Major haemorrhage from oral arteriovenous malformation during pregnancy: a case report.

This case report describes the presentation of a pregnant woman at 39 weeks gestation to The Royal Prince Alfred Hospital emergency department (Sydney, NSW) with major haemorrhage from an oral arteriovenous malformation (AVM) and foetal distress. The lesion had grown rapidly during her pregnancy and she had presented to multiple hospitals and dental practitioners who had failed to diagnose her condition and recognize the potential for major complications for the patient and her baby. Bleeding was controlled with manual pressure while she underwent an emergency Caesarean section followed by emergency angiography and partial embolization of the lesion. The bleeding did not recur, and the lesion continued to regress post-partum. This paper illustrates the diagnostic dilemma of recognizing an AVM and also the potentially disastrous consequences that could occur if a dentist was to embark on extractions or other surgical treatment in the vicinity of such a lesion without realizing its significance.

Prescribing drugs of dependence in dentistry: a review of legal and regulatory considerations.

The misuse of drugs of dependence is a major public health issue in Australia, and prescribing of these medications by dentists has increased in recent years. While there has been much focus on the appropriate indications and clinical use of these medicines in dental practice, the legal requirements of prescribing are equally important. Dental practitioners need to be aware of their legal obligations, as inappropriate prescription practices may lead to regulatory or criminal prosecution. Although dentists hold registration through the National Scheme and there is nationally standardised scheduling of drugs in Australia, the legislation governing drug laws differs for each state and territory, especially when prescribing drugs of dependence. This article summarises the legislation governing the prescription of drugs of dependence in Australia that is relevant to dental practice, providing insights into how dentists might contribute to the appropriate, safe and legal use and management of these medications.

What do Australian health consumers believe about commercial advertisements and testimonials? a survey on health service advertising.

BACKGROUND: There has been little examination of consumer attitudes towards the commercial advertising of healthcare services in Australia and how marketing is used by consumers in their health decision-making. In this research, we examined how consumers reported commercial advertising helped them to understand the health services available to them and the influence that marketing had upon their choices. METHODS: A survey instrument using a Likert scale to indicate agreement or disagreement with 21 questions was developed using qualitative interviews before being distributed online within Australia. Sampling of participants was stratified by age, gender and location. The results were subjected to statistical analysis with Spearman Rank Correlation test being used for bivariate analysis. RESULTS: One thousand five hundred sixty-four complete surveys were collected. The results revealed certain consumer beliefs, for example; the title of 'Dr' was believed to indicate skill and high levels of training (81.0%), with 80.3% agreeing incorrectly that use of the title was strictly regulated. Participants reported to have a higher confidence in their own abilities (71.2%) than the public (52.8%) in assessing health advertising. The level of self-confidence increased with higher education level and decreased by age (p < 0.05). Testimonials were reported to be lacking in reliability (67.7%) and that they should not be used in healthcare in the same manner as they are used in other industries. Only 44.8% of participants reported that they felt confident to spot a review that was not written by a genuine user of a service. CONCLUSIONS: The data demonstrated that many health consumers felt that while commercial health advertising was helpful, it was also confusing, with many participants also holding mistaken beliefs around other elements of commercial health advertising. While the advertising of healthcare services might have educational effects and be superficially empowering, advertising is primarily intended to sell, not educate. This research demonstrates that there is significant potential for healthcare advertising to mislead. Future developments in regulatory health advertising policy, and the related ethical frameworks developed by professional healthcare associations, need to consider how the consumers of healthcare services might be better protected from misleading and predatory advertising practices.

A review of the law of consent in dentistry.

The development of the law of consent has led to much discussion within the dental literature as to how these changes might impact practice. The move from a practitioner-focused standard of consent to a patient-focused standard has altered the nature of the framework required to support a patient's decision-making to avoid an allegation or finding of a negligent consent process. Contrastingly, there has been little in the way of exploration as to how the law of battery (in civil matters) and assault (in criminal cases), where consent is entirely absent, might apply to dentistry and the practice of the profession. This article considers the law of consent, using several key examples from dentistry, as well as providing an update of recent case law of relevance to dental practice.

How compliant are dental practice Facebook pages with Australian health care advertising regulations? A Netnographic review.

BACKGROUND: The National Law that regulates the dental and other health care professions in Australia sets out regulations that dictate how dental practices are to advertise. This study examines the extent to which the profession complies with these regulations and the potential impact that advertising may have upon professionalism. METHODS: A Facebook search of 38 local government areas in Sydney, New South Wales, was carried out to identify dental practices that had pages on this social media site. A framework for assessment of compliance was developed using the regulatory guidelines and was used to conduct a netnographic review. RESULTS: Two hundred and sixty-six practice pages were identified from across the 38 regions. Of these pages, 71.05% were in breach of the National Law in their use of testimonials, 5.26% displayed misleading or false information, 4.14% displayed offers that had no clear terms and conditions or had inexact pricing, 19.55% had pictures or text that was likely to create unrealistic expectations of treatment benefit and 16.92% encouraged the indiscriminate and unnecessary utilization of health services. CONCLUSIONS: This study found that compliance with the National Law by the Facebook pages surveyed was poor.

'Blowing the whistle': the ethical, professional and legal implications of raising concerns and self-regulation within dentistry.

'Whistle-blowers' are a necessary part of any system; dentistry is no different. The role of whistle-blowers in dentistry has been enshrined in Australian law since 2010. Raising concerns has become a legal duty as well as an ethical and professional obligation. It is important that these different aspects of raising concerns are explored as each adds another layer of consideration to the issue. The health professional's duty to whistle-blow could be viewed as problematic; the observance of this duty is associated with being 'trapped between a rock and a hard place' where any decision to engage or not may have negative consequences. For the obligation of raising concerns to gain acceptability within the dental profession, the concept requires reframing as being necessary for the profession's continued success. The stigma of mandatory reporting needs to be removed to allow this essential process to occur. This article will discuss the ethical, professional and legal imperatives for the dental profession to engage with whistle-blowing and the likely challenges that are likely to be met in doing so.

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.

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.

Owning the tooth: exploring the ethical and legal issues relating to the use of extracted human teeth in dental education in Australia.

Extracted human teeth have been used to practice operative techniques for a very long time. As a natural surrogate for a live tooth in vivo, their use has traditionally been very important for the development of skills in trainee dentists, as well as their qualified colleagues who wish to practise existing or new skills. As synthetic alternatives develop greater authenticity, alongside a society in which many retain their natural dentition well into old age, the current paradigm relating to how extracted teeth in dental education are used needs to be revisited. An ethical and legal dilemma that must be addressed within dental education relates to where and how teeth may be sourced. This article will seek to question whether there is a legal or ethical requirement to gain consent for the use of extracted teeth from patients, as well as exploring the status of whether extracted dental tissue can be considered to be the property of either patient or surgeon. Whilst synthetic alternatives are being utilized more frequently in education, it is unlikely that they will completely replace extracted natural teeth in the immediate future. It is therefore imperative that their use complies with legal doctrine and contemporary ethical thought.