Ethics and orthodontics - it depends on the perspective
Background: It is essential that patients are provided with optimal orthodontic care. A requirement of the provision of optimal care is that it occurs in the presence of the highest standards of professional and ethical conduct. Clinicians are bound by codes of professional conduct to maintain registration with health practitioner regulatory bodies. In addition, clinicians require the ability to overcome ethical challenges with which they may be confronted in the delivery of care. By ensuring that relevant high standards are met, the terms of a social contract can be honoured, and patient safety is assured. The objective of the research presented in this thesis was to determine professional and ethical conduct from the perspective of several aspects of orthodontic treatment provision. Method: Nine cross-sectional studies and one scoping review were undertaken to explore aspects of professionalism and ethics from the perspective of the orthodontic patient, the dental student, the orthodontic clinician, the postgraduate orthodontic student, the regulator, commerce and the publication and reporting of orthodontic research. Results: The findings suggested that moral reasoning skills among undergraduate dentistry and postgraduate orthodontic students were lacking. The findings also indicated that the content of informed consent forms regarding clear aligner therapy and orthodontic retention were suboptimal and that practice websites representing most Australian-based orthodontists failed to comply with advertising law pertaining to the provision of a health service in Australia. The results from a further study found that the information provided in the websites of orthodontic product providers were incomplete and inaccurate, and the findings from a bibliographic investigation indicated that conflict of interest and funding information appears to be underreported in studies contained within orthodontic journals. Furthermore, dissatisfaction expressed by patients about aspects of orthodontic clinical care provision was recorded in the scoping review and one study in the present thesis. Conclusions: The findings from the studies in the present thesis indicated that there are deficiencies in the ethical and professional standards required in the provision of optimal orthodontic care. This is likely to have a deleterious impact on patient care. Educators and the profession should reflect on the findings to enable consideration of how best to ameliorate professional and ethical conduct in the provision of orthodontic care.
Dentistry, ethics, informed consent, moral reasoning, orthodontics, professionalism
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