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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 3-6

Acuity of morality in dental practice management


Department of Public Health Dentistry, People's Dental Academy, People's University, Bhopal, Madhya Pradesh, India

Date of Web Publication14-May-2018

Correspondence Address:
Dr. Anshika Khare
Department of Public Health Dentistry, People's Dental Academy, People's University, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_4_18

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  Abstract 


Dentistry is a health-care profession, provides oral care as physician does. Currently, due to transient transformation in dental practice, dentistry reached its zenith level. In this segment, moral and legal aspect is one of the leading concerns in dental practice management. The duties of dentist are allied with many confront along with regulations of moral and legal compliance. The aim of this article is to endow with uncomplicated explanations of dissimilar attitude and knowledge of morality that might affect the dental profession as a whole. The literature on acuity of morality in dental practice management was identified by searching the biomedical databases as a primary research material. The databases were searched for publications from 2001 to 2016, with key articles obtained primarily from Medline, PubMed, Google Scholar, and Cochrane. The literature for the present review was obtained from the following sources such as published articles, unpublished literature, internet news clippings, and online manuals and books.

Keywords: Consent, Consumer Protection Act, dental negligence


How to cite this article:
Khare A, Saxena V. Acuity of morality in dental practice management. J Dent Res Rev 2018;5:3-6

How to cite this URL:
Khare A, Saxena V. Acuity of morality in dental practice management. J Dent Res Rev [serial online] 2018 [cited 2018 Jul 20];5:3-6. Available from: http://www.jdrr.org/text.asp?2018/5/1/3/232363




  Introduction Top


The health profession concentrating mainly on oral health is considered as the dignified profession; it is the duty of health-care providers to maintain the dignity of profession throughout their life. Hippocratic Oath is the pioneer ethical model to maintain the moral values of health-care profession.

All professions, especially the health-care professions, are in a constant state of self-assessment aimed at advancing their disciplines in a consistent and measurable fashion. For the health-care professions, the goal is to improve patient health, increase efficiency in the health-care system, and ultimately enhance society as a whole.[1]

A dentist is a health-care professional providing care for the patient, as does a physician. Obviously, there is a duty imposed on the dentist to practice dentistry at the certain standard of care.[2] Now, dentistry has been reached the high amplitudes in care delivery, research, and professional excellence. The deliverance of dental care across India is through several means where private practice forms the base of the pyramid follows by dental care renders in dental school and group practice, hospital-based practice, and corporate dental care narrows down on the tip of the pyramid [Figure 1].
Figure 1: Deliverance of dental practice across India

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Due to commercialization and globalization in health sector, the moral values of the profession are not maintained to optimal level. Heath care gradually becomes vast, but the ethical values of professionals are manifolds.

While providing oral care, a dentist has to follow certain fixed protocol and set principles on humanitarian ground to stay away from any lawsuit in the name of malpractice and dental negligence. These ideologies are vast including rapport with the patient, consent oral or written before any treatment, avoidance of iatrogenic injuries, and nosocomial causes. The awareness and adoption of the Consumer Protection Act (CPA) is of prime importance in the present scenario for safe care deliverance and dental practice management. A breach to conduct and follow these duties while rendering oral health care is collectively entitled as dental negligence.

At the present era, due to increased awareness and affluent mass media public, masses are more responsive about their rights. Negligence in health-care delivery could result serious consequences for patients. In India, dental practice has been changed over the past 50 years due to encroachment and enormous revolution, but attentiveness on moral values and ethical issues is limited.

Thus, this appraisal is an honest attempt to give uncomplicated explanations of dissimilar attitude and knowledge of morality that might affect the dental profession as a whole.

The literature on acuity of morality in dental practice management is identified by searching the biomedical databases as a primary research material. The databases were searched for publications from 2001 to 2016, with key articles obtained primarily from Medline, PubMed, Google Scholar, and Cochrane. The literature for the present review was obtained from the following sources such as published articles, unpublished literature, internet news clippings, and online manuals and books.


  Consent Top


The concept of consent comes from the ethical issue of respect for autonomy, individual integrity, and self-determination. The term consent means voluntary agreement, compliance, or permission.[3] Section 13 of the Indian Contract Act lays down that two or more persons are said to consent when they agree on the same thing in the same sense (meeting of the minds).[4]


  Provisions for Consent under Law Top


Sections 87–91, the Indian Penal Code (IPC), deals with consent. Section 88, IPC, lay down that an act is not offense, if it is not likely to cause death. Barring physical examination, any medical/dental procedure requires written consent should refer to one specific procedure and not blanket permission.[5] In case of children and mentally disabled people, proxy consent or substitute consent should be taken because he/she is a minor or mentally unsound/unconscious. In such situations, a parent or close relative can provide consent.[6],[7],[8],[9],[10]

Prisoners and persons released on bail can be treated without their consent in the interest of justice of society. However, consent of the patient cannot be defense to medical or dental practitioner in negligence.[5]

In a country like India, with massive population and narrow resources of health-care services, applicability of consent is like near to the ground. Hence, various studies were conducted to assess the fact of knowledge and applicability of consent in the Indian dental practitioners.

In 2013, a study was conducted regarding informed consent in dentistry, which showed that most dental practitioners appreciated the value of informed consent and 99% of the participants regarded consent as an integral part of dentistry. Among the types of consent, with 84.4%, verbal consent was found to be the favored method of acquiring consent over its written form.[11]

In 2015, a study was conducted regarding knowledge and attitude toward informed consent that showed 97.4% of the dental professionals acknowledged that what an informed consent is. However, only 48.7% of the participants sometimes obtained the consent. Almost 68.6% of the dentists in this study agreed that they had sufficient knowledge about verbal consent, and according to this study, verbal consent was found to be the favored method of acquiring consent.[12]

In 2016, a study was conducted on awareness of CPA, which showed that 71.8% BDS practitioners, 47.5% MDS practitioners, 75.9% interns, and 77.4% PGs took written consent from the patients. About 66% of the participants felt that taking written consent was time-consuming. Almost 27% of the participants were aware that one copy of the informed consent form should be given to the patient if asked for.[13]

According to these studies, most of the dental practitioners had sufficient knowledge about consent, but all participants not always consent their patients. Written consent was time-consuming, so the verbal consent is the most favorable way to consent.

However, in the vast scenario of dental practice, verbal consent is not a formal way to inform the patients, so written consent should be taken.


  Dental Negligence Top


The word negligence has been defined as lack of proper care and attention and culpable carelessness and is derived from Latin neglego or neglect.[14]

The Supreme Court of India believes that the essential components of negligence are three: duty, breach, and resulting damage.[15]


  Legal Process Top


Legal process of protection against legislation includes CPA. CPA was implemented in 1986 for the betterment and the protection of consumers with the aim to protect patient right against unethical practice. All the services rendered by any medical or dental health-care professional are covered under CPA except when the service is provided free of cost, especially in charitable or governmental dispensaries and hospitals and primary health centers.[16]

A variety of studies were conducted to assess the knowledge about CPA in the Indian dental practitioners.

In 2013, a study was conducted on awareness of CPA among 348 dental professionals and postgraduate students in Uttar Pradesh.

It results that 84.8% were aware about CPA, and the MDS faculty showed about more awareness as compared to BDS faculty and postgraduate students.[17] However, according to a study conducted in 2011, majority of dental professionals had poor awareness of CPA.[16],[18]

In 2014, in a study conducted on awareness regarding CPA among the study participants, 54.7% were having low knowledge scores, 23.3% had a medium score, and 21.8% (58) had a high score. When education level of the study participants was compared with knowledge regarding CPA, it was seen that 60.1% of the Bachelor of Dental Surgery graduates were having low knowledge scores and only 15.6% had high scores. Astonishingly, only one-third (30.3%) of the Master of Dental Surgery postgraduates were having high knowledge scores.[19]

In 2016, a study showed that the CPA awareness scores were significantly higher among MDS practitioners when compared with those of BDS practitioners, interns, and postgraduates.

Almost 66% of the participants found the taking of written consent to be time-consuming. Nearly 70% and 69.3% of the BDS and MDS practitioners, respectively, were updating the medical ethics.[11]

Considering the present situation, an enhancement of knowledge regarding of consent, dental negligence, and CPA is very crucial for the dentists in India. Consent, dental negligence, and CPA are foremost characters in legal perspective of practice management.


  Recommendations Top


According to the current scenario in Indian dentistry, the knowledge and applicability regarding consent and legal process of dental negligence is not appropriate. Protection of each and every patient is a prime concern during dental treatment both in private and government sector, and especially in case of camps and surveys, for this, we have to enhance the level of awareness by conducting educational programs at regular interval to increase the understanding of moral values and confidence to deal medicolegal aspects to avoid any lawsuit. The most important thing is; that all dental professionals have to set their own excellence health assured values for the safety of their consumers.


  Conclusion Top


Any fault in health care profession could results serious consequences, so it is an oblique duty of every dentist to take consent their patients and tell them about the various options available and their consequences too. Not taken consent and dental negligence both can cause the dentist to face litigation. It is keen responsibility of dentist to make the patients and all the official records updated to protect themselves against any medicolegal litigation. Hence, by following assured standards of rules and regulations in dental practice, we can save us from medicolegal and criminal litigation.

Acknowledgment

This study was widely supported by all the contributory authors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Burt BA. Fluoridation and social equity. J Public Health Dent 2002;62:195-200.  Back to cited text no. 1
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2.
Dhawan R, Dhawan S. Legal aspects in dentistry. J Indian Soc Periodontol 2010;14:81-4.  Back to cited text no. 2
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3.
Chaturvedi A. Consent-Its Medico-Legal Aspects. Medicine Update; 2000. p. 883-7.  Back to cited text no. 3
    
4.
Kohli A. Medical consent in India – Ethical and legal issues. Anil Aggrawals Internet J Forensic Med Toxicol 2007;8:19.  Back to cited text no. 4
    
5.
Murkey PN, Khandekar IL, Tirpude BH, Ninave SV. Consent – Medico Legal Aspects - Indmedica. Available from: http://www.indmedica.com/journals.php?journalid=9&issueid=86&articleid=1160&action=article. [Last accessed on 2018 Apr 09].  Back to cited text no. 5
    
6.
WMA Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects. [Last accessed on 2018 Apr 09].  Back to cited text no. 6
    
7.
Council for International Organizations of Medical Sciences. International ethical guidelines for biomedical research involving human subjects. Bull Med Ethics 2002;(182):17-23.  Back to cited text no. 7
    
8.
National Bioethics Advisory Commission. Ethical and Policy Issues in International Research. Washington, DC: National Bioethics Advisory Commission; 2000.  Back to cited text no. 8
    
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Nuffield Council on Bioethics. The Ethics of Research Related to Health Care in Developing Countries. London: Nuffield Council on Bioethics; 2002.  Back to cited text no. 9
    
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Kukreja P, Godhi S, Basavraj P. Consumer protection act and medical negligence – A brief insight. J Indian Assoc Public Health Dent 2011;17:522-7.  Back to cited text no. 10
    
11.
Farhat W, Qiam F, Shah SM, Khan M. Informed consent in dentistry: Percieved importance and limitations in Khyber Pukhtunkhwa. JKCD 2013;3:14-19.  Back to cited text no. 11
    
12.
Gupta VV, Bhat N, Asawa K, Tak M, Bapat S, Chaturvedi P, et al. Knowledge and attitude toward informed consent among private dental practitioners in Bathinda city, Punjab, India. Osong Public Health Res Perspect 2015;6:73-8.  Back to cited text no. 12
    
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Swapna LA, Koppolu P, Basil T, Koppolu D, Baroudi K. Awareness of Consumer Protection Act among the dental fraternity in India. J Orofac Sci 2016;8:27-33.  Back to cited text no. 13
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Pocket Oxford Dictionary. Oxford: Oxford University Press; 1994.  Back to cited text no. 14
    
15.
Acharya AB, Savitha JK, Nadagoudar SV. Professional negligence in dental practice: Potential for civil and criminal liability in India. J Forensic Dent Sci 2009;1:2-7.  Back to cited text no. 15
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Gupta MC, Mahajan BK. Health and law. In: Roy RN, editor. Textbook of Preventive and Social Medicine. 4th ed. New Delhi: Jaypee Publishers; 2013. p. 140-1.  Back to cited text no. 16
    
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Prasad S, Menon I, Dhingra C, Anand R. Awareness of consumer protection act among dental health professionals in dental schools of Ghaziabad, India. Oral Health Dent Manag 2013;12:262-8.  Back to cited text no. 17
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Ajithkrishnan CG, Milind TW, Thanveer K. Awareness of consumer protection act and professional idemnity claim among medical and dental college health professionals of Vadodara, Gujarat-A Review. J PEARLDENT 2011;2:42-45.  Back to cited text no. 18
    
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  In this article
Abstract
Introduction
Consent
Provisions for C...
Dental Negligence
Legal Process
Recommendations
Conclusion
References
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