Is dentistry the orphaned field of medicine? Ethical consideration for evidence-based dentistry.

It was a watershed moment when Archie Cochrane published his work on Effectiveness and efficiency: random reflections on health services which was considered the start of evidence-based healthcare as we now know it. From there onward, evidence-based dentistry (EBD) has developed and evolved and there has been little attention to the interlink between EBD and ethics. The aim of this paper is to explore some of the ethical basis of evidence-based approach to healthcare utilising Beauchamp and Childress' four principles. EBD will be examined in relation to a variety of ethical theories. The case will be made that dentistry can, at times, be considered the orphaned field of medicine and an examination will be presented about how this may affect the uptake of EBD in practice. While exploring the strengths and weaknesses of EBD from an ethical viewpoint, we will highlight some of the challenges facing many dental practitioners in judging what is considered high-quality evidence and examine ways in which this could be improved with links to patient outcomes from an ethical perspective.

How the vision of a clinician and an educator brought the MA Dental Law and Ethics course to life.

This paper reflects on an educational development, a dental law and ethics course, as the course approaches its fifth anniversary. The authors outline their personal journey into developing and delivering this course, as well as sharing their best practice in relation to teaching dental postgraduate students who may approach the subject in different ways. It also highlights the vision behind this provision and how it is received by dental practitioners. The paper shares the learners' perception of topics such as ethics in comparison to law, and it highlights the perspective of both authors in teaching and following the students' journey in this course.

Understanding continuous professional development participation and choice of mid-career general dental practitioners.

OBJECTIVE: Participating in continuing professional development (CPD) activities is a requirement for dental practitioners to keep their skills and knowledge up to date. Understanding the ways dental practitioners engage with professional development and the impact on practice is not fully known (Eaton et al. 2011, http://www.gdc-uk.org/Aboutus/policy/Documents/Impact%20Of%20CPD%20In%20Dentistry.pdf). The aim of this study was to gain insights into the ways that dentists reflect on their professional development and what may be influencing their choices. METHOD: Empirical qualitative data were collected by semi-structured interviewing of five mid-career dentists. Using grounded theory, the data were analysed for themes about CPD choice and participation. RESULTS: Three themes were identified as influences to dentists' choices of CPD with pragmatic considerations of how new learning could benefit their patients and their practices. Dental practitioners were influenced by the requirements of external regulatory bodies which they did not consider to necessarily improve practice. CONCLUSION: Dentists working in primary care in the UK are undertaking CPD which is influenced by the pragmatic requirements of running a small business and to meet regulatory requirements. In this sample, dentists are not critically reflecting on their education needs when choosing their CPD activity. Protected learning time and organisational feedback and support are recommended as a way to promote more meaningful reflection on learning and to improve professional development.

Perception of studying dental law and ethics among postgraduate dental students in the UK.

Law and ethics is an integral part of medical and dental professional practice. The subject is touched upon in the undergraduate curriculum. Historically, dentists interested in postgraduate study in this subject have accessed courses on medical law and ethics. While there are areas of shared interest (for example, consent, confidentiality) there are differences in emphasis and content (for example, end of life care, organ transplants, etc) which are not relevant to dentistry. A new postgraduate certificate (PgCert) course was approved by the University of Bedfordshire designed specifically for dental practitioners, making it the only university accredited course in the UK that is specific to dental staff. Students' perception of the subject of dental law and ethics at a postgraduate level was not known. The first PgCert student cohort was assessed at the start and the end of the course using two questionnaires. Sixteen students, all qualified dental practitioners working in the UK, took part. The perception toward the subject of dental law and ethics was in-line with the current guideline and regulations governing the dental profession. Perception of dental law was clearer at the end of the course compared to the beginning while dental ethics remained a challenging subject.

Longitudinal study of the three-dimensional development of subsurface enamel lesions during in vitro demineralisation.

A longitudinal study was made of the 3D development of subsurface enamel lesions in whole human molars. X-ray microtomography (XMT) was used to measure the 3D distribution of linear attenuation coefficients in the tissue at 8-15 stages during cumulative times of 36-107 days demineralisation through approximately 1-mm-wide windows. Although lesion morphology was consistent with preferential anisotropic dissolution parallel to enamel prisms at the advancing front, detail (at a scale of approximately 100 microm) varied in relation to exposed surface sites separated by <1 mm. The distribution of mineral in the most superficial region varied across the exposed face of each lesion. Within lesions, localised foci of low mineral concentration (at a scale of approximately 200 microm) retained their general form through successive stages of demineralisation before coalescing. The most advanced regions within a lesion seemed to correspond with surface regions with lowest mineral concentration. These findings indicate that local variations in fractional pore volume of partially demineralised enamel influence the subsequent spatial development of lesions.