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Background: Nondental factors (ie, financial, psychological, or cultural considerations) can play a role in extraction requests. The purpose of this study was to investigate whether patients' perspectives on extraction without a valid clinical indication align with those of practitioners., Methods: Dentists from 3 centers for special oral health care, oral and maxillofacial surgeons (OMFS) from 3 hospitals in the Netherlands, and their patients participated in this prospective observational study. Patients 18 years and older who requested extraction of permanent teeth other than third molars were included. Patients, dentists, and OMFS completed questionnaires., Results: A total of 21 dentists and 20 OMFS participated in this study. Among 192 dental patients and 572 patients from OMFS, patients reported nondental reasons more often (7.1% of dental patients, 3.5% of OMFS patients) than professionals (1.6% of dentists, 1.7% of OMFS). Of all extraction requests, 96.4% were granted. Extraction was not performed if both practitioner and patient cited only nondental reasons., Conclusions: Although dentists and OMFS received few requests for extraction on purely nondental grounds, patients were more likely to report extractions driven solely by nondental factors than practitioners., Practical Implications: The absence of extractions executed purely on nondental grounds is a reassuring finding, as it dovetails with the ethical principles that dental care professionals must adhere to., Competing Interests: Disclosures None of the authors reported any disclosures., (Copyright © 2025 American Dental Association. Published by Elsevier Inc. All rights reserved.)

A recent survey indicates 49% of this journal's subscribers endorse the administration of cosmetic injectables by properly trained dentists. Given the surging demand for cosmetic treatments, it's essential to establish clear guidelines and conventions defining the roles of the various healthcare professionals in various situations. There is, however, considerable discussion still and from a legal standpoint, the role of dentists within cosmetic medicine remains ambiguous. Under the Dutch Individual Healthcare Professions Act (Wet BIG), dentists are authorized to administer cosmetic injectables exclusively for dental purposes. However, based on the content of current dental training, one might argue that dentists' authorization could be extended to include facial injectable treatments in the entire face, in future. Presently, it is prudent for general practice dentists to abstain from cosmetic procedures with cosmetic injectables without a specific (aesthetic) dental objective.

Objectives: This study pertains to a secondary data analysis aimed at determining differences between oral and maxillofacial surgeons (OMFSs) and dentists handling dental extractions without an evident clinical indication., Study Design: A survey of 18 questions was conducted among 256 OMFSs in the Netherlands and a random sample of 800 dentists Respondents could answer the questions in writing or online. The data was collected in the period from November 2019 to January 2020, during which two reminders were sent. Analysis of the data took place via descriptive statistics and Chi Square test., Results: The response rate was 28.1% (n = 72) for OMFSs and 30.3% (n = 242) for dentists. In the past three years, 81.9% (n = 59) of the OMFSs and 68.0% (n = 164) of the dentists received a request for extraction without a clinical indication. The most common reasons were financial and severe dental fear (OMFSs: 64.9 and 50.9% vs dentists: 77.4 and 36.5%). Dentists were significantly more likely (75.6%, n = 114) than OMFS (60.7%, n = 34) to comply with their last extraction request without a clinical indication. Almost none of them regretted the extraction afterwards. As for the request itself, it was found that 17.5% (n = 10) of the OMFSs and 12.5% (n = 20) of the dentists did not check for patients' mental competency (p = 0.352)., Conclusions: Given that most of the interviewed dental professionals complied with non-dental extraction requests when such extractions are ethically and legally precarious, recommendations for handling such requests are greatly needed., Competing Interests: The authors whose names are listed certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright: © 2023 Broers et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The purpose of this study was to determine how often dental patients request extraction for nondental reasons and how dentists handle such requests., Methods: The authors conducted a survey among 800 Dutch dentists from November 17, 2019, through January 5, 2020. The questionnaire contained 17 items, including a hypothetical case vingette., Results: A total of 242 dentists responded to the survey (response rate was 30.3%, 48.3% of respondents were women, and mean [standard deviation] age was 45.3 [11.8] years). Sixty-eight percent of respondents reported that they had been confronted with a request for extraction on nondental grounds in the past 3 years. One-half of these dentists received such a request 5 times or fewer, 21.3% received such a request 6 through 10 times, 11.3% received such a request 11 through 20 times, and 8.8% received such a request 21 through 30 times. Their most recent request concerned a financial reason (49.7%), a combination of psychological and financial reasons (27.7%), a psychological reason (18.2%), or another reason (4.4%). Most dentists (87.5%) evaluated the patient's competency to make health care decisions. Of all nondental extraction requests, 75.6% (n = 114) were granted. Only 4.0% (n = 6) of the dentists regretted the extraction. Most dentists (82.0%, n = 191) would have refused the extraction in the hypothetical case vignette., Conclusions: Nondental requests for extraction are relatively common. Although dentists are reluctant in theory, they are likely to grant such requests in everyday practice, particularly if the patient cannot afford an indicated conservative treatment., Practical Implications: Dentists should keep in mind that they cannot ethically or legally be required to perform an intervention deemed harmful, even if an autonomous patient made the request., (Copyright © 2022 American Dental Association. Published by Elsevier Inc. All rights reserved.)

The character of a consent for treatment is not a mere hobby for lawyers; it also has consequences in daily practicein the Netherlands, particularly if it concerns questions of who should prove what in proceedings. In general, consent agreements can be divided into an obligation to achieve results and an obligation to use reasonable endeavours. In oral healthcare, there is usually a question of an obligation to use reasonable endeavours, in which professional standards must play a leading role in the behaviour of the dentist; and here there have been a number of recent developments, such as an increase in the number of (clinical) guidelines and the acceptance of wish fulfilling medicine, under strict conditions. It is concluded that recent developments in the dentist's requirement to provide evidence in proceedings have definitely not made things simpler.

Objectives: to explain the practice of wish-fulfilling medicine and how it relates to dentistry., Sources: Relevant papers, and reports from authoritative institutions were identified in Pubmed and Google Scholar., Results: Wish-fulfilling medicine refers to services provided by professionals using medical methods in a medical setting to address non-medical wishes of patients. Care-providers, medical industries, and health-insurance companies also contribute to wish-fulfilling in medicine and dentistry. Various concepts of health and illness compounded by blurred borders between health and illness offer an unstable foundation for wish-fulfilling medicine, and growing demands for these services where healthcare resources are limited can displace medically necessary treatments. Moreover, treatments without a medical or a dental necessity, can be harmful and bear the risk of futile or excessive treatments not in patients' long-term interest. Examples in dentistry are found in the field of cosmetic interventions, prosthodontics and orthodontics, where perceptions of small 'deviations' from normality prompt wishes or recommendations for intervention. Ethically, wish-fulfilling services confront the principles of the common morality if the autonomy of a patient is compromised, beneficence is unclear, harm is foreseeable, or distributive justice is compromised. Wish-fulfilling dental treatment can be restricted by legislation if it conflicts with safe, effective and efficient care, or if it interferes with patient's real needs or undermines established professional standards., Conclusions: The general understanding of wish-fulfilling medicine including its ethical and legal themes is relevant to dentistry., Clinical Relevance: Ethical considerations and legislation can guide a dentist to reflect critically on clinical decisions regarding wish-fulfilling dentistry., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Coinciding with an increasing tendency of professionals to cross national borders, there is also an increasing need to harmonise curricula. In dentistry in Europe, this tendency is undiminished. By defining international curriculum requirements for dentists, international harmonisation can be strengthened. In the Netherlands, too, harmonisation with European standards has taken place in establishing final achievement levels for dentistry curricula, as defined in a national framework. In a working environment where oral health professionals are confronted with rapid change, for example, in the division of responsibilities, future caregivers should have an optimal educational preparation for their competences, skills and expertise.

Wish fulfilling medicine (human enhancement (therapy)) concerns medical treatment without a direct medical need. In traditional medicine, a classical triad applies: 1. after investigation symptoms of illness lead to 2. a diagnosis, followed by 3. a proposal for treatment by the health care provider. In wish fulfilling medicine, the emphasis lies on patient's wishes. Wish fulfilling medicine concerns medical treatment, often at the request of the patient, and should be distinguished from shared decision-making,a form of communication seeking to meet the preferences of the patient and to actively involve the patient in his treatment. In the Netherlands, in accordance with the Healthcare Quality, Complaints and Disputes Act, health care providers have to offer good care at a good level, which is safe, effective, efficient and client-orientated, offered in a timely fashion and geared to the real needs of the client. Good care has to meet professional standards. In this way, fulfilling patients' wishes for treatment without a medical need can be restricted by law.

Wish fulfilling medicine comprises medical procedures applied without a direct medical need. In such procedures, the medical-ethical principles can come under pressure: the autonomy of the patient, when wishes originate from social pressure; beneficence when the (underlying) aim and consequences are unclear; and 'doing no harm', when that appears to be impossible. The principle of justice, too, could come under threat when especially those with a privileged socio-economic background can take advantage of wish fulfilling medicine. Regardless of whether it concerns wish fulfilling medicine or conventional medicine, respect for human dignity and the individual integrity of the patient continue to be paramount. In care ethics and moral ethics, the qualities necessary in a proper caregiver are emphasised, such as caring, compassion, commitment, honesty and personal dedication. Wish fulfilling medicine is the subject of significant ethical debate. Important aspects arising from this debate are that the risks of harm should be limited, human dignity and integrity should be respected, people should genuinely be helped and the principle of justice should be upheld.

Wish fulfilling medicine refers to medical procedures applied without a direct medical need. In wish fulfilling medicine, the wish of the patient is dominant, but wish fulfilling medicine is also promoted indirectly by healthcare providers, (pharmaceutical) companies and healthcare insurers. Wish fulfilling medicine often concerns the enhancement of appearance or performance; therefore, wish fulfilling medicine is also referred to as (human) enhancement (therapy). The line between traditional and wish fulfilling medicine is vague: the border between illness and health, normal and abnormal functioning is not sharply defined and is relative to time and place. In the Netherlands, wish fulfilling medicine is not covered in the basic package provided by healthcare insurers and is paid for by the patients themselves. However, 'pay yourself' is not a decisive criterion for wish fulfilling medicine. With new biotechnological developments the domain of wish fulfilling medicine is expanding. Some dental treatments can be considered as wish fulfilling dentistry, for example in the context of cosmetic dentistry, orthodontics, or dental implantology. Although wish fulfilling medical treatments do not cure disease, they can promote health.

Most patients who file a formal complaint against a dentist do so by way of the law concerning complaints. In 2017 the law concerning complaints was changed radically, with the intention of making the law easier for the patient to make use of and providing the patient with a financial settlement. This article considers the extent to which the possibility of being compensated has had the effect of encouraging patients to file claims in the case of the Royal Dutch Dental Association (KNMT), the complaints service with which most dentists are associated. The article also considers whether the new law has made the process of filing a complaint more readily accessible. Finally, if the law of complaints has become more appealing for patients to make use of, one could imagine that fewer cases would find their way to the disciplinary board. For that reason, the number of disciplinary complaints in 2017 is compared to the number for 2016.

The image of the professions of family doctor and dentist in the Netherlands was investigated by means of a questionnaire distributed online and in four cities. In total, 270 questionnaires were analysed. The dentist was seen more as a businessman, a solo performer for whom the interests of the patient were less highly prioritised, who,was less communicative, more associated with pain, more distant, less open to dialogue and could be trusted less than the general practitioner. Respondents also felt less safe at the dentist's office than at the general practitioner's. On average, respondents rated the general practitioner significantly higher than the dentist. Dentists scored significantly lower than general practitioners on eleven of the twelve statements. The score of the profession dentist was not significantly different from that of general practitioner in only one category, professionalism. These results indicate that the image of the dental profession is worse than that of the general practitioner.

In the present study, the extent to which dental students in Amsterdam, Groningen and Nijmegen consult scientific journals and professional periodicals was explored by means of a digital questionnaire. 333 dental students (20% response rate) participated in this study, 69% of whom had experience in conducting scientific research. 65% of the students had a subscription to a dental journal. Of the Dutch-language dental journals, the 'Nederlands Tijdschrift voor Tandheelkunde' [Netherlands Journal for Dentistry] and the 'Nederlands Tandartsenblad' [Dutch Dentists' Journal] are frequently consulted journals. International publications are consulted especially by masters students, although less frequently than Dutch dental journals. The study revealed that 77% of the students consider it important that attention is paid to the development of scientific skills early in the dental curriculum in order to adequately prepare students to select and interpret publications.

On the advice of the National Health Care Institute in the Netherlands and the institute's Board of Scientific Advisors, the minister of Health, Welfare and Sport decides whether a certain drug will or will not be included in the list of drugs covered by the basic health insurance plan mandated for all Dutch citizens. In making this decision emphasis is placed on the therapeutic value of that particular drug compared to that of the standard drug for that disorder, the impact that the inclusion of the drug would have on the budget and the drug's cost-effectiveness. In the case of disorders that do not respond or respond insufficiently to the standard treatment, however, one comes up against the limitations of this system and in some cases a necessary treatment is not reimbursed. With respect to prescribing medications, dentists are qualified to prescribe, provided they are enrolled in the so-called BIG register [that recognises the qualifications of healthcare professionals in the Netherlands]. Dental hygienists, by contrast, are not qualified to prescribe and have to limit themselves to at most recommending over-the-counter medicines. In prescribing medicines, dentists are of course limited to those about which they have comprehensive knowledge and sufficient experience. If a dentist wants to prescibe a drug that is outside his or her own experience, then he or she should consult with an oral and maxillofacial surgeon, general practitioner or medical specialist to determine whether the medication can be prescribed and if so, by whom.

In contrast to the law governing complaints and to disciplinary law, a civil law judge can sentence dentists to the restoration of all damages to patients. For this to happen, there has to be evidence of damage, responsibility and a causal connection. For the assumption of responsibility as well as a causal connection, an important question is whether a dentist has violated a relevant guideline or protocol. Moreover, dentists are not only responsible for their own mistakes, but also, in principle, for those of their employees. Depending on the situation, dentists can also be held accountable for the mistakes of a dentist who is working in their practice on a self-employed basis. Dutch dentists do not yet have to fear American situations', because damages awarded in The Netherlands are still relatively low.

Each generation likes to see itself as unique and thinks that the conditions under which people live and work are also unique. This position does not, for the most part, apply to dentists. Two questions which are now under discussion were also under discussion in the past. In the first case, this has to do with whether dentistry should be seen especially as a profession in which skill and competence are central, or as a medical discipline in which science (too) is central. The second question which was posed in the past as it is now is whether the dentist is seen especially as a salesman, albeit as a healthcare provider. Both questions are of the greatest significance for the image of dentists and also perhaps indirectly for the future of the professional group. Indeed, the answer to these questions has determined in the past as well as now the image of dentists and the degree to which the government has believed that dentists could be replaced by less highly educated non-dentists. For that reason, a clear answer to these questions ought to be formulated. It is possible that the answers given to these same questions in the past will be helpful in formulating answers now.

A 36-year old man is referred to a centre for special dental care due to problems with treatability in the general dental practice and a deteriorated oral state. His behaviour is unpredictable due to the possible development of sudden changes in the patient's consciousness which are accompanied by severe aggression. The patient suffers from a conversion disorder, a serious mental disorder which expresses itself in his case with the occurrence of psychogenic non-epileptic seizures. The patient fears that dental treatment will provoke a seizure and that he will react aggressively to his surroundings. He therefore requests that he undergoes dental treatment using general anaesthesia and patient fixation measures. This case study provides an example for the discussion of the problems and the rights of patients with severe mental disorders and the use of measures of physical restraint in dentistry.

The law promises patients a readily accessible means of filing complaints. Healthcare providers are therefore required to adopt regulations governing complaints which satisfy a number of conditions. Most dentists choose to adopt the regulations which have been established by their professional organization. In addition to handling complaints, there is also a provision for mediation, which is often used by patients. Mediation appears, then, to be a successful provision. Many complaints have their origin in insufficient knowledge of healthcare legislation and patients' rights legislation. This demonstrates that more attention should be given to these subjects in educational programmes and programmes in continuing education. The present law governing complaints is expected to be replaced this year by a new, more comprehensive law in which considerable attention will be devoted to the quality of care as well as to complaints. It seems likely, however, that the new law governing complaints will damage the effective manner in which patients' complaints are dealt with in dentistry today.

Disciplinary law can be seen as an element in the system that protects the quality of dental care and in that way helps to maintain the high level of trust which the public has in the profession. A disciplinary court case is regarded by dentists as very taxing. This is in part a result of unfamiliarity with the procedure. The procedure is also feared because of the publicity it attracts. The publicity is partly inherent in the goal of the disciplinary law. To some extent the publicity seems to be taking on the character of 'trial by media'. Questions can be raised with respect to this latter development, regarding, for example, the use of anonymity by journalists; the impact of publication, which is partially dependent on other news-worthy events; and the impact of the publication of reprimands versus the most severe sanction.

The extent of the responsibility to provide care which a dentist bears depends on whether a patient is registered with the dentist's practice. A dentist has the freedom not to register a patient with his practice, provided he does not violate the anti-discrimination laws or a cooperative professional agreement which the dentist has signed. No conditions are applied if a patient wishes to withdraw his registration, or a registration is withdrawn by mutual agreement. If a dentist wishes to terminate the treatment agreement unilaterally, this can only be done if serious reasons for doing so can be identified. The reasons for termination which will be accepted by disciplinary boards as serious depend very much on the conditions of the specific case. In cases of the unilateral termination of a treatment agreement on the part of a dentist, given the serious reasons for doing so, it is usually necessary for a dentist to take into consideration various requirements for careful conduct.

Dentists have a duty to provide care. This duty, which interestingly enough has a limited legal basis, is for the most part given form by jurisprudence. In that process, the disciplinary judge and the grievance committees pay attention especially to 2 rules of conduct and 1 regulation governing practice. In practice, it appears to be the case that rules of conduct and regulations do not always provide an unambiguous guide. The domain within which dentists operate is striking. The availability and the accessibility of dentists are not always harmonious with the personal perception of a patient. It is sometimes difficult to find a proper balance between what is a dentist is able to manage and what a patient wants.

Regulations which have been established by the professional community or by an organization of which a dentist is a member (self-regulation) have a more significant legal effect on dental care than many dentists realize. A dentist can only deviate from these regulations if he does so when motivated by the patient's best interests. Self-regulation can be relevant at the level of the professional community, the organization or the individual dentist. Self-regulation should satisfy a number of criteria if it is to be applicable to an entire professional community, specifically: it must be sufficiently authoritative, it must harmonize with existing laws and regulations and it must be easily accessible to both professionals and patients. The application of self-regulation is sometimes limited to a specific group, for example dentists who have signed a working agreement with a certain health insurance provider or who work in a certain institution. Self-regulation can entail liability not only on the part of the healthcare professional but also, in theory, on the part of those who establish the regulations.

The right to confidentiality and privacy is established in various laws and in many cases the violation of these laws provokes a reaction in the form of severe sanctions. Nevertheless, patients complain relatively seldom about violations ofprivacy laws by dentists. The right to privacy consists of a requirement of confidentiality on the part of those carrying out treatment and the patients' right to be treated without being observed by third parties. 'Third parties' do not include those involved in the treatment or someone who represents the patient. The right to confidentiality can be violated if a patient grants consent, in cases of a legal requirement or in cases ofa conflict of requirements. A separate regulation exists concerning the confidentiality and privacy of patients in the context of scientific research.

When minors are treated, a complex triangular relationship can emerge among dentist, patient and the individual legally responsible for the patient. Generally speaking, both parents are those legally responsible for a child. This might not be the case if the parents are not married to each other or have divorced, or when there is a question of a child protection ruling. The governing rule is that dentists are required to honour the obligations to the legal representatives thatfollow from the patients' rights concerning the treatment of children under the age of 12. In the case of patients between the ages of 12 and 16, dentists are required to act in accordance with their obligations to both those legally responsible and to the patients. Finally, in the case ofpatients who are 16 and older, dentists are required to act only in accordance with their obligations to the patients. There are, however, various exceptions to this governing rule. One of the most common examples is the patient who is a minor of 16 or older who is unable to determine what is in his own best interest. That criterium is also used in determining the capability to give informed consent in adults.

The relationship between a dentist and his patient is based on trust. The principle of informed consent contributes to the quality of that relationship of trust. According to the professional standards for such a relationship, it is up to the dentist to make sure that the patient is well informed. Reliable information is necessary if the patient is to be in a position to give his or her consent for treatment. The Dutch Law of Agreement to Medical Treatment (WGBO) provides aframework for informed consent. Disciplinary judges establish the scope and if necessary the limits. It is clear that, among other things, not defining the risks beforehand can be the basis for a (disciplinary) complaint. Determining the requirements of informed consent calls for familiarity with the law and communication skills. Programmes in dental education ought to devote more attention to this issue.

Dutch law requires every healthcare provider, which obviously includes dentists, to maintain health records. Most of the rules governing the health record requirement are in the Law of Agreement to Medical Treatment (WGBO). And, as is often the case with the law, interpretation is left to the (disciplinary)judge. There is, in fact, a considerable amount of legal precedent concerning what information belongs in the health record. It is not uncommon for a dentist to be on the losing side in a legal proceeding because his defence is not supported by the health record. And if it becomes clear that (a portion of) the health record has been destroyed, despite the legal requirement to maintain records, in this too the dentist can count on little sympathy from the judge. In a recent judgment, the Central Disciplinary Committee was more severe than ever- with far-reaching consequences for the relevant dentist.

With respect to disciplinary and other complaints, it is apparent that they are often based on a difference of opinion concerning professional standards for oral healthcare. Relevant differences of opinion can arise between dentists, but also in the dentist-patient relationship. A large degree of the ambiguity which lies at the basis of such discussions could be removed by the use of clear clinical guidelines. Since these are still scarce in oral healthcare, a dentist will have to rely on adequate communication to avoid conflicts. A dentist must be aware of possible conflicts of interest and of the characteristic range of the professional standards for oral healthcare. Departing from that range at the request of a patient is not an option.

A dentist should deliver oral healthcare according to the professional standard. This legal determination is not very distinct and ought to be made more specific. Guidelines, protocols, and indicators play an important role in this respect, but are scarce in oral healthcare. Provisionally, judgements of discipline and complaints committees are heavily relied upon. Those judgements indicate what efforts, and in some cases even what results, a patient could have expected from a dentist in the specified conditions.

Introduction: In view of transparency in health care, the widespread desire for more patient-centred care, and in an attempt to facilitate educational programmes that effectively respond to these changes, two research questions are formulated: (i) How do dental students rate the importance of various organisational aspects of dental practices compared with dental patients and general dental practitioners (GDPs), and what prescripts, defined as specific operational responsibilities of GDPs in these matters, do dental students propose? and (ii) In doing so, do students resemble patients or GDPs?, Methods: In two survey studies, dental students (n = 198), patients (n = 3127) and GDPs (n = 303) were asked to rate by questionnaire the importance of 41 organisational aspects of a general dental practice and proposed specific operational responsibilities ('prescripts')., Results: Seven of 41 aspects were rated as important by the majority of the students. Although in a different rank order, three aspects were predominantly selected by all three groups: continuing education, accessibility by telephone and Dutch-speaking GDP. For most aspects, significant differences were found between the prescripts proposed by students and those proposed by patients, and few differences were found between students and GDPs., Conclusion: The findings do not permit the general conclusion that the views of dental students resemble those of patients or GPDs. Looking at the overall rank order, the three respondent groups showed a great resemblance although significant differences were found for specific aspects. With regard to the proposed prescripts, students showed realistic views and the majority wants to participate in continuing education and work with protocols and guidelines. In this, they tend to resemble GDPs more than they resemble patients., (© 2012 John Wiley & Sons A/S.)

Objectives: To explore which organisational aspects are considered most important by patients when assessing a general dental practice, and which patients' characteristics influence their views on these aspects by a paper questionnaire., Participants: The questionnaire was handed out to a sample of 5,000 patients in the Netherlands., Results: The response rate was 63%. Six organisational aspects out of a list of 41 aspects were valued as most important by at least 50%. In decreasing order of importance, these were: accessibility by telephone; continuing education for general dental practitioners; Dutch-speaking general dental practitioners; in-office waiting times; information about treatments offered; and waiting lists. For four out of these six aspects, respondents' age and education significantly influenced their preferences., Conclusions: Aspects concerning the infrastructure of a general dental practice were chosen more often than aspects such as working to professional standards, working according to protocols and guidelines, quality assessment and guaranteed treatment outcomes. The findings will enable organisations to increase the transparency of health-care delivery systems to focus on those organisational aspects of dental practices that patients themselves consider most important. These findings can also assist general dental practitioners in adapting their organisational services to the preferences of patients or specific patient groups., (© 2013 FDI World Dental Federation.)

The question whether a patient needs extensive and invasive treatment, such as single-tooth fixed prosthesis, multi-teeth fixed prosthesis or oral implants, can be established only in a dialogue with mutual respect between the healthcare provider and the patient. With respect to this question, the following principles have to be considered: the patient's autonomy, beneficence, non-maleficence, and justice. These principles are reflected in legislation and are implicitly applied in complaint and disciplinary jurisdiction. When the autonomy of a patient is not sufficiently respected by a healthcare provider, a patient complaint might be the result, such as a complaint of impertinent treatment, lack of informed consent, or poor patient documentation. If beneficence or non-maleficence principles are violated, an intrinsic treatment complaint might be the result, such as a complaint of inadequate treatment planning, often based on inadequate examination, and complications or untimely failure of single-tooth fixed prosthesis, multi-teeth fixed prosthesis or oral implants. Respecting the previously mentioned principles promotes appropriate healthcare to the patient also in complex care with other healthcare providers.

A regional disciplinary board censured a dentist who allowed someone without proper authorisation to carry out a procedure and that judgement was the motivation for providing some clarification concerning the Dutch law. In the Netherlands, more than in most other countries, a relatively large amount of freedom is given to people who are not medical doctors to carry out dental procedures. This freedom does, however, have its limits and they are established in the law governing the registration of healthcare professionals (in the BIG-register). The central requirement in this law is competence. In addition, the law makes a distinction, at the present time, among a group of healthcare providers who are authorised to carry out, independently, restricted treatments (dentists), a group of healthcare providers who are authorised to perform certain functions (dental hygienists), and a group who are not authorised. Provided they satisfy legal requirements, non-authorised individuals can also carry out restricted treatments. In the future, this system might be breached, in the sense that the requirementfor authorisation will lapse.

A 42-year-old patient with cardiac problems had periodontal disease. The required periodontal treatment was only carried out after a period of 6 months. During this time, the patient was at risk of endocarditis due to a bacteraemia, a problem which was not recognized by any of the oral healthcare providers. When treating a patient who is at risk of developing endocarditis, the guidelines of the Dutch Heart Foundation (Nederlandse Hartstichting) must be observed. Deviation from the guidelines is only permissible under appropriate conditions. If treatment is being carried out by a team, then there is not only a question of shared responsibility, but also of shared liability. Adequate communication and record-keeping are vital in cases of patients who are medically compromised.

Background: Some 40 years ago, Morris and Sherlock concluded that dental students are very cynical about their future profession, and indeed become more cynical as they progress through dental school. Later studies continued to report cynicism among dental students, but some studies did not confirm the reported increase. However, any degree of cynicism among matriculating students and even more so among graduating students should be of grave concern to dental educators., Method: This study used a survey modeled after the instrument used by Morris and Sherlock. First and fifth year students at one of the dental schools in The Netherlands were presented with 10 vignettes and asked to indicate how they themselves would respond, how practising dentists would respond and how any dentist should respond., Results: We did not find a rise in cynicism. However, we did find that both freshmen and graduating dental students in The Netherlands are rather cynical, as a group, about the ethics of their future profession. Even students who believe that the professional norms themselves are sound (as evidenced by their own willingness to abide by those norms) tend to believe that many practising dentists regularly violate those norms., Conclusions: As was already reported some 40 years ago, dental students appear to harbour a widespread and persistent cynicism about the ethics of their future profession. The professionalism courses that are emerging in many dental schools around the world should take note of this challenging statistic., (2011 John Wiley & Sons A/S.)

Background: Considering the changes in dental healthcare, such as the increasing assertiveness of patients, the introduction of new dental professionals, and regulated competition, it becomes more important that general dental practitioners (GDPs) take patients' views into account. The aim of the study was to compare patients' views on organizational aspects of general dental practices with those of GDPs and with GDPs' estimation of patients' views., Methods: In a survey study, patients and GDPs provided their views on organizational aspects of a general dental practice. In a second, separate survey, GDPs were invited to estimate patients' views on 22 organizational aspects of a general dental practice., Results: For 4 of the 22 aspects, patients and GDPs had the same views, and GDPs estimated patients' views reasonably well: 'Dutch-speaking GDP', 'guarantee on treatment', 'treatment by the same GDP', and 'reminder of routine oral examination'. For 2 aspects ('quality assessment' and 'accessibility for disabled patients') patients and GDPs had the same standards, although the GDPs underestimated the patients' standards. Patients had higher standards than GDPs for 7 aspects and lower standards than GDPs for 8 aspects., Conclusion: On most aspects GDPs and patient have different views, except for social desirable aspects. Given the increasing assertiveness of patients, it is startling the GDP's estimated only half of the patients' views correctly. The findings of the study can assist GDPs in adapting their organizational services to better meet the preferences of their patients and to improve the communication towards patients.

An invasive treatment, such as the treatment involving a removable partial denture, requires a well-structured approach. Regulations governing the communication between a healthcare professional and a patient in the Netherlands can be found in the Dutch Medical Treatment Act and the Rules of Conduct for Dentists of the Dutch Society for the Advancement of Dentistry (NMT). According to the regulations in these sources, a healthcare provider needs a patient's informed consent for any medical treatment and he is required to maintain a file of medical records. Consent should be based on efficacious communication and explanation of treatment options, risks and costs. With regard to the duty to maintain records, a care plan and a treatment plan are required for an invasive treatment. A standard structure and sequence of points for the care plan and the treatment plan will reduce the risk of overlooking essential issues.

If there is no indication for tooth removal purely based on dental criteria, but the patient requests for removal due to fear of dental treatment, or because of a mental disorder such as posttraumatic stress disorder, a somatoform pain disorder or a disorder of body image perception, then the question is whether the patient is mentally competent to make this decision. In case of a tooth removal request on psychopathologic basis, a dentist has to refuse to carry out such treatment, but he should make an effort to help or guide the patient in some other way.

Assertive patients will, in the future, more readily appear with their own diagnosis. As a result, dentists will more often be confronted with sometimes rather unusual requests from patients. An extreme request from a patient is the removal of (all) teeth. The central issue in this article is how to deal with such a request. The conclusion is that the patient's autonomy is limited by the professional standards of the dentist and the patient's capacity to assess in a reasonable way what is in his own best interests.

The dental profession is gradually becoming more aware of the importance of practitioner competence in dental ethics and law. Indicative of that awareness is the explicit attention paid by ever more dental school curricula to these disciplines through courses and other dedicated learning activities. Concurrently there is also increasing professional concern about reports of illegal and unethical behaviour by dental students and practitioners. This paper discusses the results of a survey among first and fifth year students enrolled in the three Dutch dental schools, examining their ethical and legal knowledge and perceptions. Students were presented with five ethical and five legal case vignettes and asked which of three courses of actions is correct, as well as which of those courses they would undertake themselves. The study shows that the knowledge level of students in the area of health law increases between the first and fifth year but their knowledge of ethics decreases. Even more remarkable is the finding that large numbers of students are not consistent, that is, the way they plan to behave does not coincide with what they say is the morally correct way to behave.