Dental Ethics -- \"No Antibiotics

DENTAL ETHICS -- "NO ANTIBIOTICS NEEDED for DENTAL TREATMENT"

Ozar and Sokol-Based Ethical Analysis

According to Ozar and Sokol, their ethical framework for analysis and resolution of ethical dilemmas in dentistry considers the following specific issues and ranks their relative importance in the same order: First, the life and general health of the patient; second, the oral health history of the patient; third, patient autonomy; fourth, preferred practice values of dentists; fifth, esthetic values; and sixth, resource efficiency. There is no question that the Ozar-Sokol analysis requires the dentist to oppose the general practitioner's orders.

First, it is well-known that various acute and systemic infections, such as those capable of being caused by streptococci and staphylococcus bacteria are on a dramatic rise in the United States, particularly in connection with antibiotic-resistant strains. Because clinical experience and empirical research have conclusively established that, despite complete protocol compliance, invasive dental work (and other surgery more generally) can provide opportunities for bacterial infection, it is good general practice to prescribe a broad-spectrum antibiotic before invasive procedures. Since there is no question that it is in every patient's best interest to avoid unnecessary post-surgical complications and infections, the first Ozar-Sokol issue requires prophylactic antibiotic treatment.

Second, the oral health history of this patient is largely irrelevant to this particular dilemma, at least where that history is devoid of prior infectious complications. In that case, the first Ozar-Sokol principle requires antibiotics. However, if the patient's oral health history included any previous infections, the second Ozar-Sokol principle would become directly relevant and absolutely require prophylactic antibiotic treatment.

Third, patient autonomy is not directly relevant to this dilemma, only because the matter concerns different clinical judgment by practitioners. However, patient autonomy could be incorporated into a possible solution by explaining in detail the specific concerns of the dentist and the empirical justification for prophylactic antibiotic treatment. The patient would then have the autonomous right to demand antibiotics from the general practitioner.

Fourth, the dentist's preferred practice is not relevant in this dilemma and could not, for example, justify prescribing antibiotics where the potential negative consequences of their use outweighed their purpose. With respect to this principle, the combined application of principles 1 through 3 would override most concerns or rights arising in connection with Principle 4. Fifth, aesthetic values are equally inapplicable to this particular dilemma. Finally, sixth, resource efficiency also militates for the use of prophylactic antibiotics. By comparison, the cost savings attributable to the avoidance of a single instance of preventable bacterial infection could be anywhere from ten times to several thousands of times the cost of providing prophylactic antibiotic treatment before surgery. Together with the rest of the Ozar-Sokol analysis, this principle also requires deferring to the dentist.