Ethics and leadership in children's oral health

This paper reviews key ethical precepts in health care for children, and explores how interpretations of justice predict different and sometimes conflicting approaches to children's dental needs. Ethics is a core competency for health professionals because of their special responsibilities toward patients and the public. Ethical principles guiding health professionals include: (1) beneficence; (2) nonmaleficence; (3) respect for autonomy; and (4) justice. Different theories of justice lead to different responses toward public needs, such as access to dental care. The most frequently encountered response in the dental community is volunteerism, consistent with the libertarian perspective on justice. Though desirable, volunteerism alone will never solve dental access issues because such efforts do not address the problems systematically. A policy statement of the American Academy of Pediatric Dentistry (AAPD) explicitly recognizes that children have a right to oral health care. Children's unique characteristics--their vulnerability, dependence, and developmental processes-call for special arrangements to address their health needs. Given the importance of children to society, it is critical that all health sectors work together to address children's health and well-being. However, those with the greatest knowledge of children's oral health needs-pediatric dentists-must take a leadership role in creating and supporting solutions to these needs. The AAPD has an opportunity to support systemic solutions at the state and national level to ensure that all children have access to oral health care. One example of a systemic solution is the Access to Baby and Child Dentistry (ABCD) program in Washington State.