About informed consent.

Radiation therapy for malignant tumors of the head and neck is associated with significant side effects involving the oral cavity. For example, radiation therapy leads to reduced vascularity and oxygen tension of the oral hard and soft tissues and also to salivary gland dysfunction. These changes increase the risk of dental decay and oral infections and lead to reduced healing capacity following oral surgery procedures. A severe complication of radiation therapy is osteoradionecrosis of the jaw bone. The purpose of this paper is to review preradiation oral examination and treatment. Patient management regarding oral disease prior to radiation therapy has to accomplish a number of goals: (1) to identify existing oral disease and potential risk of oral disease, (2) to remove infectious dental/oral foci before the start of radiation therapy, (3) to prepare the patient for the expected side effects with information about them, (4) to establish an adequate standard of oral hygiene to meet the increased challenge, (5) to provide a plan for maintaining oral hygiene and fluoride treatment, for oral rehabilitation, and for follow-up and (6) to inform the patient about the availability of any financial support for dental treatment, and finally (7) to establish the necessary multidiciplinary collaboration within the health care system so that oral symptoms and sequelae before, during and after the radiation therapy can be reduced or alleviated. The methods used to accomplish these goals may vary between cancer centers. Each center should have a multidisciplinary team to handle such problems. After the end of radiation therapy most of the dental treatments in our patients are done by private dentists, except for some oral surgery procedures, which are performed in hospital. In our experience, the major challenge in this process is related to (1) informing of the patient, (2) timing the coordination between all the health care workers involved, (3) establishing an adequate schedule for dental treatment and follow-up, and (4) securing patient compliance to prevent or reduce the oral side effects.

Dental Care↗

PubMed2002

Dutch dental patients on informed consent: knowledge, attitudes, self-efficacy and behaviour.

In The Netherlands, the legal doctrine of informed consent is established in the 'Medical Treatment Contract Act', which was introduced in 1995. This study assessed dental patients' knowledge, attitudes and self-efficacy, as well as their self-reported behaviour concerning informed consent. One hundred and twenty-eight patients (response rate: 91.4%) filled out a questionnaire on these topics, right after their treatment or consultation. Results show that only a minority of the patients is acquainted with the 'Medical Treatment Contract Act'. However, their specific rights concerning informed consent are better known. On the other hand, patients' attitudes and self-efficacy were less positive. Dental patients' self-reported behaviour, did not reflect their attitudes and self-efficacy though. Contrary to social-psychological theory, almost no significant relations were found between the four measured variables, and self-reported behaviour could hardly be predicted by patients' knowledge, attitudes and self-efficacy. In light of these findings, it is concluded that other factors, which take into account more of a consumerist perspective on the dentist-patient relationship, probably play a more important role in predicting to what extent patients assert their rights in dental practice.

Dental Care↗