this presentation is all about the ethical issues that the orthodontists face, along with the well written informed consent and guidelines that an orthodontist needs to follow.

2. ETHICS
AND
INFORMED CONSENT IN
ORTHODONTICS
PRESENTED BY:
DR. SHREYA KOTISH
PGT 1ST YEAR

3. CONTENTS
• ETHICS
• DENTAL ETHICS
• ETHICAL PRINCIPLES IN ORTHODONTICS
• INFORMED CONSENT
• CONTENTS OF INFORMED CONSENT
• CONCLUSION
• REFERENCES

4. ETHICS
• It is derived from the Greek word ETHIKOS meaning “ Character or
conduct”
• DEFINITION:
As the branch of philosophy, it is the systematic study of what is
right and good with respect to character and conduct.

5. DENTAL ETHICS
• Dental ethics is defined as:
“The moral duties and obligations of a dentist
towards his/ her patients , professional colleagues and society”

6. ETHICAL
PRINCIPLES IN
ORTHODONTICS
TO DO NO
HARM
RESPECT
THE PERSON
JUSTICE
TO DO
GOOD TRUTHFULLNESS
CONFIDENTIALITY

7. TO DO NO HARM
• Another term is non- maleficence
• Considered to be the foundation of social morality.
• Actions of the healthcare provider should not harm
the patients in anyway
• Iatrogenic diseases-doctor induced illness
1. using unsterilized instruments.
2. Iatrogenic diseases ( excessive force, improper
bracket positioning)
3. Doing procedures beyond his competency.

8. TO DO GOOD
• Also known as Beneficence.
• It means maximum benefits to the patient with
minimum harm
• Good cost/benefit ratio.
Beneficence in Orthodontics
By treating patients with camouflage approach,
improvement in their function can be achieved by
establishing good occlusion, thus involving their chief
complaint and getting optimal aesthetics, good stability
with less invasive procedure and less cost.

9. JUSTICE
• Also known as Fairness
• This principle states that Every professional should
provide equal treatment to all patients irrespective of
caste, creed, socioeconomic status and health condition.
• Justice in Orthodontics:
Irrespective of patients lower socioeconomic status,
when she is ready to pay for orthodontic treatment she
has to be treated with camouflage(if surgery is not
compulsory) including retention period. Due to her
socioeconomic status, she should not be rejected from
being treated.

10. TRUTHFULNESS
• Another term used is VERASITY.
• It means that the dentist should communicate
honestly to the patient about the information
given, treatment rendered and the prognosis.

11. CONFIDENTIALITY
• There should be no revealing of the
information by the dentist without the
patients consent
• Except the situation where disclosure is
needed to protect others, the patient
itself and the community.

12. RESPECT THE PERSON
AUTONOMY INFORMED CONSENT

13. AUTONOMY
• Also known as Self –governance.
• It is the principle that dictates that health care professionals respects
patients right to make decisions concerning the treatment plans.
• Dentists usually try to direct the patients toward the particular mode of
treatment by stressing only over the advantages rather than mentioning
disadvantages.
• AUTONOMY IN ORTHODONTICS:
One should not force the patient to go for surgery because of momentary
benefit to the practionor, when she is in need of camouflage treatment
and that what she has chosen.

14. INFORMED CONSENT
It is a process for getting permission before conducting a
healthcare intervention on a person, or for disclosing personal
information.
TWO STEP PROCESS
• Firstly information is presented to the patient by the doctor
• Secondly, the patient satisfies himself or herself that she
understands and based upon this understanding either agrees or
refuses to undergo the treatment.

15. NAME OF THE PATIENT
DATE THE CONSENT IS TAKEN
RESULTS OF THE TREATMENT
LENGTH OF THE TREATMENT
RISK AND DISCOMFORT TO THE PATEINT
DURING THE COURSE OF TREATMENT
PAYMENT DETAILS
CONSENT TO UNDERGO TREATMENT
AUTHORIZATION FOR RELEASE OF PATIENT
INFORMATION
CONSENT TO USE OF RECORDS
SIGNATURE OF THE PATIENT
SIGNATURE OF THE WITNESS
CONTENTS
OF
INFORMED CONSENT

17. 1. NAME OF THE PATIENT
To maintain the records and easy communication with the patient.
2. DATE , THE CONSENT IS TAKEN
For medico-legal purpose
3. RESULTS OF THE TREATMENT
In this it is made sure that the treatment usually proceeds as planned,
however, it is not guaranteed that the patient will be completely satisfied by
the results.
The success of the treatment highly depends upon
• Patients cooperation in maintaining the appointments.
• Maintaining good oral hygiene
• Avoiding loose or broken appliances
• Following the orthodontist's instructions regularly.
THIS WAS ADDED TO THE CONSENT TO AVOID UNREALISTIC
OPTIMISM FROM THE PATIENTS EYE AND TO KNOW THE
PSYCOLOGY OF THE PATIENT

18. WHAT IS UNREALISTIC OPTIMISM?
The prediction that the personal future outcome
will be more favourable than that suggested by a
relevant, objective standard called UNREALISTIC
OPTIMISM.
It is of 2 types:
1. Unrealistic Absolute Optimism: It is an
unfounded belief that the result
of a certain course of action will provide a
result superior to that of an
established quantified standard( e.g..
Epidemiological or base-rate data)
2. Unrealistic Comparative Optimism: It is the
belief that the results of ones
action will exceed or transcend those of the
peers.
PSYCOLOGICAL CONSIDERATIONS
FOR TREATMENT IN ADULTS
A patient who seeks treatment primarily
because he or she wants it(internal motivation)
is more likely to respond well than a patient
whose motivation is the urging of others or the
expected impact of treatment on other
(external motivation). Adult orthodontic patient
fall in the following category:
EXCEPTIONAL PERSONALITY
NO PROBLEM
INADEQUATE PERSONALITY
PATHOLOGIC PERSONALITY

19. 4. LENGTH OF THE TREATMENT
•Length of the treatment time depends upon the severity of the problem,
growth of the patient and patients cooperation
• The actual treatment time is usually close to the anticipated treatment time,
but treatment time may be lengthened.
•If treatment time is extended, additional fees may be assessed

20. 5. RISK AND DISCOMFORT TO THE PATIENT DURING TREATMENT
a) EXTRACTIONS
•Some cases will require
the removal of
deciduous or permanent
teeth.
•Additional risks
associated with removal
of teeth that should be
discussed with the oral
surgeon.
b) ORTHOGNATHIC
SURGERY
• Certain skeletal
disharmonies may
require orthodontic T/T
and orthognathic
surgeries.
• Additional risks
associated with the
surgery should be
discussed before the
beginning of the
treatment.
c) DECALCIFICATION
AND DENTAL CARIES
•Oral hygiene if not
maintained during
orthodontic treatment, it
could result in cavities,
discoloured teeth,
periodontal disease
and/or decalcification, as
the risk is greater to an
individual wearing braces
or other appliances.
•Aggravated by consuming
sweetened beverages or
foods

21. d) ROOT RESORPTION
•The roots of some
patients undergo root
resorption during
treatment.
•Cause not known
•If observed during
treatment, your
orthodontists should
pause or remove the
appliance prior to the
completion of
orthodontic treatment
e) NERVE DAMAGE
•Orthodontic tooth
movement may
aggravate the condition
of nerve damage which
occur by the already
decayed or traumatised
tooth.
•In some cases, tooth or
teeth may be lost
f) TEMPORARY
ANCHORAGE
DEVICES
•Temporary anchorage
devices include metal
screws or plate attached
to the bone
RISKS:
1. Screws may become
loose, so they need to
be relocated or
replaced by larger
screws, otherwise are
accidently swallowed
2. Tissue around the
plate may get
inflamed, so should
be treated by surgical
excision or antibiotic
or antimicrobial
rinses.
OTHER RISKS AND
DISCOMFORTS ARE:
•INJURY FROM
ORTHODONTIC
OR ORTHOPAEDIC
APPLIANCES
•RELAPSE
• TMJ
DYSFUNCTION
•THIRD MOLARS
ERUPTION
•ALLERGIES
•GENERAL HEALTH
PROBLEMS
•PERSONAL HABITS

22. 6. PAYMENT DETAILS
To make the patient aware that the payment made to the Orthodontist
does not cover
• The treatment provided by other dental professionals
(extractions, oral prophylaxis) or medical professionals
•Cost of the treatment when patient is referred to the dental or medical
specialist, if any complications occur
7.CONSENT TO UNDERGO ORTHODONTIC TREATMENT
It is the affirmation that the patient is ready for treatment, is ready
to make the diagnostic records (X-rays) and has understood the risks and damages
associated with the treatment.

23. 8. AUTHORIZATION FOR RELEASE OF PATIENT INFORMATION
In this the patient gives the authority to the concerned doctor to release
his personal information if its necessary.
9. CONSENT TO USE THE RECORDS
In this the patient permits the orthodontist to use his/her orthodontic records,
Including photographs, made in the process of examinations, treatment, and
Retention for purposes of professional consultations, research, education, or
publication in journals.
10. SIGNATURE OF THE PATIENT, WITNESS and concerned ORTHODONTIST with DATE

24. CONCLUSION
• Healthcare is not a business.
• It is the duty of the dentist to promote and safeguard the health
of the people.
• Keeping the ethical principles in mind, it is not that we give
simple moral justification in our duty but also following these
ethical principles we will protect us legally being a professional in
providing health care with the best possible way to our
community.

25. REFERENCE
• Anusuya V, Amit Nagar. Ethical issues in clinical orthodontic practice.
Indian Journal of Orthodontics and Dentofacial Research, April-June
2016;2(2):87-89
• Informed Consent for the Orthodontic Patient: Risks and limitations of
Orthodontic Treatment: American Association of Orthodontics
• James A. Shepperd, Erika A. Waters, Neil D. Weinstein and William M.P.
Klein. A Primer on Unrealistic Optimism: Association of Psychological
Science.2015
• Caroline E. Pawlak , Henry W. Fields Jr., F. Michael Beck, and Allen R.
Firestone. Orthodontic informed consent considering information load
and serial position effect. American Journal of Orthontists.2015.11.021
• Contemporary Orthodontics, 6th Edition, William R. Proffit.