Emerging Ethical Issues in Restorative Dentistry.

This article reviews some of the merging ethical issues in restorative dentistry. This is a branch of healthcare concerned with quality of life, since retention of functioning teeth is important in allowing a healthy diet to be consumed. Yet the supply of dentists is such that, in many of the world's poorest countries, extraction is the only viable option for treating tooth decay. Available repair materials present various ethical problems. Silver amalgam is being phased out in much of the world, because of environmental concerns with mercury, yet it is cheap and reliable. Alternatives have been developed, influenced by the West's preoccupation with appearance, yet these materials are difficult to place and are less durable than amalgam. These concerns lead to significant ethical problems, which are explored in this article. It concludes by proposing a way to deal with the emerging ethical problems.

Is it Ethical to Withhold Restorative Dental Care From a Child with Occlusoproximal Caries Lesions Into Dentin of Primary Molars?

Non-restorative caries treatment (NRCT) has been mentioned as a treatment option for occluso-proximal caries lesions into dentin of primary molars. The NRCT approach for occluso-proximal caries lesions in primary molars was considered from an ethical perspective. In summary, it is not ethical to withhold restorative dental care from a child with occluso-proximal caries lesions into dentin of primary molars.

Advanced restorative dentistry - a problem for the elderly? An ethical dilemma.

The type of dental restorations taken into old age may have an adverse effect on the quality of life of the elderly. Root caries and dry mouth increase in prevalence with age and may precipitate the breakdown of remaining natural and restored teeth. At present the availability of dental personnel and facilities in residential aged care facilities (RACFs) is limited, often non-existent, and the elderly living at home may be unable to easily gain access to dental care. Thus, the provision of appropriate and timely dental treatment may not occur, resulting in prolonged pain and suffering. It is important that, as our elderly population increasingly retain natural teeth into advanced old age, appropriate funds are made available to ensure their dental health is maintained. A lack of early intervention to arrest dental disease may result in life-threatening medical consequences in the elderly, such as ventilator assisted pneumonia or the need for a general anaesthetic and possible associated medical risks. Significant local disease, such as osteonecrosis, may also result from a lack of appropriate dental intervention. The necessity to remove questionable teeth prior to irradiation for neoplastic disease or bisphosphonate prescription for neoplastic disease or severe osteoporosis emphasizes the need for regular dental care. In contrast, extensive dental restorative treatment for younger people may have benefits, such as optimal dental aesthetics and oral function, but in older individuals careful consideration should be given to select the most appropriate treatment modality so that adverse situations can be avoided or their resolution simplified should they occur later when the individual is compromised or in a RACF. This may mean the use of conservative dental restorative materials and an avoidance of complex restorative options which may be difficult for the individual or RACF staff to maintain. Some years after receipt of their complex restorations they may be unable to cope with the operative demands and financial burden of resolving their deteriorating dental situation and so complex implant-born structures and precision removable prostheses should probably be avoided for those individuals contemplating entering a care situation. Therefore, the timing of the provision of complex dentistry poses an ethical dilemma.

[The choice between 'conservation of a tooth using endodontic treatment and crown restoration' or 'extraction of the tooth and its replacement by an implant'. Recommendations for a single tooth]. / Choisir entre 'conservation d'une dent moyennant traitement endodontique et restauration coronaire' ou 'extraction de la dent et son remplacement par un implant'. Recommandations pour un élément unitaire.

Recent studies provide evidence that root canal treatment results in excellent clinical outcomes for our patients, which is in favour of the preservation of teeth. Therefore, endodontic treatment remains a highly predictable method to retain teeth with irreversible pulpal disease. Retention rates of root filled teeth of more than 90 percent have been shown. At present there are many alternative treatments available to preserve or replace diseased teeth and considerable progress has been made in this field. With the increasing popularity of implants and for some too complicated the root canal anatomy, more teeth than before are extracted to be replaced with implants. Unfortunately, there has not been that much of research identifying the best strategies for selecting one treatment approach over another. Consequently there is a need for recommendations regarding endodontic versus implant therapy.