Bioethical Issues in Conducting Pediatric Dentistry Clinical Research.

Pediatric clinical research on new drugs and biomaterials involves children in order to create valid and generalizable knowledge. Research on vulnerable populations, such as children, is necessary but only admissible when researchers strictly follow methodological and ethical standards, together with the respect to human rights; and very especially when the investigation cannot be conducted with other population or when the potential benefits are specifically for that age group. Clinical research in Pediatric Dentistry is not an exception. The aim of the present article was to provide the bioethical principles (with respect to the child/parents' autonomy, benefit/risk analysis, and distributive justice), and recommendations, including informed consent, research ethics committees, conflict of interest, and the "equipoise" concept. Current and future worldwide oral health research in children and adolescents must be conducted incorporating their perspectives in the decision-making process as completely as possible. This concept must be carefully considered when a dental clinical study research is going to be planned and conducted, especially in the case of randomized controlled trials, in which children will be recruited as participants.

Conocimiento de pediatras y padres andaluces sobre caries de aparición temprana / Knowledge of andalusian pediatricians and parents about early-onset tooth decay

OBJETIVOS: Investigar el conocimiento de pediatras y padres andaluces sobre las caries de aparición temprana y valorar si los pediatras proporcionan información a los padres sobre salud oral infantil y visitas al odontopediatra. Material y método Una muestra aleatoria de 113 pediatras y 112 padres con ni˜nos menores de 3 a˜nos recibieron un cuestionario anónimo compuesto por 14 ítems para pediatras y 16 ítems para padres. Las preguntas se agruparon en 5 bloques: visitas al dentista, higiene oral, caries, hábitos nutricionales y tratamiento de caries. Las diferencias entre los 2 grupos se establecieron mediante la prueba chi-cuadrado. RESULTADOS: Los pediatras mostraron escasos conocimientos con respecto a las visitas al dentista y al tratamiento de las caries; sin embargo, su nivel de conocimientos sobre higiene oral, caries y hábitos nutricionales era adecuado. Los padres tenían bajos conocimientos en todos los aspectos del estudio, especialmente sobre el tratamiento de las caries. No hubo diferencias significativas en el conocimiento sobre visitas al dentista entre pediatras y padres, sin embargo, los pediatras tenían un mayor conocimiento sobre higiene, caries, hábitos nutricionales y tratamiento (p < 0,001). La mayoría de los padres indicaron que los pediatras no les informaban detalladamente sobre cuidados orales ni sobre la posibilidad de visitar al odontopediatra. CONCLUSIONES: Los pediatras andaluces deberían mejorar sus conocimientos sobre las caries de aparición temprana e informar más a los padres sobre cuidados orales y sobre la posibilidad de visitar al odontopediatra. Los padres tienen unos conocimientos muy escasos sobre caries de aparición temprana, especialmente sobre tratamiento

OBJECTIVES: To determine the level of knowledge of pediatricians and parents from Andalucía (southern Spain) about early-onset tooth decay, and to assess if pediatricians provide information to parents about pediatric oral care and visits to the pediatric de Material and method A random sample of 113 pediatricians and 112 parents with children under 3 years of age received an anonymous questionnaire comprising 14 items for pediatricians and 16 items for parents, grouped into five blocks: visits to the dentist, oral hygiene, caries, nutritional habits, and treatment of caries. The chi-squared test was used to assess differences between groups. RESULTS: Pediatricians showed deficiencies in their knowledge about visits to the dentist and treatment of caries, however their level of knowledge on oral hygiene, tooth decay and nutritional habits were adequate. Parents showed a low level of knowledge in all aspects of the study, mainly about the treatment of tooth decay. There were no significant differences between pediatricians and parents in the knowledge about visits to the dentist, however pediatricians had more knowledge than the parents about hygiene, tooth decay, nutritional habits and treatment (P<0.001). Most of the parents indicated that pediatricians did not provide them detailed information on oral care, and about the possibility of visiting a pediatric dentist. CONCLUSIONS: Andalusian pediatricians should improve their knowledge about early-onset tooth decay, and provide more information to parents about the oral care and the possibility of visiting a pediatric dentist. Parents have a very low level of knowledge about early-onset tooth decay, and particularly about treatmen

The dilemma of reporting suspicions of child maltreatment in pediatric dentistry.

This study examined the factors that lead specialists in pediatric dentistry to suspect child abuse or neglect and the considerations that influence the decision to report these suspicions to social services. Focus group discussions were used to identify new aspects of child maltreatment suspicion and reporting. Such discussions illuminate the diversity of informants' experiences, opinions, and reflections. Focus groups included 19 specialists and postgraduate students in pediatric dentistry. We conducted video-recorded focus group discussions at the informants' dental clinics. All sessions lasted approximately 1.5 h. We transcribed the discussions verbatim and studied the transcripts using thematic analysis, a method well-suited to evaluating the experiences discussed and how the informants understand them. The analysis process elicited key concepts and identified one main theme, which we labeled 'the dilemma of reporting child maltreatment'. We found this dilemma to pervade a variety of situations and divided it into three sub-themes: to support or report; differentiating concern for well-being from maltreatment; and the supportive or unhelpful consultation. Reporting a suspicion about child maltreatment seems to be a clinical and ethical dilemma arising from concerns of having contradicting professional roles, difficulties confirming suspicions of maltreatment, and perceived shortcomings in the child-protection system.

Some care versus no care: an ethical analysis.

When examining solutions to mitigate dental disease and the crisis involving access to care, a question is frequently raised: "Is some care better than no care?" However, the question generally lingers unanswered. The purpose of this paper was to perform an ethical analysis of the question "is some care better than no care?" in order to ascertain whether solutions that provide "some care" are ethically justifiable.

Social vulnerability in paediatric dentistry: an overview of ethical considerations of therapeutic patient education.

Dental caries is a multifactorial condition that remains a major public health issue in high income countries. The prevalence of dental caries in children has markedly declined in most countries over the past 30 years. However, the disease continues to affect a vulnerable population defined as a high-risk group. As many public health policies are inefficient in dealing with this underprivileged group, it is necessary to find other strategies to decrease the incidence and the burden of dental caries. Defining dental caries as a chronic disease enables us to develop the concept of 'therapeutic patient education.' It is meant to train patients to self-manage or adapt treatment to their particular chronic disease and to cope with new processes and skills. The purpose of this paper is to propose a new approach to dental caries, in particular to early childhood caries. That should decrease the gravity and prevalence of the disease in this specific population. As a result, this new approach could increase the quality of life of many children both in terms of function and aesthetics.

O esclarecimento do responsável com relação ao tratamento odontológico da criança na Clínica de Odontopediatria da FO-UFMG / What parents understand of their children’s dental treatment in the Pediatric Dentistry Clinic of UFMG

O presente estudo teve por objetivo avaliar o esclarecimento prestado a 60 responsáveis com relação ao tratamento odontológico de suas crianças, com idades entre 4 e 12 anos, de ambos os sexos, que foram atendidas na clínica de Odontopediatria da Faculdade de Odontologia da UFMG. O instrumento utilizado foi um formulário, adaptado de Colares et al. (1998), aplicado aos responsáveis sob a forma de entrevista, constando de questões referentes ao esclarecimento quanto ao tratamento realizado. Foram coletados dados das crianças, dos responsáveis e da condição econômica da família. Otermo de consentimento livre e esclarecido foi aplicado em toda a amostra. Para análise estatística adotou-se os testes qui-quadrado e exato de Fisher com 5% de significância através do programa SPSS 10.0. De acordo com os resultados, foi possível averiguar que 61,7% dos responsáveis não souberam relatar corretamente o tratamento que estava sendo realizado na criança. Apesar disso, 78,3% julgaram haver participado na decisão de tratamento e 95,0% consideraram os alunos de odontologia acessíveis a questionamentos. Os resultados mostraram que não houve diferença estatisticamente significativa entre o esclarecimento e a classificação econômica da família (p = 0,284) e o relato dos responsáveis quantoao recebimento de informações sobre o tratamento (Fisher = 0,015). Desta forma, foi possível concluir que a maioriados responsáveis demonstrou não estar devidamente esclarecida quanto ao tratamento odontológico realizado em suas crianças, sugerindo que os mesmos não exerceram de forma satisfatória o direito à autonomia.

Ethics and leadership in children's oral health.

PURPOSE: This paper reviews key ethical precepts in health care for children, and explores how interpretations of justice predict different and sometimes conflicting approaches to children's dental needs. Ethics is a core competency for health professionals because of their special responsibilities toward patients and the public. Ethical principles guiding health professionals include: (1) beneficence; (2) nonmaleficence; (3) respect for autonomy; and (4) justice. Different theories of justice lead to different responses toward public needs, such as access to dental care. The most frequently encountered response in the dental community is volunteerism, consistent with the libertarian perspective on justice. Though desirable, volunteerism alone will never solve dental access issues because such efforts do not address the problems systematically. A policy statement of the American Academy of Pediatric Dentistry (AAPD) explicitly recognizes that children have a right to oral health care. Children's unique characteristics--their vulnerability, dependence, and developmental processes-call for special arrangements to address their health needs. Given the importance of children to society, it is critical that all health sectors work together to address children's health and well-being. However, those with the greatest knowledge of children's oral health needs-pediatric dentists-must take a leadership role in creating and supporting solutions to these needs. The AAPD has an opportunity to support systemic solutions at the state and national level to ensure that all children have access to oral health care. One example of a systemic solution is the Access to Baby and Child Dentistry (ABCD) program in Washington State.