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Ethical issues and dentists’ practices with children with intellectual disability

Ariane Camoin, D.D.S.,

Abstract –
Background: The provision of dental care for children with intellectual disability raises many
ethical questions.
Objective: The aim of this qualitative study was to explore approaches to dental treatment in an
anxious child with intellectual disability and the ethical dilemmas that ensue.
Methods: Semi-structured interviews were conducted between February and May 2012. A clinical
scenario was used to establish a starting point for a discussion of the clinical approach and lead to an
ethical reflection. Four topics were discussed: first contact with the patient, information, attitude
towards the patient and outcome from the practitioner’s viewpoint. The coding procedure used
thematic content analysis.
Results: Most practitioners fetched the patient from the waiting room personally, greeted them,
gave them special attention, and either began the consultation at once, or used distraction to relax
the patient. Verbal language and tell-show-do were most often used to provide information. Anxiety
and pain were evaluated using parental assessment and standardised scales. A reassuring attitude was
adopted. An ethical dilemma arose if the patient refused care or had to be restrained. Practitioners
reported sacrificing ethical values (patient autonomy, beneficence and non-maleficence) when making
a clinical decision.

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