Evolving Standards in Professional Ethics

Evolving Standards in Professional Ethics

* Type of orthodontic treatment needed for the child.

Okay, let's talk about informed consent and shared decision-making with parents and kids – it's definitely not the same stuffy lecture it used to be! Back in the day, the doctor was pretty much the boss, especially when dealing with children. Parents listened, nodded, and that was that. Orthodontic treatment can help improve your child's smile Youth orthodontic correction pediatrics. But things are changing, and thankfully so.


Now, there's a real push for informed consent. That means parents (and, increasingly, the kids themselves, depending on their age and maturity) need to understand what's going on. We're talking about explaining the diagnosis in plain language, outlining the treatment options (not just the one you, as the provider, think is best), and honestly discussing the potential risks and benefits of each. It's not about overwhelming them with medical jargon, but about empowering them to make the right choices for their child.


And then there's the "shared decision-making" part. This isn't just about passively receiving information; it's about actively participating in the process. It means listening to parents' concerns, their values, and their understanding of their child. It also means, when appropriate, directly involving the child in the conversation. Kids, even young ones, often have their own perceptions, fears, and hopes that need to be considered. Ignoring them is not only ethically questionable but can also impact the success of the treatment.


The "evolving expectations" bit is crucial. What was considered acceptable ten years ago might not cut it now. The internet has changed everything; parents are more informed (or misinformed!), they have access to a wealth of information (good and bad), and they're more likely to question authority. Professional ethics need to keep pace. It's not about giving in to every demand, but about fostering a collaborative relationship built on trust and mutual respect. It takes more time, more patience, and more genuine communication, but ultimately, it leads to better outcomes and a stronger doctor-patient-family bond. It's about recognizing that healthcare decisions are rarely black and white, and the best path forward is often found through a thoughtful, shared journey.

Navigating the ever-shifting terrain of professional ethics is a delicate dance, especially when children are involved. Nowhere is this more apparent than in the tricky balancing act of parental desires, a child's well-being, and sound clinical judgment. It's like walking a tightrope strung between deeply held beliefs and what we, as professionals, know to be true and beneficial.


Parents, understandably, come to us with their own hopes, dreams, and anxieties for their child. They may have a specific vision of success, a particular therapeutic approach they favor, or fears that drive their decisions. These desires are valid and deserve respect. However, they don't always align with what's actually in the child's best interest, as determined by our professional assessment and understanding of child development.


This is where our clinical judgment comes into play. We're trained to observe, assess, and understand the child's needs, often in ways that parents, caught up in their own perspectives, might miss. We see the anxiety lurking beneath the surface, the developmental delays masked by charm, the unspoken fears that a child is too young to articulate. Our ethical obligation compels us to prioritize the child's well-being, even when it means having difficult conversations with parents.


Finding that balance isn't easy. It requires empathy, open communication, and a willingness to collaborate. We need to actively listen to parental concerns, acknowledge their perspective, and explain our clinical reasoning in a way that is understandable and respectful. Sometimes, it involves educating parents about alternative approaches or helping them reframe their expectations. Other times, it requires setting firm boundaries and advocating for the child's needs, even when it's unpopular.


Ultimately, the goal is to create a therapeutic alliance where the child's best interests are at the heart of every decision, and where parents feel heard and understood, even if their desires aren't always met. It's a challenging but vital aspect of ethical practice, one that demands constant reflection and a commitment to doing what's right for the child, even when it's hard.

* Duration of the orthodontic treatment plan.

Trying to get young patients through the door – that's advertising and marketing in a healthcare setting. But when we talk about kids, ethics just has to be front and center. It's not the same as selling sneakers, you know? We're dealing with vulnerable individuals, often impressionable and easily influenced.


Think about it: are we preying on insecurities with ads promising perfect smiles or flawless skin? Are we using cartoon characters or catchy jingles to bypass parental judgment and go straight for the child's desire? Are we downplaying risks or exaggerating benefits of treatments just to boost numbers? These are serious questions.


Ethical advertising respects autonomy. It gives families the information they need to make informed decisions, without resorting to manipulation or pressure tactics. It's about transparency – being upfront about costs, potential side effects, and alternative options. It's about avoiding comparisons with "ideal" images that can fuel body image issues or unrealistic expectations.


Ultimately, attracting young patients should be about building trust, not just building revenue. It's about prioritizing their well-being and ensuring that marketing practices align with the core values of healthcare: honesty, integrity, and a genuine commitment to the best interests of the child. Failing to do so isn't just bad ethics, it's bad medicine.

* Geographic location and its cost of living.

Evolving Standards in Professional Ethics: The Technological Tightrope in Pediatric Orthodontics


Pediatric orthodontics, a field dedicated to shaping young smiles, has been irrevocably transformed by technological advancements. From 3D printing of aligners to sophisticated cephalometric analysis software, we have tools unimaginable just a generation ago. But this technological revolution has also woven a complex tapestry of ethical dilemmas that demand careful consideration and a constant re-evaluation of our professional standards.


One key area of concern is informed consent. While traditional braces were a relatively straightforward proposition, the myriad of options available today – clear aligners, temporary anchorage devices (TADs), digitally planned treatments – require a more nuanced explanation to parents and, crucially, the child. Are we truly ensuring that families understand the benefits, risks, and limitations of each technology, especially when faced with persuasive marketing and the allure of quicker, seemingly less invasive solutions? Are we guarding against the potential for "digital orthodontics" to be oversold, promising outcomes that aren't always achievable?


Furthermore, the ease with which we can now manipulate digital imaging and simulate treatment outcomes raises ethical questions about transparency and potential for misrepresentation. While these simulations can be valuable communication tools, they can also create unrealistic expectations or even be used deceptively. Are we rigorously adhering to the principle of veracity, presenting these simulations as potential outcomes rather than guaranteed results? The line between informative marketing and misleading advertising can become blurred, demanding unwavering ethical vigilance.


The cost implications of advanced technologies also present a significant ethical challenge. While some innovations may offer superior outcomes, they often come with a higher price tag. Are we ensuring equitable access to care, or are we inadvertently creating a two-tiered system where the most effective treatments are only available to those who can afford them? This necessitates a commitment to exploring cost-effective alternatives and advocating for policies that promote equitable access to orthodontic care for all children, regardless of socioeconomic status.


Finally, the increasing reliance on artificial intelligence in treatment planning raises questions about professional responsibility and the potential for bias. While AI algorithms can analyze vast amounts of data and assist in diagnosis and treatment planning, they are not infallible. We must remain critically engaged, scrutinizing the recommendations of AI systems and exercising our clinical judgment to ensure that treatment decisions are based on the best interests of the individual patient, not just algorithmic efficiency. The human element – empathy, critical thinking, and a deep understanding of the patient's needs – must never be sacrificed at the altar of technological progress.


In conclusion, technological advancements in pediatric orthodontics offer tremendous potential for improving patient care. However, they also bring forth a new generation of ethical dilemmas that require ongoing dialogue, critical reflection, and a firm commitment to upholding the highest professional standards. As we continue to embrace these advancements, we must remain mindful of the potential pitfalls and strive to ensure that technology serves humanity, rather than the other way around. The evolving standards of our profession demand nothing less.

* Orthodontist's experience and specialization.

Okay, so professional ethics, right? And we're talking about how things are changing. One HUGE thing is patient privacy and keeping their data safe in this digital world. Think about it: doctors used to lock paper files in cabinets. Now? A patient's entire medical history can be floating around on servers, in the cloud, on laptops... it's everywhere.


That's a massive responsibility. It's not just about following HIPAA rules, though that's definitely the baseline. It's about understanding that people are trusting you with their most personal information - things they might not even tell their families. And if that information gets leaked, stolen, or misused, the damage can be devastating. We're talking about ruined reputations, identity theft, discrimination...it's serious stuff.


The ethical piece comes in because technology is constantly evolving. Laws and guidelines often lag behind. So, it's not enough to just follow the rules. You need to be proactive, thinking about potential vulnerabilities, staying updated on the latest threats, and advocating for stronger security measures. Are we training staff adequately? Are we using the most secure systems available, even if they cost a little more? Are we being completely transparent with patients about how their data is being used and protected?


The ethical standard is shifting from simply complying with regulations to actively safeguarding patient data as a matter of fundamental respect and trust. It's about recognizing that digital security isn't just a technical problem, it's a deeply human one. And it's up to us, as professionals, to get it right.

* Use of advanced technology or techniques.

Okay, so let's talk about money and motives, because that's really what "addressing conflicts of interest and financial transparency in treatment planning" boils down to in the context of evolving ethical standards. It's a mouthful, I know, but it's essential.


For a long time, the assumption was that healthcare professionals acted solely in the best interest of their patients. And, you know, most of the time, that's true. But we're human. We have mortgages, kids to send to college, and maybe even a weakness for fancy coffee. And sometimes, those personal interests can subtly (or not so subtly) influence the choices we make for our patients.


Think about it: Does the doctor prescribing the most expensive medication always truly believe it's the best option, or are they influenced by incentives from the pharmaceutical company? Does the therapist recommending extra sessions really feel they're necessary, or are they just padding their income? These are tough questions, and not always easy to answer, even for the professional involved.


That's why evolving ethical standards are pushing for greater transparency. It's not about assuming everyone's corrupt, but about acknowledging the potential for bias and creating safeguards. This means being upfront with patients about any potential financial connections we have to the treatments we're recommending. It means disclosing if we receive kickbacks, bonuses, or other benefits related to specific therapies or products.


It also means encouraging a culture of open communication and critical self-reflection within the profession. Are we constantly evaluating whether our recommendations are truly in the patient's best interest, or are we simply falling into comfortable patterns that benefit ourselves?


Financial transparency isn't just about ticking boxes on a form. It's about building trust. When patients understand the potential influences on their treatment plan, they can make more informed decisions and feel more confident in the care they receive. Ultimately, it's about ensuring that the focus remains squarely where it should be: on the well-being of the patient, not the bottom line. And that's an ethical standard worth fighting for.

Crossbite
Unilateral posterior crossbite
Specialty Orthodontics

In dentistry, crossbite is a form of malocclusion where a tooth (or teeth) has a more buccal or lingual position (that is, the tooth is either closer to the cheek or to the tongue) than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.[1][2]

Anterior crossbite

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Class 1 with anterior crossbite

An anterior crossbite can be referred as negative overjet, and is typical of class III skeletal relations (prognathism).

Primary/mixed dentitions

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An anterior crossbite in a child with baby teeth or mixed dentition may happen due to either dental misalignment or skeletal misalignment. Dental causes may be due to displacement of one or two teeth, where skeletal causes involve either mandibular hyperplasia, maxillary hypoplasia or combination of both.

Dental crossbite

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An anterior crossbite due to dental component involves displacement of either maxillary central or lateral incisors lingual to their original erupting positions. This may happen due to delayed eruption of the primary teeth leading to permanent teeth moving lingual to their primary predecessors. This will lead to anterior crossbite where upon biting, upper teeth are behind the lower front teeth and may involve few or all frontal incisors. In this type of crossbite, the maxillary and mandibular proportions are normal to each other and to the cranial base. Another reason that may lead to a dental crossbite is crowding in the maxillary arch. Permanent teeth will tend to erupt lingual to the primary teeth in presence of crowding. Side-effects caused by dental crossbite can be increased recession on the buccal of lower incisors and higher chance of inflammation in the same area. Another term for an anterior crossbite due to dental interferences is Pseudo Class III Crossbite or Malocclusion.

Single tooth crossbite

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Single tooth crossbites can occur due to uneruption of a primary teeth in a timely manner which causes permanent tooth to erupt in a different eruption pattern which is lingual to the primary tooth.[3] Single tooth crossbites are often fixed by using a finger-spring based appliances.[4][5] This type of spring can be attached to a removable appliance which is used by patient every day to correct the tooth position.

Skeletal crossbite

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An anterior crossbite due to skeletal reasons will involve a deficient maxilla and a more hyperplastic or overgrown mandible. People with this type of crossbite will have dental compensation which involves proclined maxillary incisors and retroclined mandibular incisors. A proper diagnosis can be made by having a person bite into their centric relation will show mandibular incisors ahead of the maxillary incisors, which will show the skeletal discrepancy between the two jaws.[6]

Posterior crossbite

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Bjork defined posterior crossbite as a malocclusion where the buccal cusps of canine, premolar and molar of upper teeth occlude lingually to the buccal cusps of canine, premolar and molar of lower teeth.[7] Posterior crossbite is often correlated to a narrow maxilla and upper dental arch. A posterior crossbite can be unilateral, bilateral, single-tooth or entire segment crossbite. Posterior crossbite has been reported to occur between 7–23% of the population.[8][9] The most common type of posterior crossbite to occur is the unilateral crossbite which occurs in 80% to 97% of the posterior crossbite cases.[10][3] Posterior crossbites also occur most commonly in primary and mixed dentition. This type of crossbite usually presents with a functional shift of the mandible towards the side of the crossbite. Posterior crossbite can occur due to either skeletal, dental or functional abnormalities. One of the common reasons for development of posterior crossbite is the size difference between maxilla and mandible, where maxilla is smaller than mandible.[11] Posterior crossbite can result due to

  • Upper Airway Obstruction where people with "adenoid faces" who have trouble breathing through their nose. They have an open bite malocclusion and present with development of posterior crossbite.[12]
  • Prolong digit or suckling habits which can lead to constriction of maxilla posteriorly[13]
  • Prolong pacifier use (beyond age 4)[13]

Connections with TMD

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Unilateral posterior crossbite

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Unilateral crossbite involves one side of the arch. The most common cause of unilateral crossbite is a narrow maxillary dental arch. This can happen due to habits such as digit sucking, prolonged use of pacifier or upper airway obstruction. Due to the discrepancy between the maxillary and mandibular arch, neuromuscular guidance of the mandible causes mandible to shift towards the side of the crossbite.[14] This is also known as Functional mandibular shift. This shift can become structural if left untreated for a long time during growth, leading to skeletal asymmetries. Unilateral crossbites can present with following features in a child

  • Lower midline deviation[15] to the crossbite side
  • Class 2 Subdivision relationships
  • Temporomandibular disorders [16]

Treatment

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A child with posterior crossbite should be treated immediately if the child shifts their mandible on closing, which is often seen in a unilateral crossbite as mentioned above. The best age to treat a child with crossbite is in their mixed dentition when their palatal sutures have not fused to each other. Palatal expansion allows more space in an arch to relieve crowding and correct posterior crossbite. The correction can include any type of palatal expanders that will expand the palate which resolves the narrow constriction of the maxilla.[9] There are several therapies that can be used to correct a posterior crossbite: braces, 'Z' spring or cantilever spring, quad helix, removable plates, clear aligner therapy, or a Delaire mask. The correct therapy should be decided by the orthodontist depending on the type and severity of the crossbite.

One of the keys in diagnosing the anterior crossbite due to skeletal vs dental causes is diagnosing a CR-CO shift in a patient. An adolescent presenting with anterior crossbite may be positioning their mandible forward into centric occlusion (CO) due to the dental interferences. Thus finding their occlusion in centric relation (CR) is key in diagnosis. For anterior crossbite, if their CO matches their CR then the patient truly has a skeletal component to their crossbite. If the CR shows a less severe class 3 malocclusion or teeth not in anterior crossbite, this may mean that their anterior crossbite results due to dental interferences.[17]

Goal to treat unilateral crossbites should definitely include removal of occlusal interferences and elimination of the functional shift. Treating posterior crossbites early may help prevent the occurrence of Temporomandibular joint pathology.[18]

Unilateral crossbites can also be diagnosed and treated properly by using a Deprogramming splint. This splint has flat occlusal surface which causes the muscles to deprogram themselves and establish new sensory engrams. When the splint is removed, a proper centric relation bite can be diagnosed from the bite.[19]

Self-correction

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Literature states that very few crossbites tend to self-correct which often justify the treatment approach of correcting these bites as early as possible.[9] Only 0–9% of crossbites self-correct. Lindner et al. reported that 50% of crossbites were corrected in 76 four-year-old children.[20]

See also

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  • List of palatal expanders
  • Palatal expansion
  • Malocclusion

References

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  1. ^ "Elsevier: Proffit: Contemporary Orthodontics · Welcome". www.contemporaryorthodontics.com. Retrieved 2016-12-11.
  2. ^ Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F (October 2009). "Malocclusion and occlusal traits in an urban Iranian population. An epidemiological study of 11- to 14-year-old children". European Journal of Orthodontics. 31 (5): 477–84. doi:10.1093/ejo/cjp031. PMID 19477970.
  3. ^ a b Kutin, George; Hawes, Roland R. (1969-11-01). "Posterior cross-bites in the deciduous and mixed dentitions". American Journal of Orthodontics. 56 (5): 491–504. doi:10.1016/0002-9416(69)90210-3. PMID 5261162.
  4. ^ Zietsman, S. T.; Visagé, W.; Coetzee, W. J. (2000-11-01). "Palatal finger springs in removable orthodontic appliances--an in vitro study". South African Dental Journal. 55 (11): 621–627. ISSN 1029-4864. PMID 12608226.
  5. ^ Ulusoy, Ayca Tuba; Bodrumlu, Ebru Hazar (2013-01-01). "Management of anterior dental crossbite with removable appliances". Contemporary Clinical Dentistry. 4 (2): 223–226. doi:10.4103/0976-237X.114855. ISSN 0976-237X. PMC 3757887. PMID 24015014.
  6. ^ Al-Hummayani, Fadia M. (2017-03-05). "Pseudo Class III malocclusion". Saudi Medical Journal. 37 (4): 450–456. doi:10.15537/smj.2016.4.13685. ISSN 0379-5284. PMC 4852025. PMID 27052290.
  7. ^ Bjoerk, A.; Krebs, A.; Solow, B. (1964-02-01). "A Method for Epidemiological Registration of Malocculusion". Acta Odontologica Scandinavica. 22: 27–41. doi:10.3109/00016356408993963. ISSN 0001-6357. PMID 14158468.
  8. ^ Moyers, Robert E. (1988-01-01). Handbook of orthodontics. Year Book Medical Publishers. ISBN 9780815160038.
  9. ^ a b c Thilander, Birgit; Lennartsson, Bertil (2002-09-01). "A study of children with unilateral posterior crossbite, treated and untreated, in the deciduous dentition--occlusal and skeletal characteristics of significance in predicting the long-term outcome". Journal of Orofacial Orthopedics. 63 (5): 371–383. doi:10.1007/s00056-002-0210-6. ISSN 1434-5293. PMID 12297966. S2CID 21857769.
  10. ^ Thilander, Birgit; Wahlund, Sonja; Lennartsson, Bertil (1984-01-01). "The effect of early interceptive treatment in children with posterior cross-bite". The European Journal of Orthodontics. 6 (1): 25–34. doi:10.1093/ejo/6.1.25. ISSN 0141-5387. PMID 6583062.
  11. ^ Allen, David; Rebellato, Joe; Sheats, Rose; Ceron, Ana M. (2003-10-01). "Skeletal and dental contributions to posterior crossbites". The Angle Orthodontist. 73 (5): 515–524. ISSN 0003-3219. PMID 14580018.
  12. ^ Bresolin, D.; Shapiro, P. A.; Shapiro, G. G.; Chapko, M. K.; Dassel, S. (1983-04-01). "Mouth breathing in allergic children: its relationship to dentofacial development". American Journal of Orthodontics. 83 (4): 334–340. doi:10.1016/0002-9416(83)90229-4. ISSN 0002-9416. PMID 6573147.
  13. ^ a b Ogaard, B.; Larsson, E.; Lindsten, R. (1994-08-01). "The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3-year-old children". American Journal of Orthodontics and Dentofacial Orthopedics. 106 (2): 161–166. doi:10.1016/S0889-5406(94)70034-6. ISSN 0889-5406. PMID 8059752.
  14. ^ Piancino, Maria Grazia; Kyrkanides, Stephanos (2016-04-18). Understanding Masticatory Function in Unilateral Crossbites. John Wiley & Sons. ISBN 9781118971871.
  15. ^ Brin, Ilana; Ben-Bassat, Yocheved; Blustein, Yoel; Ehrlich, Jacob; Hochman, Nira; Marmary, Yitzhak; Yaffe, Avinoam (1996-02-01). "Skeletal and functional effects of treatment for unilateral posterior crossbite". American Journal of Orthodontics and Dentofacial Orthopedics. 109 (2): 173–179. doi:10.1016/S0889-5406(96)70178-6. PMID 8638566.
  16. ^ Pullinger, A. G.; Seligman, D. A.; Gornbein, J. A. (1993-06-01). "A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features". Journal of Dental Research. 72 (6): 968–979. doi:10.1177/00220345930720061301. ISSN 0022-0345. PMID 8496480. S2CID 25351006.
  17. ^ COSTEA, CARMEN MARIA; BADEA, MÎNDRA EUGENIA; VASILACHE, SORIN; MESAROÅž, MICHAELA (2016-01-01). "Effects of CO-CR discrepancy in daily orthodontic treatment planning". Clujul Medical. 89 (2): 279–286. doi:10.15386/cjmed-538. ISSN 1222-2119. PMC 4849388. PMID 27152081.
  18. ^ Kennedy, David B.; Osepchook, Matthew (2005-09-01). "Unilateral posterior crossbite with mandibular shift: a review". Journal (Canadian Dental Association). 71 (8): 569–573. ISSN 1488-2159. PMID 16202196.
  19. ^ Nielsen, H. J.; Bakke, M.; Blixencrone-Møller, T. (1991-12-01). "[Functional and orthodontic treatment of a patient with an open bite craniomandibular disorder]". Tandlaegebladet. 95 (18): 877–881. ISSN 0039-9353. PMID 1817382.
  20. ^ Lindner, A. (1989-10-01). "Longitudinal study on the effect of early interceptive treatment in 4-year-old children with unilateral cross-bite". Scandinavian Journal of Dental Research. 97 (5): 432–438. doi:10.1111/j.1600-0722.1989.tb01457.x. ISSN 0029-845X. PMID 2617141.
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