24 June 2005
Considering that the practice of dentistry is encompassed by the general ethical standards governing the patient-doctor relationship, as provided by the code of medical deontology in general, the ICB notes that a number of dental activities, especially those for aesthetic purposes, deserve special bioethical attention. The face and above all the mouth are “multifunctional instruments” and represent a primary element of approach and comparison not only with the external world, but they reflect the image we have of ourselves and our identity. Similar considerations also apply for orthodontics: the correct dynamic and functional orthodontic diagnosis must be accompanied by a complete medical history of the patient, as well as, if necessary, the support of a psychologist, above all for children, due to the significant effect that the use of dental appliances can have on interpersonal relations. Therefore, it is essential on proposal of the treatment plan to discuss the aesthetic and psychological motivations. In the case of a child failing to co-operate, the ICB considers that coercive intervention by the parents should not be permitted, given that, treatment is customarily preventive care and not required for an ongoing pathology, this makes the child’s approval frequently difficult to obtain.
With regard to this, the ICB draws attention to the issue of informed consent, which risks being involuntarily neglected, on account of the frequently friendly relationship between dentist and patient. The information must be fully comprehensive and detailed; therefore, it would be appropriate to have a statement written by the patient, of his own hand, in relation to the understanding of the nature, aims, and risks of the treatment and the patient’s own duties in the period following treatment, such as follow-up visits, the rules of hygiene etc.
In addition, the document refers specifically to the lack of attention to tooth and periodontal disease by successive governments, especially for the elderly and the handicapped and the inconsistency of preventive measures affecting, most of all, the weaker sectors of society and children.
Lastly, the ICB points out the shortage and inadequacy of dental experimentation conducted on animals, and hopes that dentists will be included among those entitled to animal testing (specifications prescribed by law 413/93 on conscientious objection) it is recommended, however, that the practice of animal testing should be carried out solely for therapeutic purposes.