Synthesis

ETHICAL CHALLENGES IN AESTHETIC DENTISTRY

Marius NEAGU1, Bianca HANGANU2, Magdalena IORGA3, Beatrice IOAN4

1M.D., Ph.D. student, resident physician in Legal Medicine, “Gr. T. Popa” University of Medicine and Pharmacy Iasi, Romania
2
M.D., resident physician in Legal Medicine, “Gr. T. Popa” University of Medicine and Pharmacy Iasi, Romania
3
Ph.D., Lecturer, psychologist, “Gr. T. Popa” University of Medicine and Pharmacy Iasi, Romania
4
M.D., Ph.D., Associate Professor, “Gr. T. Popa” University of Medicine and Pharmacy Iasi, Romania
Corresponding author: [email protected].

Abstract Patients might ask for aesthetic dentistry

Aesthetic dentistry is a branch of dentistry which aims
procedures for various reasons. Some wish to
primarily at improving patient’s physical appearance and, correct their dental aesthetic anomalies for
to a lesser extent, the functionality of teeth. This field raises granting longevity to their teeth. Others ask for
particular ethical dilemmas and requires a careful dental improvement because of their narcissism,
evaluation of patient’s needs and wishes versus his/her
clinical best interests. In this article, the authors discuss the psychological or personality disorders, or
main ethical challenges in the field of aesthetic dentistry in career and social progression. Some of the
the light of the four “classical” principles of bioethics: aesthetic surgery procedures might improve
autonomy, beneficence, non-maleficence and justice. The
the health and function of teeth, while others
authors conclude that the principles of medical ethics
should be at the very foundation of the field of aesthetic are of no benefit or even have a negative effect
dentistry, for establishing a patient-physician relationship upon teeth [5].
which could lead to optimum clinical outcomes, while Aesthetic dentistry raises complex and
respecting the wishes of the patient and promoting his/
her best interests.
difficult questions related to the reasons for
Keywords: ethics, bioethic principles, aesthetics, dentistry. offering a particular treatment option to a
particular patient, the proficiency of the physician
1. INTRODUCTION in carrying out a certain procedure, the risk-
benefit assessment and the correct information
of the patient.
Ethical principles are moral rules to be applied Analyzed in the present study are some of the
for achieving an ethically correct medical practice. ethical dilemmas which emerge in the field of
The four “classical” principles - individual aesthetic dentistry from the perspective of the
autonomy, beneficence, non-maleficence and above-mentioned ethical principles.
justice - are the ideals to be aspired by all health
care professionals, grounded in the core values
2. AUTONOMY
of the medical profession [1].
Ethical standards in modern society need to
be adapted to the rapidly changing situations of In general terms, autonomy is the capacity of
everyday life, in general, and of medical practice, a person for self-governance. In medical practice,
in particular. In the last decade, a body of the respect for autonomy allows the patients to
literature on ethics in dentistry has emerged. make free and informed decisions on their
However, this field is still behind the level of the medical care based on their own values and
ethical debate in general medicine, despite the wishes. Respect for autonomy means, on one
challenges raised by its rapid development [2,3]. hand, providing relevant information to patients
Aesthetic dentistry involves the application of and, on the other, abstaining from inferring their
restorative techniques with the aim of improving choices. The dentist has the duty to inform the
patient’s physical appearance, without targeting patient on his/her treatment options, including
functionality [4]. the risks and benefits of each of them, leaving the

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 ETHICAL CHALLENGES IN AESTHETIC DENTISTRY

patient to make the final decision on the treatment The principles of beneficence and non-
preferred and also on the physician who will maleficence reflect each other and together
provide it [6]. impose to all physicians and, implicitly, to
In dental medicine and in aesthetic dentistry, dentists, the duty to carefully balance the risks
informing the patient may become a difficult and benefits of the medical procedures offered
task, if considering the wide range of materials to their patients for maximizing the former and
and techniques that may be used. At the same minimizing the latter ones [11]. To do so, dentists
time, the physician needs to clearly differentiate have the duty to permanently update their
between the needs and interests of the patient, theoretical and practical skills and also to treat
and make this difference clear to the patient, as the patients within the limits of their professional
well [7]. The wish of the dentist to gain more competence by respecting the current professional
money by recommending a certain expensive standards. They also have to keep in mind and
procedure, despite the best interest of the accept that there are situations in which
patient, and by providing to the latter partial safeguarding patient’s welfare means to send
information on it, in order to grant acceptance, him/her to health care professionals with
superior knowledge, skills or experience [12].
is ethically questionable. This medical attitude
In aesthetic dentistry, respect for beneficence
generates a conflict of interests due to the double
and non-maleficence imposes to minimize the
role of the dentist, as a health care provider and
risks and maximize the benefits associated with
a professional - who runs his/her own private
the medical procedures by choosing the
practice which, on long term, may have a minimally invasive procedures, which are
“boomerang” effect, by affecting the professional associated with lower risks and better results. A
reputation of the physician [8]. relevant aspect in this context is the impact of the
In the field of aesthetic dentistry, the aesthetic dentistry procedures on the general
psychological suffering of the patient is essential health status of the patient. This means, on one
in the decision-making process. However, hand, that the dentist has to collect all relevant
patient’s wishes are not absolute even if, as information about patient’s health condition
showed above, autonomy is a principle of utmost and, on the other, that he/she has to adapt the
importance in medical practice [9]. The dental procedures he applies for minimizing the risks
treatments need to strike the right balance to patient’s health [13]. In cases in which the risks
between the aesthetic aspect of teeth and their of the aesthetic procedures for the health of the
functioning. The dentist has the legal right and patient are significant and unjustified by the
the deontological obligation to refuse to provide expected results, the principle of autonomy will
a certain procedure if he/she considers that it be overshadowed by the duty of the dentist to
will not benefit or even harm the patient and promote the benefit and to minimize the risks to
might further compromise the former’s the patient [14].
professional reputation [10].
4. JUSTICE
3. BENEFICENCE AND NON-
MALEFICENCE Equitable access to health care is a basic
human right, as stated in the UN Universal
Beneficence is reflected in the duty of every Declaration of Human Rights: “everyone has the
health care professional to maximize the good right to a standard of living adequate for health
for his/her patient [11]. and well-being, including medical care and
Non-maleficence derives from the ancient necessary social services” [15]. Theoretically,
requirement Primum non nocere and, in according to the principle of justice, physicians
contemporary practice, obliges physicians to have the duty to make sure that medical care is
avoid doing harm to patients and to protect them available to all people [1,16]. Practically, the
against harm [11]. medical resources are limited, especially for

International Journal of Medical Dentistry 247

Marius NEAGU, Bianca HANGANU, Magdalena IORGA, Beatrice IOAN

expensive medical procedures - such as aesthetic 3. Beauchamp T, Childress J. Principles of Biomedical

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