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THE ETHICS OF DENTAL OVERTREATMENT ON PATIENT CARE

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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.