IN THE LITERATURE
 

Aires CP, Hugo FN, Rosalen PL, Marcondes FK. Teaching of bioethics in dental graduate programs in Brazil. [in Portuguese]
Braz Oral Res. 2006 Oct-Dec;20(4):285-9.
In the field of human research, researchers are faced with unexpected moral dilemmas, as a result of the development of technologies applied to health. Due to the great importance of this issue, our objective was to evaluate bioethics instruction in the education of researchers in Brazilian graduate programs in dentistry. Eighty-seven graduate programs in dentistry, recognized by CAPES (Coordination for the Improvement of Higher Education Personnel) were evaluated in this study. Data were extracted independently by two researchers from the CAPES website, and from the websites of the graduate programs, directly or via links to the programs available at the CAPES website. Forty-eight out of 87 programs had an ethics/bioethics course as part of their curricula. Of the graduation programs graded 5, 6 or 7 by CAPES, 38% included bioethics courses, while 62% of the programs graded 3 or 4 by CAPES had bioethics courses as part of their curricula. These findings are an alert to those involved in dental research education, as they showed that, although resolution 196/96 by the National Council of Health regulating human research in Brazil was published ten years ago, bioethics instruction in Brazilian graduate programs in dentistry is still at an incipient stage. This situation indicates a need for ethics pedagogy in the education of young researchers.

Asai RG, Jones KD Jr. Am I obligated to treat a patient whose need for emergency care stems from dental tourism?
J Am Dent Assoc. 2007 Jul;138(7):1018-9.

Barbeau J. Lawsuit against a dentist related to serious ocular infection possibly linked to water from a dental handpiece.
J Can Dent Assoc. 2007 Sep;73(7):618-22.
Available on-line at: http://www.cda-adc.ca/jcda/vol-73/issue-7/618.html
This case report highlights the risks that may be associated with amoebae in the water of a dental unit. A woman with contact lenses visited her dentist for replacement of a bridge. During the treatment, a stream of water was directed from the handpiece into her right eye. Because of subsequent pain in the eye, the patient consulted several ophthalmologists, who discovered abrasive lesions of the cornea and inflammation. Despite antibacterial and anti-inflammatory treatments, the patient"s visual acuity declined gradually over a period of several days. A microbiological examination nearly 2 months later revealed amoebae in corneal samples. A lawsuit against the dentist was initiated. Although a causal relation with the dental treatment was rejected by the judge in this case, high numbers of amoebae in the water of dental units can present a risk if a patient with pre-existing corneal lesions is splashed. According to the precautionary principle, complete evidence of risk does not have to exist to institute measures to protect individuals and society from that risk. This case reinforces the importance of having patients wear safety glasses during dental treatments and of dental personnel draining the waterlines of dental units, as recommended by the Canadian Dental Association.

Baumeister SE, Davidson PL, Carreon DC, Nakazono TT, Gutierrez JJ, Andersen RM. What influences dental students to serve special care patients?
Spec Care Dentist. 2007 Jan-Feb;27(1):15-22.
This study examines factors associated with graduating dental students' motivation to deliver services to special care patients. We investigated community context and student characteristics, which would influence potential behavior. Higher percentages of older adults and low-income residents in the community were positively correlated with interest in serving special care populations. Factors which correlated with individual student characteristics included having a father with at least a college education, a higher number of weeks spent in extramural clinical rotations, preparedness to provide care to disabled patients, and service orientation and socially conscious attitudes. Frail elderly and disabled persons have limited access to dental care, which is compounded by a shortage of skilled dental professionals who are willing to treat these populations. Our findings suggest that interest in special care dentistry is partly conditioned by the dental school's demographic and dental market context. This study is important to dental educators and policymakers because the challenge of providing care to the "special patient" will increase in the future.

Botto RW. Addressing the marketplace mentality and improving professionalism in dental education: response to Richard Masella's "Renewing professionalism in dental education".
J Dent Educ. 2007 Feb;71(2):217-21. (Comment on: J Dent Educ. 2007 Feb;71(2):205-16.)
Richard Masella has written a very thought-provoking article that makes many excellent arguments regarding critical issues about professionalism in dental education. Rather than focus on minor points of contention, this response to his article highlights two main areas for further discussion. The first is the impact of the "marketplace" mentality and how there needs to be a balance between fiscal responsibility and ethical and professional responsibility. Changes in language are suggested as a starting point. Instead of using the term "productivity" to describe the goal, we need to focus on the process of behaving ethically, effectively, and efficiently in the provision of care to patients as well as in general professional behavior. The second major emphasis is on recommendations for improving the ethical climate of the dental college community and the teaching, exhibition, and celebration of professionalism. Included in this area are discussions of white coat ceremonies and honor codes, as well as the importance of recognizing the impact of the hidden curriculum in dental ethical education. Masella has made a major contribution by bringing forth strong arguments for discussing whether dental education truly is committed to teaching professionalism in a way that has meaning and impact rather than simply complying with accreditation standards. While there are certainly several points that appear to be speculative and could be debated in Masella's article, he has provided a valuable catalyst for discussion and introspection by identifying critical issues for both dental education and organized dentistry to address.

Chambers DW. Small ethics.
J Am Coll Dent. 2007 Spring;74(1):27-34.
Traditionally, ethics in the professions has focused on big problems that could be found on other peoples' back porches. Small, habitual, frequent, and personal lapses get little attention. In this essay, the literature on opportunism is applied to dentistry with a view toward bringing matters of "near ethics" within reach. Examples of small lapses are discussed under the headings of shirking, free riding, shrinkage, pressing, adverse selection, moral hazard, and risk shifting. The conditions that support opportunism include relationships with small numbers of transactions and uneven access to information. Practical limits on understanding all the consequences of agreements and the costs of supervising others and enforcing corrections of breaches are inescapable aspects of opportunism. Opportunism may not be accepted by all as the subject matter of ethical, but curbing it is a worthy goal and understanding the causes and management of opportunism casts some light on the ethical enterprise. Four suggestions are offered for addressing issue of opportunism.

Decaluwe F, Renckens A. The inducement of demand in dental medicine in Belgium [Article in French]
Rev Belge Med Dent. 2006;61(4):251-68.
Many factors are important for the existence of supplier-induced demand (SID). Not just the individual practitioner is responsible; his or her behaviour might be influenced by the specific organisation of the market for health care/dental care. The article investigates the characteristics of the Belgian market for dental care and analyses the way in which they might influence the occurrence of SID and/or overconsumption. Attention goes to the payment system of dentists in Belgium, the health insurance system, dentist density and the regulation of the sector. Also mentioned are the recall system and other (governmental) initiatives that may influence patients' and practitioners' behaviour. Some factors--not yet systematically investigated--may be relevant as well: personal characteristics of the dentist (gender in particular) and the way companies direct practitioners' and patients' behaviour.

Delattre VF. Antemortem dental records: attitudes and practices of forensic dentists.
J Forensic Sci. 2007 Mar;52(2):420-2.
This study was designed to provide insight concerning the attitudes and practices of forensic dentists regarding antemortem dental records reviewed for purposes of dental identification. Forensic dentists were invited to participate in a 10 item survey. The majority of the respondents reported a considerable amount of experience in dental identifications of the deceased. Sixty-six percent reported having suspected dental negligence or fraud in their antemortem record reviews. Only 17% believe that a forensic dentist should report suspected dental negligence, while 31% agree that dental fraud should be reported. Their response to additional issues addressed in the study suggests diversity in the practices and attitudes of forensic dentists in the use of antemortem dental records. In conclusion, opening a dialogue among practicing forensic dentists may lead to a standardized set of recommendations by the appropriate societies in the forensic dental community.

Dummett CO. Salute to a pioneer dental ethicist: Robert Edwin Blackwell, DDS, MS.
J Health Care Poor Underserved. 2006 Nov;17(4):683-9.

Ernst S, Elliot T, Patel A, Sigalas D, Llandro H, Sandy JR, Ireland AJ. Consent to orthodontic treatment--is it working?
Br Dent J. 2007 May 26;202(10):E25; discussion 616-7. Epub 2007 Apr 13
OBJECTIVE: To determine the level of patient and/or parent recall of previous consent to orthodontic treatment. DESIGN: Patients and/or parents of children who had been consented for orthodontic treatment were asked to complete a questionnaire on consent at least six months into their treatment. SETTING: Bristol Dental Hospital. SUBJECTS AND METHODS: Forty-one consecutive patients and eight of their parents, with a combined age range of 12-59 years, with 61% being female and 39% male. The patients, and where applicable their parents, were identified as having previously signed a consent form at least six months previously. Each was asked to complete a questionnaire on aspects of the consent process. RESULTS: Patients and parents demonstrated a high level of recall for the consent process concerning appliance type (89.8%), the reasons for treatment (96%), risks (75.5%), length of treatment (83.3%), the opportunity to ask questions (96%), and whether other information was provided (94%). However, further questioning on risks demonstrated poor recall for important factors such as decay (36.8%), root resorption (less than 21%), retention (56.3%) and length of retention (35%). CONCLUSIONS: Overall the consent process works well but specific areas of concern centre around the risks of orthodontic treatment.

Forsyth L, Woof M. The implications of the Human Tissue Act 2004 for dentistry.
Br Dent J. 2006 Dec 23;201(12):790-1.
Partly as a consequence of the inquiries into the events at the Bristol Royal Infirmary and the Royal Liverpool Children's Hospital (Alder Hey), the Government recently enacted the Human Tissue Act 2004. The main provisions of the Act came into force on 1 September 2006 and have potential implications for dentists.

Garetto LP, Senour WE. Using an ethics across the curriculum strategy in dental education.
J Am Coll Dent. 2006 Winter;73(4):33-7.
The curriculum in ethics and professionalism at the Indiana University School of Dentistry is described. The principles upon which the program is based include integration throughout the entire curriculum, extensive use of cases and group discussion, and incorporation with the problem-based learning methodology used in the school. Symbolic events, such as a White Coat Ceremony and discussion of cases with Fellows of the American College of Dentists are used to reinforce the material. Evaluation of the students on ethical knowledge and behavior are conducted in simulations and in clinical ratings.

Gonçalves ER, Verdi MI. Ethical problems in patient care at a dental school clinic. [Article in Portuguese]
Cien Saude Colet. 2007 May-Jun;12(3):755-64.
An exploratory, descriptive and qualitative survey was conducted at the Dentistry School, Santa Catarina State Federal University, Brazil, in order to identify and analyze the ethical problems involved in patient care at this teaching clinic. Data were collected through semi-structured interviews with professors of clinical disciplines and assessed through the Analysis of Content technique, using the bioethical principles of the autonomy of the patient and the confidentiality of the information as references. Some analysis categories were identified, pointing to the existence of several ethical problems in the daily patient care routines at this teaching clinic. They include scheduling stand-by patients, favored care for the friends of lecturers and employees, a lack of information offered to patients on treatment and imaging procedures, distortions in the use of deed of informed consent, etc. The constantly vulnerable situation of the patients became quite clear, together with the importance and responsibility of the professors in building up the ethical competence of future dentists.

Gordon E, Batchelor P.  A longitudinal study into changing ethical attitudes of newly-qualified dentists in South-East England.
Prim Dent Care. 2007 Apr;14(2):73-8.
OBJECTIVE: To report the ethical stances taken by newly-qualified dental graduates working in the south-east of England and how these changed over their first two years in practice. METHODS: A longitudinal self-completed questionnaire-based study using scenarios and closed questions was completed by an initial group of 135 vocational dental practitioners at the very beginning of their vocational training year, at the end of the year, and, finally, at the end of the subsequent year. Their answers were then analysed to see whether or not their views had changed during this period. RESULTS: At the commencement of the study in 2003, 133 (99%) newly-qualified dental graduates completed the questionnaire and answered the closed questions. The following year, 129 (96%) completed these documents and in 2005, at the end of the study, this figure was 97 (72%). There was considerable variation in the attitudes taken by the responding dentists. Reported attitudes changed over the study period in seven of the nine scenarios. Responses to the scenarios used could be grouped into three categories: those in which there was no change; those in which the change happened following completion of vocational training; and those in which there was a continual change. Answers to the four closed questions indicated a growing negativity to practice within the National Health Service over the study period. CONCLUSIONS: Dental educators need to be aware of the findings from this study. The importance of the ethical attitudes held and the reasons underpinning them should be explored if problems with delivery of care are to be avoided in the future.

Gorter RC, Storm MK, te Brake JH, Kersten HW, Eijkman MA. Outcome of career expectancies and early professional burnout among newly qualified dentists.
Int Dent J. 2007 Aug;57(4):279-85.
OBJECTIVES: To measure burnout development, outcome of expectations with regard to dental career and feelings of being unprepared for practice among newly graduated general dental practitioners. METHODS: In 1997, 50 dentists were approached to fill in the Maslach Burnout Inventory, Dutch version (UBOS) and some additional variables between six months and one year after graduation at the Academic Centre for Dentistry Amsterdam (ACTA) (76% response). Six years later, in 2003, the same 50 dentists, plus another 60 who had graduated in the same period at ACTA, were approached (78% response). RESULTS: Using Repeated Measures analysis, mean scores of dentists for whom two measurements were available on the three UBOS subscales (N=24) showed no statistically significant changes over six years on Emotional Exhaustion, Depersonalisation, or Personal Accomplishment. The same was true for group means of all in 1997 (N=33) compared with all in 2003 (N=82). However, according to manual criteria, varying percentages (7.2% - 24.4%) of dentists showed an unfavourable level on either one of the UBOS dimensions. Factors most frequently mentioned to be responsible for being unprepared for practice were: law and insurance matters (61.2%), practice organisation (56.6%) and staff management (55.2%). Most frequently reported factors that came out (much) worse than expected were: stressfulness of work (45.1%), and staff management (43.4%). CONCLUSIONS: Burnout appears no threat for the average newly qualified dentist. However, some individuals report alarmingly high burnout scores at an early professional stage. Practice management is the professional aspect about which young professionals worry most. It is recommended that dental schools pay attention to practice management skills and the stressfulness of work in the curriculum. Also, longitudinal monitoring of dental students and newly qualified dentists on burnout development is strongly advocated.

Hamel O, Marchal C, Sixou M, Hervé C. Ethical reflection in dentistry: first steps at the Faculty of Dental Surgery of Toulouse.
J Am Coll Dent. 2006 Fall;73(3):36-9.
The goal of this work is to contribute to ethical reflection in the dental profession through the example of a survey of ethical reflection and ethical issues in dentistry conducted at the dental school of Toulouse. A written survey was given to the heads of departments and to the sixth-year students and also to the dental faculty at the hospital dental clinic in order to estimate their level of understanding and concern about these topics.

Hopcraft M, Sandujat D. An analysis of complaints against Victorian dental care providers 2000-2004.
Aust Dent J. 2006 Dec;51(4):290-6.
BACKGROUND: There are little data available on the number and type of complaints made against dental care providers in Australia, despite anecdotal reports of an increasing trend in health-related complaints and litigation. METHODS: Data were obtained from the Dental Practice Board of Victoria on complaints received between July 2000 and December 2004. RESULTS: There were 651 complaints against all dental care providers in the study period, which equates to a rate of 4.1 complaints per 100 dental care providers per year. Dentists were responsible for 490 of the complaints, with 66 complaints against dental prosthetists and 43 complaints against dental specialists. There were very few complaints against dental therapists and students, and no complaints against dental hygienists, with 47 complaints against unregistered people or institutions. CONCLUSIONS: This study found that there was a relatively low rate of complaints made against dental care providers in Victoria, with most occurring against dentists in private practice in Melbourne. Less that 10 per cent of complaints resulted in an adverse finding against the dental care provider.

Lal SM, Parekh S, Mason C, Roberts G. The accompanying adult: authority to give consent in the UK.
Int J Paediatr Dent. 2007 May;17(3):200-4.
BACKGROUND: Children may be accompanied by various people when attending for dental treatment. Before treatment is started, there is a legal requirement that the operator obtain informed consent for the proposed procedure. In the case of minors, the person authorized to give consent (parental responsibility) is usually a parent. AIM: To ascertain if accompanying persons of children attending the Department of Paediatric Dentistry at the Eastman Dental Hospital, London were empowered to give consent for the child's dental treatment. DESIGN: A total of 250 accompanying persons of children attending were selected, over a 6-month period. A questionnaire was used to establish whether the accompanying person(s) were authorized to give consent. RESULT: The study showed that 12% of accompanying persons had no legal authority to give consent for the child's dental treatment. CONCLUSION: Clinicians need to be aware of the status of persons accompanying children to ensure valid consent is obtained.

Lopez-Nicolas M, Falcón M, Perez-Carceles MD, Osuna E, Luna A. Informed consent in dental malpractice claims. A retrospective study.
Int Dent J. 2007 Jun;57(3):168-72
With the introduction of informed consent in dental practice in Spain during the last ten years activity has been focused on avoiding complaints rather than on giving adequate information to the patient. However, in the eyes of many professionals the document by which patients accept the cost or estimated charge of treatment is the equivalent of informed consent. Although Spanish law permits verbal consent in some cases (low risk therapeutic activities), some dentists interpret this law in a very broad way. The aim of this paper was to study the fulfilment of informed consent in relation to professional malpractice claims presented to the College of Dentists of the province of Murcia, south east Spain (regional professional association) during the last twelve years (n=52). Evaluation of the complaints pointed to adequate professional behaviour in 14 cases and malpractice in 38 cases (in 29 of which the treatment applied was technically correct but with inadequate information provided during the process, while nine cases represented technical errors). The written document of informed consent was absent in 40 cases, although the verbal information supplied was considered adequate in 14 cases. When the document of informed consent was present (12 cases) it was considered unsuitable, although adequately complemented by oral information.

MacDonald-Jankowski DS, Orpe EC. Some current legal issues that may affect oral and maxillofacial radiology: part 1. Basic principles in digital dental radiology.
J Can Dent Assoc. 2007 Jun;73(5):409-14.
Available on-line at: http://www.cda-adc.ca/jcda/vol-73/issue-5/409.html
Developments in oral and maxillofacial radiology affect almost every aspect of dentistry: some change the legal framework in which Canadian dentists practise; some re-emphasize established standards of care, such as the dental radiologist's mantra, ALARA (using a dose that is as low as reasonably achievable) and viewing images in reduced ambient lighting. Developments in the legislation that regulates the use of radiology, such as Health Canada"s Safety Code 30 for radiation safety in dentistry and the Healing Arts Radiation Protection Act, also affect the practice of dental radiology. Some technical developments, such as charge-coupled devices and photostimulatable phosphors, are already well-known to the profession. Teleradiology, currently used in hospitals, but unfamiliar to most dentists (especially those working in urban communities), may soon have an impact on dentistry when it is used for Canada"s electronic health record, now under development. In this first of 2 articles about dental digital technology, we discuss the legal impact of developments in oral and maxillofacial radiology on dental practice and patient care.

Macdonald-Jankowski DS, Orpe EC. Some current legal issues that may affect oral and maxillofacial radiology. Part 2: digital monitors and cone-beam computed tomography.
J Can Dent Assoc. 2007 Jul-Aug;73(6):507-11.
Available on-line at: http://www.cda-adc.ca/jcda/vol-73/issue-6/507.html
In this second of 2 papers about technological developments in dental radiology, we discuss the legal impact of using digital monitors and cone-beam computed tomography (CBCT) on dental practice. Although some technical developments such as charge-coupled devices and photostimulatable phosphors are commonly used in the dental profession, some, such as greyscale monitors, are better known in medicine as standards of care for primary diagnosis. This complex subject has been overviewed. The recent emergence of CBCT, which is changing current approaches to imaging for preimplant planning, has provoked a number of legal dilemmas, such as an accompanying responsibility for reading and interpreting large fields of view that include extragnathic areas that are ordinarily outside the dentist"s purview.

Mersel A. Continuing education: obligation or duty? The European dilemma.
Int Dent J. 2007 Apr;57(2):109-12
Continuing dental education is now a professional and ethical obligation. The practising dentist has the responsibility to be a continuous learner by participating in educational programmes. This requirement for a career long education system provides awareness to the public that the dental profession is dedicated to the maintenance of high evidence-based education and permanent research into the best quality standards. Numerous European countries are involved in this process in an attempt to harmonise basic guidelines.

Nash DA. On ethics in the profession of dentistry and dental education.
Eur J Dent Educ. 2007 May;11(2):64-74

Nuzzolese E, Di Vella G. Future project concerning mass disaster management: a forensic odontology prospectus.
Int Dent J. 2007 Aug;57(4):261-6.
The world has experienced a plethora of mass disasters in recent years: acts of terrorism, bombings, earthquakes, hurricanes, typhoons, air crashes and other transportation mishaps, not to mention armed conflicts and migrants drowned in the Mediterranean Sea. In reviewing mass disasters to date, the principal difficulties have not changed: (1) large numbers of humans fragmented, co-mingled, and burned remains; (2) difficulty in determining who was involved in the disaster; (3) acquisition of useful medical and dental records and radiographs; (4) legal, jurisdictional, organisational, and political issues; (5) internal and external documentation and communication problems; (6) application of universal human forensic identification codes. Forensic dentistry plays a major role in victim identification. DNA and dental identification of human remains depends on sufficient availability of ante mortem information, existence of sufficient post mortem material and a comparison or match between ante and post mortem details. Forensic odontology is a specialty with a specific training, and cannot simply be carried out by dentists without such training. Strategies for developing an international forensic odontology capacity and resources are needed for the management of dead bodies following a mass disaster, together with universal guidelines and codes. To this end, Interpol's forms have proved to be a good starting point to meet these requirements.

Palacios-Sánchez B, Cerero-Lapiedra R, Campo-Trapero J, Esparza-Gómez G. Oral piercing: dental considerations and the legal situation in Spain.
Int Dent J. 2007 Apr;57(2):60-4.
Body piercing has become increasingly popular in Western countries, especially among young people. However, not everyone is aware of its potential risks, which may develop local and systemic complications shortly after, or long after the piercing procedure. Given that the oral cavity is one of the most frequent sites for piercing placement, the aim of this paper is to familiarise the oral healthcare professional with oral piercing and its possible sequelae in order to educate patients prior to and after piercing practices and address any complications that may arise.

Patthoff DE. The need for dental ethicists and the promise of universal patient acceptance: response to Richard Masella's "Renewing professionalism in dental education".
J Dent Educ. 2007 Feb;71(2):222-6. (Comment on: J Dent Educ. 2007 Feb;71(2):205-16.)
Richard Masella's "Renewing Professionalism in Dental Education: Overcoming the Market Environment" reveals why professionalism is nearly dead in America; it also shows the good of commerce and the excesses of commercialism in the market. More importantly, it collects and summarizes most of the relevant forms of education currently available to teach professionalism and professional ethics in dentistry; it then briefly examines whether those forms of education are used and if they are effective. Masella also asks some key challenging questions. His select and limited references lead to deeper studies about the nature and definition of professionalism and how it might be learned and presented. His suggestions for renewing professionalism are minimal; this sets the stage for proposing and selecting other ideas that need attention and development. Some of those ideas and suggestions, such as competition and collaboration, four types of dentistry, understanding two conflicting meanings of desire and need, and universal patient acceptance were recently explored in a workshop, "Professional Promises: Hopes and Gaps in Access to Oral Health Care" (procedings published in the November 2006 Journal of Dental Education), and were not yet available to Masella when his article was authored. His article, though, stimulates good discussion and action. Its data and substance show why, for example, dentistry needs to develop a core cadre of full-time practicing professional dental ethicists. Currently, there is only a small but very dedicated group of volunteers trying to meet our society's need to bring new life to professionalism in dentistry and our market.

Peltier B, Dower JS Jr. The ethics of adopting a new drug: articaine as an example.
J Am Coll Dent. 2006 Fall;73(3):11-20
The introduction of articaine as a local anesthetic agent and the number of reported cases of paresthesia are used to develop issues surrounding dentists' responsibility to investigate the evidence associated with product claims and to evaluate the use of treatments through various appropriate ethical lenses. The evidence on safety and efficacy of articaine are reviewed, followed by a discussion of various relevant ethical perspectives, including standard of care, professional codes, normative principles, weighing interests, and a hierarchy of core values. The authors recommend against the use of articaine.

Reid KI, Mueller PS, Barnes SA. Attitudes of general dentists regarding the acceptance of gifts and unconventional payments from patients.
J Am Dent Assoc. 2007 Aug;138(8):1127-33.
BACKGROUND: Professional boundaries ensure that a dentist's focus remains on the patient's welfare. Such boundaries may be compromised by accepting gifts from patients. METHODS: General dentists attending a continuing dental education conference completed an anonymous questionnaire about professional boundaries and acceptance of gifts from patients. The authors compared subjects' responses to questionnaire items and calculated descriptive statistics. RESULTS: Of the 333 dentists attending the conference, 219 (65.8 percent) submitted a completed or partially completed survey. Of the respondents, 81.2 percent endorsed receiving gifts, 82.5 percent thought accepting inexpensive gifts was acceptable, 79.7 percent would accept a dinner invitation from a patient, 52.1 percent would accept a $1,000 discount from a business owned by a patient and 59.0 percent would fabricate a set of dentures in exchange for house-painting services. More than one-third of respondents stated they would not accept a gift worth $25 to $100, and 51.1 percent would not accept a gift worth more than $100. There were no statistically significant differences in responses stratified by sex, age and years in practice, with the exception that female dentists were significantly less likely to accept a dinner invitation. Logistic regression models revealed that younger dentists and dentists with fewer years in practice were less likely to respond "agree" or "strongly agree" to accepting gifts worth $25 to $100, and female dentists were less likely to respond "agree" or "strongly agree" to accepting a dinner invitation. CONCLUSION: A majority of dentists endorsed accepting gifts from patients, which may put them at risk of violating boundaries with patients. Practice Implications. Our findings suggest that general dentists should establish policies regarding the receipt of gifts from patients and inform them of such policies.

Riaud X. Story of three SS dentists during World War II: Pr Hugo Blaschke, Dr Hermann Pook and Dr Willy Frank [Article in French]
Vesalius. 2006 Dec;12(2):79-93
This story of three SS dentists shows very clearly that the medical code of ethics, under a totalitarian regime, ends where ideology begins. Professor Hugo Blaschke provided dental care to the most eminent Nazi leaders, but he also was the senior SS dentist. He was in charge of dental care in the Waffen-SS, and therefore, he had responsibility for the stocks of dental gold collected from the mouths of those who died in the concentration camps, in order to make dentures for his soldiers. Dr Hermann Pook was the dentist in charge of all the other dentists practising in the concentration camps. He was responsible for gathering statistics on the dental care provided for prisoners in the camps. His instructions were very clear: "No conservation or restorative treatment. Only extractions, and with no anaesthesia!" He was also in charge of gathering the gold that was collected in the camps, for the financial department of the SS. Dr Willy Frank, an Auschwitz dentist, took part in the selection of some of the convoys for the gas chambers. His participation in the collection of gold from the mouths of the dead was also established. These three men were sentenced to prison for War Crimes and Crimes against Humanity.

Santoro V, De Donno A, Dell'Erba A, Introna F. Esthetics and implantology: medico-legal aspects .[Article in English, Italian].
Minerva Stomatol. 2007 Jan-Feb;56(1-2):45-51.
In recent years the high number of malpractice lawsuits in dentistry has attracted closer attention of dental practitioners to its medico-legal aspects. Implantology, in particular, presents many points of medico-legal concern connected with the difficulties inherent to dental procedures and objectives (both functional and esthetic), as well as full patient collaboration as an essential part of successful treatment. An accurate assessment of each case by the clinician is fundamental, especially in circumstances where esthetic considerations are preponderant as, for instance, in the frontal sectors. In such cases, the options of implantology or of a traditional fixed prosthesis need to be carefully weighed in light of the patient's anatomic condition. The patient should therefore receive complete information and be made fully aware of the risk of treatment failure, as well as possible complications, limits to the procedures, and the fact that successful outcome will also depend on her/his scrupulous observance of the practitioner's instructions. In short, the aim is to make the patient an active ''accomplice'' in treatment. To this end, the use of an extremely detailed information leaflet is strongly advised; after careful clarification of any doubts the patient may have, the patient's written informed consent should be obtained. Nevertheless, there is the risk that excessive intrusion of bureaucracy into medical procedures in defence of the practitioner against malpractice suits may hinder the principal aim of traditional medicine, i.e. to provide the best care for the patient through mutual trust fostered within the doctor-patient relationship.

Schwartz B. The evolving relationship between specialists and general dentists: practical and ethical challenges.
J Am Coll Dent. 2007 Spring;74(1):22-6.
As dentistry evolves, so has the interrelationship between specialists and dentists, in many cases to maintain a full office schedule amidst changes in patient needs and practice philosophies. This essay will consider the ethical implications as well as the enablers and disablers of relationships between specialists working in a general dentist's office. Dentists need to consider all of the ethical implications before embarking on new relationships between dentists and specialists in order to best maintain patient trust and to provide enhanced patient care.

Sidebotham PD, Harris JC. Protecting children.
Br Dent J. 2007 Apr 14;202(7):422-3.
Safeguarding children from maltreatment and neglect is part of the responsibility of all health professionals, and dental practitioners may be in a unique position to recognise and respond to concerns of this kind. This article outlines some of the ways that abuse can present to the dental team and describes the action that should be taken if abuse is suspected in a young patient.

Sofola OO, Folayan MO, Denloye OO, Okeigbemen SA. Occupational exposure to bloodborne pathogens and management of exposure incidents in Nigerian dental schools.
J Dent Educ. 2007 Jun;71(6):832-7.
The goal of this study was to determine the frequency of occupational exposures to bloodborne pathogens amongst Nigerian clinical dental students, their HBV vaccination status, and reporting practices. A cross-sectional study of all clinical dental students in the four Nigerian dental schools was carried out by means of an anonymous self-administered questionnaire that asked questions on demography, number and type of exposure, management of the exposures, personal protection against cross infection, and the reporting of such exposures. One hundred and fifty-three students responded (response rate of 84.5 percent). Only thirty-three (37.9 percent) were fully vaccinated against HBV. Ninety (58.8 percent) of the students have had at least one occupational exposure. There was no significantly associated difference between sex, age, location of school, and exposure. Most of the exposures (44.4 percent) occurred in association with manual tooth cleaning. There was inadequate protection of the eyes. None of the exposures were formally reported. It is the responsibility of training institutions to ensure the safety of the students by mandatory HBV vaccination prior to exposure and adequate training in work safety. Written policies and procedures should be developed and made easily accessible to all workers to facilitate prompt reporting and management of all occupational exposures.

White DA, Morris AJ, Hill KB, Bradnock G. Consent and school-based surveys.
Br Dent J. 2007 Jun 23;202(12):715-7.
Possession of information on population health needs is at the heart of the commissioning process. The move to local commissioning arrangements for all NHS dental services makes this particularly relevant for dentistry. High response rates in surveys are necessary for the results to be sufficiently valid to inform commissioning decisions. Our recent experience in organising and undertaking school-based epidemiological surveys has demonstrated an increasing problem with recruiting subjects of all ages. This has significant implications for dental epidemiological surveys in the future.