How dentists and oral and maxillofacial surgeons deal with tooth extraction without a valid clinical indication.

OBJECTIVES: This study pertains to a secondary data analysis aimed at determining differences between oral and maxillofacial surgeons (OMFSs) and dentists handling dental extractions without an evident clinical indication. STUDY DESIGN: A survey of 18 questions was conducted among 256 OMFSs in the Netherlands and a random sample of 800 dentists Respondents could answer the questions in writing or online. The data was collected in the period from November 2019 to January 2020, during which two reminders were sent. Analysis of the data took place via descriptive statistics and Chi Square test. RESULTS: The response rate was 28.1% (n = 72) for OMFSs and 30.3% (n = 242) for dentists. In the past three years, 81.9% (n = 59) of the OMFSs and 68.0% (n = 164) of the dentists received a request for extraction without a clinical indication. The most common reasons were financial and severe dental fear (OMFSs: 64.9 and 50.9% vs dentists: 77.4 and 36.5%). Dentists were significantly more likely (75.6%, n = 114) than OMFS (60.7%, n = 34) to comply with their last extraction request without a clinical indication. Almost none of them regretted the extraction afterwards. As for the request itself, it was found that 17.5% (n = 10) of the OMFSs and 12.5% (n = 20) of the dentists did not check for patients' mental competency (p = 0.352). CONCLUSIONS: Given that most of the interviewed dental professionals complied with non-dental extraction requests when such extractions are ethically and legally precarious, recommendations for handling such requests are greatly needed.

Financial, psychological, or cultural reasons for extracting healthy or restorable teeth.

BACKGROUND: The purpose of this study was to determine how often dental patients request extraction for nondental reasons and how dentists handle such requests. METHODS: The authors conducted a survey among 800 Dutch dentists from November 17, 2019, through January 5, 2020. The questionnaire contained 17 items, including a hypothetical case vingette. RESULTS: A total of 242 dentists responded to the survey (response rate was 30.3%, 48.3% of respondents were women, and mean [standard deviation] age was 45.3 [11.8] years). Sixty-eight percent of respondents reported that they had been confronted with a request for extraction on nondental grounds in the past 3 years. One-half of these dentists received such a request 5 times or fewer, 21.3% received such a request 6 through 10 times, 11.3% received such a request 11 through 20 times, and 8.8% received such a request 21 through 30 times. Their most recent request concerned a financial reason (49.7%), a combination of psychological and financial reasons (27.7%), a psychological reason (18.2%), or another reason (4.4%). Most dentists (87.5%) evaluated the patient's competency to make health care decisions. Of all nondental extraction requests, 75.6% (n = 114) were granted. Only 4.0% (n = 6) of the dentists regretted the extraction. Most dentists (82.0%, n = 191) would have refused the extraction in the hypothetical case vignette. CONCLUSIONS: Nondental requests for extraction are relatively common. Although dentists are reluctant in theory, they are likely to grant such requests in everyday practice, particularly if the patient cannot afford an indicated conservative treatment. PRACTICAL IMPLICATIONS: Dentists should keep in mind that they cannot ethically or legally be required to perform an intervention deemed harmful, even if an autonomous patient made the request.

Wish-fulfilling medicine and wish-fulfilling dentistry.

OBJECTIVES: to explain the practice of wish-fulfilling medicine and how it relates to dentistry. SOURCES: Relevant papers, and reports from authoritative institutions were identified in Pubmed and Google Scholar. RESULTS: Wish-fulfilling medicine refers to services provided by professionals using medical methods in a medical setting to address non-medical wishes of patients. Care-providers, medical industries, and health-insurance companies also contribute to wish-fulfilling in medicine and dentistry. Various concepts of health and illness compounded by blurred borders between health and illness offer an unstable foundation for wish-fulfilling medicine, and growing demands for these services where healthcare resources are limited can displace medically necessary treatments. Moreover, treatments without a medical or a dental necessity, can be harmful and bear the risk of futile or excessive treatments not in patients' long-term interest. Examples in dentistry are found in the field of cosmetic interventions, prosthodontics and orthodontics, where perceptions of small 'deviations' from normality prompt wishes or recommendations for intervention. Ethically, wish-fulfilling services confront the principles of the common morality if the autonomy of a patient is compromised, beneficence is unclear, harm is foreseeable, or distributive justice is compromised. Wish-fulfilling dental treatment can be restricted by legislation if it conflicts with safe, effective and efficient care, or if it interferes with patient's real needs or undermines established professional standards. CONCLUSIONS: The general understanding of wish-fulfilling medicine including its ethical and legal themes is relevant to dentistry. CLINICAL RELEVANCE: Ethical considerations and legislation can guide a dentist to reflect critically on clinical decisions regarding wish-fulfilling dentistry.

Views of patients and general dental practitioners on the organizational aspects of a general dental practice.

OBJECTIVE: To examine the views of patients and general dental practitioners (GDPs) on the organizational aspects of a general dental practice and to see whether their views differ. BACKGROUND: Health care has increasingly centred on the patient over the last two decades, and the patients' opinions have been taken more seriously. Although in other health-care sectors research on organizational aspects has been performed, research in dental care is lacking on this subject. DESIGN: We developed two questionnaires covering 41 organizational aspects of a general dental practice: one for GDPs and one for dental patients. The questionnaires were handed out in dental practices to 5000 patients and sent to 500 GDPs. RESULTS: We describe the results of the organizational aspects mentioned most by 25% of the dental patients. For most aspects, the views of the patients and GDPs differed significantly. However, both respondent groups mentioned the same category the most. CONCLUSIONS: The results of this study could be used on a policy level for the development of guidelines and on a practice level for individual GDPs to adjust practice management to the preferences of patients.

Limited rights of minors in the Dutch healthcare.

In many countries, if not all, the autonomy of minors is limited. Especially in countries with comprehensive legislation in the field of health law the (lack of) autonomy of minors may create challenges. These problems become more complex if the costs of treatment are not paid by the government or covered by insurance. Some challenges are: At what age is a minor able to decide about his health? As not every treatment is the same, how should the system take this into account? The Netherlands has a long history of very comprehensive health care legislation. This legislation includes a section about the treatment of minors that addresses the questions of the conditions in which the autonomy of minors is limited. Though this legislation is limited to the Netherlands other countries face the same challenges.

Patients' priorities in assessing organisational aspects of a general dental practice.

OBJECTIVES: To explore which organisational aspects are considered most important by patients when assessing a general dental practice, and which patients' characteristics influence their views on these aspects by a paper questionnaire. PARTICIPANTS: The questionnaire was handed out to a sample of 5,000 patients in the Netherlands. RESULTS: The response rate was 63%. Six organisational aspects out of a list of 41 aspects were valued as most important by at least 50%. In decreasing order of importance, these were: accessibility by telephone; continuing education for general dental practitioners; Dutch-speaking general dental practitioners; in-office waiting times; information about treatments offered; and waiting lists. For four out of these six aspects, respondents' age and education significantly influenced their preferences. CONCLUSIONS: Aspects concerning the infrastructure of a general dental practice were chosen more often than aspects such as working to professional standards, working according to protocols and guidelines, quality assessment and guaranteed treatment outcomes. The findings will enable organisations to increase the transparency of health-care delivery systems to focus on those organisational aspects of dental practices that patients themselves consider most important. These findings can also assist general dental practitioners in adapting their organisational services to the preferences of patients or specific patient groups.

The estimation of patients' views on organizational aspects of a general dental practice by general dental practitioners: a survey study.

BACKGROUND: Considering the changes in dental healthcare, such as the increasing assertiveness of patients, the introduction of new dental professionals, and regulated competition, it becomes more important that general dental practitioners (GDPs) take patients' views into account. The aim of the study was to compare patients' views on organizational aspects of general dental practices with those of GDPs and with GDPs' estimation of patients' views. METHODS: In a survey study, patients and GDPs provided their views on organizational aspects of a general dental practice. In a second, separate survey, GDPs were invited to estimate patients' views on 22 organizational aspects of a general dental practice. RESULTS: For 4 of the 22 aspects, patients and GDPs had the same views, and GDPs estimated patients' views reasonably well: 'Dutch-speaking GDP', 'guarantee on treatment', 'treatment by the same GDP', and 'reminder of routine oral examination'. For 2 aspects ('quality assessment' and 'accessibility for disabled patients') patients and GDPs had the same standards, although the GDPs underestimated the patients' standards. Patients had higher standards than GDPs for 7 aspects and lower standards than GDPs for 8 aspects. CONCLUSION: On most aspects GDPs and patient have different views, except for social desirable aspects. Given the increasing assertiveness of patients, it is startling the GDP's estimated only half of the patients' views correctly. The findings of the study can assist GDPs in adapting their organizational services to better meet the preferences of their patients and to improve the communication towards patients.

The chasm between knowing and choosing the ethical course of action. A survey of dental students in the Netherlands.

The dental profession is gradually becoming more aware of the importance of practitioner competence in dental ethics and law. Indicative of that awareness is the explicit attention paid by ever more dental school curricula to these disciplines through courses and other dedicated learning activities. Concurrently there is also increasing professional concern about reports of illegal and unethical behaviour by dental students and practitioners. This paper discusses the results of a survey among first and fifth year students enrolled in the three Dutch dental schools, examining their ethical and legal knowledge and perceptions. Students were presented with five ethical and five legal case vignettes and asked which of three courses of actions is correct, as well as which of those courses they would undertake themselves. The study shows that the knowledge level of students in the area of health law increases between the first and fifth year but their knowledge of ethics decreases. Even more remarkable is the finding that large numbers of students are not consistent, that is, the way they plan to behave does not coincide with what they say is the morally correct way to behave.

Deciding about patients' requests for extraction: ethical and legal guidelines.

BACKGROUND: and Overview. Dentists frequently are faced with patients' requests for an extraction, sometimes of the entire dentition. In this article, the authors offer guidelines to help dentists and oral surgeons make decisions regarding such requests for extraction. CONCLUSIONS: In most cases of patients' requesting extractions, the ethical principle of nonmaleficence will play a decisive role in the dentist's decision making. In cases in which the request appears influenced by a specific mental condition such as a phobia of dental treatment, extraction rarely is justifiable. Practice Implications. Dental professionals should keep in mind that they cannot be forced to carry out treatment that is at odds with the ethical principle of nonmaleficence or that is outside of the bounds of accepted treatment. To aid dentists in making treatment decisions in such cases, the authors present a flowchart that integrates possible considerations.

Preventing dentists' involvement in torture: the developmental history of a new international declaration.

BACKGROUND: For more than half a century, the risk of physicians participating in torture has received thoughtful attention in the field of medicine, and a number of international organizations have issued declarations decrying such involvement. Despite publications that provide evidence of dentists' having participated in torture as well, until recently the dental profession was quiescent on the subject. METHODS: The authors describe the historical background for a new declaration against dentists' participation in torture developed by the International Dental Ethics and Law Society and the Fédération Dentaire Internationale (FDI) World Dental Federation. They review various levels of involvement by dentists in torture and related activities in reference to existing World Medical Association declarations. Finally, they outline the process of drafting the new dental declaration, which was adopted by the FDI in October 2007. CLINICAL IMPLICATIONS: The authors provide insight and guidance to clinicians who diligently serve their patients, unaware that they may face military or other pressures to participate in torture.

Dentists in double trouble: the (un)fairness of punishing for the same mistake twice.

BACKGROUND: and Overview. Many state dental practice acts allow for the suspension or revocation of a dentist's license on the basis of a previous conviction for illegal behavior, even if the behavior is not related to the practice of dentistry. Penalizing a dentist twice for the same behavior appears to violate the legal principle "ne bis in idem"-that is, no double penalty for the same socially undesirable behavior. However, disciplinary measures are not intended primarily to penalize the offender but rather to protect the public and the reputation of the profession. In this article, the authors review various cases in which boards disciplined convicted dentists and propose criteria for discerning between situations in which such "double trouble" is fair and unfair. CONCLUSIONS: and Practice Implications. The authors conclude that such disciplinary actions are fair only if four criteria concerning the following are fulfilled: the relationship between the dentist's illegal behavior and dental treatment or privileges of the dentist; the severity of the crime; the frequency of the illegal behavior; and the balance between crime and punishment.