Managing Pediatric Dental Patients: Issues Raised by the Law and Changing Views of Proper Child Care

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 9/18/2009
Article title: Managing Pediatric Dental Patients: Issues Raised by the Law and Changing Views of Proper Child Care
Author(s): Bross DC
Journal: Pediatric Dentistry
Volume (number): 26:2, 125-30, 2004
Major topic: Behavior Management Case Law
Type of Article: Editorial
Main Purpose: This article discusses legal issues relating to behavior management of pediatric dental patients and changing views of proper child care in a dental practice setting.
Materials and Methods: N/A
Findings: The laws relating to pediatric dentistry determine standards of care and also include changes in public expectations of reasonable care. The legal decisions can dictate how the standards of care change for pediatric dentists. Also reports of child abuse on mistreatment have sensitized patients and parents which necessitates that we make our decisions based on new research and thoughtful anticipation of improvements in care of children. Informed consent is evolving from the litigious 1960’s and 70’s to a document that represents “what a reasonable patient in the same or similar situation would want to know about the risks and benefits to the child before consenting to treatment.” Surveys indicate lack of use of informed consent for behavior management techniques and pharmacologic management. While it is agreed that many behavioral interventions are so benign as to not need consent, sedation and costs on the other hand need informed consent. Standards of care occasionally depart from what is acceptable to parents and pediatric dental patients like Hand Over Mouth Airway Restricted. Without an informed consent describing probability of success and risks of adverse effects, the dentist is at serious liability risk. Pharmacologic management has been shown to need informed consent. It is important that in the case of general anesthesia risks such as brain damage and death are listed even thought the probability is low. It is suggested that more research is needed to provide information about the effects of behavior management, as well as the safety of general anesthesia.
Key points/Summary : In summary, the author suggests that there is a change in paradigm from the dentists understanding of what is good for the patient to what the patient or parent deems acceptable. Research is needed to study evidence as to what is stated is good is actually good treatment. The goal is to provide the most benign treatment with the least negative consequences to achieve quality health care to children
Assessment of article: Poor article written by a lawyer with little or no knowledge of what it takes to treat children. I think that it is important that the dental clinician get involved in determining what is acceptable care so that legal bureaucrats do not mess things up.