The Ethics of Interproximal Reduction

Interproximal reduction (IPR) has become particularly popular with the use of removable aligners. Clinical and ethical factors concerning the use of interproximal reduction to facilitate orthodontic alignment are discussed. CPD/Clinical Relevance: An understanding of the aetiological factors of a malocclusion is essential to enable full discussion of the risks and benefits, or the alternatives to IPR.

[How to evaluate psychological risks: an ethics of aesthetic demand in orthodontics]

Evaluating risks is part of the day-to-day practice of all orthodontists. Most of the time we forget that healing a patient also requires an evaluation of what is called the psychological risk. Indeed, focusing on harmonisation matters, we tend to omit that patient's requests, especially aesthetic requests, may conceal psychological problems. Such a risk is even higher when it comes to orthodontic-surgical protocols, as the physical changes are more radical. We will discuss the specificities of aesthetical demand, its links with the social discourse and the way self-esteem and reflection in the mirror are closely intermingled. Should we forget to take into account the psychological dimension of any patient, this could be a breach of professional ethics. We will furthermore consider the means we have to recognize patients with a high psychological risk. It is not in our hands to help these patients psychologically. It is in the hands of a mental health specialist, whose adress and phone number we should know in order to refer our patients to him/her.

Practical aspects to undertaking research in the primary care setting: experience from two studies

AIMS

To discuss the practical aspects of conducting research in a primary care setting, from the perspectives of the practitioner and the research team.

METHODS

Various issues are discussed, including the relevance of research questions being generated in this setting, the advantages to both parties and the processes involved in conducting a study in specialist practice. This paper describes two recent studies (a randomized clinical trial and a qualitative study) conducted within specialist practice, to illustrate some of the potential difficulties.

CONCLUSIONS

The success of conducting a study in primary care is determined by a variety of factors, including an interested specialist practitioner, motivated staff in a well-organized practice and the close support of an academic-based research team.

[Therapeutic patient education for children and adolescents: some dentofacial orthopedic reflections]

Non-compliance and, even more, abandonment of treatment raise many questions. From a medical and economic point of view, these occurrences affect the efficiency of the proposed therapy. These failures therefore invite us to question the nature and purpose of health care providers' mission. Adherence of the patient to medical advice is a key factor to the success of the therapy. Therefore, how can we modify the patient's behaviour, particularly when dealing with teenage patients? How can we adopt and make our own a therapeutic strategy encouraging cooperation of patients? Patient education, recently integrated into the French public health code (Code de la santé publique), brings new elements to answer these questions. The purpose of the present work is to question the concept of patient education, notably with regards to medical ethics. What can patient education bring to medical practices that face non compliance or deficiency of adherence to treatment recommendations? What new perspectives does patient education bring, notably regarding medical practices?

Dental ethics case 6. Stalled payment for ongoing orthodontic treatment--balancing responsibilities

It is not always easy for an orthodontist to strike the right balance between a caring, supportive and patient-centered approach, and the need to make a living and to run a profitable business in order to achieve this. Striving to act ethically and professionally at all times will help find this elusive balance and ultimately it will be more rewarding and professionally satisfying. Especially when dealing with children whose lives may be dramatically affected by the interruption or cessation of treatment, orthodontists have a duty to reassure themselves about the financial stability of their contractual relationships with patients or parents. Having consistent financial policies and flexible payment options may assist in this regard. Even in the face of non-payment of fees, treatments that have begun must in some form continue if their cessation would compromise the best interests of patients.

Selling orthodontic need: innocent business decision or guilty pleasure?

The principal objective for most patients seeking orthodontic services is a detectable improvement in their dentofacial appearance. Orthodontic treatment, in the mind of the patient, is something that makes you look better, feel better about yourself, and perhaps enhances your social possibilities, ie, to find a companion or make a positive impression during a job interview. Orthodontics, as a speciality, has collectively advanced the idea that enhanced occlusion (bite) improves the health and longevity of the dentition, and as a result many patients seeking orthodontic services affirm that their secondary goal of treatment is an oral health benefit. It would appear that there is some disparity between the end-user of orthodontic services and the orthodontic provider's perception of what constitutes orthodontic need. The aim of this paper is to examine two contrasting models that characterise how dentists 'sell' orthodontic services to patients and to discuss the conflict between professional ethics, practice management and evidence-based decision-making in orthodontic practice.