American Dental Association Principles Research Articles

What should I do when a patient just wants antibiotics?

What should I do when a patient just wants antibiotics?

You want me to do what?

You want me to do what?

Ethical obligations when concerned about the work of another dentist

Q I received a call from a dentist who has a highly educated patient who gets “routine cleanings” at his office and gets any necessary treatment from another dentist, Dr. X, who calls himself a “holistic dentist.” Dr. X recommended to the patient that she have 2 mandibular anterior teeth, previously treated endodontically, extracted. The teeth were completely asymptomatic and “within normal limits.” Dr. X told the patient that endodontically treated teeth are a nidus of infection because they contain a foreign body, referring to the endodontic filling material. The patient had the teeth removed and is planning further prosthetic replacement. The questioning dentist was a former member of his state dental board. He recognized Dr. X’s name; Dr. X had been investigated in the past and received a censure for doing the same “treatment” as stated above. What are the ethical obligations of the questioning dentist?

Googling a patient

Googling a patient

Calling yourself a specialist: Things to consider

Calling yourself a specialist: Things to consider

Justifiable criticism and dental amalgam

Justifiable criticism and dental amalgam

Dealing with patient requests to provide only treatment covered by insurance.

Dealing with patient requests to provide only treatment covered by insurance.

Suggesting a health services credit card to patients

Q A woman came to my offi ce recently for an emergency examination. She had an unrestorable tooth, and I recommended an extraction. She was eager to have the tooth removed, and soon aft er I completed the procedure she returned for a comprehensive examination. She had neglected her teeth for years and now was in need of extensive treatment. I provided several options to treat her missing teeth, one of which was placement of several implants, abutments and crowns. I also suggested the lessexpensive treatment alternative of partial dentures. Th e patient liked the idea of having “permanent” restorations, but when presented with the cost, she indicated that she was unable to pay the fee. I know that she would like to receive this comprehensive treatment, so I recommended a health services credit card to her. Th e card off ers patients a no-interest plan, but I know that many patients do not pay the balance on time and, thus, are subject to an extremely high interest rate that is applied from the fi rst day. I did not point out those specifi c terms, just the no-interest plan. Because she is the one signing up for the plan, do I have an obligation to make her aware of the penalties for delayed payment? Is it suffi cient to tell her to read the agreement thoroughly? A raise an important concern that, given the current economy, likely will arise more frequently. Th e American Dental Association Principles of Ethics and Code of Professional Conduct1 (ADA Code) provides some useful guidance in resolving your questions. Section 5, Veracity (“truthfulness”), is particularly relevant to the issues you raise. Th is Principle recognizes that “[t]he dentist has a duty to communicate truthfully.”1

Providing care in temporary volunteer dental clinics and programs

Q state and many others hold oneor twoday volunteer dental programs. Many of these programs are called “Mission of Mercy.” The American Dental Association also sponsors “Give Kids A Smile Day.” These events often amount to temporary dental clinics. After reading recently about possible hepatitis B virus transmission at one of these clinics, I wonder what the ethical implications of these events and clinics might be.

What Are Dentists' Ethical Obligations Regarding the Provision of Emergency Care When They Are Not Available to Provide That Care?

What Are Dentists' Ethical Obligations Regarding the Provision of Emergency Care When They Are Not Available to Provide That Care?

Do your patients know the alternatives for their oral care?

The recession has placed considerable financial stress on most Americans. The implications for oral preventive care and needed treatment have been significant and obvious. It is my observation as I have spoken with many practitioners in the country that many still are feeling the effects of the recession. Most dentists have seen a significant reduction in clinical activity in their practices and much more reluctance on the part of patients to accept elective dentistry. However, in my opinion, when the various alternatives for treatment are explained to patients, they make quite logical choices for their treatment, in spite of their caution in spending money at this time. In this column, I explain my own beliefs and clinical behavior relative to providing adequate education for patients, which allows them to make informed choices about both elective and mandatory procedures. CONDUCTING PATIENT EDUCATION The patient education procedure easily can be delegated to staff members who are familiar with the practice’s philosophy, the procedures that are performed routinely in the practice and the availability of specialty care in the community. Although this is a delegable task, the practitioner must remember that, ultimately, the treating dentist remains legally responsible to ensure the patient is given sufficient information to make an educated decision and to obtain the patient’s informed consent. The information must be understandable, and the patient must have the opportunity to consult with others as desired and to have his or her questions answered by the treating dentist. The most logical people to whom patient education should be delegated are dental hygienists. Usually, they have a significant amount of time to talk to patients during the initial diagnostic appointment and subsequent preventive appointments. In-depth education of patients about their oral condition and treatment needs can be accomplished effectively during these times. Dental assistants and front-desk personnel also are capable of sharing in patient education tasks. Educating patients regarding treatment choices is required under state laws as part of obtaining informed consent. In addition, the ethical principle of patient autonomy found in the American Dental Association (ADA) Principles of Ethics and Code of Professional Conduct requires that treatment options be communicated to the patient so that he or she can provide informed consent. The fact that it can work as a marketing tool is an additional benefit. Regardless of who provides the education, the following concepts usually provide adequate information, allowing patients to comfortably take part in treatment planning decisions and to feel confident that they are accepting the correct care. Do your patients know the alternatives for their oral care?

WHAT IS THE ETHICAL COURSE OF ACTION FOR A DENTIST WHOSE PATIENT'S PREVIOUS DENTIST MAY HAVE TREATED THE WRONG TOOTH?

WHAT IS THE ETHICAL COURSE OF ACTION FOR A DENTIST WHOSE PATIENT'S PREVIOUS DENTIST MAY HAVE TREATED THE WRONG TOOTH?

What Are the Ethical Obligations of a Dentist Who Suspects That His or Her Partner May Be Impaired by an Addiction to Pain Medication?

What Are the Ethical Obligations of a Dentist Who Suspects That His or Her Partner May Be Impaired by an Addiction to Pain Medication?

ARE DENTISTS LOSING THEIR STATUS AS ‘PROFESSIONALS'?

ARE DENTISTS LOSING THEIR STATUS AS ‘PROFESSIONALS'?

What is My Ethical Responsibility When my Employer Authorizes Treatments that I Believe are Unnecessary?

What is My Ethical Responsibility When my Employer Authorizes Treatments that I Believe are Unnecessary?

How Do I Deal With What I Perceive to Be Overtreatment by Another Dentist When His or Her Patients Come to Me to Discuss Their Proposed Treatment Plans?

How Do I Deal With What I Perceive to Be Overtreatment by Another Dentist When His or Her Patients Come to Me to Discuss Their Proposed Treatment Plans?

Are There Ethical Considerations to Keep in Mind As a Dentist Approaches Retirement?

Are There Ethical Considerations to Keep in Mind As a Dentist Approaches Retirement?

Is It Ethical for a Specialist to Demonstrate Surgical Techniques to a General Dentist Untrained in the Procedure So That the Dentist Can Perform These Procedures on His or Her Own?

Is It Ethical for a Specialist to Demonstrate Surgical Techniques to a General Dentist Untrained in the Procedure So That the Dentist Can Perform These Procedures on His or Her Own?

SHOULD A LOCAL PEER-REVIEW COMMITTEE TAKE A CASE THAT INVOLVES A NONMEMBER OF THE AMERICAN DENTAL ASSOCIATION?

QI am chair of a component dental society's peer-review committee. All of our patients' complaints are sent through the constituent society's office, which coordinates the process. Recently, a patient complained about treatment by a local dentist. I was informed by the state office that the dentist was not a member of the American Dental Association (ADA). Some members of our peer-review committee feel that we should not take the case when a non-ADA member is involved. Is it unethical for our committee to refuse to work with the dentist and patient to help resolve the complaint?

How Can I Ethically Handle Referrals to a Specialist Against Whom There Are Allegations of Unethical Behavior?

Q As a general dentist in a small community, there are a limited number of specialists to whom I can refer patients. I am aware, through a number of sources I believe to be credible, that a particular specialist allegedly is engaged in unethical treatment of female patients. This same dentist recently was disciplined by the professional licensing board for previous related, although not identical, inappropriate conduct. Neither the state board nor society peer review and ethics committees have yet taken any action related to these new allegations. Until these bodies act on these new allegations, I am uncomfortable in referring patients to this specialist. The only other option for this specialty care involves patients' traveling between 40 and 80 miles. Is it ethical for me not to refer patients to this particular practitioner, and how do I respond if patients ask why I am referring them to a specialist so far away rather than the specialist in our town?