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Ethical Questions in Dentistry

Article · January 1993

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 Book Reviews
Ethical Questions in
Dentistry, 2nd ed.
James T. Rule, D.D.S., M.S., and
Robert M. Veatch, Ph.D.
Chicago: Quintessence Publish-
ing, 2004. 340 pp., indexed.
$35.00 paperback
ISBN 0-86715-443-8
Reviewed by:
Robert B. Stevenson, D.D.S.,
M.S., M.A., Clinical Assistant
Professor, Department of Restor-
ative and Prosthetic Dentistry, The
Ohio State University College of
Dentistry, 305 West 12th Ave.,
Columbus, OH 43218-182375;
Stevenson.113@osu.edu.
1200
Ethical Questions in Dentistry, 2nd ed., presents a detailed over-
view of ethical theory and principles followed by eighty-eight clinical
dentistry cases in which the moral or ethical obligations of professionals
are in conflict and where arguments for differing courses of actions can
be made. Readers are asked to determine the ethically correct response to
such conflicts based on ethical reflection. The book is suitable for dental
care providers at all levels.
The authors begin with discussion of basic ethics, including the struc-
ture of professions and the professional’s responsibilities, morality, and
values. Then they provide a protocol or format for resolving ethical ques-
tions based on ethical principles and reflection. The clinical cases are grouped
and discussed in a manner to help illustrate specific ethical ideals.
The first edition of Ethical Questions in Dentistry (1993) noted that
some dental schools did not offer courses in ethics and that many that did
emphasized jurisprudence. The book is intended to offer a “general ap-
proach to ethical reasoning in dental-related problem solving . . . to either
the dental practitioner or the dental student.” Many consider the first edi-
tion to be the first-ever textbook devoted to dental ethics.
The second edition contains twelve new cases that invite discussion
on licensure, access to care, corporate sponsorship of graduate education,
sexual harassment, advertising, and financial and HIV issues. An entirely
new chapter on professions serves as a frame of reference. While there is
still no consensus about what a profession actually is, the authors have
added two new aspects to the first edition’s definition, including self-regu-
lation and collegial discipline. Great emphasis is again placed on the fidu-
ciary relationship between doctor and patient, in which “mutual expecta-
tions of trust are expected.”
Clinical cases in part two illustrate general ethical principles such
as doing good (beneficence), avoiding harm (nonmaleficence), fidelity,
honesty, justice, and autonomy. Part three case studies involve special
problems with issues in third-party financing, HIV and other blood-borne
diseases, ethical concerns in schools of dentistry, and dealing with incom-
petent, dishonest, or impaired professionals.
The subject of fee-splitting is mentioned in the first edition but for
some reason is absent in the second edition. Fee-splitting can take the
form of lavish gifts or unduly generous favors as well as kickbacks and
under-the-table payments. In effect, the referring dentist or referral ser-
vice “sells” patients to the highest bidder. Withholding information from
patients about any fee-splitting arrangements would seem to compromise
the dentist’s veracity as well as obstruct the patient’s ability to render
completely informed consent. The ADA Code mentions unethical fee-
splitting twice, in Section 4.E and Section 5.F.4.
The first appendix contains the Hippocratic Oath, the preamble to
the American Medical Association Code of Ethics, and the complete ADA
Principles of Ethics and Code of Professional Conduct, including advi-
sory opinions revised to January 2004. The second appendix presents a
legal perspective of informed consent to complement chapter eight, which
Journal of Dental Education ■ Volume 68, Number 11

Mosby’s Dental Drug
Reference, 6th ed.,
Handheld Software
edition
Tommy W. Gage, R.Ph., D.D.S.,
Ph.D., and Frieda Atherton
Pickett, R.D.H., M.S.
St. Louis: Mosby, 2003. Illus.,
indexed. $38.95
Reviewed by:
Tracy M. Dellinger, D.D.S., M.S.,
F.A.G.D., F.A.A.H.D., Associate
Professor, Department of Ad-
vanced General Dentistry, Univer-
sity of Mississippi School of Den-
tistry, 2500 North State St.,
Jackson, MS 39216-4505;
tdellinger@sod.umsmed.edu.
November 2004 ■ Journal of Dental Education
deals with issues of autonomy. The requirements of an “Adequate In-
formed Consent” are provided courtesy of Roger L. Eldridge, D.D.S.,
J.D., University of Maryland Dental School.
A glossary provides convenient reference for sixty-eight relevant
terms and is helpful for those who encounter terms such as deontologism,
consequentialism, and normative relativism for the first time.
The book is well supported by references at the end of each chapter.
The first four chapter bibliographies total 121 citations, and the remain-
ing ten chapters include more than 100. The book’s table of contents is
available for online viewing at the publisher’s website, www.quintpub.com.
Overall, the book is well written and highly readable. The size of
print is slightly larger than in the 282-page first edition. Page size has
increased in the second edition, now eight by ten inches, with wider mar-
gins for notes. Case studies and discussions are set off in light blue screen,
which helps distinguish them.
The book is not illustrated other than photos of the authors, but the
addition of blue print for clinical cases makes it more colorful than the
first edition. The paperback binding is sturdy and attractive. The text is
suitable for pupils of dental ethics at every level, from dental students and
patients to faculty and board examiners.
Ethical Questions in Dentistry, 2nd ed., is certainly appropriate for
a communal dental library and highly recommended for any conscien-
tious dental team member. Keep it chairside for quick reference to per-
plexing ethical predicaments.
Mosby has delivered a dental drug reference that is light, portable,
and teeming with pertinent information for the dental professional. Based
on the preceding sentence alone, the reader may assume that this is a
valuable asset to each dental reference library. However, there are some
drawbacks to utilizing a personal handheld device for reference material,
as well as the software that is developed for it. Mosby has gone out of its
way to make the format user-friendly and informative. The publisher has
also set the cost of the hand-held program to be comparable with its pa-
perback edition of the same name. This is an advantage when compared
to drug reference materials, which are currently available from other
sources, such as Lexi-Comp or ePocarates.
Initial start-up costs must be considered for the dental professional
planning on utilizing this drug reference. The program is provided on a
CD-ROM that must be run on a Windows-based computer system with
Internet connection. The drug reference is in an eBook format accompa-
nied by its own reader program, Mobipocket Reader 4.6. The start-up
CD-ROM requires the user to register both the Mobipocket Reader pro-
gram and the Mosby’s Dental Drug Reference, 6th ed. This security feature
helps prevent pirating via duplication or multiple users on a single valid
license. Once registered, the programs may be saved to the user’s handheld
device (also referred to as a personal digital assistant or PDA) via a syn-
chronizing mechanism. The programs are compatible with a variety of
PDA platforms, including Palm and Pocket PC formats. Handheld de-
vices range in price from $80 to $800, depending on the internal memory,
1201
 programming platform, and capabilities of the PDA. This review utilized
a Palm m505 (which can be purchased for less than $100) consisting of
8mb internal memory, color screen, and an SD card expansion slot. Due
to the memory requirements of the programs, both the reader program
and the drug reference were saved and utilized from an SD card.
Once opened, the drug reference may be navigated by various meth-
ods. As with the printed version, Mosby’s Dental Drug Reference, 6th ed.
allows the reader to search by brand/generic name and appendices listing
medications that affect taste and xerostomia or are herbal/nonherbal rem-
edies. Additionally, the handheld version contains navigation tools based
on drug classes and therapeutic/pharmacologic categories. This informa-
tion is well cross-referenced and easily navigated via keyboard typing of
a drug’s name or touchpad “tapping” on a drug via its brand name, ge-
neric nomenclature, drug class, or therapeutic index. Once the user is com-
fortable with navigation throughout the program, drugs may be evaluated
by various subtopics, including action, usage, dosage and routes, side ef-
fects, contraindications, precautions, pharmacokinetics, drug interactions
related to dentistry, dental considerations, and brands and classes. Leg-
ibility of the data is enhanced by the multicolor format and font selections
that allow the reader to pick a size/format that is most comfortable for the
user. The hand-held adaptation differs from the paperback edition by
omission of the weights and equivalents, local anesthetic calculations,
and dose/weight calculations charts commonly found in the printed ver-
sion.
Overall, I would give Mosby’s Dental Drug Reference, 6th ed. for
Handheld Devices a mixed review. It is an informative tool for any dental
professional who is comfortable with handheld devices. Mosby sets a high
standard when compared with other drug reference sources by providing
supplemental information specifically geared towards dental profession-
als. However for those users who have never utilized a PDA previously,
significant time is necessary to become comfortable with the navigation
and utilization of the software. A drawback that will be noticed by the
experienced PDA user will be the lack of periodic drug updates. The drug
reference is static unless a newer edition is purchased and downloaded.
Another drawback is that many of the drug reference functions are tem-
porarily disabled if the program is removed from the PDA. This is of
significance for those users who save the program to an external memory
card instead of the internal handheld device memory. Correction of the
problem requires additional synchonization of the Mobipocket Reader
with the www.mobipocket.com website whenever the memory card is re-
placed into the PDA.

1202 Journal of Dental Education ■ Volume 68, Number 11

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