondieron a un formulario en línea con dos preguntas sobre concepciones de ética; en la segunda, 59 participantes deliberaron sobre dos situaciones de salud que implican conflictos bioéticos. Las respuestas se sometieron a un análisis textual discursivo, por medio del cual se constató que la mayoría de los estudiantes comprende la ética como una orientación individual en las conductas sociales y profesionales. Esta concepción restringida de la ética aparece también en los ejercicios de toma de decisiones. Se concluye que la enseñanza de la bioética debe contemplar el papel de los contextos singulares en la toma de decisiones, haciendo hincapié en el respeto por la vida, y no solo en el tratamiento de enfermedades. Tal enseñanza, inserida de manera transversal en la formación, valoriza el cuidado centrado en las personas.

Local analgesia in paediatric dentistry: a systematic review of techniques and pharmacologic agents.

PURPOSE: To evaluate the evidence supporting effects and adverse effects of local analgesia using different pharmacological agents and injection techniques during dental treatment in children and adolescents aged 3-19 years. METHODS: A systematic literature search of databases including PubMed, Cochrane, and Scopus was conducted in November 2016. The PRISMA-statement was followed. Two review authors independently assessed the selected randomised control trials for risk of bias and quality. RESULTS: 725 scientific papers were identified. 89 papers were identified to be read in full text of which 80 were excluded. Finally, 9 papers were evaluated for quality and risk of bias. Many of the included papers had methodological shortcomings affecting the possibility to draw conclusions. Information about ethical clearance and consent were missing in some of the included papers. No alarming adverse effects were identified. One study was assessed as having low risk of bias. This reported inferior alveolar nerve block to be more effective than buccal infiltration for dental treatment of mandibular molars, while no differences were found regarding pharmacological agents. CONCLUSIONS: At present, there is insufficient evidence in support of any pharmacologic agent or injection technique as being superior compared to others. There is a need for more rigorous studies which also handle the ethical issues of including children in potentially painful studies.

The Role of Self- and Peer Assessment in Dental Students' Reflective Practice Using Standardized Patient Encounters.

The aim of this study was to gain insight into the nature of the role played by self- and peer assessment in the development of dental students' reflective practice skills and the value gained through structured encounters with standardized patients. Four standardized patient encounters in an objective structured clinical exam (OSCE) format served as a learning experience for students to demonstrate decision making and communication skills in complex scenarios regarding issues of ethics. Self- and peer assessment and peer-to-peer discourse were used to enhance student reflection. A sample of 16 peer pairs was randomly selected from the population of 108 fourth-year students who participated in the 2014 Clinical Dental Ethics OSCE. Data were collected from self- and peer assessment forms. Five overall performance themes (personal affect, verbal communication, professional demeanor, relationship-building, and patient management) and three student learning themes (application and knowledge, ways to change, and impressed with peer/increased confidence in self) were identified. The results showed that peer assessment ratings were consistently higher than those in the self-assessments, but overall the students deemed both their peers' and their own decision making and communication skills to be quite good. These students rated their experience with the OSCE and self- and peer assessments as positive, appreciating the importance of reflection and learning from their peers. These results provide support for the continued formative use of standardized patient OSCEs and self- and peer assessment to help students develop skills in decision making, communication, professionalism, and reflection.

Ethical considerations in community oral health.

As the public's oral health care needs increase in complexity, there is renewed attention to the ethical dimensions of community oral health decision making and the development of public health ethics in teaching and research in dentistry. Despite their reduction globally, oral diseases persist with a particular distribution pattern that is a reflection of the increasingly widespread inequality in access to community oral health preventive and dental care. This is due to differences in the appropriateness, availability, accessibility, and acceptability of oral health education and the care provided. This article provides an overview of community oral health from an ethical perspective, including the importance of equity, human rights, and social justice in providing oral health care to the underserved. The need for a paradigm shift from highly technical and individualistic dental training curricula is discussed, together with the need to instill a holistic approach to ethical and social responsibility in new dental graduates. It concludes with some possible strategies, using the overarching principles of ethics and bioethics that are applicable to practice among vulnerable populations.

Some care versus no care: an ethical analysis.

When examining solutions to mitigate dental disease and the crisis involving access to care, a question is frequently raised: "Is some care better than no care?" However, the question generally lingers unanswered. The purpose of this paper was to perform an ethical analysis of the question "is some care better than no care?" in order to ascertain whether solutions that provide "some care" are ethically justifiable.

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.

A critical appraisal of holistic teaching and its effects on dental student learning at University of Bergen, Norway.

The curriculum of the dental faculty at the University of Bergen, Norway, was revised and a new curriculum implemented in 1998 based on the principles of holistic teaching and patient-centered treatment. The first candidates graduated in 2003. The change of curricula, experience gained, and lack of an evidence base for holistic teaching justify a general discussion of all relevant aspects associated with this approach. The purpose of this article was to make a contribution towards such a discussion. A PubMed search regarding holistic teaching in dentistry was performed. Of the 211 entries on holistic teaching, few discussed holism in depth; none reported outcome measures comparing old and new curricula. Data collected from students graduating in 2003 (new curriculum) and 2000 (old curriculum) on their satisfaction with the teaching comprise a possible outcome measure. In most respects, using prosthodontics as an example, no differences between the two groups of students were found. Students studying under the new holistic curriculum were less satisfied than those studying under the old one regarding the number of available teachers and teachers' feedback on student performance. Both holistic teaching/patient-centered treatment and a more traditional subject-specific approach have advantages and disadvantages, and neither can be practiced in its pure form for ethical and practical reasons. The quantitative results of this study did not support the hypothesis that holism improved students' satisfaction with the teaching. A wide discussion of holism in dental education is needed, along with outcome measures when curricula are changed.

Percepción de docentes y alumnos sobre documentos Odontológicos legales utilizados en la práctica clínica de Facultades de Odontología del Paraguay año 2011 / Perception of teachers and students on legal documents used in the Dental Clinical Practice of Dental Schools in Paraguay in 2011

El odontólogo tiene grandes responsabilidades en la sociedad, en función de la misma existen normas éticas y legales que le dan un norte a ese profesional. Todas las actividades odontológicas deben ser plasmadas en documentaciones que son el medio por el cual se demuestra la actuación del mismo. La confección del consentimiento informado es obligatoria según los Códigos Penal y Sanitario y la historia clínica lo es para asegurar una medicina de calidad. El mejor lugar para impartir esta enseñanza es la facultad durante la formación del estudiante. Se evaluó la percepción de docentes y estudiantes sobre documentos odontológicos legales utilizados en la práctica clínica de Facultades del Paraguay con el propósito de tomar medidas correctivas necesarias inculcando el verdadero objetivo de estos documentos en la Institución. Es un estudio observacional descriptivo y componente analítico, se aplicó un cuestionario auto administrado a 233 sujetos. Se observó percepción del 63%; sólo el 3% considera la confección del consentimiento informado como un acto médico y el 92% cree necesario un centro de admisión de pacientes en su Institución. No se observó significancia estadística en relación del tipo de Institución pública o privada y la percepción sobre los documentos odontológicos p= 0,1 p> 0,05

Homeopathy and its ethical use in dentistry.

Media coverage of homeopathy over the past few years has tended to concentrate on the very negative position taken by sceptics, while the possible benefits of homeopathy are ignored. This has resulted in coverage that has been rather one-sided, inaccurate and at times hysterical. A perfect example is Dr David Shaw's opinion piece 'Unethical aspects of homeopathic dentistry' (Br Dent J 2010; 209: 493-496) which falls far short of providing a basis for balanced intellectual discussion. The authors are therefore grateful to the BDJ for the opportunity to outline the case for integrating homeopathy in dental practice.

Atenção precoce e educação em saúde na atividade laboral: uma abordagem da infecção pelo HIV/Aids na odontologia do trabalho / Early attention and health education in work activity: an approach to HIV/Aids Iinfection in dental work

Introdução: a equipe de saúde ocupacional possui a responsabilidade de exercer o cuidado e a atenção integral de indivíduos infectados pelo HIV, noque diz respeito à saúde bucal, que perpassa desde a assistência até a realização de campanhas informativas e preventivas nas empresas em que prestam serviço. Objetivo: descrever os aspectos preventivos e educativos relacionados à infecção pelo HIV/aids por meio de uma visão da atuação prática da Odontologia do Trabalho através de uma revisão da literatura. Métodos: foi realizado um levantamento bibliográfico que utilizou periódicos científicos,livros técnicos, notas técnicas, publicações de organismos nacionais e internacionais (Medline, SciELO e Lilacs no período de 1988 até 2010). Resultados:as atribuições do cirurgião-dentista na odontologia do trabalho perpassam desde a observação e o controle de infecções da cavidade oral, bem como depossíveis manifestações orais provenientes da infecção pelo HIV, além do trabalho de promoção da saúde bucal, até a realização de campanhas informativase preventivas nas empresas em que prestam serviços. Conclusão: a busca pela atualização dos conhecimentos técnico-científicos é prevista por norma regulamentadora e dará ao profissional a segurança necessária para não agir de forma preconceituosa e discriminatória, capacitando-o para a realização deum trabalho educativo junto aos demais componentes do seu ambiente laboral e social, incluindo indivíduos infectados pelo HIV.

Introduction: the occupational health team has the responsibility of taking comprehensive care of individuals infected by HIV in relation to oral health care since that comprehends the informative campaigns and preventive actions in companies that provide service. Objective: to describe the preventive and educational aspects related to HIV/aids through an over view of the performance practice of dentistry labour through the literature review. Methods:we conducted a literature review that used scientific journals, technical books, technical notes, publications, national and international (Medline, SciELO and Lilacs in the period between 1988 to 2010). Results: the tasks of the dentist in dental work permeate the observation and control of infections of theoral cavity, as well as oral manifestations of HIV infection, in addition to efforts to promote oral health, the informative and preventive campaigns in the companies they serve. Conclusion: the search for the updating of technical and scientific knowledge is provided by regulation and professional will secureenough acting not to prejudicial and discriminatory way, enabling him to carry out educational work with the other components of their work environmentand social, including individuals infected by HIV.