Fcd Ethical and Legal Issues

7/30/2019 Fcd Ethical and Legal Issues

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IDNT3361/3362 FCD IIIEthical and Legal Issues Assignment

Scenario III

Group MembersYousr Kanbour

Yusef Khadembashi

Ilana Kohan

Xinyi Lai

Ealin Lee

Penelope Lindsay Rueda

Nicholas Liyanage (20777258)

Vernice Lo

Chee Kian Loy
https://www.facebook.com/yousr.kanbourhttps://www.facebook.com/yousr.kanbourhttps://www.facebook.com/youkay24https://www.facebook.com/youkay24https://www.facebook.com/ilana.kohanhttps://www.facebook.com/ilana.kohanhttps://www.facebook.com/xinyi.lai.311https://www.facebook.com/xinyi.lai.311https://www.facebook.com/ealin.leehttps://www.facebook.com/ealin.leehttps://www.facebook.com/penny.lindsayhttps://www.facebook.com/penny.lindsayhttps://www.facebook.com/nicholas.liyanage.12https://www.facebook.com/vernice.lohttps://www.facebook.com/vernice.lohttps://www.facebook.com/cheekian.loy.5https://www.facebook.com/cheekian.loy.5https://www.facebook.com/cheekian.loy.5https://www.facebook.com/vernice.lohttps://www.facebook.com/nicholas.liyanage.12https://www.facebook.com/penny.lindsayhttps://www.facebook.com/ealin.leehttps://www.facebook.com/xinyi.lai.311https://www.facebook.com/ilana.kohanhttps://www.facebook.com/youkay24https://www.facebook.com/yousr.kanbour


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In a time where litigation rules our dental practices, it is important to obtain informedconsent from a well advised patient. Similarly, it is important for a dentist to only performtreatment that is consistent with their own ability and that they feel is adequate for thepatients treatment needs and expectations. With a wide access to information, patientshave increasingly become aware of treatment types and have expectations of treatment

outcomes. In some cases these expectations are unrealistic and as a dentist it isimportant to ensure that we provide our patients with the relevant information required tomake a balanced clinical judgement about the types, cost, timeframe, implications andconsequences of treatment, this protects not only the dentist, but also benefits thepatients in the long run. In this scenario, the 22 year old patient has demanded crowntreatment, which

WHAT FACTORS ARE INVOLVED

Treatment options for the aesthetic restoration of anterior teeth can range from minimallyinvasive procedures to procedures which involve the extensive removal of tooth

structure. To decide which treatment that will produce the most optimum outcome forthis patient, it is important to consider her age, the state of her existing dentition, thecause of the staining, her caries risk level, her financial limitations, patient education andthe dentists skill and willingness to perform the procedure.

Age is an important factor to consider - having extensive restorations placed at a youngage would mean a lifetime of replacing these restorations, with each replacementremoving more tooth structure.

It is crucial to examine the state of the existing dentition before deciding what treatmentto undertake. Doing extensive restorations on perfectly intact teeth is over treating and

unnecessary and alternative options should be considered.

The cause of the staining should be investigated - often staining is caused by smokingor diet, and these extrinsic stains can be removed and prevented in the future.The patients caries risk is highly influential in deciding treatment - assessment of theirdiet and oral hygiene is a necessity. A patient with little motivation to maintain oralhygiene will have their caries and periodontal disease risk elevated by the placement ofcrowns.

Although the patient has stated that cost is not an issue, it is not clear whether thepatient has been made known that she may require endodontic or periodontic treatment

before her restorative treatment commences. Furthermore there is likely to be expensiveongoing cost such a replacement of the crowns after a number of years, or futureendodontic and periodontal problems.

The patient needs to be made fully understood that crowns are not a conservativeoption, there is no way of restoring the tooth structure that will be need to be removedfor the crowns and that by having this treatment they will be predisposing themselves toother dental conditions for life. The patient needs to also be educated about other moreconservative options before commencement of treatment. It is highly unlikely that thepatient is aware that they can achieve a very similar aesthetic result with a much moreconservative option such a composite restoration or a veneer, even bleaching.

REFERENCES : case selection and overtreatment=


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OPTIONS YOU WOULD CONSIDER

The patient needs to be educated on what other treatment options are available to her,and should be encouraged to pursue a less invasive treatment option. Bleaching could

be a treatment that has the potential to lead to a satisfactory aesthetic result. As theteeth are currently minimally restored, bleaching is appropriate as the contour andocclusion of the teeth will not be altered, and minimal risks exist as a result of treatment.If the outcome of bleaching is not desirable, more invasive options could be considered.Porcelain veneers, whilst more invasive than bleaching, can result in greatly enhancedaesthetics. These could be considered as a treatment option if bleaching isunsuccessful, or if contraindications exist to bleaching. The use of composite to build upthe teeth is possible, but has limited aesthetic value if the staining is extensive, andtherefore the patients presenting complaint has not been fully addressed. Compositewould have to be very thick to give an aesthetic outcome, and this would result inchanges in the contour and occlusion of the teeth that would most likely be

unacceptable.

Crowning of all the maxillary teeth is the option that the patient desires, and this needsto be considered as a potential treatment. However, as the indications for treatment arepurely aesthetic and the patient is young, crowning of the teeth should really bediscouraged. Crowns need regular maintenance, and are unlikely to last for the lifetimeof the patient, necessitating the need for more tooth preparation and loss of toothstructure. However, crowns, whether full ceramic crowns or PFM crowns, can lead to ahighly aesthetic outcome for the patient. If the patient (after being educated on heroptions) still is insistent on crowns, a compromise could be made to only crown the teeththat are visible on smiling.

No treatment is also an option that needs to be presented, because the patient is in nopain and has no dental disease. The patient needs to be aware that the treatment she isrequesting is purely aesthetic, but it will have lifelong biological effects.

LEGAL AND MORAL/ETHICAL PRINCIPLES

In this case the dentists actions are governed by a series of moral and ethical principlesoutlined by both of the major Australian Dental Associations. A dental practitioner has agreater level of knowledge in the field when compared to the patient and thus has an

ethical and legal responsibility to assist the patient in making a well-informed decisionabout any potential treatment. The dentist must always provide information regarding therisks, cost and consequences of the treatment they wish to undertake. This is particularlyso in cases of cosmetic importance. In the case of the decision to treat generalisedstaining with multiple full coverage PFM crowns, the patient should be informed aboutthe estimated cost, number of appointments required and problems associated withmultiple crowned teeth such as a requirement for more stringent oral hygiene habits. Thepatient should also be advised of other possible treatment options and what makes themmore or less favourable. Effort should be made to provide as much information as isappropriate and relevant.

The dentist should always strive to ensure conservation of natural tooth structure toensure the best possible prognosis for the remainder of the tooth structure. This is a very


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important principle in this case. However it is most critical that the patients freedom ofchoice is respected and that if they have been given the proper facts they can maketheir own informed decision to receive the treatment they desire. In this scenario if the

patient is determined to have all teeth crowned, the dentist must express any concernsregarding this treatment option including the unsuitability of the treatment, and if

applicable, inform the patient of your level of experience and expertise as anundergraduate dentist. Medico-legal issues must be considered prior to thecommencement of any dental treatment. To best avoid litigation, when the treatmentplan has been confirmed the dentist must obtain written consent from the patient. It isalso advisable to ensure meticulous record-keeping as proof of all discussions held withthe patient.

ADVICE

Her case does not indicate for a crown and bridge treatment in terms of invasiveness

of treatment Compare indications of treatment available for tooth discoloration. These include

bleaching, porcelain laminate veneers. For bleaching, it is indicated for minimallyinvasive treatment, whilst for laminate veneers it is indicated when greater aestheticcontrol is desired.

Compare advantages, disadvantages, implications and consequence of the differentoptions available.

o In terms of invasiveness, bleaching is the least, followed by laminateveneers and then by crowns. Moreover, with any tooth structure removal,these procedures are irreversible and destructive. And the moredestructive the procedure the more care and thought should be given long

term prognosis of the treatment.o In particularly, although every treatment will require maintenance, crown

needs a greater degree of maintenance. Given her young age, suchdestructive option undertaken would eventually have implication on longterm oral health maintenance. Therefore, made known other options areavailable, which are less invasive in nature.

o Bleaching is not without its risk, compared to laminate veneers, it haslimited aesthetic improvement and it has gingival recession risk.

o For porcelain laminate veneers, they require resin bonding, despite beingcheaper than crowns it still has desirable aesthetic improvement andclinically proven longevity.

After providing relevant information, allow patient to make a decision based on freewill, eventually the treatment option picked up is dependent on patientchoice/demand, which at the same time means the patient has to be responsible forher teeth and the treatment she chooses. Upon which if you as a dentist do not feelcomfortable, the patient can be referred. Whilst informing patient of your reason ofdoing so.

Dietary advice - parafunctional habits too. If they want teeth they are happy with,they have to do the right things to look after them


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ACTIONS

It is of the utmost importance that the patient is thoroughly informed about all of their

treatment options and the route of action that the clinician intends to take. In this

scenario, the destructive disadvantages involved with such largely invasive treatmentsignificantly outweigh any benefits perceived by the patient. It is the responsibility of the

clinician to explain why placing crowns on many healthy teeth is not an appropriate

treatment. They must also ensure that they supply the patient with informative literature

about the alternative treatment options available to them as well as answering any

additional questions the patient may have. The motivations behind the requested

treatment are also an aspect that should be considered in the discussion of the available

treatment options. Understanding the purpose behind the desired treatment may allow

the clinician to assist the patient in making an informed decision.

Regardless of which treatment the patient and clinician decide to undertake, treatment ofthe cause of the staining is of primary importance and must be undertaken. If, even after

extensive discussion about the unsuitability of the proposed treatment, the patient

decides that she still wants crowns on all her teeth and the clinician does not feel that

they have the required skills necessary to carry out the treatment, the patient should be

referred to another clinician. If the clinician agrees to go ahead with the proposed

treatment, they must ensure that the patient provides the necessary informed consent

paperwork as well as keeping detailed records which will be needed in the event of

future litigation or grievances.


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References

Documents

Fcd Ethical and Legal Issues