Ethical Dilemmas among Undergraduate and Postgraduate Students of Dental School

Dr.Archana.R*, Dr.Selva kumar.C, Dr.Sunayana Manipal, Dr.Raja kumar, Dr.Prabu

*Correspondence to: Dr.Archana.R , India.

Copyright.

© 2025 Dr.Archana.R This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 15 Feb 2025

Published: 01 Mar 2025                   

ABSTRACT

AIM: Aim of the study was to create awareness on ethics among Undergraduate and Postgraduate Dental students.

METHODOLOGY: The type of study is descriptive study done among undergraduates and postgraduates of the dental college. A self designed, questionnaire consisting of 25 questions, provided the opportunity for students to present their perceived ethical dilemmas during the course. Purposive sampling technique was used. The sample size is 212 students. The questions were close ended type. All the data were entered in Microsoft excel and statistics was calculated using SPSS software. Chi-square statistics was used.  Results are represented using multiple bar chart type.

RESULTS: Only 8 ethical dilemmas were faced by majority of the students out of 25 diplomatic situations given in the form of questionnaire. The most often identified ethical issues were in prosthodontics (67.9%),refusal of treatment in AIDS patients(70.30%), dilemma was seen in teaching oral hygiene instruction as result of time constraints(70.80%),disclosing the patient illness to the relative dentist(69.30%).

CONCLUSION: The dilemmas were seen as a result of lack of time management and inexperience. Majority of the students were found to be ethical.

KEY WORDS: Time management, Ethical dilemmas, sampling technique

Introduction

Ethics is defined as "a set of principles defined to protect the human dignity, integrity, self determination, confidentiality, right and health of population and people concerning them[1].  Ethics, money making, finishing quota on time are important aspect in the students life and it is need to be addressed. Dental schools have great responsibility in training the students as good dentist by developing the skills (practical works),  person of good conduct, and management of money while getting his/her instruments and dental material. The various responsibility of dentist that is described above should not pressure the students and make them to act unethical .So a dental school should reinforce on the ethics to be followed. The aim was to convert personal values into the practice.

Dental training programs are required to be ethical and competent in the application of ethical principles and

professional responsibility as they pertain to patient care and practice management. The dental school's efficiency of teaching students to be ethical could be taught as a role model, lecture classes, getting students red-handed while doing mistakes in the clinical work. Nevertheless, the dental students land up in lot of unethical issue during clinical sessions, so opinions could be provided by the faculty to act wise by saving the situation from the difficulty, and teaching the students to act clever, confident without ethical change in the treatment plan. These situations should be investigated analysed and the mistake can be rectified by discussing with the faculty.

Sound ethical knowledge is essential to maintain conduct with patient, informing the treatment plan prior. Dentist should not undermine the patient-physician relationship of colleague to attract patient. Dentist should not give importance to factors such as creed, political affiliation, sexual orientation in between her/his duty and patient. Dental ethics is pertained to the moral duties toward patients, professional colleagues and to the society.

 Aim of the study was to create  awareness on ethics among undergraduate and postgraduate students.

Methodology

The present study is a cross sectional questionnaire study of the total population of 3rd year BDS undergraduate, CRI and Post graduate Dental Students. Purposive sampling technique was used. 212 Students accepted voluntarily, thus giving a response of 72%.  Efforts were not made to contact the student who were absent on the day of the study. Participants were informed to return the questionnaires after filling. The responses were anonymous, except the year of study was categorised.  The questionnaires contained questions in English, which is the medium of instruction in the dental college. A self designed questionnaire, that consists of 25 questions. Out of the 25 questions, 20 questions were of yes or no type and the remaining 5 had binary options. Qualitative collection of data is followed. The questionnaires were distributed to students after approval from Head of the department of public health dentistry. The 3rd Year Undergraduate participants were requested to assemble in the lecture hall on the predetermined day. The CRI's and Post Graduates were given the questionnaires in their respective department during their Leisure hour. All the voluntary participants were given sufficient time to give their response and questionnaires were collected back on the same day. No cross copying were allowed. Questions opened the mind of students to share their dilemmas of ethics during quota completion during their BDS or MDS course, and how they might encounter the critical situation during their practice in future. The data was entered in a Microsoft Excel sheet and statistical analysis was done using SPSS software. Chi-square statistics was used and P-value was set at 0.05.

 Results     

According to this study the results obtained are ,ethical dilemma were faced in prosthodontics (67.9%), refusal of treatment in AIDS patients(70.30%), teaching oral hygiene instruction as result of time constraints(70.80%),disclosing the patient illness to the common interest people  69.30%

Only 8 ethical dilemmas were faced by majority of the students out 25 diplomatic situations given in the form of questionnaire. Hence, majority of the students were found to be ethical

Discussion

In the fast moving world, every individual is in a dilemma either being money minded (or) a person of ethics. But only few people manage both in profession. Dentistry is not confined to work of non living things, but we deal with a living human being like us, so it is essential to be ethical as well as, without forgetting to earn for the livelihood. The questionnaire being close ended type, where not able to ask the reason for the unethical issue. But the comparative study holds reasons for the dilemma’s faced.                                                                                                                                  

Fabrication of denture is a long process. During trimming or polishing the dentures, are more likely to break. As lack of time, students seal the denture using self-cure, which can result in decrease transverse strength and rigidity.[2] Presence of residual monomer from self -cure can harm the oral tissue.                                                                                   

Gossiping is human nature and sometime is a pleasure, to relieve stress. But being a professional there are some norms to hold to among colleagues, society and the patients. Patient trust the doctor and reveals his (or) her illness. Betrayal to the patient by disclosing the patient issue to common interest people at home, says research ethical committee. [3]

Everyone in this world has got only 24 hours. But some people have capacity for time management .Medical case history is the primary step to know about the patient and his illness in detail. Medical case history reveals past illness, family history, personal history etc. It is the trump card for the diagnosis. Students were not able to take complete case history due to time constraints. Lack of inadequate case history taking can lead to physician’s malpractice and patients unsatisfactory. [4]                    

AIDS, is a group of disease where the CD4 lymphocytes of body cells are reduced. The public does not know about the pathology behind this. But being a dentist, awareness should be created rather than being afraid. AIDS patient should not be neglected. If we did not treat and encourage them, then who else will treat?? AIDS patient are not ghost or witches they belong to our race ' THE HUMANS’. AIDS patients should be treated by following sterilisation protocols.  The fear of treating AIDS patients was due to fear of transmission and lack of knowledge about sterilization protocol.[5] AIDS patient must be educated, encouraged and treated. If the dentist fails doing them, there is no point in celebrating worlds AIDS day (December-1). 

Cleanliness is next to Godliness. Generally the public greet the noble professionals as GODS. Being in such position, sterilisation of instruments is essential. Lack of sterilisation was because of lack of instruments and inadequate time for sterilisation protocols. When the patients flow rate was high, the students did not have adequate instruments and inadequate time to meet the needs.[6]

Brushing and flossing is a daily care regime for every living being. Mostly patients are unaware of the brushing techniques. Most of patients brush in a horizontal motion.  Dental students will know the type of brush and type of brushing technique is different for every individual. For example, mentally retarded patients are advised to follow Fone's technique and other patients are asked to follow modified Bass method. Students were unable to teach technique to the patients because of inadequate teaching models and time constraints.[7] Student must allot first 3-5 minutes for oral hygiene instructions.

Trigeminal neuralgia is a nerve injury that is related to trigeminal nerve. This disease is characterised by severe pain, localized in middle third of face. The treatment modalities opted by students are only symptomatic treatment such as prescribing Carbamazepine, but long time usage of drug lead to adverse drug reactions. Instead surgical operation such as balloon compression, gamma knife could be opted for complete relief from pain.[8]                                                                                        

Impaction is a medical terminology used amongst the dentist commonly. Presence of 2 school thoughts regarding the removal of impacted teeth. [9]Prophylactic extraction causes silent iatrogenic injury in the mere absence of pathology. While other school of thought is about development of pathology is more common in impacted teeth. The British National Institute for Clinical Excellence is unequivocal in its recommendation, adopted by the National Health Service: “The practice of prophylactic removal of pathology-free impacted third molars should be discontinued. There is no reliable evidence to support a health benefit to patients from the prophylactic removal of pathology-free impacted teeth.[10]

Following the ethics is difficult, but a student must do justice to his/her conscience and to his/her patient who believes in. Talking is easy, but walking the talk is difficult. Patient always doubt, what the Dentist say, but believes in by action. Lead the society by example

Conclusion

Out of 25 issues, only 8 issues were found to unethical. It's clear that majority of students are ethical and they will be ethical in future too. Students were not intentionally   unethical but situations like quota completion ,time limits, inexperience and lack of material availability made them unethical at certain points, despite of theoretical enforcement about ethics in class.

Respect for autonomy beneficence, non -maleficence and   justice are the founding principle. These principles were termed as 'prima facie'. Prima facie means that principles are binding to each other, when they conflict with another moral principle. So this study reveals the reasons for acceptance of ethics in class, failing to follow them in clinic. Research is from the student’s point of view, has pointed the difficulty felt by the students.

References

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