Final Lecture Ethics

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ا ا  ا‬ *What is Dental Negligence? (‫ إه ل‬:  ) When you go to the dentist you expect to receive a professional service and treatment. However, sometimes injuries and suffering are caused through the negligence of these professionals. Dental Negligence is basically any injury or suffering caused by Dentists failure to meet their 'duty of care' towards the patient, or can be claimed when careless or incorrect dental work leading to personal injury. * Now, what are the situations that can be arise dental negligence? For example: 1- Nerve injuries that affected a patient’s ability to taste, or that caused permanent numbness in the tongue (or even just part of the tongue); that result from incorrect local anesthesia that may traumatized or cutting the lingual nerve. 2- Complications arising from negligently completed crowns and bridges ; this is very important, when you are doing complete crown & bridge preparation you must prepared tooth to fabricated for crown & bridge, & the problem in our country that we decrease the visits & this is very painful to the patient. Or; if the dentist don’t learn any thing about tooth preparation & he doing over preparation & reach to the pulp of the tooth, this is a problem!! 3- Dentists’ failures to take a patient’s relevant medical history into account before acting; you should take a medical history & this is a very protected part, for example; patient with heart 1

failure, hemophelia …., you must deal with them carefully, & you must deal with this part as routine situations - &this is main thing to successful in your job. 4- Failure to detect oral cancer, periodontal disease, or other diseases; that is what you are study in oral pathology & there are important why? Because you are studying sequamous cell carcinoma, apthus ulcer etc… & you can discovering the oral cancer easily , but if you don’t know & the patient leave you then discovered the cancer by other dentist that means end of you, other thing important that is PDL diseases; many of our clinics don’t have PDL probe & they don’t examine the patient from periodontal disease , if the patient appear after many years & he lost his teeth do to aggressive periodontitis & he going back to the chart &the dentist don’t mention that, they will convict the dentist, so if you cant do proper diagnosis you must convert the patient to specialist. 5- Certain complications from anesthesia, even when releases are signed: For example; anterior dental block between 2 premolars, some time you might giving anesthesia in wrong way & this is a problem, & ethical back ground to you if you don’t know how to giving the anesthesia in correct procedure you must be don’t giving him especially when you are undergraduate . 6- Unnecessary extraction of multiple teeth; for many ways to make an implant for the patient, & this is complicated either from periodontal pulp diseases or from endodontic pulp diseases , but the dentist didn’t know the correct procedure to deal with this cases. 7- Extraction of wrong teeth (Oh, yes….it happens) ;( Because the dentist is careless as simple as that, if you extract a wrong tooth that is mean you are careless & this is happen.

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* Informed consent: Is a process by which a patient is apprised (informed) of the nature and risks of a proposed treatment that may be occur during the treatment, including no treatment or observation only, and then accepts a treatment plan (consents) . That means the patient getting a paper to accept the plan of treatment, & that is very important because you protect your self from any complication may be occurs during the procedure. *Now; the types of patient concept; 1) Implied concept; Provided the patient has the ability to give it, implied consent is given when the patient agree to treatment, or at least does not object. In dentistry; we have from our teaching the plan, for ex; In surgery; we have a minor surgery such as getting impacted lower 8, & in this procedure might be complication like swelling & continuous pain, etc… all of this complication should be written. Or; another procedure such as general anesthesia especially in children & the complication of this procedure also should be written. 2) Written concept: Written consent is a preferred means of obtaining & documenting the patient’s consent & understanding of the procedure, In dentistry, written informed consent usually is obtained for anesthesia involving sedation or general anesthesia, as it is for many other procedures , in certain countries that are even cavity preparation include.

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Practitioners generally advise patients about both minor common complications or even serious rare complications that can occur with the proposed procedures; *Now, What is the condition, that do not required an informed consent in dentistry or in your clinic??!!!! Emergency cases, but you must know how to deal with these cases. * Guidelines for Informed Consent: 1) Use simple words & phrases:

Very important because you might use a complex words your patient doesn’t know what that is mean such as if you write: after surgery procedure you may get a hyper plastic enlargement tissue … , so you should use a very easy word to make the patient understand that. 2) Avoiding technical terms, so that it may be easily understood. 3) Avoid overly broad statements such as “any and all treatment:

To protect your self don’t ever written statements such that: this procedure don’t have any complication at all. 4) When possible, this should occur on a day separate from the treatment (question in exam): why? To become the patient leave

it & understand what you do ‫ " م !   م‬#$"‫ ا ا‬#%‫* ا )  ( ور‬+ ‫) إدا أ أن‬ ( -"‫ا أ‬./" ‫ج‬1‫ا‬ 5) To assist the patient in making an informed decision about having the proposed treatment, the dentist should explain:

-The nature of the proposed treatment

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-The benefits of the proposed treatment, & the consequences of not having the proposed treatment -The most common & severe risks associated with the proposed treatment -Reasonable alternatives to the proposed treatment, including the risks and benefits (the doctor just read the slide)

*Now: Items appearing on a consent form for a minor: 1) Name & date of birth of pediatric patient, for every child who enter to the clinic 2) Name, relationship to patient, and legal basis for adult to consent on behalf of minor . 3) Treatment, alternatives, & risks; that means if you want to do a very critical procedure for a child such a surgery you should take a concept from his father or any some one legally responsible on him. 4) Potential adverse sequelae specific to the procedure 5) An area for the patient or parent/guardian to indicate all questions have been asked 6) Signature lines for the dentist, parent or legal guardian & a witness. *Informed Consent Should be; Procedure specific, with multiple forms likely to be used Updated or changed accordingly as changes in treatment plans occur. *When Written Consent Is Required ? _ If new drugs are to be used _ If experimentation or clinical testing is involved _ If a patient’s identifiable photograph is used _ If minor children are treated in a public program 5

_If the treatment takes more than 1 year to complete ( question in exam) You need to have a concept *Conclusion; _The patient education & informed consent process plays an important role in assuring realistic expectations, enhancing your relationship with patients, & improving patient outcomes _ Additionally, a well-established informed consent process may assist in preventing & defending malpractice claims _Take the time to consider whether your informed consent process effectively educates patients and protects you from potential malpractice claims ( the doctor just read this slide) _ THE END_  5‫ أ‬6784‫ و‬69 23‫ و‬. 8 7+ 23 ‫ ا‬234‫و‬ A % B. -/<
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Final Exam will be held on (Thursday 14/8/2008) at these halls 0n line: Lab. 4 from no. 1 - no. 43 .1 Lab.8 from no. 44 – n. 84 .2 Lab. 10H2 from no. 85 – no. 155 .3 According to the list of names provided to you by the your C.R.

Note; the lecture of dr. khansaa ababneh about; (control of infection are include in the final exam)

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