A medico-legal review of some current UK guidelines in orthodontics: a personal view.
This article is a critical analysis from a medico-legal perspective of some current authoritative UK clinical guidelines in orthodontics. Two clinical guidelines have been produced by the Royal College of Surgeons of England and four by the British Orthodontic Society. Each guideline is published with the analysis immediately following it. Following recent UK case law (Bolitho v City & Hackney Health Authority, 1997) which allows the courts to choose between two bodies of responsible expert medical opinion where they feel one opinion is not 'logical', it is likely that the UK courts will increasingly turn to authoritative clinical guidelines to assist them in judging whether or not an appropriate standard of care has been achieved in medical negligence cases. It is thus important for clinicians to be aware of the recommendations of such guidelines, and if these are not followed the reasons should be discussed with the patient and recorded in the clinical case notes. This article attempts to highlight aspects of the guidelines that have medico-legal implications. (+info)
Professional and community efforts to prevent morbidity and mortality from oral cancer.
BACKGROUND: Oral and pharyngeal cancers cause significant morbidity and mortality, yet there has been little improvement in survival rates in the past 30 years. Because early diagnoses significantly increase survival rates, the authors summarize several approaches to educating and mobilizing the dental profession and the public about this problem. Clinicians are invited to initiate similar programs to catalyze change in their own communities. METHODS: The authors found that many approaches have been used to define the problem and initiate change. These include surveys, focus groups, development of consortia, media programs, flyers, leaflets, prescription pads, legislation and professional endorsements. RESULTS: In Maryland in 1996, only 20 percent of adults reported receiving an oral cancer examination, and most oral cancers were diagnosed at late stages by physicians, not dentists. Results of the public educational campaigns in the regions of New York/New Jersey and Maryland have not been formally evaluated, but there is a developing consensus that oral cancer diagnostic practices in the regions with active educational programs are increasing. CONCLUSIONS: Coalitions or partnerships among individuals and organizations from government, academia, private practice, industry, the general community and the media can affect awareness about oral cancer prevention and early detection on a regional basis. CLINICAL IMPLICATIONS: By increasing awareness of oral cancer among the dental profession and the public, earlier diagnosis of these cancers with consequent improved cure rates is likely. Providing oral cancer diagnostic services as a routine part of an oral examination also may motivate patients to visit the dentist at least once a year. (+info)
Ethics; 'In consideration of the love he bears.' Apprenticeship in the nineteenth century, and the development of professional ethics in dentistry. Part 2. Hippocrates' long shadow.
This two part paper takes a look at the ancient institution of apprenticeship. As stated in the introduction to the first part,(1) it regards the conventions of the scheme as having had a positive influence on the morality, legal identity, and professional allegiance of dentists during the ethical development of their profession in the nineteenth century. The first paper looked at the particular application of apprenticeship through the evidence of indentures in the BDA museum. This second paper enlarges on the view that the wider social institution of apprenticeship was at least in part responsible for the development of the ethics of the dental profession. (+info)
TRICARE; changes included in the National Defense Authorization Act for fiscal year 2005; TRICARE Dental Program. Interim final rule.
The Department is publishing this interim final rule to implement sections 711 and 715 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA-05), Public Law 108-375. Specifically, that legislation makes young dependents of deceased Service members eligible for enrollment in the TRICARE Dental Program when the child was not previously enrolled because of age, and authorizes post-graduate dental residents in a dental treatment facility of the uniformed services under a graduate dental education program accredited by the American Dental Association to provide dental treatment to dependents who are 12 years of age or younger and who are covered by a dental plan established under 10 U.S.C. 1076a. This rule also corrects certain references in 32 CFR 199.13. The rule is being published as an interim final rule with comment period in order to comply with statutory effective dates. Public comments are invited and will be considered for possible revisions to the final rule. (+info)
Esthetics and implantology: medico-legal aspects.
In recent years the high number of malpractice lawsuits in dentistry has attracted closer attention of dental practitioners to its medico-legal aspects. Implantology, in particular, presents many points of medico-legal concern connected with the difficulties inherent to dental procedures and objectives (both functional and esthetic), as well as full patient collaboration as an essential part of successful treatment. An accurate assessment of each case by the clinician is fundamental, especially in circumstances where esthetic considerations are preponderant as, for instance, in the frontal sectors. In such cases, the options of implantology or of a traditional fixed prosthesis need to be carefully weighed in light of the patient's anatomic condition. The patient should therefore receive complete information and be made fully aware of the risk of treatment failure, as well as possible complications, limits to the procedures, and the fact that successful outcome will also depend on her/his scrupulous observance of the practitioner's instructions. In short, the aim is to make the patient an active ''accomplice'' in treatment. To this end, the use of an extremely detailed information leaflet is strongly advised; after careful clarification of any doubts the patient may have, the patient's written informed consent should be obtained. Nevertheless, there is the risk that excessive intrusion of bureaucracy into medical procedures in defence of the practitioner against malpractice suits may hinder the principal aim of traditional medicine, i.e. to provide the best care for the patient through mutual trust fostered within the doctor-patient relationship. (+info)
Economic impact of regulating the use of amalgam restorations.
OBJECTIVE: This article estimates the financial impact of a ban on amalgam restorations for selected population groups: the entire population, children, and children and women of childbearing age. METHODS: Using claim and enrollment data from Delta Dental of Michigan, Ohio, and Indiana and the American Dental Association Survey of Dental Services Rendered, we estimated the per capita use and annual rate of change in amalgam restorations for each age, gender, and socioeconomic subgroup. We used population projections to obtain national estimates of amalgam use, and the dental component of the Consumer Price Index to estimate the annual rate of change in fees. We then calculated the number of dental amalgams affected by the regulation, and the fees for each of the years 2005 to 2020. RESULTS: If amalgam restorations are banned for the entire population, the average price of restorations before 2005 and after the ban would increase $52 from $278 to $330, and total expenditures for restorations would increase from $46.2 billion to $49.7 billion. As the price of restorations increases, there would be 15,444,021 fewer restorations inserted per year. The estimated first-year impact of banning dental amalgams in the entire population is an increase in expenditures of $8.2 billion. CONCLUSIONS: An amalgam ban would have a substantial short- and long-term impact on increasing expenditures for dental care, decreasing utilization, and increasing untreated disease. Based on the available evidence, we believe that state legislatures should seriously consider these effects when contemplating possible restrictions on the use of amalgam restorations. (+info)
Dental devices: classification of dental amalgam, reclassification of dental mercury, designation of special controls for dental amalgam, mercury, and amalgam alloy. Final rule.
The Food and Drug Administration (FDA) is issuing a final rule classifying dental amalgam into class II, reclassifying dental mercury from class I to class II, and designating a special control to support the class II classifications of these two devices, as well as the current class II classification of amalgam alloy. The three devices are now classified in a single regulation. The special control for the devices is a guidance document entitled, "Class II Special Controls Guidance Document: Dental Amalgam, Mercury, and Amalgam Alloy." This action is being taken to establish sufficient regulatory controls to provide reasonable assurance of the safety and effectiveness of these devices. Elsewhere in this issue of the Federal Register, FDA is announcing the availability of the guidance document that will serve as the special control for the devices. (+info)
Leadership development in dental education: report on the ADEA Leadership Institute, 2000-08.
This report describes participants' assessment of their experiences in the American Dental Education Association (ADEA) Leadership Institute program. The ADEA Leadership Institute is designed for mid-career faculty members who desire to attain administrative roles within their own or other institutions or enhance their effectiveness in these roles. This year-long program, conducted in four phases, is ADEA's flagship career enhancement program and provides dental educators with perspectives about oral health policy and legislation, organization and financing of higher education, the dental school's role within the parent institution, financial management, legal issues, recruiting faculty, and opportunities to acquire and practice skills associated with effective leadership. ADEA Leadership Institute Fellows also explore team-building, personality preferences, leadership styles, emotional intelligence, stress management, work-life balance, strategies for leading change, and giving and receiving feedback, as well as engaging in self- and peer assessment throughout the year. Each year up to twenty-one fellows are selected to participate in the institute in a competitive application process. In 2009, 149 fellows who participated in the institute from 2000 to 2008 were invited to take part in a survey to establish their profiles and academic leadership roles, determine their perceptions of the benefits from the institute curriculum, and elicit their suggestions for improvement. The survey response rate was 73 percent (n=109). Ninety-nine percent of respondents gave an overall positive assessment of their experiences. The most beneficial experiences, according to respondents, included networking with the program participants, advisors, and instructors (78 percent); self-discovery through self-assessments and evaluations (44 percent); and a 360 degree feedback process to provide additional reflection about areas for improvement (17 percent). Least beneficial experiences identified by survey respondents included sessions devoted to oral health legislation (33 percent), group projects (28 percent), and mentorship received during the institute year (12 percent). In the final part of the survey, participants provided suggestions for improvements and new areas for program planners to consider. Additions to the current curriculum (30 percent)-such as how to recruit and retain faculty-and advanced leadership training (15 percent)-including behavioral change theory-topped the improvement list. The results of this study indicate that the ADEA Leadership Institute is fulfilling its mission. Fellows are advancing in their careers and assuming administrative leadership roles within their home institutions while making scholarly contributions to the literature and undertaking leadership positions in ADEA. (+info)