Oral Health Matters: The Ethics of Providing Oral Health During COVID-19.

Oral health is a critical part of overall health. The current COVID-19 pandemic has highlighted the importance of oral health. In this article, we describe how dental practice has been impacted by COVID-19, identify the public health response to COVID-19, and explain the gradual resumption of dental care after the initial disruption due to the pandemic. Finally, we discuss how long-standing health disparities in oral health have been exacerbated by the current pandemic.

Ethics, Economics and Dentistry for Individuals with Disabilities in New York State.

The ADA Principles of Ethics and Code of Professional Conduct is an expression of the obligation occurring between the profession and society to meet the oral health needs of the public. At a time of economic concerns for the profession, suggestions are made to bring together the ethics of the profession and the need to expand services to underserved populations, including individuals with disabilities and the poor. The profession's effort to secure economic support for such an effort is possible with increased legislative awareness of the magnitude of the problem. To this end, the number of individuals with disabilities was developed for each Congressional district in New York State in an effort to challenge members of Congress to recognize the need in terms of their constituents, rather than in terms of the tens of millions with disabilities in the United States-which become "just numbers," not actual people.

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.

Inequity in oral health care for elderly Canadians: part 2. Causes and ethical considerations.

The Canadian Health Measures Survey, conducted between March 2007 and February 2009, revealed unmet dental needs among older adults in Canada. This article, the second of a 3-part series, explains that the inequity in oral care faced by elderly Canadians is due largely to the current fee-for-service dental service system. However, the inequity has arisen because of financial, behavioural and physical barriers, and both the community at large and the dental profession have a social responsibility to reduce this unfairness and provide equitable access to oral care for older people.

HUMAN RIGHTS AND NIGERIAN PRISONERS--ARE PRISONERS NOT HUMANS?

In Nigeria, just like in many other parts of the world, one of the most extensively discussed issues on the public agenda today is the increase in prison population. The aims of imprisonment are protection, retribution, deterrence, reformation and vindication. Investigations revealed that the prison services have been,neglected more than any other criminal justice agency in Nigeria. For example, most of the prisons were built during the colonial era for the purpose of accommodating a small number of inmates. Human Rights are the basic guarantees for human beings to be able to achieve happiness and self-respect; consequently, in most jurisdictions, the Human Rights Act confirms that these Rights do not stop at the prison gates. However, most States fail to meet the Human Rights obligations of their prisoners. As regards to health, for example, every prison should have proper health facilities and medical staff to provide dental and psychiatric care among others. This article discusses the Nigerian Prison System and challenges, trends and the related Human Rights and Ethical issues in Nigerian prisons. Some of the unmet needs of Nigerian prisoners which include, inter alia, living in unwholesome cells, delayed trial of inmates, lack of voting rights, access to information, lack of conjugal facilities for married prisoners, poor and inadequate nutrition, poor medical care, torture, inhumane treatment and the need to protect prisoners in a changing world. The present report has policy implications for reforming prison services in Nigeria, and countries that sing from the same song sheet with Nigeria on prison services, to conform to the Fundamental Human Rights of prisoners in the 21St century.

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.

[Diagnostic Test Requests in the Family Medicine Consultation: An Ethical Perspective Concerning Requests for Maxillofacial Computerized Tomography Scan Prior to Dental Implants]. / A Transcrição de Exames na Consulta de Medicina Geral e Familiar: Perspetiva Ética Sobre o Caso do Pedido de Tomografia Computorizada Maxilofacial para Realização de Implantes Dentários.

In the Portuguese National Health Service, little attention has been paid to oral health care. The almost nonexistence of a dentistry network raises concern about accessibility to services, and justifies the need to call on a predominantly private provision of services. The coexistence between the public and private settings is not always easy, especially when services need to interact and actively collaborate in order to find answers to the patient's problems. Dental implant procedures and the need to perform a previous maxillofacial computerized tomography to study the bone bed where osseointegrated dental implants are placed are a common situation. The current governmental regulation, blinded to the clinical context, may limit the accessibility to the tests. Based on this scenario, we discuss the possible options from an ethical point of view, framing the patient's and the physician's perspective and the relation between both. We conclude that the medical decision can't be disregarded from the clinical evaluation, in the intimacy of the medical consultation. This is an ethical duty that overrules the administrative and bureaucratic constraints. A good management of this apparent dichotomy may enhance better health and greater empowerment for the patient.

A saúde oral tem sido pouco cuidada no contexto do Serviço Nacional de Saúde em Portugal. A quase inexistência de uma rede de medicina dentária levanta problemas de acessibilidade que condicionam a necessidade de complementar os serviços públicos com uma oferta predominantemente privada. Mas esta coexistência não é sempre fácil, sobretudo quando há necessidade dos serviços se cruzarem e colaborarem ativamente na resolução dos problemas do doente. Uma situação comum é a colocação de implantes dentários e a necessidade de realizar uma tomografia computorizada maxilofacial prévia para estudo de leito para colocação de implantes dentários osteointegrados, onde a aplicação de regulação governamental desenquadrada do contexto clínico pode condicionar a acessibilidade aos tratamentos. Com base neste cenário, discutem-se as opções do ponto de vista ético, na perspetiva do doente, do médico e da relação entre ambos. Conclui-se que a decisão médica não pode ser desenquadrada de uma avaliação clínica que apenas o ambiente de intimidade da consulta médica pode proporcionar. É um imperativo ético que se sobrepõe aos constrangimentos administrativos e burocráticos e que se bem gerido é potenciador de uma melhor saúde e de maior capacitação da pessoa.

Ethics and leadership in children's oral health.

PURPOSE: This paper reviews key ethical precepts in health care for children, and explores how interpretations of justice predict different and sometimes conflicting approaches to children's dental needs. Ethics is a core competency for health professionals because of their special responsibilities toward patients and the public. Ethical principles guiding health professionals include: (1) beneficence; (2) nonmaleficence; (3) respect for autonomy; and (4) justice. Different theories of justice lead to different responses toward public needs, such as access to dental care. The most frequently encountered response in the dental community is volunteerism, consistent with the libertarian perspective on justice. Though desirable, volunteerism alone will never solve dental access issues because such efforts do not address the problems systematically. A policy statement of the American Academy of Pediatric Dentistry (AAPD) explicitly recognizes that children have a right to oral health care. Children's unique characteristics--their vulnerability, dependence, and developmental processes-call for special arrangements to address their health needs. Given the importance of children to society, it is critical that all health sectors work together to address children's health and well-being. However, those with the greatest knowledge of children's oral health needs-pediatric dentists-must take a leadership role in creating and supporting solutions to these needs. The AAPD has an opportunity to support systemic solutions at the state and national level to ensure that all children have access to oral health care. One example of a systemic solution is the Access to Baby and Child Dentistry (ABCD) program in Washington State.

The need for dental ethicists and the promise of universal patient acceptance: response to Richard Masella's "Renewing professionalism in dental education".

Richard Masella's "Renewing Professionalism in Dental Education: Overcoming the Market Environment" reveals why professionalism is nearly dead in America; it also shows the good of commerce and the excesses of commercialism in the market. More importantly, it collects and summarizes most of the relevant forms of education currently available to teach professionalism and professional ethics in dentistry; it then briefly examines whether those forms of education are used and if they are effective. Masella also asks some key challenging questions. His select and limited references lead to deeper studies about the nature and definition of professionalism and how it might be learned and presented. His suggestions for renewing professionalism are minimal; this sets the stage for proposing and selecting other ideas that need attention and development. Some of those ideas and suggestions, such as competition and collaboration, four types of dentistry, understanding two conflicting meanings of desire and need, and universal patient acceptance were recently explored in a workshop, "Professional Promises: Hopes and Gaps in Access to Oral Health Care" (procedings published in the November 2006 Journal of Dental Education), and were not yet available to Masella when his article was authored. His article, though, stimulates good discussion and action. Its data and substance show why, for example, dentistry needs to develop a core cadre of full-time practicing professional dental ethicists. Currently, there is only a small but very dedicated group of volunteers trying to meet our society's need to bring new life to professionalism in dentistry and our market.

A welcome to the workshop on "professional promises: Hopes and gaps in access to oral health care".

Starting with the belief held by some of the workshop participants that access to basic oral health care is a natural human right and that the oral health care system in the United States must serve the common good, we conducted a meeting of ethicists, practicing dentists, dental hygienists, dental educators, and others to discuss ethical issues related to access to care. As one of the meeting organizers, the author discusses in these introductory remarks his background and personal perspectives on why the dental profession has a moral obligation to better address the access issue.

Ethics, access, and care.

There are two very different ways of understanding access and care that are at work in contemporary American society. One of these is the understanding that our society's health professions have about access and care as they consider their ethical commitment to respond to patients' oral health needs. The other is how these matters are understood within America's public culture. In this view, needs--including health care needs--are no different in kind or ethical significance from unmet desires of any sort. This article will spell out the differences between these two ways of understanding care and access. Comprehending the distance that separates the health professions' perspective from much of mainstream American thinking on these matters is essential to a careful discussion of the ethics of access to oral health care.

Four ways we approach ethics.

Most people use four different approaches when making ethical decisions. Some people use one approach predominantly, while others vary their approaches according to the circumstances. In either case, the approaches usually are chosen unconsciously. A main source of conflict in decision making occurs when two parties argue or negotiate their positions from different moral approaches, for these different moral approaches are not convincing to one another. People may be persuaded to change their minds only when a stronger position is raised within their own moral approach. The different moral approaches are the principle, consequences, virtue/character, and moral sentiment approaches. Conflicts in decision making can become easier to resolve when decision makers first recognize they are using different moral approaches and then choose to negotiate within the same moral approach.

Basic oral health needs: A public priority.

Is there a way to support a special ethical status for unmet oral health needs within our pluralistic, liberty-loving American society? Some people in American society, perhaps many people, believe that some kinds of human needs have special ethical importance. But very few people outside the oral health professions have ever considered that unmet oral health needs might belong to this category. This article will examine why some kinds of needs are thought to have special ethical importance and propose that certain categories of oral health care are needs that fit this description. Without thinking these issues through, we who argue for improved access to oral health care will remain unable to provide an adequate answer to a very legitimate question, namely: improved access to what? When this task has been completed, the article will consider some of the implications of such a view for our society.

Band-aid solutions to problems of access: Their origins and limits.

Many persons lack adequate access to oral health services. The causes of this are a constricted understanding of the roles of governments and professions. Both those groups have responsibilities to ensure that a decent level of oral health care is available to all persons in the United States. If the dental professions as a whole were to embrace this ideal, the sacrifices required of any one professional would be minimal.

Codes and colleagues: Is there support for universal patient acceptance?

This article is a refinement of verbal reactions to O'Toole's and Corsino's remarks at a national conference on Access to Oral Health Care held at the headquarters of the American Dental Association in August 2005. The article consists of two parts, each part an answer to specific questions. The first is a reaction to Corsino's explanation of Patthoff's concept of Universal Patient Acceptance. Acceptance is supported and endorsed, and a case is made for the importance of a clear and accurate explanation of Universal Patient Acceptance, as it has a much greater likelihood of being embraced by dentists than "access" seems to have. A review of relevant codes of ethics in dentistry reveals mixed and uneven support for Universal Patient Acceptance. The second part of this article compares the way that the profession of psychology views access and acceptance with the way that dentistry seems to view them and concludes that, if dentistry is to remain a caring profession rather than a commercial enterprise, acceptance must be embraced.

Building moral communities? First, do no harm.

As concern for the oral health of vulnerable populations grows, dentistry continues to seek effective ways to respond. In August 2005, Dr. Donald Patthoff and Dr. Frank Catalanotto convened a national workshop at the American Dental Association headquarters on the ethics of access to oral health care. A series of papers were produced for the workshop and subsequently revised for publication. This one responds to the paper by Dr. David Chambers on moral communities and the discursive imperative for building community and consensus around issues affecting equitable access to oral health care. I explore three interrelated issues that ought to be considered when endeavoring to build moral communities: 1) the problem of power relations-a fundamental constituent within discourse that can impede constructive efforts; 2) the discursive disconnect between theoretical ethics and social constructs affecting dentistry; and 3) the bioethical principle of nonmaleficence as a priority in the desire for building moral communities. In essence, this article responds also to the call from ethicists who see a significant need for substantive interdisciplinary contributions to inform how people at different social levels react in ethically problematic situations in its broad social context.

Professional promises: Summary and next steps.

A summary of the key themes discussed during the sessions is provided highlighting the participants' recommendations for addressing the ethics of access. Areas reviewed included strategies utilizing ethics as an educational tool. The need for professional associations and accrediting and licensing bodies to address access to care in their guidelines is an additional recommendation. Networking, sharing resources, and continuing the dialogue about ethics and access to care are identified as important strategies following the workshop. The summary also highlights promises made to continue the dialogue about the issue in various forums.

How did we get here? Where are we going? Hopes and gaps in access to oral health care.

This article reviews the history and future good of acceptance ethics and helps frame the publication of papers presented at the workshop on Professional Promises: Hopes and Gaps in Access to Oral Health Care. Discovery and development of Universal Patient Acceptance (UPA), a practical application of acceptance ethics, is key to systematizing access to oral health; UPA expands partnerships among professional volunteerism, culture, and economic structures. A Veterans' Administration health services preventive dentistry research project and a West Virginia school children's preventive dental program raised awareness of acceptance. A state insurance crisis revealed an underlying systems ethics problem that was not purely legal, political, educational, economic, or scientific in nature. Key players were identified for dialogue, and questions were ranked. UPA was articulated and proposed as a unique, practical, and positive professional promise. The experience involved PEDNET, a dental ethics education group. An intensive applied dental ethics course for practicing dentists was developed; it attracted the American College of Dentists (ACD) and American Dental Association (ADA). Annual ACD LeaderSkills helped expand continuing education of ethics; several dental ethics summits were initiated. Concepts like discourse, adequate care, and viewing organizations as both persons and machines motivated further exploration of acceptance. Separating acceptance from diagnosis, treatment, and payment improves discourse on the various philosophical notions and practical applications that dominate each area.