General dentistry
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Practicing dentists are likely to be familiar with the prospect of patients who request controlled substances for doubtful indications. Torn between ethical obligations of beneficence and nonmaleficence, the dentist may be uncertain whether to prescribe a medication with the intention of alleviating pain or to refuse the prescription due to concerns related to chemical dependency, underlying emotional illness, or ulterior motives on the part of the patient. Pharmaceutical choices often do not provide a mechanism for sidestepping this dilemma as chemically dependent patients may be quite sophisticated in their knowledge of drugs and the ways in which to couch their requests. ⋯ However, dentists must always be open to the possibility that a particular patient's assertion of chronic physical pain may be of complex origin. When this is the case, appropriate treatment is essential and may involve referring the patient to others with specialized skills. Dentists should not withhold pain medication from patients with uncontrolled pain in the final stages of life.
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Sexual harassment in the workplace is harmful to employees and disruptive. While the ethical obligations arising from the doctor-patient relationship do not address a dentist's ethical obligations toward his or her employees, the more general ethical obligations to the profession and those of business ethics would mediate against the creating or tolerance of sexual harassment in the workplace. ⋯ While any gender in any position may be the victim of sexual harassment, women who occupy subordinate positions are the most likely targets of these overtures. Dentist-employers are wise to be proactive in providing an appropriate protocol for employees to use when they perceive sexual harassment in the workplace.
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Athletes who participate in competitive and recreational sports are at significant risk of orofacial injury. The use of mouth guards can reduce that risk substantially. The known incidence of orofacial trauma and benefits of athletic mouth guard use are reviewed. Dental health professionals are advised to advocate mouth guards for athlete-patients.
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Pain referred to the chest, with implications of cardiac distress, is described in a patient with a history of temporomandibular disorder (TMD). An anatomically-based hypothesis is included to explain the reported chest symptoms. The basis for nociceptive neuronal interactions between the muscles of the head and neck has been reported previously. The patient described here suffered from myofascial pain of the muscles of mastication and the postural muscles of the head and neck.