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.