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.

Translation, Cross-cultural Adaptation and Reliability Analysis of the Survey of Anxiety and Information for Dentists (SAID) among Brazilian Adolescents

ABSTRACT Objective: To translate, perform a cross-cultural adaptation and reliability analysis of the Survey of Anxiety and Information for Dentists (SAID) for use with Brazilian adolescents. Material and Methods: The SAID was translated into Brazilian Portuguese and back-translated to English. An expert committee compared both versions and examined their equivalence. Then, a face validation was performed with 10 adolescents. The SAID was applied in printed format with 25 questions. Participants answered and commented on the questions with a researcher to confirm the understanding and provide suggestions. The suggestions were implemented, and the expert committee approved the final version of the SAID in Brazilian Portuguese. The psychometric properties were tested with 60 adolescents aged 10 to 19 years. Participants answered the Brazilian version of the SAID before their first dental appointment and two weeks later to determine test-retest reliability. Reliability was analyzed by internal consistency analysis (Cronbach's alpha) and test-retest (ICC). Results: The instrument presented excellent reliability according to internal consistency (Cronbach's alpha = 0.77) and test-retest coefficients (ICC = 0.88; 95% CI: 0.81-0.93). The Kappa coefficients and the degree of agreement of the dichotomous questions indicated good reproducibility of the new version. Conclusion: The SAID translation, cross-cultural adaptation and reliability analysis were completed successfully. Thus, the Brazilian version of the SAID can be a useful survey tool for dental care of adolescent patients.

Ethical issues and dentists' practices with children with intellectual disability: A qualitative inquiry into a local French health network.

BACKGROUND: The provision of dental care for children with intellectual disability raises many ethical questions. OBJECTIVE: The aim of this qualitative study was to explore approaches to dental treatment in an anxious child with intellectual disability and the ethical dilemmas that ensue. METHODS: Semi-structured interviews were conducted between February and May 2012. A clinical scenario was used to establish a starting point for a discussion of the clinical approach and lead to an ethical reflection. Four topics were discussed: first contact with the patient, information, attitude towards the patient and outcome from the practitioner's viewpoint. The coding procedure used thematic content analysis. RESULTS: Most practitioners fetched the patient from the waiting room personally, greeted them, gave them special attention, and either began the consultation at once, or used distraction to relax the patient. Verbal language and tell-show-do were most often used to provide information. Anxiety and pain were evaluated using parental assessment and standardized scales. A reassuring attitude was adopted. An ethical dilemma arose if the patient refused care or had to be restrained. Practitioners reported sacrificing ethical values (patient autonomy, beneficence and non-maleficence) when making a clinical decision. CONCLUSIONS: There is a wide range of practices but no consensus. This study shed some light on the different perspectives of dentists, most of whom adopted a utilitarianist viewpoint. In this context, ethical reflection is necessary to avoid a detached attitude or, worse, abuse. Further study would enrich this reflection.

Percepción de estomatólogos sobre atención estomatológica a pacientes sordos. La Habana, 2016 / Dentists´ perception of dental care of deaf patients. Havana, 2016

Introducción: La sordera es una discapacidad neurosensorial que provoca un problema de salud pública que afecta no solo al individuo que la padece sino también a su entorno familiar y social. Objetivo: Identificar la percepción de los estomatólogos sobre la atención estomatológica a los pacientes sordos. Material y Método: Se realizó un estudio descriptivo de corte transversal, con una muestra de 42 estomatólogos, entre 29 y 69 años de edad, de ambos sexos, pertenecientes a las Clínicas Estomatológicas de los Policlínicos Docentes del Municipio Marianao en La Habana, en los meses de junio y julio de 2016. Se realizó encuesta. Las variables estudiadas fueron: edad, sexo, conocimientos sobre las reglas de comunicación con el paciente sordo, conocimiento de las posibles causas de insatisfacción de los pacientes sordos durante la atención estomatológica, reconocimiento de los elementos a considerar durante la atención estomatológica al paciente sordo y conocimiento de factores capaces de generar estímulos negativos durante la atención estomatológica al paciente sordo.Resultados: El sexo femenino fue el de mayor predominio con 73.8 por ciento. El 66.7 por ciento de los Estomatólogos no conoce las reglas de comunicación de los pacientes sordos y 78.6 por ciento no conoce los aspectos a tener en cuenta durante la atención al paciente sordo. El 100 por ciento de los encuestados no reconoce los estímulos negativos ni las posibles causas que provocan insatisfacción en dicha población. Conclusiones: La mayoría de los estomatólogos encuestados son del sexo femenino, no reconocen las reglas de comunicación ni los aspectos a tener en cuenta durante la atención al paciente sordo; mientras que la totalidad de ellos desconoce los factores capaces de generar estímulos negativos o las posibles causas que provocan insatisfacción en la atención a estos pacientes(AU)

Introduction: Deafness is a neurosensorial disability which causes a public health problem that affects not only the individual who suffers from it, but also his social and family environment. Objective:To identify the dentists´ perception of dental care they deliver to deaf patients. Material and methods:A descriptive cross-sectional study was conducted, which comprised a sample of 42 dentists aged from 29 to 69 years, of both sexes, who work in the Dental Clinics of the Teaching Polyclinics located in Marianao Municipality, Havana, in June-July, 2016. A survey was made. The variables studied were: age, sex, knowledge about the rules for communication with the deaf patient, knowledge of the possible causes of dissatisfaction of the deaf patients with dental care, recognition of the elements to consider during dental care of the deaf patient, and knowledge of the factors which are capable to generate negative stimuli during the dental care of the deaf patient. Results:The highest predominance was observed in females (73.8 percent). The 66.7 percent of dentists do not know the rules for communication with deaf patients, and the 78.6 percent of them are unaware of the aspects to keep in mind during the care of the deaf patient. The 100 percent of the surveyed dentists do not recognize neither the negative stimuli nor the possible causes that lead to dissatisfaction in this population. Conclusions: Most of the surveyed dentists are female, they do not know neither the communication rules nor the aspects to keep in mind during the care of the deaf patient; whereas the totality of them are unaware of the factors that are capable to generate negative stimuli or the possible causes which lead to dissatisfaction in the attention to these patients(AU)

Dentistry's social contract and the loss of professionalism.

The social contract between society and the dental profession is essential to the ability to provide high quality dental care to patients. The social contract defines the profession and its place in society, giving the profession its legitimacy. Society bestows benefits upon the dental profession in exchange for our ability to alleviate pain and suffering caused by oral disease. This article seeks to explore the nature of this social contract in the provision of oral health care and what may become of the profession should the expectations of either party not be met. Changing beliefs within society and within the profession have led to new concepts of professionalism that focus upon alternative values to what is termed 'nostalgic professionalism'. It is concerning when these new values begin to focus upon financial reward built upon commercial practices, with patients slipping away to be replaced with clients; the dentist-patient relationship lacking in any degree of altruism. This article will argue that breaches in the social contract are not to the benefit of patients or the profession and that whilst specifics of the contract will inevitably change, the nature of this should not.

Social media and professionalism: does the profession need to re-think the parameters of professionalism within social media?

Social media is no longer a new concept, with social media platforms dominating how many communicate. It would be unrealistic to expect that dentistry would not become involved in the use of social media for professional reasons, as well as professionals using social media platforms privately. Despite it being acceptable for dental professionals to have social media presence, those dental professionals have a framework of professional, ethical and legal obligations to which they must conform when using social media. This article seeks to discuss how unintentionally professionalism may be breached by dental professionals not making a distinction between social media and other facets of professional life. There is need for a discussion about how as a profession, dentistry may perceive the effects of professional interaction with social media on the profession's wider relationship with society and whether current regulatory advice goes far enough to protecting the interests of patients. It is important for the use of social media by dental professionals to fit within the established social contract between the profession and society and failure to observe the terms of this will cause damage to the patient-professional relationship.