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- Dentist
I think that every single decision you make could be an ethical dilemma. Examples:
1. You see dark looking material in a groove on a tooth, you think you should restore with a filling, but research says you can simply place a sealant over it and it should work. Which do you do? Which costs more? Which makes YOU more money?
2. You see a tooth that could probably get by with a large filling, but you recommend a crown because you know the patient can afford it and won't complain if they have to pay. Do you tell the patient a large filling might work?
3. You are a 4th year dental student and you need to do 3 more root canals to graduate, but don't have any patients that need them, so you "accidentally" breach the pulp chamber to require a root canal. Did you let the patient know before that this might happen? Was it negligence or greed?
4. You are in private practice in a hurry and you do a composite filling- saliva accidentally flows all over your preparation after you have prepared it for bonding. You know that it might not [scoff- definitely won't] bond to the tooth without recleaning it and re applying your bonding protocol, but should you go ahead anyways because the patient is ready to leave?
5. You are in a hurry and you forget to wipe down the room before the patient comes. You didn't do anything "invasive" in the previous appt. so you continue. Should you ask them to leave and them re clean the room?
6. You nick the adjacent tooth while preparing your crown, enough to cause problems in the long run. Should you restore the tooth with the nick for free? Should you charge?
7. You get a crown back from the lab and it doesn't fit well around the margins. In fact it is wide open. The patient is frustrated and ready to leave, but you know it doesn't fit. Should you just cement it and "watch it" as you go?
8. You see a suspicious lesion in the mouth and think it may be something unusual or not benign. Should you watch it? Should you refer to a specialist? Should you biopsy? How much should you charge for the biopsy?
9. A patient has insurance that starts on the new year, but they are in pain on December 27th and desperately need a root canal. Do you do the root canal on the 27th and charge it to insurance on the first of the year?
10. You have a molar tooth near the maxillary sinus that may cause an oroantral communication if not taken out carefully. You have to see 10 more patients today to get your quote for the office. You think you can get it out without having a problem, even though it's a possibility. Do you take 5 minutes to explain that to the patient or trust your judgement?
11. You are in a high volume medicaid clinic and you see 25 patients a day. Your peers want you to fill teeth that you feel can be salvaged with just fluoride varnish and some oral hygeine instructions. They say that the teeth don't stand a chance because they are "poor and won't take care of their teeth anyways". What do you do?
12. You place a post in a tooth you just did a root canal on and then do a build up and a crown. You think you may have cracked the tooth root when placing the post. Do you tell the patient?
I had a friend say that a dental license is a license to steal; I never knew what he meant until now. I have not been faced with these dilemmas, but I know from personal experience people who have been and from some of my patients [and their poor dental work]. It is hard to find a good dentist simply because it is hard to find an ethical person nowadays it seems. There are a lot of good dentists, but there are a lot of bad ones too- ethical dilemmas are always right under our nose.
These are great examples! But FYI #9 is more than an ethical dilemma, it's insurance fraud.
#9 is really quite easy. Open the tooth, remove the pulp and any other debris, medicate the tooth, and reappoint them to finish the endo after Jan 1st. Then on the 27th bill the patient for the radiograph and either palliative treatment of pain, or and endodontic file out, or whatever you feel like for that day
That scenario isn't an ethical dilema, that's more or less a fact of practice! Situations like that happen in dental offices all across the country, every year
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This is interesting! Keep these going 👍
