Elsevier

Dental Abstracts

Volume 60, Issue 1, January–February 2015, Pages 22-23
Dental Abstracts

The Big Picture
To tell or not

https://doi.org/10.1016/j.denabs.2014.07.017Get rights and content

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Background

You find a left Class II relationship with peg-shaped lateral incisors in a 13-year-old patient. The retained maxillary left deciduous canine is mesial to the maxillary left permanent canine, with the remainder of the secondary dentition having already erupted. The family’s concern is for the disproportion of the maxillary anterior teeth and the maxillary right midline deviation caused by the extra tooth. Orthodontic records confirm the need to extract the retained left deciduous canine for

The Fiduciary Relationship

Health care professionals are in a fiduciary relationship that implies that trust arises between the patient and the doctor as an integral part of the professional connection. The patient is in a highly vulnerable position because of the trust placed in the professional. The ethical principle of fidelity means the keeping of commitments and promises. It can be explicit or implicit, but both are equally binding. Fulfilling both forms of fidelity, especially when one is not monitored by others,

Practical Application

In the example given, a deontologist would see that the correct action would be to report the error to the patient’s parents even if there are negative repercussions because this act would respect the ethical principle of fidelity. A utilitarian would find no moral reason to inform the family if the final result reflects equal quality, even if the wrong tooth was extracted. If such a therapeutic error is not noticeable in the final result, should the parents be told about it?

In choosing what to

Discussion

The decision will ultimately reflect your respect for the fiduciary relationship with the family. The best course would be for the dentist to apologize to the family. This apology plus your support may be enough to assure the family that you will both do the best job possible on the patient’s behalf.

Clinical Significance

The course of action in difficult circumstances may not be clear but should be based on principles that put the patient’s interests first. A sincere effort to resolve the

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Greco PM: Is ignorance bliss? Am J Orthod Dentofacial Orthop 145:555-556, 2014

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