IN THE LITERATURE

IN THE LITERATURE

Baron S: Oral transmission of HIV, a rarity: emerging hypotheses. Journal of Dental Research, July 2001, Vol. 80(7):1602-4
At the outset of the HIV epidemic, there was concern that HIV might be transmitted casually from the oral secretions of HIV carriers during kissing, dental treatment, biting and aerosolization. The authors review the prevalence of oral transmission of HIV and conclude that the rarity of oral transmission is likely due to the protective action of normally hypotonic saliva and other chemical inhibitors. This natural protection may be enhanced in dental practice by the hypotonicity of the rinse water used for patients.

Berk NW: Teaching Ethics in Dental Schools: Trends, Techniques, and Targets. Journal of Dental Education. August 2001, Vol. 65, 8: 744-750.
The importance of promoting ethical behavior in dental students is reflected in the emphasis on formal ethics training within the curricula of most US dental schools. Today, state-of-the-art ethics education has moved from purely didactic instruction to more interactional teaching methods that promote student introspection and group problem-solving. This paper provides an overview of trends in ethics teaching in dental schools and the current teaching approaches advocated in health science schools. In addition, future needs in dental ethics education are explored including the importance of addressing the unique aspects of the dental education environment.

Christensen GJ: The credibility of dentists. Journal of the American Dental Association, August 2001, Vol. 132(8): 1163-5.
The author discusses the findings of the 2000 annual Gallup Poll regarding honesty and ethics among US professionals. Once again, dentists made the "top 10" (at place 8 with 58% of respondents deeming dentists "ethical"). Nevertheless, the author believes there has been a change in the public’s perception of the profession of dentistry. He concludes that the profession’s reputation is at risk of being eroded by a variety of negative developments, including advertising by dentists, high fees, excessive treatment, unwillingness to treat at inconvenient hours, and unwillingness to accept responsibility for failed treatment.

Cochran MA: Whatever Lola Wants... Operative Dentistry 2001, Vol. 26(3): 217-218.
In this Editorial, the author discusses the increasing pressures placed on many dentists by their patients to meet patient demands, even if the care requested may not be appropriate. He concludes that cosmetic treatments have a definite place in dentistry, but dentists may not subjugate their professional responsibility to maintain the health and function of the patients’ oral environment to satisfy patients’ perceptions of attractiveness.

Crossley ML, Shearer AC, Mellor AC, Bridgeman AM: Treatment planning for the problem patient: restorative, ethical, legal and psychological perspectives. Case I: Emma. Dental Update. 2001 Jun;28(5):241-6
'Emma' is the first of a series of four articles that aims to look at some of the problems patients may present with when they visit their dentist. Each article starts with a brief scenario about the hypothetical patient and his/her clinical problems. As well as the clinical problem, each case also raises ethical, legal or psychological problems. All of these issues are discussed and possible management strategies and treatment options described.

Desai M, Brearley Messer L, Calache, H. A study of the dental treatment needs of children with disabilities in Melbourne, Australia. Australian Dental Journal, March 2001, Vol. 46(1): 41-50.
A total of 300 children with disabilities in Melbourne, Australia, was studied with reference to their oral disease and treatment needs. Despite 41 per cent of children requiring simple treatment, the preventive and treatment needs of many remained unmet. Following examination, diagnosis and treatment planning by a dentist, much of the preventive, simple treatment and oral health promotion could be performed by trained dental auxiliaries. An epidemiological survey followed by the implementation and evaluation of a long-range public dental health care plan for children and adolescents with disabilities is needed urgently

Hammer K, Hodges KO, Johnson R: Prioritization of Professional Issues by Idaho Dental Hygienists. The Journal of Dental Hygiene, Summer 2001, Vol. 75(3) 222-230.
The article reviews the findings of a survey among 652 dental hygienists in the State of Idaho (USA) concerning, amongst others, legislative and professional issues. The authors conclude that many dental hygienists are concerned about maintaining quality education programs, reducing illegal practices (particularly dental hygiene services by dental assistants), and self-regulation.

Meskin LH: Do No Harm. Journal of the American Dental Association, September 2001, Vol. 132(9): 1200, 1202.
In the Editorial, the author reviews the amalgam controversy, including several recent law suits in the US, alleging that individual dentists and the profession of dentistry as a whole are conspiring against the public. The author concludes that dentists are actually meeting their professional obligations to the public by defending amalgam, instead of capitalizing on patients’ unfounded fears by replacing amalgam restorations. The author lists several reasons why removal of amalgam is not in the patients’ best interest.

Ozar D: A position paper: six lessons about managed care in dentistry. Journal of the American College of Dentists. 2000, Vol. 68(1):30-35.
The limitation of resources available for oral health care makes it inevitable that groups (such as third parties) would arise with a view toward conservation of these resources. Although the concept of adequate care has been generally operationally defined in dentistry, a confusion remains between adequate and best. Dentists may be under an ethical obligation to inform patients of all available treatment options (ranging from the adequate to the best) and to perform the selected treatment to the best of their ability, but they are not obligated to offer only the best alternative or to expect that society will make the resources available for that level of care.

Peltier B: The ethical responsibility of professional autonomy. Journal of the California Dental Association, July 200, Vol. 29(7):522-5

Dentistry has historically been practiced autonomously, and many dentists place a high value on professional independence. This article outlines the conceptual basis for professional autonomy and asserts that dentists can retain independence only by aligning values with patients and remaining trustworthy in the eyes of the public.

Schouten BC: How do Dutch dentists deal with patients' rights in practice? (in Dutch) Nederlands Tijdschrift voor Tandheelkunde, May 2001, Vol. 108(5):179-83
In the Netherlands patients rights are regulated in the 'Medical Treatment Contract Act'. This article describes how dentists deal with those rights in daily practice. The results of a survey among Dutch dentists show that the implementation of patient rights in dental practice is far from ideal. Over a third of the respondents has had complaints about a lack of information from their patients. Respondents who attended post-graduate courses on dentist-patient communication dealt better with a number of patient rights than respondents who did not attend such courses. Confusion over how to interpret the rights of patients and the duties of the dentist could underlie the lack of implementation of those rights.

Wahl MJ: Amalgam--Resurrection and redemption. Part 1: the clinical and legal mythology of anti-amalgam. Quintessence International, 2001, Vol. 32(7):525-35
Dental amalgam has come under attack for its allegedly poor physical properties and clinical performance in addition to its poor appearance. It has been claimed that the American Dental Association has a hidden agenda to protect amalgam and that other countries have banned its use. The author reviews the literature and concludes that the vast majority of amalgam restorations do not cause fractured cusps or have recurrent caries; instead they tend to last longer than resin composite restorations. The ADA has no vested interest in protecting amalgam. The use of amalgam has not been banned in any country in the European Union. According to the latest scientific information available, dental amalgam is remarkably durable and long-lasting.