Browsing by Author "Du Toit, J."
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Item Ethical issues in replacing a single tooth with a dental implant(South African Dental Association, 2014) Naidoo, Sudeshni; Du Toit, J.A general dental practitioner experienced in the placement of dental endosteal implants attends to a 32-year old female patient at her first consultation and treatment planning visit. The patient's oral hygiene was exemplary, her dentition restoration free except for the left central incisor which was non-vital following trauma several years earlier. The tooth had internal resorption, was mobile, had a resorbed apex, was symptomatic, and is by the practitioner's judgement indicated for extraction. The dilemma then was, what were the options for tooth replacement? Treatment options included: a removable partial prosthesis with a single tooth (acrylic, chrome cobalt), fixed multi-tooth partial prosthesis (porcelain, composite, porcelain-metal), fixed single tooth (porcelain, porcelain-metal), or an endosteal implant - supported crown (screw retained, cement retained). The dentist recommended extraction and immediate placement of an implant with a provisional crown. The patient was not comfortable with the idea of having a 'titanium screw' in her jaw and expressed her deep-seated fear of dentists. The cost of this treatment option was also a concern but she was grateful to be able to have the treatment in a single visit and leave without a missing front tooth. At an appointment soon thereafter, the incisor was removed an endosteal implant placed together with an implant provisional tooth in place.Item Minor's request for confidentiality(South African Dental Association, 2014) Naidoo, Sudeshni; Du Toit, J.Following uncomplicated root canal treatment on a lower molar tooth, the 14 year old patient presented a few weeks later, together with her mother, complaining about an ulcer on her palate. Her mother assumed the lesion was related to the earlier dental treatment. On examination, the ulcer on the palate appeared to be a syphilitic chancre. I informed the patient that I did not think that the lesion was related to the recent RCT but rather looked very much like a sexually transmitted lesion. I then carefully asked if she had recently had oral sex and she said "Yes, with my boyfriend, but please do not tell my mother!"Item Planning for treatment ethically(South African Dental Association, 2014) Naidoo, Sudeshni; Du Toit, J.While dentistry remains firstly a health profession, it is naive and unrealistic not to realise that business considerations and financial compensation for services rendered play an important role in achieving a successful private practice. A fundamental principle of professional ethics in healthcare is that serving a patient's best interests should always take precedence over any consideration of profit or personal gain. George Merck, the founder of Merck Pharmaceuticals said 'Medicine is for the patient, not for the profits. The profits follow'..., the same can be said for dentistry. However, since dentists are in a position to gain financially from their professional recommendations, there is a risk of their having a conflict of interest, whether actual or perceived.Item Unanticipated treatment complication and legal recourse(South African Dental Association, 2015) Naidoo, Sudeshni; Du Toit, J.A middle - aged, partially edentulous Caucasian female patient presented to a general dentist for extraction of a mandibular tooth. The tooth was removed by the dentist, but following incomplete resolution of pain the patient returned three months later for a consultation. The dentist diagnosed an abscess following radiographic investigation and referred the patient to a specialist who diagnosed a fracture of the mandible. The fracture had occurred unbeknown to the dentist and was consequently treated by a reduction procedure. The patient has since pursued legal action against the dentist.Item Xenografts and Religious beliefs(South African Dental Association, 2014) Naidoo, Sudeshni; Du Toit, J.A 24-year old Hindu female presented with missing central incisors and grossly decayed lateral incisors. Her options were varied - to have a fixed partial denture, removable partial denture, or an implant supported prosthesis/prostheses. From the initial consultation, she decided that once the teeth were extracted she would prefer dental implant placement. She did not want a partial denture because she felt she might have difficulty with self maintenance and was not confident with the aesthetics it might offer. She specifically wanted independent tooth replacement. Upon extraction of the lateral incisors, a full thickness flap was elevated, revealing an anterior maxillary ridge too deficient in bone to accommodate the planned dental implants. It was explained to the patient that bone was lacking in the area and that an additional augmentation procedure would be required. This would entail a bone block harvested from her ramus, fixed in place at the implant site and packed with bone particulate. The patient, though hesitant to have additional and extensive surgery, felt obliged to continue on the clinician's recommendation. The bone block was fixed in place and bone particulate, harvested from the patient's upper jaw, was combined with bovine bone particulate and packed between the block and placed implants. A membrane of porcine pericardium stabilised the graft, the wound was closed and the patient left to heal for a period of 8 months. She was not informed about the fact that some of the components of the graft were of animal origin.