Question

Your last patient of the day is Luana G., a 16 year old girl, who has...

Your last patient of the day is Luana G., a 16 year old girl, who has Down syndrome. She presents with moderate mental retardation. This is the first dental appointment in her life, as she has a fear of clinical settings, and her parents have not wanted to frighten or upset her. Your clinical exam reveals substantial plaque, biofilm and calculus formation, deep periodontal pockets, and extensive gingival inflammation. Radiographs show severe alveolar bone loss around most of her teeth. There is furcation involvement and some mobility present. There is also extensive cervical decay present on all of her mandibular anterior teeth. Due to Luana’s mental deicis, it is difficult to determine if she experiencing oral discomfort. Half way through your appointment, however, Luana refuses to open her mouth, starts to cry, and rocks back and forth. Her parents say this is her typical behavior when she is upset. How would you classify Luana’s periodontal condition? What ethical principles are in conflict in this dilemma? What is the best way for you to handle this ethical dilemma?

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