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AIM: (1) To determine the repartition of criteria which can be considered as marks of lack of assent by the child with intellectual disabilities from the dentist's point of view and whether that influences the decision to examine the patient or not. (2) To explain the decision of practitioners and determine the ethical implications of these practices. METHODS: An anonymous and structured questionnaire was distributed online using the scenario of a 9-year-old child with moderate cognitive impairment with eight different oppositional behaviours. The practitioners were asked about their perception of the patient's lack of assent and about their decision to perform the dental examination or not. RESULTS: The proportion of them who performed a dental examination despite the patient's refusal represented between 13% and 28.8% of the population of respondents. CONCLUSION: There was an ambivalence among the practitioners who carried out a dental consultation when children were uncooperative. They adopted a teleological point of view. It calls for us to reflect on the ethical principles of autonomy and beneficence.

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Introducción: La sordera es una discapacidad neurosensorial que provoca un problema de salud pública que afecta no solo al individuo que la padece sino también a su entorno familiar y social. Objetivo: Identificar la percepción de los estomatólogos sobre la atención estomatológica a los pacientes sordos. Material y Método: Se realizó un estudio descriptivo de corte transversal, con una muestra de 42 estomatólogos, entre 29 y 69 años de edad, de ambos sexos, pertenecientes a las Clínicas Estomatológicas de los Policlínicos Docentes del Municipio Marianao en La Habana, en los meses de junio y julio de 2016. Se realizó encuesta. Las variables estudiadas fueron: edad, sexo, conocimientos sobre las reglas de comunicación con el paciente sordo, conocimiento de las posibles causas de insatisfacción de los pacientes sordos durante la atención estomatológica, reconocimiento de los elementos a considerar durante la atención estomatológica al paciente sordo y conocimiento de factores capaces de generar estímulos negativos durante la atención estomatológica al paciente sordo.Resultados: El sexo femenino fue el de mayor predominio con 73.8 por ciento. El 66.7 por ciento de los Estomatólogos no conoce las reglas de comunicación de los pacientes sordos y 78.6 por ciento no conoce los aspectos a tener en cuenta durante la atención al paciente sordo. El 100 por ciento de los encuestados no reconoce los estímulos negativos ni las posibles causas que provocan insatisfacción en dicha población. Conclusiones: La mayoría de los estomatólogos encuestados son del sexo femenino, no reconocen las reglas de comunicación ni los aspectos a tener en cuenta durante la atención al paciente sordo; mientras que la totalidad de ellos desconoce los factores capaces de generar estímulos negativos o las posibles causas que provocan insatisfacción en la atención a estos pacientes(AU)

Introduction: Deafness is a neurosensorial disability which causes a public health problem that affects not only the individual who suffers from it, but also his social and family environment. Objective:To identify the dentists´ perception of dental care they deliver to deaf patients. Material and methods:A descriptive cross-sectional study was conducted, which comprised a sample of 42 dentists aged from 29 to 69 years, of both sexes, who work in the Dental Clinics of the Teaching Polyclinics located in Marianao Municipality, Havana, in June-July, 2016. A survey was made. The variables studied were: age, sex, knowledge about the rules for communication with the deaf patient, knowledge of the possible causes of dissatisfaction of the deaf patients with dental care, recognition of the elements to consider during dental care of the deaf patient, and knowledge of the factors which are capable to generate negative stimuli during the dental care of the deaf patient. Results:The highest predominance was observed in females (73.8 percent). The 66.7 percent of dentists do not know the rules for communication with deaf patients, and the 78.6 percent of them are unaware of the aspects to keep in mind during the care of the deaf patient. The 100 percent of the surveyed dentists do not recognize neither the negative stimuli nor the possible causes that lead to dissatisfaction in this population. Conclusions: Most of the surveyed dentists are female, they do not know neither the communication rules nor the aspects to keep in mind during the care of the deaf patient; whereas the totality of them are unaware of the factors that are capable to generate negative stimuli or the possible causes which lead to dissatisfaction in the attention to these patients(AU)

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The ADA Principles of Ethics and Code of Professional Conduct is an expression of the obligation occurring between the profession and society to meet the oral health needs of the public. At a time of economic concerns for the profession, suggestions are made to bring together the ethics of the profession and the need to expand services to underserved populations, including individuals with disabilities and the poor. The profession's effort to secure economic support for such an effort is possible with increased legislative awareness of the magnitude of the problem. To this end, the number of individuals with disabilities was developed for each Congressional district in New York State in an effort to challenge members of Congress to recognize the need in terms of their constituents, rather than in terms of the tens of millions with disabilities in the United States-which become "just numbers," not actual people.

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When examining solutions to mitigate dental disease and the crisis involving access to care, a question is frequently raised: "Is some care better than no care?" However, the question generally lingers unanswered. The purpose of this paper was to perform an ethical analysis of the question "is some care better than no care?" in order to ascertain whether solutions that provide "some care" are ethically justifiable.

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This study evaluates several ethical dilemmas of by dental practitioners treating persons with mental disabilities (PMD) by dentists in the Netherlands and Belgium. Ethical dental care for PMD is a hot topic. Worldwide different treatment strategies are used in the dental treatment of this patient group. In addition, cultural aspect seems to play an important role in the choices made. The latter can explain the difficulty in creating European and worldwide guidelines on this issue. A questionnaire was sent to dental practitioners interested in treating PMD persons both in the Netherlands and in Belgium including questions on the use of behaviour management techniques, use and attitude towards sedation and physical fixation and the cooperation with other health care personal. Behaviour management techniques and sedation are frequently used. Dentist of the Netherlands and Belgium in general reject the restraint of PMD persons. However, limited use of manual restraint in accordance with the carers and the close surrounding of the patient seems to be accepted. Dental practitioners are sometimes confronted with an emotional dilemma in treating PMD and the majority feels that it is a continuous challenge to obtain optimal result of the dental treatment.

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Managing patients with dementia requires a practitioner to exercise diverse skills. Communicating with the patient (as their dementia allows), relatives, caregivers and medical personnel are essential elements in the care process. Diagnosis of oral health problems may not be straightforward, clinical examination and treatment planning may be hampered by poor cooperation from the person with dementia. Practitioners must view any treatment from the patient's perspective and balance this with the requirements for sound clinical care. The consent process must be approached in a manner that fulfils the ethical responsibilities that acknowledge patient rights. This can be difficult when managing a patient with dementia. This paper will explore issues surrounding the consent process and the provision of oral health care to people suffering from dementia. It is hoped that readers will be stimulated to review their practice; especially related to informed consent, whether they routinely manage patients with dementia or not. Such practice evaluation should consider the wants and needs of patients and families on a broader than clinical basis and thus enhance the care that is brought to this group of interesting and often challenging patients.

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