Patient autonomy and the bad result

Article Abstract:

'Patient autonomy' is a term used to describe the choice of care and treatment that is most consistent with the patient's needs and values. However, some patients may make a treatment choice that the dentist disagrees with, such as when a patient insists on extraction of a tooth that the dentist believes can be restored. A dentist has the right to refuse to provide therapy that does not meet his practice standards. Dentists should give patients the opportunity to make an informed decision regarding consent to treatment by outlining the various treatments available and explaining the advantages and disadvantages of each. Bad results are frequently caused by the patient's neglecting dental problems, missing appointments, and failing to follow the dentist's advice. Therefore, patients who exercise their autonomy by choosing the type of dental care they receive should bear the responsibility for bad results. The dentist should document the patient's decision as evidence, and records should be kept of missed or cancelled appointments. Documentation should also include the patient's symptoms, the recommendations given to the patient, and the patient's choice of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dentist and patient, Dentist-patient relations, editorial

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Ethics and the patient with dementia

Article Abstract:

A 75-year-old woman was uncooperative during a recent dental examination. Although she appeared alert, she refused to be examined. Subsequently, on a visit when she was accompanied by her adviser, oral examination was performed, but the patient was reluctant and at one point bit the dentist. Although the dentists, nursing home staff, and the patient's adviser agreed that this woman's oral disease should be treated, she consistently refused professional intervention. The patient's chart indicated primary dementia, but she had never been found to be incompetent by the legal system. This case points up ethical difficulties. Although dental professionals are committed to the detection of problems and early intervention, the treatment of a patient against her will may violate basic rights. There seems to be no easy resolution for this dilemma. One possible preventive measure is to discuss preferences for future dental care with elderly patients. These preferences could then be included in the dental history. Along with the input of close relatives and caregivers, this information might provide a basis for treatment if signs of mental deterioration should one day ensue. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Complications and side effects, Dementia, Dental ethics

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Understanding the value of teeth to older adults: influences on the quality of life

Article Abstract:

Older adults who have teeth may enjoy a higher quality of life than those who do not have teeth. This includes both natural teeth and dentures. Among 1,018 individuals over 65 years old, 818 had teeth and 200 did not have teeth. Almost half thought that having teeth had a positive effect on their appearance to themselves or others. Over 40% believed that having teeth affected their chewing and biting, their eating or their enjoyment of eating. Thirty-eight percent thought that having teeth affected their overall comfort and health. Most did not think that having teeth affected their moods, weight, appetite, romantic relationships or success at work. Dentists can use this information to market their services more effectively to elderly individuals.

Social aspects, Quality of life, Teeth

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