Grand Rounds Presentation Sparks Ethics Discussion

Blake Rogers DMD 13 presented Grand Rounds on Wednesday, October 31, 2012, based on a case during his externship at Dental Healthworks in Keene, New Hampshire. The case presented both unique medical and ethical challenges.

“The case raises a lot more than what most of us think are our responsibilities as dentists,” said Dr. Carl Mcmanama, who introduced Rogers’ presentation.

Rogers presented the case of a 17-year-old boy with rampant decay and complaints of one sore tooth. The patient has Attention Deficit Hyperactivity Disorder (ADHD), which created medical implications including inattention to oral care and xerostomia. Rogers proposed solutions such as a power toothbrush to make brushing easier, early morning appointments when patients are most attentive, and a fluoride rinse. He advocated the “tell-show-do” method to teach brushing and flossing to ensure the patient understands how to care for himself at home.

Finances were a concern too. Although the patient is covered by Medicaid, he could not afford additional items such as a power toothbrush.

The top concern was the lack of oral care instruction the child received at home from his mother, who had dentures in place by age 30 and little oral health knowledge. Massachusetts law requires dentists to report child abuse or neglect. Under the law, a child whose oral health deteriorates to the point that it limits daily function is suffering neglect. The dentist must inform the parent of the child’s situation and if the parent fails to improve it, the dentist must report the abuse.

The case sparked a lively debate among the audience. Some suggested there is little benefit to reporting abuse of a patient who will become an adult in a few months. Others suggested reporting would help the patient’s 10-year-old sister receive better treatment. Others stated that regardless, the dentist would be legally obligated to report or face punishment.

Rogers reminded faculty and fellow students to watch out for signs of neglect in the future. “The majority of abuse occurs in the head and neck area,” he said, “but only a small percentage of abuse is reported by dentists. We need to be cognizant of that fact.”