The ethics of experimenting in dental practice

There is a common misconception that scientists conduct research in their labs or clinics and practitioners do not experiment, but only use the best results reported in the literature. This confusion comes about because dentists are not trained in, nor do they normally observe, the formal requriments of research protocol or ethics. It is generally believed that the norms that apply to clinical practice also cover all situations where dentists innovate in their treatment protocols with a view toward discovering more effective ways to treat patients or where they modify a standard protocol in hopes of better serving the needs of an atypical patient. In this 2002 paper from the Dental Clinics of North America (Volume 46, Number 1, pp. 29-44), David W. Chambers challenges the concept that useful general knowledge is created only outside dental practice and then transferred into the office. But if it is the case that practitioners experiment, even to the limited extent of customizing materials and methods to their own needs or the particular circumstances of patients, there are ethical considerations. All modifications are not equally justifiable, the patient should be involved in "partially tested" approaches in a different way from the routine, and there needs to be sound reason to believe the innovation will not fall below the standard of care. Experimental practice has the characteristics of high probability of success, structured observation, realistic settings, and careful documentation. Heroic measures can only be undertaken when available options have failed and with full consent of the patient. A two-part ethical test is proposed for experimenting in practice: (a) If the dentist believes members of the community (patients, colleagues, or society generally) would be offended or outraged by an action, provided that they became aware of the relevant details--to not do it! (b) If the dentist believes members of the community would be concerned by an action, provided they became aware of the relevant details--discuss it with them. There is also an ethics of evaluating and adopting the research literature to one's office. Some of the requriments in this area include maintaining a current and critical familiarity with developments, understanding the difference between the internal validity of studies in the context where they were conducted and the likely adaptations or cautions needed when customizing the literature to individual practices, and knowing the proper weights to give to the literature and one's own clinical experience.