Ethical Dilemmas in Dentistry

Dentistry is a profession that involves direct contact with people. Given this predicament, it is only necessary for dentists to follow a specific ethics or rules of engagement. Like the Ten Commandments being summed up in to two greater commandments, dental ethics revolves on two important actions. First is beneficence or actions that benefit others. These are actions that help prevent or eliminate harm and improve others’ situations. The second is nonmaleficence or actions that do not harm patients or the act of providing treatments that are effective and without malice of any kind (Pantilat, 2008).

While both actions are meant to provide all possible benefits for the patients, most of the time one negates the outcome of the other. It happens in many cases as in the one to be discussed in this paper. On the first encounter, the patient complained feeling pain on the lower left side, with a visible decay under an old filling, invading the tooth’s nerve canal. It was immediately suggested for the patient to get a root canal as treatment. During the root canal process, a file accidentally broke in one of the patient’s canal. The process was discontinued and the pain lingered.

There had been a suggestion for the tooth to undergo bypass but the process has seemed impossible, so the tooth was removed instead. However, even after the removal of the tooth, the patient still felt continued extreme pain. Given these details, it was theorized that while the patient was undergoing root canal, in which a file broke within the mesial buccal of the patient, the performing dentist may have probably pierced a mandibular nerve. The patient was then x-rayed in order to find if there are tracts that may prove this theory.

There had been no tracts and the theory was too improbable as mandibular nerves are placed too deep into the tooth. A dentist trying to do this may have to pierce through the tooth, through the canal of the tooth, through an inch thick of bone, through the canal wall, and through artery and vein. Furthermore, a file is the least tool for this kind of job. As such, new theories were proposed. One of which is that the patient may be starting to develop a painful bone infection. Another is that the patient may have something that inflames the whole socket and brings the pain.

These other two theories are more plausible as compared to the initially proposed problem, but as most prognoses; these would take more tests and may cause more pain to the patient. Carefully reviewing this case, it may be said that there was a breach in the nonmaleficence rule. The suggestion of getting a root canal, which brought continued pain to the patient, may be considered as this kind of act; given that nonmaleficence suggests that dentists must not try ineffective treatments on patients (Pantilat, 2008). Although there had been no malice in this recommended treatment, it still did not alleviate harm.

The same thing may be said to the second suggested treatment, which was to have the tooth removed. However, this said breach in the rule of nonmaleficence may be invalid considering that dentists are also to follow the rule of beneficence. Since the rule of beneficence suggests that dentists and even other medical practitioners are to act in accordance to what may benefit the patient, prevent harm or decrease its possibility (Pantilat, 2008), the action recommended for the initial diagnosis may be considered proper and only applicable.

The case presented symptoms pointing to the need for the initial and secondary treatments as such, the dentist only acted accordingly. There had not been any hint that the pain may continue after treatment. Ergo, the accusation of a breach in the nonmaleficence rule is in conflict with the necessary actions which the rule of beneficence calls for. Concluding, the case is but one of the many cases in which the two important rules stand in conflict of each other. While an act may be considered against one rule, the other rule may be used to justify it.

This is said to be very common as the rule of beneficence asks for immediate treatment. However, treatments mostly come with risks. These risks are commonly the points suggestive of the breach in the rule of nonmaleficence. As such, it may suffice to say that it is impossible to follow one and not stand in conflict with the other, especially in a profession where most treatments are like tests for better treatments.


Pantilat, Steven MD. 2008. Beneficence vs. Nonmaleficence. UCSF School of Medicine. Retrieved Feb 26, 2009, from http://missinglink. ucsf. edu/lm/ethics/Content%20Pages/fast_fact_bene_nonmal. htm

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