Allukian M Jr & Adekugbe O. The practice and infrastructure of dental public health in the United States. Dental Clinics Of North America 2008 Apr; Vol. 52 (2), pp. 259-80.
Dental public health is a unique and challenging American Dental Association-recognized specialty because the patient is the entire community or population, such as a school, neighborhood, city, state, or the nation, with a focus on vulnerable populations. Limited resources are maximized through prevention, policies, programs, and organized community efforts to respond to great unmet needs. Although dental public health professionals are few in number, millions of people every day have better oral health because of these professionals, who work on the local, state, and national level.

Ardenghi DM. Dentists' ethical practical knowledge: a critical issue for dental education. Eur J Dent Educ. 2009 May;13(2):69-72.
Dentists, just like teachers, when moving from school to the workplace (dental offices and classrooms respectively), may find it difficult to apply theories learned during formal education to the complexities of the workplace environment. These difficulties constitute a critical issue for dental education in the area of ethics. In teacher education, the knowledge teachers develop for dealing with the situations they encounter in the classroom is called teachers' practical knowledge. In this study, I discuss the concept of teachers' practical knowledge within the context of dentistry, focusing on the ethical dimensions of dentistry practice, arguing for a dentists' ethical practical knowledge. In this sense, I articulate the similarities between teachers' practical knowledge and its equivalent in dental education, suggesting alternatives for dental education that could foster the development of dentists' ethical practical knowledge.

Beemsterboer P. These are wonderful people. The Journal Of The American College Of Dentists 2008 Vol. 75 (2), pp. 4-5.
The position of academic dean in a dental school affords an opportunity to observe young men and women growing into professionals. I have seen numerous quite acts of thoughtful kindness and unselfish service. I have also witnessed the personal struggles of students working through their academic dishonesty and the challenges of balancing patients' needs with their own. Professional education is transformative, and faculty members play a key role as models and guides helping students become ethical practitioners.

Bjørndal L & Reit C. Endodontic malpractice claims in Denmark 1995-2004.  Int Endod J. 2008; 41(12):1059-65.
AIM: To study the reasons for and outcome of malpractice claims handled by the regional and national Danish Dental Complaint Boards (DCB) from 1995 to 2004. Specific attention was paid to endodontic claims. Three hypotheses were explored: endodontic malpractice claims are frequent, they are mostly due to technical shortcomings and male dentists are overrepresented. METHODOLOGY: The reasons for the claims were classified and assigned to at least one of 14 categories. Cases assigned to the 'endodontic treatment' category were further sub-categorized, and reasons for malpractice were examined. An age and gender analysis of dentists and complaining patients was performed only on data obtained from the endodontic cases. RESULTS: Overall, 3611 malpractice claims were registered. In 43% of the cases the dentist was judged to be guilty of malpractice. In the majority of the appealed cases the original verdict was affirmed (62.2%) by the national DCB. After crown & bridge treatment (23%) endodontic treatment was the next frequent malpractice claim (13.7%), in which 'technical complications or incorrect treatment' was the most frequent sub-categorization (28.4%). Reasons for endodontic malpractice verdicts were related to root filling quality, the use of a paraformaldehyde product and instrument fracture. Male dentists were most often involved in an endodontic claim, and the majority of complainants were females. CONCLUSIONS: Endodontic malpractice claims were relatively common in Denmark. Perceived technical shortcomings dominated the patients' complaints concerning root canal treatment. Male dentists and female patients were overrepresented indicating a gender influence on aspects of the doctor-patient communication important for liability claims.

Bolin KA. Assessment of treatment provided by dental health aide therapists in Alaska: a pilot study. Journal Of The American Dental Association 2008, Vol. 139 (11), pp. 1530-5
BACKGROUND: Dental health aide therapists (DHATs) in Alaska are authorized under federal law to provide certain dental services, including irreversible dental procedures. The author conducted this pilot study to determine if treatments provided by DHATs differ significantly from those provided by dentists, to determine if DHATs in Alaska are delivering dental care within their scope of training in an acceptable manner and to assess the quality of care and incidence of reportable events during or after dental treatment. METHODS: The author audited the dental records of patients treated by dentists and DHATs who perform similar procedures for selected variables. He reviewed the records of 640 dental procedures performed in 406 patients in three health corporations. RESULTS: The author found no significant differences among the provider groups in the consistency of diagnosis and treatment or postoperative complications as a result of primary treatment. The patients treated by DHATs had a mean age 7.1 years younger than that of patients treated by dentists, and the presence or adequacy of radiographs was higher among patients treated by dentists than among those treated by DHATs, with the difference being concentrated in the zero- to 6-year age group. CONCLUSIONS: No significant evidence was found to indicate that irreversible dental treatment provided by DHATs differs from similar treatment provided by dentists. Further studies need to be conducted to determine possible long-term effects of irreversible procedures performed by nondentists. CLINICAL IMPLICATIONS: A need to improve oral health care for American Indian/Alaska Native populations has led to an approach for providing care to these groups in Alaska. The use of adequately trained DHATs as part of the dental team could be a viable long-term solution.

Brands WG. [Expert advice in liability cases] [in Dutch]. Ned Tijdschr Tandheelkd. 2009;116(5):228-33.
Concerning cases of liability, dentists in the future will probably have to call on expert help or act as experts on behalf of a colleague with increasing frequency. Dentists who consider acting as experts in liability cases will have to develop their expertise especially in civil law and disciplinary law. Matters which in this respect should receive special attention are: the expert must act in conformity with the law on Medical Treatment Agreement; the expert's report must make clear what the legal basis is of the report's conclusions; the legal basis must be substantially supported by the facts, conditions and findings that are mentioned in the report; the expert must act independently and refrain from subjective judgments, assumptions and unprofessional and prejudicial qualifications.

Brands W & Welie JVM. Dentists in double trouble: the (un)fairness of punishing for the same mistake twice. Journal of the American Dental Association 2008 139(9):1249-55.
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. 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.

Brennan DS, Singh KA & Spencer AJ. Health system values and social values of dental practitioners. Health Policy (Amsterdam, Netherlands) 2008 Vol. 86 (2-3), pp. 318-24
OBJECTIVES: To describe the social and health system values of dentists, examine the associations of essential and instrumental health system values and social values with health system values. METHODS: A random sample of Australian dentists was surveyed by mailed self-complete questionnaires in 2004 (response rate=72%, n=191). RESULTS: A minority agreed with egalitarian social values (19%), while the majority endorsed the essential health system values of fair access (84%), quality of care (93%), efficiency (82%), respect for patients (90%) and patient advocacy (81%). A minority agreed with the instrumental health system values of personal responsibility (48%) and social solidarity (45%), but a majority agreed with social advocacy (73%), provider autonomy (95%), consumer sovereignty (91%) and personal security (65%). The strongest associations between essential values and instrumental values (P<0.05) were observed between the essential value of fair access and the instrumental values of social advocacy (rho=0.51) and social solidarity (rho=0.43). Egalitarian values were associated with [odds ratio; 95% CI] the essential value of fair access (2.35; 1.24-4.45) and the instrumental value of social solidarity (2.39; 1.31-4.34). CONCLUSIONS: Dentists endorsed essential health system values, but varied in their support for instrumental health system values. A minority endorsed egalitarian values, which were positively associated with the essential value of fair access and the instrumental value of social solidarity. It is important to consider the role of values of key stakeholders such as providers and patients in health policy development.

Brons S, Becking AG & Tuinzing DB. Value of informed consent in surgical orthodontics. J Oral Maxillofac Surg. 2009 May;67(5):1021-5.
PURPOSE: Informed consent forms an important part of treatment, especially in the case of elective treatment. The aim of this survey was to establish how much patients can recall of the information given during an informed consent interview before orthognathic surgery. During the consultation, attention was given to all aspects of the treatment. However, because of "insurance-related factors," the need for treatment because of functional reasons was stressed over esthetics. The recall of information given during an informed consent interview before orthognathic surgery was measured using a questionnaire. MATERIALS AND METHODS: Patients with a mandibular deficiency with a low mandibular plane angle were questioned after an informed consent interview regarding surgical orthodontic treatment. RESULTS: Esthetics were more frequently and functional problems were less frequently recalled as the reason for operation than was expected. The risk of a change in the sensation of the lower lip by surgery was frequently recalled as a reason to refrain from the operation. The overall recall rate of the possible risks and complications of orthodontic surgery was 40%. CONCLUSIONS: No reports were found of comparable research on the preoperative recall after consultation before surgical orthodontic surgery. The aspects of communication that can improve recall must be clarified. A recall rate of 100% seems a utopia, although an arbitrary line is needed to determine the quality of an informed consent interview.

Chate RA. An audit of the level of knowledge and understanding of informed consent amongst consultant orthodontists in England, Wales and Northern Ireland.  Br Dent J. 2008;205(12):665-73.
OBJECTIVE: To determine the level of knowledge and understanding of informed consent amongst consultant orthodontists. DESIGN: A questionnaire which covered a range of legal issues on informed consent as it pertains to clinical practice in three of the four nations of the United Kingdom. SETTING: Hospital orthodontic departments in England, Wales, and Northern Ireland. SUBJECTS AND METHODS: A questionnaire was initially issued to 14 consultant orthodontists working in the East of England as a regional audit project on informed consent in 2005. After the completion of the audit in 2006, the pilot data were used to refine the questionnaire for wider circulation. The project was then submitted to the British Orthodontic Society (BOS) clinical effectiveness committee which subsequently gave its endorsement for national circulation. The questionnaire was then sent to 216 other consultants in June 2007, with two further postings to non-responders before the survey was closed four months later. The standard required for clinical practice to be lawful is that all of the questions should be answered correctly. RESULTS: Of the 233 consultant orthodontists who were invited to participate, 183 complied (78.5%) and 50 did not (21.5%). Of those who responded, 179 answered the questionnaire (76.8%) while four had either resigned or retired (1.7%). Out of the 21 answers to the 11 questions that were posed, the mean, median and mode correct response rates were 12 (57%), 11 (52%), and 10 (48%) respectively. The areas which were found to have the poorest level of understanding included what explanations patients need from clinicians in order for them to give consent, how to fully judge if a patient is capable of giving consent, how to manage a patient deemed incapable of giving consent, the legal status of fathers consenting on behalf of their children, whether consent forms have to be re-signed if the start of treatment is delayed by six months or more, and that dentists referring a patient for treatment requiring a general anaesthetic have the same duty to receive consent for the anaesthesia as do the clinicians who will be performing the surgical procedure. CONCLUSIONS: The results of this audit indicate certain key areas of deficiency in the knowledge and understanding of informed consent amongst consultant orthodontists. The findings provide an opportunity for all clinicians to improve their education and therefore their potential to comply with both the ethical obligation and the legal requirement of gaining valid consent before the start of any treatment.

Dougall A & Fiske J. Access to special care dentistry, part 3. Consent and capacity. British Dental Journal 2008 Jul 26; Vol. 205 (2), pp. 71-81
This article considers what is meant by informed consent and the implications of the Mental Capacity Act in obtaining consent from vulnerable adults. It explores a number of conditions which impact on this task, namely dyslexia, literacy problems and learning disability. The focus on encouraging and facilitating autonomy and the use of the appropriate level of language in the consent giving process ensures that consent is valid. The use of appropriate methods to facilitate communication with individuals in order to be able to assess capacity and ensure that any treatment options that are chosen on their behalf are in their best interests are outlined. The use of physical intervention in special care dentistry in order to provide dental care safely for both the patient and the dental team is also considered.

Dym H. Risk management techniques for the general dentist and specialist. Dental Clinics Of North America 2008 Jul; Vol. 52 (3), pp. 563-77
Malpractice litigation is part of everyday clinical practice and is an area of which all dentists need to be aware. With proper forethought and planning, this vexing issue can be controlled and made less anxiety producing. The astute clinician must be as diligent in risk-reduction management and strategies as he/she is in practicing excellent dentistry. This article discusses various preventive measures that can be used to help mitigate malpractice claims and preclude them from developing. Good patient communication, rapport, and excellent documentation are the keys to minimizing, and possibly eliminating future lawsuits.

Ellen RP & Singleton R. Human rights and ethical considerations in oral health research. Journal of the Canadian Dental Association 2008 Vol. 74 (5), pp. 439
Although international agreements set the framework for research ethics, countries vary in their interpretation and execution. The Government of Canada guidelines are based on the Tri-council policy statement: ethical conduct for research involving humans (2005) and the new CIHR guidelines for health research involving Aboriginal people (2007). In this critical review, we address 3 areas of educational value to practitioners who care for the oral health needs of the public, research trainees and research investigators who advance knowledge pertaining to oral health: protection of human study participants, conflicts of interest and investigator integrity. Its main message is that ethical health care should be supported by a strong foundation of ethical research. Available on-line at: http://www.cda-adc.ca/jcda/vol-74/issue-5/439.html

Gallagher J, Clarke W& Wilson N. Understanding the motivation: a qualitative study of dental students' choice of professional career. European Journal Of Dental Education 2008 May; Vol. 12 (2), pp. 89-98
BACKGROUND: Given the changing nature of the dental workforce, and the need to retain the services of future members, it is important to understand why current dental students perceive that they were motivated to study dentistry. Qualitative research provides the opportunity to explore the underlying issues in addition to informing subsequent quantitative research. The objectives of this research were to investigate final-year dental students' motivation for studying dentistry and how they perceive this has been modified during their undergraduate degree programme. METHODS: Purposive sampling of a representative group of 35 final-year dental students at King's College London Dental Institute to participate in audio-taped focus groups. Qualitative data were analysed using Framework Methodology. RESULTS: The findings suggest a strong emphasis on having a career, providing 'professional status', 'financial benefits', 'job security, flexibility and independence' and 'good quality of life'. Students reported being attracted by features of the job, supported to a greater or lesser extent by personal experience, family and friends. It appears however that students' initial motivation is being tempered by their experiences during their undergraduate degree programme, in particular, the 'responsibilities of an intensive professional education', their 'mounting student debt' and the perception of 'feeling undervalued'. his perception related to dentistry in general and National Health Service dentistry in particular, being undervalued, by government, patients, the public and members of the dental profession. CONCLUSIONS: Students' vision of a 'contained professional career' within health care, providing status and financial benefits, appears to have influenced their choice of dentistry. Pressures relating to student life and policy changes are perceived as impacting on key components of professional life, particularly status in the social and economic order. The implications for educators, professional leaders and policy makers are explored.

Gilmour J & Stewardson DA. Morale of vocational dental practitioners in the United Kingdom. British Dental Journal 2008 Jun 14; Vol. 204 (11), pp. E18
OBJECTIVE: This study was undertaken to devise a suitable survey instrument to measure morale, and to undertake an assessment of morale amongst vocational dental practitioners (VDPs) in the UK. DESIGN: Postal questionnaire survey. SETTING: Dental vocational training schemes in the UK. SUBJECTS: Vocational dental practitioners. METHOD: A confidential postal questionnaire was used to measure levels of morale among all VDPs in the UK in 2007. RESULTS: A response rate of 76.7% was achieved. The mean morale score for Scottish VDPs was significantly higher than that of the Northern Irish VDPs, which in turn was significantly higher than those of the VDPs in England or Wales. In England and Wales females recorded higher morale scores than males. Lowest morale scores were associated with statements referring to concerns about future changes to NHS dentistry, and the limits on treatment within the NHS system. The highest scores were associated with good working relationships. CONCLUSION: The use of an appropriately tested questionnaire has provided a convenient objective measure of morale. The morale of VDPs in the United Kingdom was lower than expected. Scottish VDPs recorded higher morale scores than other VDPs and responded more positively in the survey instrument. The most negative responses from all VDPs were regarding the effect of the NHS system on treatment and concerns about future changes to the NHS.

Goodhew PM. The regulation of the dental profession in New Zealand. The New Zealand Dental Journal 2008 Mar; Vol. 104 (1), pp. 4-9.
Professions have developed and evolved in response to many different societal pressures. The dental profession in New Zealand is no exception, and (in particular) has been influenced by--and has influenced--changing regulatory environments since the nineteenth century. The Health Practitioners Competence Assurance Act (2003) is the latest Act to regulate dentistry, and has many details that will affect the practice of dentistry in New Zealand and challenge the dental profession to respond in new ways.

Holt VP. The need for leadership and vision in dentistry. A personal view. Primary Dental Care (UK) 2008 Jul; Vol. 15 (3), pp. 113-9
This paper considers how dentistry has developed in the United Kingdom (UK) over the last 60 years and concludes that dentists have failed to be proactive and to shape the systems for the delivery of an optimal level of care to the population. It suggests that there is a need for far better leadership and for dentists, as individuals and as a profession, to rediscover the sense of vision that they once had and to shape their destinies, rather than accepting the current situation. The author goes on to explain how this might be done. Since the inception of the National Health Service (NHS), the dental profession in the UK has, to a large extent, been dominated by the politics of the NHS, by changing fee structures and contracts, by reports from the Review Body on Doctors' and Dentists' Remuneration (DDRB), and by strategies adopted by successive governments, especially during the last two decades. These strategies have resulted in cohorts of disillusioned dental practitioners reducing their commitment to, or opting out of, NHS contracts and committing themselves, to a greater or lesser extent, to private practice. It is now over three years since for the first time, the proportion of dentistry provided under private contact in the UK, as measured by gross fees, exceeded that provided under NHS contract. The profession has shown a remarkable lack of imagination in organising itself to provide the best kind of care for patients. Instead of being proactive and visionary, it has allowed itself to become a political football. This has led to the progressive deskilling of many practitioners, and a manifest failure to secure the long-term oral health of patients. This paper considers how the situation could be improved and looks at four aspects, which are: 1. 21st century dentistry: state of the art versus reality? The contrast between what is clinically possible and what the profession currently delivers. 2. What are we here for? The need for a new vision for dentistry, the profession and the future, and the need for a new sense of mission. 3. A responsibility for the profession. The responsibility of the profession for providing patients (and funding bodies) with advice. 4. Leading the way: a new-look personal development plan. The personal development needs of dentists, with much more emphasis on interpersonal and leadership skills.

Huff K, Huff M & Farah C. Ethical decision-making for multiple prescription dentistry. General Dentistry. 2008 Sep-Oct; Vol. 56 (6), pp. 538-47
Technology provides a selection of treatment choices for dental problems. Dental ethics must be applied to the development of a treatment plan and the selection of methods. Treatment options should consider the patient's circumstances and desires as well as the dentist's decision as it relates to best practices in dentistry. This article presents four case studies that illustrate the process of ethical decision-making for the appropriate treatment.

Humayun A, Fatima N, Naqqash S, Hussain S, Rasheed A, Imtiaz H & Imam SZ. Patients' perception and actual practice of informed consent, privacy and confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore. BMC Medical Ethics 2008; Vol. 9, pp. 14
The principles of informed consent, confidentiality and privacy are often neglected during patient care in developing countries. We assessed the degree to which doctors in Lahore adhere to these principles during outpatient consultations. MATERIAL & METHOD: The study was conducted at medical out-patient departments (OPDs) of two tertiary care hospitals (one public and one private hospital) of Lahore, selected using multi-stage sampling. 93 patients were selected from each hospital. Doctors' adherence to the principles of informed consent, privacy and confidentiality was observed through client flow analysis performed by trained personnel. Overall patient perception was also assessed regarding these practices and was compared with the assessment made by our data collectors. RESULTS: Some degree of informed consent was obtained from only 9.7% patients in the public hospital and 47.8% in the private hospital. 81.4% of patients in the public hospital and 88.4% in the private hospital were accorded at least some degree of privacy. Complete informational confidentiality was maintained only in 10.8% and 35.5% of cases in public & private hospitals respectively. Informed consent and confidentiality were better practiced in the private compared to the public hospital (two-sample t-test > 2, p value < 0.05). There was marked disparity between the patients' perspective of these ethical practices and the assessment of our trained data collectors. CONCLUSION: Observance of medical ethics is inadequate in hospitals of Lahore. Doctors should be imparted formal training in medical ethics and national legislation on medical ethics is needed. Patients should be made aware of their rights to medical ethics.

Hutchins B & Cobb S. When will we be ready for academic integrity? Journal Of Dental Education 2008 Vol. 72 (3), pp. 359-63
The academic dental community has been taken aback by recent events involving student cheating. Several of these events have served as the catalyst for a number of recent journal articles on the subject, providing an invaluable overview of the problems. There have also been several articles over the last few years that have considered student behavior and how institutions can address professionalism. Unfortunately, administrations can only do so much with their policies and curricula, which is why this article is directed toward the individuals that have the most influence on how policies are administered, curricula are implemented, and students are directed: that is, the faculty. This article discusses various ways faculty members can become more intimately involved in the development of professionalism at their institutions and encourages the creation of a four-year program that establishes a culture of professionalism.

Iovino RP. Justice, dentistry and American democracy. N Y State Dent J. 2008; 74(5):46-9.
Justice is a complex virtue that occupies a significant place in dental ethics. Working towards its realization is integral to seeking attainment of the fair and proper provision of health care. Comprehensive concepts of justice include legal, social and political divisions, all of which provide avenues that may be utilized by a society seeking advancement of the common good. This paper to explore the broader concepts of justice, including legal, social and political, as they relate to dentistry. The paper covers the duty to render fair treatment, the social contract, the market as social coordinator, and the license as economic and ethical tool.

Jacobson N & Frank CA. The myth of instant orthodontics: an ethical quandary. Journal Of The American Dental Association 2008 Apr; Vol. 139 (4), pp. 424-34
BACKGROUND: There is a clinical trend of using porcelain veneer restorations (PVRs) for the correction of malaligned anterior teeth. Use of PVRs for this purpose raises clinical and ethical dilemmas. TYPES OF STUDIES REVIEWED: A literature review of four different topics (PVR preparation, enamel thickness of anterior teeth, dentinal bonding adhesive effectiveness and PVR long-term success) was conducted to determine the optimal preparation for a successful PVR. The amount of tooth malalignment that may be corrected with a PVR without adversely affecting its success was calculated. RESULTS: The optimal preparation for a successful PVR may have dentin exposed in the body of the preparation. However, most of the preparation must be in enamel, and all the margins must end in enamel. The strength of a dentin bond varies greatly owing to a multistep, technique-sensitive cementation process and is weaker than an enamel bond. It is not possible to correct atypical gingival esthetics (uneven gingival margins, uneven papillae, short papillae and bulbous gingivae) resulting from malaligned teeth through use of PVRs. CONCLUSIONS: and CLINICAL IMPLICATIONS: Aligning a healthy tooth with a PVR is not a conservative procedure and more conservative treatment options (such as orthodontics, bleaching, direct bonding and enamelplasty) should be offered to the patient. In addition, the inability to restoratively improve gingival relationships with PVRs may result in achieving less-than-optimal esthetics. A clinician should present only treatment options that involve predictable, conservative restorations or that preserve healthy tooth structure. Aligning teeth with PVRs may create ethical dilemmas that can be resolved with the help of the American Dental Association Principles of Ethics and Code of Professional Conduct.

Jones DW. Scandinavian tragedy. British Dental Journal 2008 ; 204(5): 233-4
This paper briefly reviews the logic surrounding the controversial banning of dental amalgam by the Norwegian government. The very small contribution from dentistry to environmental mercury pollution and the significant advantages of amalgam as a dental restorative are emphasised.

Koka S. Conflict of interest: the Achilles heel of evidence-based dentistry. The International Journal Of Prosthodontics 2008 Vol. 21 (4), pp. 364-8.

Kvaal SI. Ethical and legal considerations in a case of research fraud. The Journal Of The American College Of Dentists 2008 Summer; Vol. 75 (2), pp. 29-35
In 2006 a researcher at the main hospital in Norway admitted that he had forged data in a study published in the medical journal The Lancet that was co-authored by 13 others from both Europe and America. The researcher, dually qualified in dentistry and medicine, immediately admitted fabricating the results. A Commission of Enquiry reported that most of his publications were fabricated or manipulated and that he was alone in the fraud. As a result, the researcher lost his authorization to practice medicine and dentistry. His action has shaken the trustworthiness of science and the trust for the scientific community, both in the institutions that support the research and in the review process in science publications. Following this revelation, the management of scientific fraud has been widely discussed, including concerns about the dual role of a Commission of Enquiry as both investigator and judge, and also the legal rights of fraudulent scientists. Other issues concern the responsibilities of supervisors and institutions in the guidance of candidates in research procedures and ethics. In addition, commentaries have appeared in national newspapers as well as in medical and dental scientific journals. Various issues have been discussed, including the fact that editors and referees in scientific publications rarely have the opportunity to check raw data, which emphasizes the need for data confirmation by independent groups. These reflections have been fruitful for the community, although it will not, nor can it, prevent fraud in the future.

Lantz MS. Dental students persuade the Michigan Dental Association to strengthen its codes of ethics: do actions speak louder than words? The Journal Of The American College Of Dentists. 2008, Vol. 75 (2), pp. 22-6
This is a case study of how four different groups viewed proposed language in professional ethics codes regarding personal relationships with patients. The ADA Council on Ethics, Bylaws, and Judicial Affairs; the House of Delegates of the Michigan State Dental Association; and first-year students at the University of Michigan School of Dentistry favored a strongly worded statement in their codes, while the House of Delegates of the ADA passed a statement that was more "advisory" in nature. Support material concerning the statement on personal relationships is presented as an ethics case, and suggestions are presented regarding the ethical principles underlying positions on the issue.

Leake JL & Birch S. Public policy and the market for dental services. Community Dentistry And Oral Epidemiology 2008 Aug; Vol. 36 (4), pp. 287-95
Social inequality in access to oral health care is a feature of countries with predominantly privately funded markets for dental services. Private markets for health care have inherent inefficiencies whereby sick and poor people have restricted access compared to their healthy and more affluent compatriots. In the future, access to dental care may worsen as trends in demography, disease and development come to bear on national oral healthcare systems. However, increasing public subsidies for the poor may not increase their access unless availability issues are resolved. Further, increasing public funding runs counter to policies that feature less government involvement in the economy, tax policy on private insurance premiums, tax reductions and, in some instances, free-trade agreements. We discuss these issues and provide international examples to illustrate the consequences of the differing public policies in oral health care. Subsidization of the poor by inclusion of dental care in social health insurance models appears to offer the most potential for equitable access. We further suggest that nations need to develop national systems capable of the surveillance of disease and human resources, and of the monitoring of appropriateness and efficiency of their oral healthcare delivery systems.

Lipkin M, Zabar SR, Kalet AL, Laponis R, Kachur E, Anderson M, & Gillespie CC. Two decades of Title VII support of a primary care residency: process and outcomes. Academic Medicine 2008 Vol. 83 (11), pp. 1064-70
PURPOSE: To assess 23 years of Health Resources and Services Administration (HRSA) Title VII Training in Primary Care Medicine and Dentistry funding to the New York University School of Medicine/Bellevue Primary Care Internal Medicine Residency Program. The program, begun in 1983 within a traditional, inner-city, subspecialty-oriented internal medicine program, evolved into a crucible of systematic innovation, catalyzed and made feasible by initiatives funded by the HRSA. The curriculum stressed three pillars of generalism: psychosocial medicine, clinical epidemiology, and health policy. It developed tight, objectives-driven, effective, nonmedical specialty blocks and five weekly primary care activities that created a paradigm-driven, community-based, role-modeling matrix. Innovation was built in. Every block and activity was evaluated immediately and in an annual, program-wide retreat. Evaluation evolved from behavioral checklists of taped interviews to performance-based, systematic, annual objective structured clinical examinations. METHOD: The authors reviewed eight grant proposals, project reports, and curriculum and program evaluations. They also quantitatively and qualitatively surveyed the 122 reachable graduates from the first 20 graduating classes of the program. RESULTS: Analysis of program documents revealed recurring emphases on the use of proven educational models, strategic innovation, and assessment and evaluation to design and refine the program. There were 104 respondents (85%) to the survey. A total of 87% of the graduates practice as primary care physicians, 83% teach, and 90% work with the underserved; 54% do research, 36% actively advocate on health issues for their patients, programs, and other constituencies, and 30% publish. Graduates cited work in the community and faculty excitement and energy as essential elements of the program's impact; overall, graduates reported high personal and career satisfaction and low burnout. CONCLUSIONS: With HRSA support, a focused, innovative program evolved which has already met each of the six recommendations for future innovation of the Alliance for Academic Internal Medicine Education Redesign Task Force. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Machesney A. Data protection in dentistry--your responsibilities. Journal Of The Irish Dental Association 2008 Jun-Jul; Vol. 54 (3), pp. 141

Malmstrom HS. Ethics in a postgraduate proqram. The Journal Of The American College Of Dentists 2008, Vol. 75 (2), pp. 14-7
Experiences with residents in a general practice residency parallel the recent literature on academic integrity among dentists. Based on this background, a planned integrated ethics and professionalism program is outlined for the University of Rochester School of Medicine and Dentistry.

Marshman Z & Hall MJ. Oral health research with children. International Journal Of Paediatric Dentistry 2008 Jul; Vol. 18 (4), pp. 235-42
BACKGROUND: There has been a shift towards research with children and the adoption of the concept of child-centred research. However, the majority of oral health research is conducted on children, rather than with them. OBJECTIVE: This study aimed to provide an overview of contemporary approaches to research with children. CONSIDERATIONS: The methodological considerations of such research include: the power relationship between the adult researcher and the child participant, with important factors of language use, the setting for the research, appropriate analysis, and quality of the data; ethical factors such as the purpose and risks of the research, confidentiality, recruitment, funding, information to children and parents, consent, and dissemination; and appropriate methods. Methods suitable for oral health research with children include quantitative techniques such as questionnaires and qualitative approaches including interviews individually or in groups and participatory techniques such as time-lines/life grids, drawings, and vignettes. CONCLUSION: There is considerable scope to access children's perspectives of their oral health and care through actively involving them in research. To conduct such research, however, requires training or collaboration with colleagues from other disciplines.

Maio G [The dentist between medicine and cosmetology. Ethical shortcomings of the esthetics boom in dentistry][in French, German]. Schweiz Monatsschr Zahnmed. 2009;119(1):47-56.
Dentistry has evolved from a genuine medical practice to a mere business. From an ethical point of view it is asked whether this evolution creates more problems than it solves. The paper elaborates four arguments against this evolution and shows that aesthetics in dentistry which works only according to market categories runs the risk of loosing the view for the real need of patients. Dentistry which comprehends itself as part of a market will be nothing else than a part of a beauty industry which has the only aim to sell something, but not the aim to help people. Such a dentistry makes profit from the ideology of a society which serves only vanity, youthfulness and personal success and which is losing the sight for real values. The real value of man cannot be reduced to his appearance and medicine as an art should feel the obligation to resist these modern ideologies and should help people to get a more authentic attitude to themselves. If modern dentistry fails to think about these implications it will lose its identity as medicine, which would be too great a loss.

Milsom KM, Threlfall A, Pine K, Tickle M, Blinkhorn AS & Kearney-Mitchell P. The introduction of the new dental contract in England - a baseline qualitative assessment. British Dental Journal 2008 Jan 26; Vol. 204 (2), pp. 59-62.
OBJECTIVE: To record immediately prior to its inception the views of key stakeholders about the new dental contract introduced in April 2006. METHOD: Nineteen participants (11 dental practice principals and eight primary care trust dental leads) were interviewed using a semi structured approach to find out their views and opinions about dental practice, the reasons for introducing the new dental contract, its implementation and content of the new dental contract. An analysis based upon the constant comparative method was used to identify the common themes about these topics. RESULTS: Practice principals expressed satisfaction with working under pilot Personal Dental Services schemes but there was a concern among dental leads about a fall in dental activity among some dentists. All participants believed the new contract was introduced for political, financial and management reasons. All participants believed that it was introduced to limit and control the dental budget. Participants felt that implementation of the contract was rushed and there was insufficient negotiation. There were also concerns that the contract had not been tested. Dental practitioners were concerned about the calculation and future administration of the unit of dental activity system, the fixing of the budget and the fairness of the new dental charge scheme. Dental leads were concerned about patient access and retention and recruitment of dentists under the new contract. CONCLUSIONS: The study found a number of reasons for unease about the new dental contract; it was not perceived as being necessary, it was implemented at speed with insufficient negotiation and it was seen as being untested. Numerous and varied problems were foreseen, the most important being the retention of dentists within the NHS. Participants felt the contract was introduced for financial, political and managerial reasons rather than improving patient care. The initial high uptake of the new dental contract should not be viewed as indicating a high level of approval of its content.

Nuzzolese E &  Di Vella G. Forensic dental investigations and age assessment of asylum seekers. International Dental Journal 2008 Jun; Vol. 58 (3), pp. 122-6
Age estimation is useful in forensic investigations to aid in the process of identifying unknown victims as well as living individuals. In many countries age estimation is commonly used to assist immigration authorities in deciding whether refugees or illegal migrants have reached that designated age that separates a juvenile from an adult. This is particularly important for the protection of unaccompanied minors. Italy is a country of great appeal for immigration as people from other Mediterranean countries can easily reach Italian coasts. In Italy, as in other western world countries, unaccompanied asylum seekers deemed to be under 18 face a very different path through the immigration system. They cannot be deported and are sent through a juvenile system where they have access to education programmes and may be granted a residence permit. The Section of Legal Medicine of the University of Bari was approached by Judges and Immigration Police with the question to assess the age of unaccompanied asylum seekers who claim to be below 18 years of age. The contribution of forensic odontologists for age estimation was recognised and since November 2006 age estimation of asylum seekers in Bari (Italy) relies on clinical and dental examination together with skeletal maturation as seen on radiographs of the left hand and wrist, the pelvis for iliac crests and root development and mineralisation of third molars as seen on an orthopantomogram.

Ogle OE. Credentialing. Dental Clinics Of North America 2008 Jul; Vol. 52 (3), p. 469-81
Credentialing is the administrative process for validating the qualifications of licensed professionals and appraising their background. It is used by hospitals and other health care facilities, educational institutions, and insurance companies to ensure the qualification of their clinicians and to grant privileges to provide specific services and perform different medical or dental procedures. This article familiarizes the reader with the credentialing process and the documentation that is needed

Pitak-Arnnop P, Sader R, Hervé C, Dhanuthai K, Bertrand JC, & Hemprich A. Reporting of ethical protection in recent oral and maxillofacial surgery research involving human subjects. Int J Oral Maxillofac Surg. 2009 Jul;38(7):707-12.
This retrospective observational study investigated the frequency of reporting ethical approval and informed consent in recently published oral and maxillofacial surgery (OMS) research involving human subjects. All research involving human subjects published in the International Journal of Oral and Maxillofacial Surgery, Journal of Oral and Maxillofacial Surgery, British Journal of Oral and Maxillofacial Surgery, and Journal of Cranio-Maxillofacial Surgery during January to June 2005-2007 were analysed for disclosure of ethical approval by a local ethical committee and obtaining informed consent from the subjects. 534 articles were identified; ethical approval was documented in 118 (22%) and individual patient consent in 135 (25%). 355 reports (67%) did not include a statement on ethical approval or informed consent and only 74 reports (14%) disclosed statements of both. Ethical documentation in retrospective and observational studies was scant; 12% of randomised controlled trials and 38% of non-random trials did not report both of ethical protections. Most recent OMS publications involving humans failed to mention ethical review or subjects' consent. Authors must adhere to the international research ethics guidelines and journal instructions, while editors should play a gatekeeper role to protect research participants, uphold scientific integrity and maintain public trust in the experimental process and OMS profession.

Rademakers L & Gorter RC. Vergrijzing en mondzorg in Nederland. Een verkenning. [in Dutch; Ageing and oral health care in The Netherlands. An explorative study] Nederlands Tijdschrift Voor Tandheelkunde, 2008 Oct; Vol. 115 (10), pp. 527-32
In order to investigate which initiatives are being taken in The Netherlands to anticipate a change in oral health care demands as a result of ageing, 9 experts in the field of oral health care for the elderly were interviewed. The experts were selected because of their varied expertise and involvement in geriatric dentistry. Those interviewed were unanimous in the opinion that the demand for oral health care among the elderly will increase in the years to come. National initiatives to improve oral health care for the elderly appear to be limited. This situation can be changed by getting professional homecare more involved in oral health care for the elderly, and by regular dental checkups, stimulated by more actively operating general dental practitioners. For those in homes for the elderly and nursing homes, there appears to be no national policy with regard to oral health care. Several initiatives have been undertaken to improve dental health care, but those differ from institution to institution. According to the interviewed experts, financing, government prioritization, and health care laws are major bottlenecks on the road to the improvement of oral health care for the elderly.

Reynolds PP. A legislative history of federal assistance for health professions training in primary care medicine and dentistry in the United States, 1963-2008.  Academic Medicine 2008 Vol. 83 (11), pp. 1004-14
This article reviews the legislative history of Title VII of the United States Public Health Service Act. It describes three periods of federal support for health professions training in medicine and dentistry. During the first era, 1963 to 1975, federal support led to an increase in the overall production of physicians and dentists, primarily through grants for construction, renovation, and expansion of schools. The second period, 1976 to 1991, witnessed a shift in federal support to train physicians, dentists, and physician assistants in the fields of primary care defined as family medicine, general internal medicine, and general pediatrics. During this era, divisions of general internal medicine and general pediatrics, and departments of family medicine, were established in nearly every medical and osteopathic medical school. All three disciplines conducted primary care residencies, medical student clerkships, and faculty development programs. The third period, 1992 to present, emphasized the policy goals of caring for vulnerable populations, greater diversity in the health professions, and curricula innovations to prepare trainees for the future practice of medicine and dentistry. Again, Title VII grantees met these policy goals by designing curricula and creating clinical experiences to teach care of the homeless, persons with HIV, the elderly, and other vulnerable populations. Many grantees recruited underrepresented minorities into their programs as trainees and as faculty, and all of them designed and implemented new curricula to address emerging health priorities.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Reynolds PP. Title VII innovations in American medical and dental education: responding to 21st century priorities for the health of the American public. Academic Medicine 2008 Vol. 83 (11), pp. 1015-20
The Title VII Training in Primary Care Medicine and Dentistry grant program has been an engine for innovation by providing funds to develop and implement new curricula, new models of care delivery, and new methods of fellowship and faculty development. During period one, 1963-1975, the disciplines of family medicine and physicians assistants (PAs) first received funding to establish residency programs in family medicine and student training for PAs. Other innovations included interdisciplinary training and curricula in substance abuse and nutrition. During period two, 1976-1991, Title VII funds supported implementation of general dental residency programs. In family medicine, general internal medicine, and general pediatrics, ambulatory care training was expanded with a focus on community-oriented primary care and preventive medicine, as well as curricula in ethics, distance learning, behavioral health, and what is now called evidence-based medicine. During period two, Title VII also helped build the infrastructure of primary care through funding to recruit faculty, to expand training sites into community settings, and to incorporate topics relevant to primary care. During period three, 1992-present, innovations shifted to areas of clinical relevance or national priority, training in the care of vulnerable populations, and design of educational strategies to eliminate health disparities, often through collaborative partnerships between medicine, dentistry, and public health. This article focuses on three areas that reflect much of the current work of Title VII grantees: clinical skills and practice improvement, interdisciplinary models of training and patient care, and care of vulnerable and underserved populations.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

Rinaldi E & Shin A. Asset protection: why a preventive approach is the best insurance against liability. Journal Of The American Dental Association 2008 Feb; Vol. 139 (2), pp. 185-9
BACKGROUND: Asset-protection planning is critical for people in high-risk professions, such as dentistry. Planning requires a careful weighing of risks, such as the risk of a lawsuit versus that of relinquishing control of assets. The authors examine several lawful techniques that may protect a dentist's assets from claims of future creditors. CONCLUSIONS: Asset-protection planning, if done early and with the guidance of an attorney well-versed in the subject, can help deter creditors from claims resulting from malpractice suits, divorce, business partner disputes, bad investments, poor tax planning or a combination of these. Practice Implications. Careful planning can minimize the risk to a dentist's personal assets and the assets of the practice resulting from a lawsuit or other liabilities.

Romer M. Consent, restraint, and people with special needs: a review. Spec Care Dentist. 2009 Jan;29(1):58-66.
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 aides used for immobilization (i.e., restraint) during treatment may further complicate the situation. This area is controversial and has even resulted in legal difficulties for some dentists. Several topics related to the use of restraint are addressed in this article. A review of the literature and applicable laws pertaining to consent issues for people with special needs is presented and appropriate use of medical immobilization is discussed. Existing guidelines are reviewed. Informed consent and the use of restraint should be incorporated into overall guidelines for the use of anesthesia, sedation, and alternative behavior management techniques in providing dental care to patients with special needs.

Ryan FS, Cedro MK, Pabari S, Davenport-Jones L & Noar JH. Clinicians' knowledge and practice of data protection legislation and information management. Br Dent J. 2009; 206(2): E4; discussion 90-1.
AIMS: The aim of this study was to review current legislation and guidance on information governance and to audit clinicians' management of confidential patient information and knowledge of published guidelines in a teaching hospital. MATERIALS AND METHODS: A questionnaire was developed based on published Department of Health, General Dental Council and National Health Service guidance. This was then piloted and distributed to clinicians to complete. RESULTS: A review of the current guidance revealed many confusing and unclear areas. However, clinicians' knowledge of information governance was generally good, with an overall correct response rate of 73%. CONCLUSIONS: All clinicians have an ethical and legal obligation to protect confidential patient data and to be aware of their responsibilities. Local guidelines need to be clarified to help clinicians to manage patient data effectively.

Rule JT, & Bebeau MJ. Hugo A. Owens: dentist, civil rights leader, politician. The Journal Of The American College Of Dentists 2008 Summer; Vol. 75 (2), pp. 6-10
For 44 years Dr. Hugo A. Owens was a distinguished practitioner and community leader in Portsmouth, Virginia. Besides his affinity to for dentistry, he was driven by two other passions: politics and civil rights. In 1970 he was one of the first African-Americans elected to the Portsmouth City Council. He was reelected for the next term and appointed Vice Mayor, a position he held for eight years. His political successes were preceded by his activities as a civil rights leader, which began in 1950 and lasted through the 1960s. In a remarkable series of negotiations and litigations, Dr. Owens was the prime mover in the desegregation of the City of Portsmouth. In all three 'careers, Dr. Owens used dentistry as a home base for the expression of his activist philosophy of providing help for others when they were unable to do things for themselves.

Sadeghi M & Hakimi H. Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients. J Dent Educ. 2009;73(6)
Dental treatment procedures frequently involve blood and saliva that may be contaminated with HIV. The purpose of this cross-sectional survey was to assess Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients. In 2008, a fifty-three-item self-administered questionnaire was conducted on all 750 dental students who participated in the 10(th) Dental Student Congress in Isfahan, Iran. The overall response rate to the questionnaire was 60.7 percent. The total mean knowledge and attitudes scores were 82.1 percent (excellent) and 57.4 percent (negative), respectively. There were no significant differences in the knowledge or attitude scores between male and female students. A majority of the students were aware of the association between HIV and oral candidiasis (98.1 percent), major aphthous (95.8 percent), and Kaposi's sarcoma (93.8 percent). Although a majority of the students had excellent knowledge (78.4 percent), only 1 percent had professional attitudes about treating patients with HIV/AIDS. Therefore, it is important that dental students, as future dentists, develop not only the necessary practical skills but also attitudes that will prepare them to treat HIV/AIDS patients.

Sanz M, Widström E & Eaton KA. Is there a need for a common framework of dental specialties in Europe? European Journal Of Dental Education 2008 Vol. 12 (3), pp. 138-43
This paper aims to promote discussion about dental specialties and post-graduate dental education in the European Union (EU). Previously, dental educators have concentrated their efforts of seeking Pan-EU convergence in undergraduate dental education. However, the impact of the enlargement of the EU, the new European Commission (EC) Directive of professional training and the Bologna Process all impact on post-graduate (specialist) just as much as on undergraduate dental education. The provisions of the new EC directive mean that, unlike new medical specialties, new Pan-EU dental specialties cannot be created purely because they exist in two-fifths of EU Member States. At present, some EU Member States recognise eight or more dental specialties, whereas others recognise none. It is suggested that changing needs and demands of patients, which reflect a general improvement in oral health, increased wealth and an aging population will place increasing demands on dentistry to provide more complex care and treatment and that the current undergraduate curriculum cannot be expanded to provide suitable training to meet these needs and demands. There is thus a need to expand dental specialist training in all EU Member States, to agree common standards for specialist education and to officially recognise a wider range of Pan-EU dental specialties. The paper concludes that in order to achieve these goals, there is a need of a better collaboration between competent authorities, including governments, universities, dental associations and the various Pan-European Scientific Specialist Organizations.

Shaw D. Dentistry and the ethics of infection. Journal Of Medical Ethics 2008; 34(3): 184-7.
Currently, any dentist in the UK who is HIV-seropositive must stop treating patients. This is despite the fact that hepatitis B-infected dentists with a low viral load can continue to practise, and the fact that HIV is 100 times less infectious than hepatitis B. Dentists are obliged to treat HIV-positive patients, but are obliged not to treat any patients if they themselves are HIV-positive. Furthermore, prospective dental students are now screened for hepatitis B and C and HIV, and are not allowed to enrol on Bachelor of Dental Surgery degrees if they are infectious carriers of these diseases. This paper will argue that: (i) the current restriction on HIV-positive dentists is unethical, and unfair; (ii) dentists are more likely to contract HIV from patients than vice versa, and this is not reflected by the current system; (iii) the screening of dental students for HIV is also unethical; (iv) the fact that dentists can continue to practise despite hepatitis B infection, but infected prospective students are denied matriculation, is unethical; and (v) that the current Department of Health protocols, as well as being intrinsically unfair, have further unethical effects, such as the waste of valuable resources on 'lookback' exercises and the even more damaging loss of present and future dentists. Regulation in this area seems to have been driven by institutional fear of public fear of infection, rather than any scientific evidence or ethical reasoning.

Shaw D & Macpherson L & Conway D. Tackling Socially Determined Dental Inequalities: Ethical Aspects of Childsmile, the National Child Oral Health Demonstration Programme in Scotland. Bioethics 2009; 23(2): 131-139
Many ethical issues are posed by public health interventions. Although abstract theorizing about these issues can be useful, it is the application of ethical theory to real cases which will ultimately be of benefit in decision-making. To this end, this paper will analyse the ethical issues involved in Childsmile, a national oral health demonstration programme in Scotland that aims to improve the oral health of the nation's children and reduce dental inequalities through a combination of targeted and universal interventions. With Scotland's level of dental caries among the worst in Europe, Childsmile represents one of the largest programmes of work aimed at combating oral health inequalities in the U.K. The areas of ethical interest include several contrasting themes: reducing health inequalities and improving health; universal and targeted interventions; political values and evidence base; prevention and treatment; and underlying all of these, justice and utility.

Thomas MV, Jarboe G & Frazer RQ. Regulatory compliance in the dental office. Dental Clinics Of North America 2008 Jul; Vol. 52 (3), pp. 629-39
Dentists in the private sector, as well as their academic counterparts, must comply with a variety of federal, state, and local regulations. The scope of this regulation ranges from specifying who may engage in the practice of dentistry to the disposition of extracted teeth. In this review, some requirements imposed by various regulatory agencies are described. Because of the importance of state and local oversight, each clinician must determine what state and local requirements exist for them. A number of states have enacted various regulations that are more stringent than the federal versions. It is necessary, therefore, to seek appropriate local counsel regarding applicable statutes and regulations.

Trathen A & Gallagher JE. Dental professionalism: definitions and debate. Br Dent J. 2009 Mar 14;206(5):249-53.
Professionalism has been identified as a core component of revalidation by the General Dental Council. However, analysis and debate over what it means to be a professional dentist is lacking in modern dentistry in the United Kingdom. The aim of this article is to open a debate on concepts of professionalism within dentistry, drawing on established thoughts in medicine and more limited material from the dental domain. The scope of discussion will extend to include definitions of professionalism, ethical issues within professionalism, professionalism in relation to revalidation and where all of these issues relate to dentistry perceived as a business. We can learn much from the medical community who have been driven to consider 'medical professionalism in a changing world', and in support of 'better patient care'. However, we can also contribute to the wider debate on professionalism by tackling the business angle, which has been largely ignored by our medical counterparts, and adding greater weight to the ethical implications of being a professional.

Turner L. Cross-border dental care: 'dental tourism' and patient mobility. British Dental Journal 2008 Vol. 204 (10), pp. 553-4
Patient mobility is increasing. 'Dental tourism' is driven by numerous factors. These factors include the high cost of local care, delays in obtaining access to local dentists, competent care at many international clinics, inexpensive air travel, and the Internet's capacity to link 'customers' to 'sellers' of health-related services. Though dental tourism will benefit some patients, increased patient mobility comes with numerous risks. Lack of access to affordable and timely local care plays a significant role in prompting patients to cross borders and receive dental care outside their local communities.

Weaver K, Morse J & Mitcham C. Ethical sensitivity in professional practice: concept analysis. Journal Of Advanced Nursing 2008 Jun; Vol. 62 (5), pp. 607-18,
This paper is a report of a concept analysis of ethical sensitivity. BACKGROUND: Ethical sensitivity enables nurses and other professionals to respond morally to the suffering and vulnerability of those receiving professional care and services. Because of its significance to nursing and other professional practices, ethical sensitivity deserves more focused analysis. DATA SOURCES: A criteria-based method oriented toward pragmatic utility guided the analysis of 200 papers and books from the fields of nursing, medicine, psychology, dentistry, clinical ethics, theology, education, law, accounting or business, journalism, philosophy, political and social sciences and women's studies. This literature spanned 1970 to 2006 and was sorted by discipline and concept dimensions and examined for concept structure and use across various contexts. The analysis was completed in September 2007. FINDINGS: Ethical sensitivity in professional practice develops in contexts of uncertainty, client suffering and vulnerability, and through relationships characterized by receptivity, responsiveness and courage on the part of professionals. Essential attributes of ethical sensitivity are identified as moral perception, affectivity and dividing loyalties. Outcomes include integrity preserving decision-making, comfort and well-being, learning and professional transcendence. Our findings promote ethical sensitivity as a type of practical wisdom that pursues client comfort and professional satisfaction with care delivery. CONCLUSION: The analysis and resulting model offers an inclusive view of ethical sensitivity that addresses some of the limitations with prior conceptualizations.