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THE NEXTDDS Student Ambassador Blogs


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      As dental students, we are constantly faced with hypotheticals, conjectural paradigms of clinical corruption, and solutions to navigate such trying situations. While countless classes are dedicated to core sciences such as biochemistry, one class in particular stood out to me among the rest. A course I took about ethics in the dental practice served as a guide to help students circumvent unethical situations and prevent unethical behavior in the future, while emphasizing the importance of prioritizing patient needs.

One major issue plaguing the world of dentistry is the inappropriate prescription of dental care. This practice has become increasingly rampant as practitioners abuse their patients’ trust for their own financial gain, offering more expensive or unnecessary treatment plans to patients who lack the ability to discern between their options. This violates the ethical principle of justice, which states that practitioners must be fair to patients.  


When evaluating a patient, practitioners must make a clear distinction between elective and necessary dental treatment. Patients will be able to make an informed decision once all treatment options are presented along with the corresponding risks and benefits of each plan. In an educational setting, it is simpler to negate financial biases, but the daunting list of clinical requirements threatens to provoke unethical behaviors as students prepare to graduate. As a result, students begin learning about justice and veracity in the beginning of their dental education, and are taught to truthfully explain why the prescribed treatments are necessary, along with the corresponding risks and benefits. 


The harsh reality is that overtreatment is a huge disservice to patients, as enamel cannot be replaced. Over time, teeth become increasingly more susceptible to bacterial byproduct attacks and casualties from traumatic events, causing patients to require more dental treatment. When dentists overtreat, they compromise tooth structure that could otherwise have continued to serve as a masticatory device which distributes occlusal forces, withstands erosive dietary acid attacks, and maintains the patient’s vertical dimension.


Sometimes overtreatment may result from a lack of dental IQ when patients opt for one treatment over another. Some patients request specific treatments that they may not necessarily need and are unaware of the harm that these treatments may cause. For example, a dentist may offer bleaching or cosmetic veneers instead of esthetic crowns requested by the patient. At times, patients may turn down conservative treatment plans due to cost or expectations, and instead opt for a more aggressive treatment that accomplishes the same result. However, it is the provider’s duty to inform patients of suitable alternatives as an expert in the field and refuse to supply treatments that are not in the best interest of the patient.  


This is a core value termed nonmaleficence, which promotes the patient’s well-being through the “do no harm” principle. Dentists must practice ethically and provide patients with the best care and protect all patients from harm. Allowing patients to choose between alternative treatment plans and selecting a plan that they prefer is known as autonomy, or self-governance. Patients should also have the option to elect to have no dental treatment, and have the risks and benefits of refusing treatment explained accordingly.  


In addition, pain may play an influential role in patient preference as well. For example, if a patient feels pain, he or she may feel a sense of urgency to remove the tooth instead of treating and possibly saving it with a restoration. More aggressive treatment plans may be called for after extractions, as practitioners offer ways to replace the missing dentition and occlusion begins to change. During this process, teeth may drift or fracture due to changes in occlusion, calling for even more extensive treatments as the remaining dentition is accommodates for any changes. Overtreatment causes an array of supplementary issues, which is why it is always best to devise a conservative treatment plan, monitor small lesions, and prioritize pain so the patient’s needs are taken care of. This principle is known as beneficence, or the “do good” principle.  


Not all overtreatment is intentional. For example, some practitioners may not be up to date on newer practices, such as laser technology or microsurgery, which provide minimally invasive treatment modalities as in contrast to outdated protocols. This exemplifies the importance of staying current and learning about the constantly evolving field of dentistry. Research and new technology coalesce to create new advances and materials in the field, which serve to improve patient care.  


Instead of overtreating through elaborate treatment plans, practitioners should hold off on treatment that is not necessary, and instead inform the patient of any questionable lesions so they can be monitored. To combat overtreatment, providers can recommend more frequent patient visits in order to monitor smaller lesions, and provide conservative treatment plans, the “best-case scenario,” and explain to the patient that more extensive treatment may be necessary in the future. Any dentist who proposes unnecessary treatment is engaging in unethical conduct, and may be causing serious harm to the patient. 

The Impact of Dental Mission Trips Home and Abroad

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By Emma Guzman, DDS

I have always had a passion for going overseas and providing dental services to those in need. During my undergraduate studies, I went to Mexico on a dental mission and, while in dental school, participated in a mission to the Dominican Republic and Jamaica. Each experience was very different, but they all were extremely memorable and enriching. I think this passion stems from being a first-generation American and knowing the lack of dental literacy and access to care in other countries.


On all three trips, dentists, residents, students, and volunteers provided free dental care. We went to small towns and dental clinics in the local schools. We brought our own equipment and used local supplies provided to us as well. Most of the treatment performed were extractions. Our main goal was to get the patients out of pain and remove diseased teeth from their mouths. We also treated children, performed fillings, and were able to do some esthetic cases. I played a different role on each trip, which gave me different perspectives on mission trips. On the Mexico trip, I supported staff, triaged patients, assisted the providers, sterilized instruments, and translated (since I speak Spanish).

On the trip to the Dominican Republic, I served as a provider. This was only a few months after starting clinical experiences, so I was certainly nervous about providing treatment. When we walked into the clinic at the local elementary school and saw the number of patients waiting to be seen, I understood the impact that being there would make. In Jamaica, I took part in organizing the clinic, choosing supplies, providing education and, of course, treatment. By this trip, I was more confident and efficient and was able to treat more patients.

These experiences were the most memorable aspects of dental school because these patients were truly in need, having no access to dental care. They were very appreciative and it was a blessing to be able to help them. The biggest impact these trips had on me is in how I look at myself as a provider. I believe I came out of every trip better than I was before. I had to think on my feet and work in environments that were not ideal. For example, we had to work in 90-degree rooms with two fans for eight students or working on four-foot chairs when you are almost six feet tall! It takes a toll on your back (not to mention the sweating!) but every moment was worth it.


Nothing compares to how you feel after giving relief to someone who has been in pain for months or fixing a chipped tooth that prevented a patient from smiling. I absolutely recommend participating in dental mission trips. Don’t forget, in the United States there are parts of the country that have very little access to dental care and need our services. Do your part!