IN THE LITERATURE
 

Professional Promises: Hopes and Gaps in Access to Oral Health Care (Thematic Journal Issue)
Journal of Dental Education. 2006 Nov;70(11)
URL: http://www.jdentaled.org/current.shtml
Contributions:



Brands WG: The standard for the duty to inform patients about risks: from the responsible dentist to the reasonable patient.
Br Dent J. 2006 Aug 26;201(4):207-10.
Complaints or claims against dentists by dissatisfied patients usually consist of three parts: the dentist did not perform the treatment as s/he should have done; the dentist did not inform the patient properly about the risks involved with the treatment; the dentist did not keep records. In most cases it is not too difficult for a judge or dental board member, if necessary with the aid of an expert witness, to decide whether the treatment was indeed below standard. The same applies to dentist's record keeping. The recrimination concerning the information given is something else. This deals with the extent of the duty to inform a patient as well as the proof that sufficient information was given. These difficulties do not only appear in court, but also in dental surgeries. This article will focus on the evolution in the jurisprudence concerning the duty to inform patients about risks as well as on the recently changed guidelines of the General Dental Council (GDC) regarding informed consent. Finally some simple tests will show that informing patients about risks does not have to be a risky and time consuming business for the dentist.

Chalfin H. Ethics and professionalism: the past, present, and future.
J Am Coll Dent. 2006 Spring;73(1):42-7.
A retrospective look at the history of medicine is highlighted by the relationship of trust and service that characterize the professions. This foundation for ethics is being challenged today by forces such as the rapid growth of managed care, the liberalized regulations on professional advertising, and the emergence of a better-informed public that is far less inclined to accept a doctor's recommendation as the final word. While acknowledging a changing reality, dentistry--individually and collectively--must re-establish the primacy of ethics as the touchstone of professionalism.

Furst I & Furst S: A 25-year-old woman presents for treatment with a chipped front tooth and a black eye. Should I ask about domestic violence and, if it is occurring, what should I do?
J Can Dent Assoc. 2006 Jul-Aug;72(6):534-5
Available on-line at: http://www.cda-adc.ca/jcda/vol-72/issue-6/527.pdf

Kingsbury D: Is “Professionalism” at Odds with Practice-Management Education and Success?
J Can Dent Assoc. 2006 Oct-Nov;72(7): 815-818
Available on-line at: http://www.cda-adc.ca/jcda/vol-72/issue-9/815.html

de Freitas SF, Kovaleski DF, Boing AF, de Oliveira WF: Stages of moral development among Brazilian dental students.
J Dent Educ. 2006 Mar;70(3):296-306.
This research study aimed to evaluate the level of moral and ethical development of first-year students in a dental school. The students were presented with a dilemma that touched on personal and conflicting values. In responding to the questions posed, they had to present their criteria for judgments and norms that directly influence their behavior. Answers were then analyzed, leading to the categorization of interviewees into five stages of moral development according to Kohlberg's moral development system. The first, lowest stage in Kohlberg's system was reached by 11 percent of students. Most interviewees (47 percent) were in stage two, where individuals are conscious of their own conflicting interests, but an individualistic and instrumental set of morals tends to regulate those interests. Thirty percent of interviewees were identified with stage three, and 8.3 percent were found in stage four, whose main characteristic is the perception of self as a member of society, thus integrating interpersonal perspectives. Only one student reached stage five, in which the person recognizes universal rights and establishes a hierarchy of priorities. No individuals were found in stage six of moral development. The level of moral development found was low for students at this level, which may compromise the optimal moral development of the future dentist. The low level of moral development found may jeopardize the work of the future professionals, their treatment of patients, and society as a whole.

Filanova V & Romer M: Providing dental care to patients with developmental disabilities: medical/legal issues.
N Y State Dent J. 2006 Mar-Apr;72(2):36-7
Dentists providing treatment to individuals with developmental disabilities are often faced with unique medical/legal issues. Obtaining informed consent when a patient does not have capacity can be an involved process. Issues regarding therapeutic aids used for immobilization during treatment may further complicate the situation.

Henwood S, Wilson MA, Edwards I: The role of competence and capacity in relation to consent for treatment in adult patients.
Br Dent J. 2006 Jan 14;200(1):18-21.
Obtaining informed consent for dental and medical treatment is a fundamental ethical and legal responsibility for all clinicians. It is an opportunity for patients to have healthcare that is based on their informed choice. The assessment of a patient's competence is an essential part of the consent process and clinicians need to be aware that patients can be misunderstood and wrongly deemed incompetent. This paper aims to aid the clinician to better understand the concept of patient competency and capacity in relation to obtaining valid consent.

Matthew IR, Walton JN, Dumaresq C & Sudmant W: The Burden of Debt for Canadian Dental Students: Part 3. Student Indebtedness, Sources of Funding and the Influence of Socioeconomic Status on Debt.
J Can Dent Assoc. 2006 Oct-Nov;72(7):818-
Available on-line at: http://www.cda-adc.ca/jcda/vol-72/issue-9/819.html
In recent years, tuition fees at most universities across Canada have increased substantially, particularly in professional programs such as dentistry. Anecdotal evidence suggests that these increases have a significant adverse impact on the educational experience of dental students. In January 2004, students at Canada's 10 dental schools were invited to participate in a survey on costs, debt and other factors related to attending dental school in Canada. This third article in a series of 4 examines the effects of funding sources and socioeconomic status (SES) on dental students' debt. The survey provided key information about the costs of attending dental school and the levels of debt among dental students across Canada. Choice of school and year of study had a significant effect on the overall costs of attending dental school, and dental students' costs were largely financed by private loans or other forms of debt. Canadian dental students' average debt varied between $24,000 to $26,000 per annum, depending on their year of study. Key determinants of borrowing included type of residence, SES, total costs, and number of dependents. Students who lived at home or with relatives borrowed significantly less than those who were renting. Parents' SES was related to students' access to forms of educational funding that result in no debt burden. SES also played a role in determining the likelihood of a student pursuing further professional education.

Orr DL & Curtis WJ: Obtaining written informed consent for the administration of local anesthetic in dentistry.
J Am Dent Assoc. 2005 Nov;136(11):1568-71.
BACKGROUND: The purpose of this study was to examine the frequency with which dentists obtain written informed consent for the administration of local anesthetic in dentistry. METHODS: The authors administered an informal survey to 252 dentists. RESULTS: Most respondents who practiced a dental specialty or limited their practice to anesthesiology for dentistry obtained written informed consent for the administration of local anesthetic. Most general practitioners did not. CONCLUSIONS: Written informed consent appears to be obtained more often by dental specialists and dentists limiting their practices to anesthesiology for dentistry than by general practitioners. PRACTICE IMPLICATIONS: All dentists may want to consider obtaining written informed consent for the administration of local anesthetic.

Yamalik N: The responsibilities and rights of dental professionals 1. Introduction.
Int Dent J. 2006 Apr;56(2):109-11.
Dentists have well-defined legal, professional and ethical duties to their patients, the public and the profession. However, regular evaluations are necessary because their role and responsibilities are continually changing under the influence of a variety of internal and external forces and they further broaden as the profession evolves. Although a significant emphasis is placed on their responsibilities, professional rights of dentists also deserve particular interest because they are intimately related with these responsibilities. Furthermore, these rights enable dentists to serve and protect their patients and the community, provide quality care and comply with their broad responsibilities. In the first part of this series of three articles the responsibilities of dentists are analysed, while the second part focuses on the dentists' professional rights.

Yamalik N: The responsibilities and rights of dental professionals 2. Professional responsibilities.
Int Dent J. 2006 Jun;56(3):168-70.
Although dentists have well recognised legal, professional and ethical responsibilities, the definition of their role and the corresponding responsibilities broaden further as the profession evolves, the demands from dentistry increase and the context of professionalism changes. Thus, continuous evaluation of the role and responsibilities of dentists is vital for provision of quality care, improvement of professional standards and maintaining professional status. In addition, efforts must be made to uphold the credibility of the profession and the associated public trust as well as meeting the increasing expectations from the profession and individual dentists.

Yamalik N: The responsibilities and rights of dental professionals 3. Professional rights.
Int Dent J. 2006 Aug;56(4):224-6.
Professional status, professional autonomy, clinical freedom, self-regulation and the right to serve patients and the community seem to be the main rights of dentists. Although they simply may be seen as privileges that are related to being a dentist, these rights cannot be considered independent from dentists' roles and responsibilities. They are, in fact, valuable tools that serve dentists to meet their broad responsibilities that arise from the 'social contract' between the profession and the public.