Ethics and Medicolegal Prospictive In Orthodontics Volume 6 - Issue 5

Hussam M Abdelkader*

• Professor of Orthodontics, Alazhar University, Cairo, Egypt

Received: July 12, 2018;   Published: July 16, 2018

*Corresponding author: Hussam M Abdelkader, Professor of Orthodontics, Alazhar University, Cairo, Egypt

DOI: 10.26717/BJSTR.2018.06.001412

Abstract PDF

Orthodontic practice as any other dental-and medical specialty is covered by certain fundamental ethics which will be taken strictly in consideration and strictly respected. The following are some points of special consideration in this very critical issue:

Inform Before Perform is our Golden Role

Making orthodontic decision is not our sole responsibility, but we have to respect the moral and legal authority of the parents. We are the guide leader for taking the decision on very sound bases putting in consideration the patient’s benefit as the first priority to conduct orthodontic treatment. Use the best available evidence to explain your point of view to the patients’ side, take the appropriate time, whatever it is, before starting treatment. During treatment, we must have enough time at each recall visit to explain to the patient’s side the progress of treatment and any remarks on the patient performance.

Benefits and Risk-and Limitation of Orthodontic Treatment

If we can explain to the patients the benefits of a pleasant smile and healthy teeth with orthodontic treatment, we have on the other equally recognized that there are some risks and limitations. These potential risks and limitation seldom contraindicate treatment but should be considered and understood by the orthodontists while making the decision of treatment.

Treatment Time

The total time of treatment of dental malocclusion could be estimated on an average according to the severity of dental malocclusion. The total time of treatment can be delayed beyond our primary estimation; broken appointments and/or broken appliance are the most common factors in this regards. concerning the broken appliance we have to be honest and differentiate between our responsibility and the patient responsibility.

Non-Ideal Orthodontic Treatment Outcome

We must be clear from the very begging that we are treating our patients to the standard norm, putting in consideration our psychosomatic norm.

Occasionally a person who has grown normally and in average proportions may not continue to do so. If growth becomes disproportionate, the jaw relationship can be affected and treatment objectives may have to be compromised. Skeletal growth disharmony is a biological process beyond the orthodontist’s control. Due to the size and shape/missing teeth ideal results may not be possible. Restorative (crowns, bonding, veneers and bridges) may be needed to achieve ideal result.

Relapse

After removal of the orthodontic appliance at the end of active treatment phase, retainer will be placed with complete instruction to minimize relapse. Full co-operation in wearing retainer appliances is vital. We will make our correction to the highest standards and in many cases overcorrect to in order to accommodate the rebound tendencies. But we have to be very honest and differentiate between our responsibility and the patient responsibility. If we treat patients beyond our orthodontic limitations, relapse will be the end result. We are treating our patients putting in consideration the long term stability of the treatment outcome. In this regards we have to establish good occlusion without any premature occlusal contacts, occlusal equilibration is an essential phase in orthodontic treatment after the active treatment phase.

Informed Consent Form

The consent form must be very clear and written in a very simple languish, a way as much as we can from sophisticated medical terms, in such a way to be understandable by the parents’ side, whatever their educational level. The orthodontist should explain the reasons for treatment, the orthodontic procedures to be used, the risks, the alternatives, and patient and parent responsibilities during treatment. On the other hand, the importance of recall visits particularly for critical risks such as relapse, caries, and periodontal problems.

Medicolegal Concern Regarding the Diagnostic Orthodontic Radiographs

It is a firm obligation from the medicolegal responsibility to screen the pretreatment orthodontic radiographs to exclude, first of all, any pathology-and or anatomical anomalies before taken any other specialty consideration. Second opinion could be essential in some cases.

Patients’ Orthodontic Records

All patients’ orthodontic records must be filed in good condition after orthodontic treatment for appropriate time. Some countries recommended 4 to 10 years. Second, do not use patients’ records in any publications whatever it is, especially extraoral photographs, without patients clear written approval. Third, please do not take any additional records such as radiographs and photographs for the purpose of research work only. Again patient’s clear written approval is a must.

Transfer Patient to Another Orthodontist

If we transfer our patients to another orthodontist for any reason, keep copy of the patient records, and transfer all patient’s records to the concerned doctor with covering letter summarizing honestly, clearly and carefully the patient’s case from the very begging to the last visit.

Touching Our Patient

From the medicolegal point of view, it is only acceptable to touch the patient’s face by three fingers for support; the fifth, the fourth and the third finger. As a firm obligation; do not touch physically the patient by any part of your body. This obligation is applicable for both sexes; patient side and doctor side, otherwise you will be faced by the dilemma of sexual harassment, even between the same sexes.

Dental Assistant

It is a form obligation to have a dental assistant all the time in the operating room and one of the patient’s relatives if it is possible

Orthodontist Outlook and Behavior

Be careful regarding your dressing, behavior and attitude in the clinic. We have to differentiate carefully between words of appreciation and complements and words which could be considered as a way of sex harassment.

Infection Control

Infection control protocol must be strictly followed.