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Biomedical subjects

G T Chiodo

Publications and source records attributed to G T Chiodo.

At least 37 records · Page 2Linked to original sources
PubMed1985

Dental treatment during pregnancy: a preventive approach.

Applying the basics of preventive dentistry at the primary level will broaden the scope of prenatal care. Dentists should encourage all patients of childbearing age to seek oral health counseling and examination as soon as they learn they are pregnant. Specific printed information on pre- and postnatal fluoride, plaque control, nutrition, and tooth development should be available for pregnant patients. Recall systems should allow for pregnant patients. Emergency problems should not be deferred for treatment in the second trimester but should be alleviated immediately. Indicated medications should not be withheld because of pregnancy but patients must be informed of benefits and risks. Consultation with the patient's physician is always appropriate.

Consultants↗
PubMed1985

The effects of denturism on denture prices.

In 1978, the country's first denturism initiative was passed in Oregon, legalizing the independent construction of dentures by non-dentists. The major campaign issue was the effect denturism would have on the cost of dentures. A review of Oregon dental insurance data shows that the costs of dentures, which had been rising at the same rate as other dental services, had a much lower rate of increase after passage of the denturism initiative.

Dental Auxiliaries↗
PubMedDate not supplied

Patient death and bereavement: what is the dentist's role?

The dentist's role following a patient's death has not been examined to date; neither has the attrition rate of a dental practice because of deaths of patients belonging to that practice. This topic was explored through a survey of 400 Oregon dentists. Seventy-two percent of dentists in active practice who participated in the survey had at least one patient death each year; the mean number of patient deaths per year was five. Following these deaths, most dentists reported providing some type of emotional support to the bereaved survivors. Dentists send sympathy cards 72% of the time and attend funerals 27% of the time; 55% of dentists regard the majority of their patient deaths as unexpected. These deaths are a source of emotional stress for dentists, as are subsequent discussions with survivors. Only 3% of the respondents reported having received formal education in death and bereavement, and 66% of dentists believe that some type of education in dying and bereavement should be included in dental school.

Bereavement↗
PubMedDate not supplied

Confidentiality and the curb-side consultation.

Dentists who encounter friends or relatives who request professional opinions about oral health problems are placed in difficult positions that may impose a duty to provide some advice or intervention. Even more awkward is the situation in which a dentist recognizes a pathosis in a nonpatient who is not seeking advice. The ethical principle of beneficence may confer an obligation upon the dentist to act in a professional role even though no professional relationship exists. There are criteria that guide providers in establishing that such a duty of specific beneficence is present; dentists must meet this duty while not violating the same principle of doctor-patient confidentiality that would exist if the nonpatient were, in fact, a patient.

Adolescent↗
PubMedDate not supplied

The dentist's role in end-of-life care.

Dentists and dental specialists have much to offer in ensuring proper pain management in end-of-life care for terminally ill patients. As the population of the United States ages and devastating disease processes continue to affect many, the need for oral comfort care measures will further increase. In an ideal situation, the dentist will be among those consulted in advance of beginning therapeutic regimens that have significant oral side-effects or for cases in which oral care after treatment has begun is accompanied by greatly increased risk. The objectives for dentists caring for terminally ill patients include ensuring comfort, eliminating sites of infection or potential infection, understanding the patient's preferences enhancing oral function, and, when desired, protecting self-esteem through esthetic maintenance. The provision of adequate pain management and comfort care is an unequivocal ethical obligation for the benefit of these patients. Dentists have a further ethical obligation to share their knowledge with physicians and patients to set a higher standard for comfort care for the terminally ill.

Antineoplastic Agents↗
PubMedDate not supplied

Disclosure of mistakes.

In the course of professional practice, errors will occur and patients may be harmed because of them. The ethical obligation to respect patients' autonomy requires that dentists reveal mistakes to patients if the mistake significantly affects the patient's health and well-being. Answering the question, "would most people think they have a right to know of this type of mistake if it happened to them?" may be helpful in determining the significance of an error. An open disclosure and examination of professional mistakes will be beneficial to patients, doctors, and the practice. Fear of legal reprisals or thoughts that the mistake could be effectively concealed from the patient cannot justify failing to inform the patient of an error and may put the dentist in greater legal peril. Dentists who attempt to hide errors from patients violate the patient's autonomy and risk implicating the profession as one which cannot be trusted.

Ethics, Dental↗
PubMedDate not supplied

Ethical issues in the acceptance of gifts: Part 1.

It brightens the day of any health care provider when a patient presents him or her with a personal gift. These thoughtful items express sincere appreciation and are evidence of a solid, trust-based provider-patient relationship. However, there is a significant ethical difference between accepting small gifts of appreciation versus gifts of great financial value. While the patient may be expressing the same appreciation with this substantial gift, he or she may also be attempting to curry special consideration or feel some pressure to please the provider. In addition, acceptance of these large gifts produces the appearance of an improper relationship between the doctor and the gift-giving patient. Patients who offer gifts of great value should receive a sensitive explanation as to why the gift cannot be accepted.

Dentist-Patient Relations↗
PubMedDate not supplied

Sexual boundaries in dental practice: Part 2.

Sexual harassment in the workplace is harmful to employees and disruptive. While the ethical obligations arising from the doctor-patient relationship do not address a dentist's ethical obligations toward his or her employees, the more general ethical obligations to the profession and those of business ethics would mediate against the creating or tolerance of sexual harassment in the workplace. The legal implications of participating in sexual harassment or allowing it to persist in the dental office are significant and dentists should be aware that employees enjoy legal protections against this inappropriate and potentially unlawful behavior. While any gender in any position may be the victim of sexual harassment, women who occupy subordinate positions are the most likely targets of these overtures. Dentist-employers are wise to be proactive in providing an appropriate protocol for employees to use when they perceive sexual harassment in the workplace.

Dental Staff↗
PubMedDate not supplied

Sexual boundaries in dental practice: Part 1.

Sexual contact between doctors and patients is unethical, legally perilous, cause for professional discipline at times, and often viewed as an outrageous transgression by the public. While it is true that some provider-patient couples go on to get married and "live happily ever after," this is not always the case. However, if these relationships fail, a now embittered ex-paramour is empowered with the options of bringing legal and/or disciplinary action against the doctor and may be motivated by the distinct possibility of significant financial reward. Patients place enormous trust and respect in their health care providers. In addition, patients reveal sensitive, confidential information to doctors and do so with the expectation that it will be used only for their best interests. This dynamic creates a substantial power imbalance between doctors and patients and this power differential must never be exploited. Dentists who find themselves romantically attracted to patients must either avoid initiating a more intimate relationship or refer the patient to another provider. Dentists who are the recipients of romantic inquiries by patients should establish clear boundaries. If the dentist is available and interested in the patient, dating may occur only after the patient has been reassigned to another dentist and a suitable time period has elapsed.

Dentist-Patient Relations↗
PubMedDate not supplied

Managed care--serving two masters.

It is likely that enrollment in managed care dental plans will continue to increase. Dentistry can respond to this trend by resisting it; however, just as the health care marketplace drove medical care into managed care mechanisms, so too will these forces impact dentistry. For those who are participating in managed care dental plans, it is heartening that current data indicate that most types of patient care are not adversely affected by reimbursement mechanisms. Dentistry, however, should seek out opportunities to shape the managed care format and must be at the table to assure that ethical principles and conflicts of interest receive due consideration. Dentists who treat patients under a managed care reimbursement system must be certain that the plan does not require providers to sacrifice patient autonomy or compromise care in the process of serving two masters.

Cost Control↗
PubMedDate not supplied

Is there a doctor in the house?

The two cases presented deal with urgent situations experienced by persons unknown to the dentist in the area. It is likely that dentists, physicians, nurses, and other medical professionals will encounter persons in urgent need of medical attention in other venues. Certainly, it is possible for someone to experience an emergency in a ballpark, grocery store, church, or other public gathering. While these settings may not offer the advantage of a medical emergency kit, they do pose the same ethical requirement for those trained in medical management of urgent problems to step forward, identify themselves, and attempt to help the ill person. Fortunately, most non-air settings usually allow for contacting emergency medical help and prompt transport to hospitals. The public may never reach a general understanding of the extent to which doctors other than physicians are trained to handle medical emergencies. Similarly, when someone in a crowded theater yells, "Is there a doctor in the house?" he or she most likely is thinking about a physician. This does not mean that a dentist is excused from acting as a medically trained Good Samaritan. The ethical obligation of specific beneficence requires dentists to minister to the ill in medical emergencies unless a more qualified health care provider is present and identifies himself or herself. The ethical obligation of general beneficence requires dentists and other citizens to assist those in urgent circumstances whose needs do not call upon specialized knowledge or training. Fortunately, the law in this country is designed to protect those who do attempt to help those in need.

Aerospace Medicine↗
PubMedDate not supplied

Ethical duties when patients make suspicious narcotic requests.

Practicing dentists are likely to be familiar with the prospect of patients who request controlled substances for doubtful indications. Torn between ethical obligations of beneficence and nonmaleficence, the dentist may be uncertain whether to prescribe a medication with the intention of alleviating pain or to refuse the prescription due to concerns related to chemical dependency, underlying emotional illness, or ulterior motives on the part of the patient. Pharmaceutical choices often do not provide a mechanism for sidestepping this dilemma as chemically dependent patients may be quite sophisticated in their knowledge of drugs and the ways in which to couch their requests. Dentists have an ethical obligation to move beyond simply refusing prescriptions for patients suspected to be chemically dependent; they should sensitively discuss the issue with these patients and be prepared to offer referral for intervention. However, dentists must always be open to the possibility that a particular patient's assertion of chronic physical pain may be of complex origin. When this is the case, appropriate treatment is essential and may involve referring the patient to others with specialized skills. Dentists should not withhold pain medication from patients with uncontrolled pain in the final stages of life.

Analgesics, Opioid↗
PubMedDate not supplied

The dentist's role in bereavement support.

An aging population that is retaining more dentition and an increasing number of persons affected by terminal illnesses have resulted in dentists encountering dying patients and patient deaths with increasing frequency. These events call upon dentists and their staffs to provide support for the terminally ill and for survivors of the deceased. Dentists are effective in providing bereavement support and survivors benefit greatly from it. However, this type of support is stressful for dentists and many report the need for more formal education in this area. The ethical basis for dealing effectively with a dying patient's need for open and honest discussion derives from the obligations of the doctor-patient relationship. These ethical requirements carry over to providing some level of bereavement support for the surviving loved ones of the deceased and address the professional duties of compassion and care. Sending a sympathy card with a personal note, attending the patient's funeral, or making a follow-up telephone call to the patient's survivors are all appropriate, beneficial, and appreciated.

Aged↗
PubMedDate not supplied

Treatment recommendations: "doctor knows best".

Patients often develop an abiding trust in their health care providers and may agree with any recommendations that a dentist offers. This level of trust is a compliment to the dentist and the profession. However, patients who request that a doctor perform the treatment that he or she feels is best and who prefer to avoid an informed consent process must be educated as to the role of informed consent and their part in the process. Even when a patient is adamant in refusing information about his or her condition or states a clear reason as to why he or she does not desire to know a diagnosis or treatment plan (for example, dental phobia or fear of cancer), the dentist has an ethical and legal obligation to work with an appropriate surrogate of the patient's choice and make reasonable attempts at including the patient in the discussion. These patients should be offered the option of discussing the diagnosis and treatment alternatives with a family member or friend present and may include such a surrogate in the informed consent process. When patients clearly lack capacity to consent, the process of informed consent will revert automatically to appropriate surrogates. Finally, patients from different cultures may bring a new set of considerations to the process of informed consent and may require that a modification of the Western tradition be considered, allowing a significant role for the family of the patient in making treatment decisions.

Culture↗