Tag Archives | patient

Dental Anxiety Associates with Pain During Dental Procedures

It is well known by dentists that some patients experience dental anxiety, with some patients have worse dental anxiety than others. In a review article titled “Dental Anxiety Is Considerably Associated With Pain Experience During Dental Procedures,” by Mike T. John, appearing in J Evid Base Dent Pract, 2013, issue 13, pp. 29-30, the issue of dental anxiety in dental patients is explored. The study reviews a study titled “Predictors of pain associated with routine procedures performed in general dental practice,” by Tickle M, Milsom K, Crawford FI, and Aggarwal VR, in Community Dent Oral Epidemiol, 2012 Aug;40(4):343-50. In the original study 508 patients who visit 38 different dentists in England participate. Dental anxiety was measured with the Corah Dental Anxiety Scale which resulted in a score between 4 and 20. This score was grouped into 4 different variables representing anxiety. The dental patients were asked to rate their intensity of pain on a scale of 0 to 10 during the procedure, after the procedure, and later after the procedure (not immediate). The researchers performed logistic regression and found that very anxious patients had a fivefold increased odds of experiencing pain during the dental procedure compared to patients who had […]

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Ethical Issues for Consent in Dentistry

An article appears in the Journal of Medical Ethics, vol. 39, pp. 59-61, January 2013, titled “Consent in dentistry: ethical and deontological issues,” written by Adelaide Conti, Paola Delbon, Laura Laffranchi, and Corrado Paganelli. The authors are from Italy and so the focus of the article is a discussion of some of the ethical issues in dentistry. I have previously discussed some ethical issues in medicine and dentistry. See for example, Attending to the Patient in the Informed Consent Process and Are Dentists Ethical or Scam Artists?. In the article the authors say “The right of patients to make decisions about their healthcare has been enshrined in legal statements: in Italy the National Constitution establishes that personal liberty is inviolable and that no one may be obliged to undergo any given health treatment except under the provisions of the law…In addition, the Charter of fundamental rights of the European Union and the Council of Europe’s ‘Convention on human rights and biomedicine’ establish the general rule of free and informed consent in the health field.” The authors touch on how it is possible that some treatment options provided by dentists may be considered a disfigurement in some cultures but a sign […]

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Patient Safety and the Culture of Cover-Up

An interesting article was written by George Lundberg titled “A culture of cover-up has slowed the patient safety movement” on December 1, 2012, on KevinMd.com located at http://www.kevinmd.com/blog/2012/12/culture-coverup-slowed-patient-safety-movement.html. In the article Dr. Lundberg says “Promoting patient safety, preventing medical error, preventing physician error, preventing errors in diagnosis, preventing nurse error, preventing surgical error, preventing communication error, preventing health illiteracy error, preventing errors from language barriers, preventing laboratory error, preventing computer error, preventing patient mix-ups, preventing right and left side of body mix-ups, preventing mistakes, since mistakes are the stepping stones to failure. Recognizing human frailty, recognizing physician humanity, recognizing system fallibility, owning up to problems, eliminating cover-up, acting out professionalism, recognizing that professionalism means self governance, individually and as groups. Self criticism, peer criticism, a culture of peer review, honesty, truth, disclosure, fairness, and negotiated settlements. Objective evaluation and commitment to quality. Quality improvement by preventing error. Systematic error, systematic prevention of error. An error caught before an action is taken based upon that error is, in effect, not an error. These are the fundamental truths that the patient safety movement is all about.” Dr. Lundberg later says “However, sad to say, improvement in documented actual patient safety has lagged […]

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Is Creative Diagnosis on the Rise in Dentistry?

A very interesting MyView column by the American Dental Association (ADA) is titled “Creative Diagnosis” by Jeffrey Camm, D.M.D. located over at http://www.ada.org/9151.aspx and published October 21, 2013. In the column the author touches on an issue he faces as a dentist where he has patients who have seen other dentists who were likely unethical in their treatment (and treating when it is not warranted) – a term he calls creative diagnosis. Of course one can ask, what is the motivation for creative diagnosis and one would answer money and staying afloat. Essentially the author describes several cases he has dealt with at his practice: A 16 year old patient who graduates from his pediatric practice and sees a new dentist who then says she has 16 cavities. The patient and her mother of course are upset and he reviews her teeth. He then asks 5 other dentists to review the radiographs and finds a diagnosis of between 0 and 4 cavities. (suggesting the new dentist was practicing creative diagnosis) In another case he sees a 2 year old who comes in with a full mouth series of radiographs. He says a child that young has no business having a […]

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The American Dental Association: Is it Patient-Centered, Science-Based and Ethically-driven?

Some time recently (within the past 6 months) the ADA (American Dental Association) has updated their about me page over at http://www.ada.org/aboutada.aspx. A new video appears and under it the text reads “This American Dental Association video tells our story and highlights how the ADA has always been a patient-centered, science-based and ethically-driven association. It captures the ADA’s spirit and what the ADA strives to be.” Viewing the video the words patient centered, science-based, and ethically-driven are repeated. The video also throws around the terms continuous learning, research and development, patents, and up to date. In one segment a dentist presumably says do no harm, always do good, treat people with fairness and honesty, and respect the doctor patient relationship. Unfortunately I disagree with the ADA’s assertion that they have always been patient-centered, science-based, and ethically-driven. As stated before on this website, see for example this blog post http://blog.teethremoval.com/the-war-on-healthcare-patients-who-hate-doctors I was never made clear that wisdom teeth were no longer commonly removed in other countries prior to having my healthy wisdom teeth extracted in June of 2006. Guidelines from SIGN and NICE existed in 1999 and 2000 respectively see http://www.teethremoval.com/controversy.html. If the ADA was always a patient-centered, science-based and ethically-driven […]

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