Your next patient, Josiah S, has recently relocated to your town, approximately 6 months ago, and is a new patient to your practice. He is a 45 year old divorced male, who admits to smoking approximately 15 cigarette per day, and drinks a night alcoholic cocktail. He works in sales, and due to his hectic travel schedule, tells you that he has had to cancel his last few dental hygiene appointments.
Your intraoral exam reveals that Josiah presents with moderate calculus and plaque biofilm. His gingival tissue appear red and swollen, have blunted papillae, and bleed readily upon palpation. You take a full mouth series of radiographs that show generalized horizontal bone loss throughout his mouth. You begin to probe his mouth, to determine his pocket reading when he sits up in the dtal chair and demands that you stop. He states that he has always refused periodontal probing, as he just “can't stand the pain” and that the last dental office abided by his wishes. He refuses to let you continue “poking around his gums” and ask that you just proceed to cleaning his teeth, so he can be on time for his 11:00 am business appointment.
How would you classify Josiah’s periodontal conditions?
What ethical principles are in conflict in this dilemma?
DO you have an ethical obligation to treat this patient?
What is the best way to address/discuss Josiah’s treatment plan with him?
What, if any alternatives, can you offer Josiah in terms of his treatment plan?
Answer :
Josiah is suffering with periodentitis .
Periodentitis : periodentitis is a inflammatory disease of supporting tissue of teeth caused by specific micro organisms or group of specific micro organisms resulting in progressive destruction of periodental ligament and alveolar bone with product formation ,recession or both .
It is a infectious disease resulting in inflammation eithin the supporting tissue of the teeth ,progressive attachment loss and bone loss.
Ethical principles :
Whatever reason for refusing treatment ,We must understand that patients do have the right of refusal
Patient have the right to seek treatment from their dentist of choice and doctors have right to treat patients of their choice ,with in bounds of human rights legislations .
Dentist can take signature from patient that he is refused for treatment after explaining about disease prognosis ,treatment etc .
Yes ,we have ethical obligations to treat patient
If the patient refuses recomnended treatment and take signature in informed refusal form or chart notes , this notion should be made : patient refused recommendations for treatment of periodental disease .
Treatment plan :
Provision of alternate treatment ,it is not ideal treatment ,possibly a temporary crown or a large restoration .
Debridement is a alternate treatment option for the patient who refuses periodental treatment . There is no harm in it ,and certainly no risk to license ,as long as the documentation is thorough .
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