Explain the Over-Treatment Ethical Dilemma in Dentistry.

Paper instructions:

Over-treatment is increasingly recognized as one of the most common ethical dilemmas in the dental field that needs to be addressed [6]. It is defined as getting a patient through some medical or dental procedures when there is practically no proof that such a treatment will improves the patient’s wellbeing result [2]. The application of pointless, excessive, inefficient operations or medications can increase patient’s satisfaction with the provided healthcare services. Moreover, this issue has not been examined adequately in the literature of dentistry. Numerous dental specialists keep working with an aggressive therapeutic approaches that may bring up to a pointless treatment should now be viewed as improper. Without focusing, here, on the ethics of cosmetics as primarily falling under a medical need or a consumer want [16], most experienced dentists may agree that the less that is done to the teeth for cosmetic reasons, the lesser are the risks of dissatisfaction, disappointment, or threat of litigation [11]. The moral parts of over-treatment in dentistry suggest another significant side of the issue. Close to the clinical studies concerning pointless treatment, there is extra moral worry about accomplishing more-than-what-is-required. For instance, in an investigation, specialists detailed over-treatment as a moral difficulty they encountered in choosing the correct treatment in various circumstances. The main focus of this study is to broaden knowledge of the dilemma of over-treatment and ethical values in dentistry. 

Objective: 

This research expands understanding of over-treatment dilemma and ethical principles in dentistry.

Material and methods:

A computerized database search was used to collect publications related to over-treatment using PubMed and Google Scholar search engines and Saudi Digital Library (SDL) database provided by Princess Nourah University. The search was performed using a variety of keywords such as “over-treatment”, “unnecessary treatment”, and “ethics in dental treatment”. Search limits were restricted to articles published from 2015 until 2020. However, due to the lack of adequate number of relevant publications,  the time limit was expanded to the period from 2008 until 2020. The inclusion criteria were: articles written in English language, availability of full text, and the time-period limit.

Discussion:

Currently, many concepts on dental practice have been dramatically changed [10]. Additionally, due to the massive spread of media and it’s enormous influence on communities and patient interests. Nevertheless, this expansion implants several misconceptions among populations . Accordingly, numerous dentists can provide an over treatment despite the fact that is poor effectiveness or unnecessary procedure in order to not dishearten the patients and transform them into frustrated consumers [2]. Consequently, the dental practitioners should distinguish between the patient’s autonomy and what can ethically unacceptable. In addition, understanding the patients’ requirements is essential to strengthening doctor-patient relationships. However, according to ethical considerations in over treatment providing an unrealistic or destructive treatment to achieve patients desire, it’s considered completely unethical [10]. Dentist part of duty is explaining, discussing and analyzing samples for studies or other diagnostic procedures to clear the realistic therapy frameworks [10]. Moreover, one of the major components of any procedure in dentistry is confirmed that the benefit and value that the patients will receive is always greater than the potential  risks and  harms that might occur with  the  proposed treatment [4]. Therefore, the benefit of the patients including their satisfaction and desires is reasonable with successful predictable outcome of function, long-term stability and quality of life [4]. Furthermore, over treatment might be also as consequent to insufficient acknowledgement about unnecessary treatment among dental practitioners [5]. According to a study done by Kazemian in Switzerland, the study was aimed to assess the meaning of nonessential treatment from ethical point of view and the study results has been demonstrated that a part of participated dentists confessed that some colleagues’ action might  in response to condition that terminate in planning over-treatment [5]. In another study about clinical decision making that was done by Zadik Y and Levin L. , the undergraduate education failure has been reflected in the form of over treatment among beginners’ dentists[11]. In which the young practitioners routinely resort to undertaking surgical caries treatment rather managing  the carious lesions according to the patient’s clinical presentation and caries risk assessment[11]. Moreover, many dental practitioners’ shortcomings in understanding or familiarity of ADA/FDA Guide to Patient Selection for Dental Radiographic Examinations lead to over diagnosis. On the other hand, numerous patients believe that over diagnosis is evidence of professional dentists and better dental care [1]. Nevertheless , according to Baelum V.‘s paper a minor dependence on radiographs without utilizing a clinical visual-tactile procedure for caries lesion detection, in this instance, might lead to considerable over diagnosis or over-treatment [1]. However, there is a lack of current available studies about the ethical dilemma of over-treatment in Dentistry . Ethical dilemma of over-treatment might still be a matter of concern in the profession of dentistry. Therefore, the findings revealed the importance of ethical principles ,in which teaching ethics as a curriculum should be established, and enhance ethical awareness among health providers. 

Results: 

Twenty articles were initially found and then filtered according to the exclusion and inclusion criteria. Twelve articles were selected due to their relevancy to our aim. As a health care provider, over-treatment must follow ethical principles according to the code of ethical dentistry (CED) and World Dental Federation (FDI) regulations. On the other hand, numerous patients believe that over-treatment is an act of professional dentists and indicate providing better dental care. The dentists part of duty is explaining, discussing and analyzing samples for studies or other diagnostic procedures to clear the realistic treatment plan.

Conclusion:

The findings of this research reveals that the awareness of ethical principles, particularly about over-treatment is important. This emphasizes the significance of incoprating ethics in dental education curricula and enhancing ethical awareness among patients. Moreover, decisions on patients’ treatment must be based, foremost and first, on their health needs, while respecting their desire.

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