Vol. 13 – Number 51 – 2020
Original article
Page 82-89
Ethical and bioethical dilemmas in evidence based preventive and interceptive Orthodontics indication
Ivan Toshio Maruo¹
Abstract
Objectives: The aim of this study was to analyze whether in face of “Evidence-Based Dentistry”, it would be ethical for the dentist, regardless of his/her specialty, to perform preventive and interceptive orthodontic treatments in children and adolescents. Methods: Prevalence of different malocclusions in deciduous, mixed and permanent dentition, laws related to dentists’ competences in Brazil, and results of systematic reviews and of meta-analyses
on comparing orthodontic treatment effectiveness in 1 or 2 phases were analyzed by the ethical references of “willingness-permission-duty” and the bioethical principles of “autonomy”, “beneficence”, “non-maleficence” and “justice”. Results and Final Considerations: It was concluded that: 1) High prevalence of malocclusions in deciduous, mixed and permanent dentition justifies dentists willingness to treat them; 2) According to Brazilian law, General Dentist, Pediatric Dentist, Orthodontist and Jaws Functional Orthopedist have legal permission to treat malocclusions in children and adolescents; 3) According to the bioethical principles of non-maleficence, beneficence and justice, the ethical dentist should only indicate preventive and interceptive orthodontic treatment for certain types and severities of malocclusions, considering psychosocial aspects involved and the patients maturity and parental awareness; 4) By the bioethical principle of autonomy, the legal representative of the growing patient with malocclusion must be informed about scientific evidence for and against preventive and interceptive orthodontic treatment by means of Informed Consent, in order to be able to decide whether he/she wishes the patient to be submitted to this procedure.
Descriptors: Preventive Orthodontics, evidence-based Dentistry, dental ethics, bioethics, informed consent.
¹ Master and Doctor in Orthodontics – PUCPR, Graduated by the Brazilian Board of Orthodontics and Facial Orthopedics.