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LEGAL IMPLICATION OF DENTAL
RESEARCH AS IT RELATES TO DENTAL
TECHNOLOGIST
A PRESENTATION BY
OKORIE PETER CHIDIEBERE
(RDT, B.TECH)
@
2012 NATIONAL CONFERENCE OF THE
NATIONAL ASSOCIATION OF DENTAL TECHNOLOGISTS’ OF NIGERIA (ADTN)
11TH -12TH, OCTOBER, 2012
HELD AT EMPIRE SUITES, DAVID MARK BYE – PASS,
MAKURDI, BENUE STATE
Dentistry is the branch of medicine that is involved in the study, diagnosis,
prevention, treatment of diseases and rehabilitation of the patients lost
teeth/tissues, disorder and conditions of the oral cavity, maxillofacial area / the
adjacent and associated structures and their impact on the human body. Dentistry is
a wide discipline encompassing the Dental Surgery, Dental Technology and Dental
Therapy/Hygiene. (American Dental Association, 2010)
CONCEPTUALISATION
Dental Technology is a restorative/rehabilitative aspect of dentistry that deals
with the art and science of design, construction or fabrication and servicing of
dental, or oral (oro-facial) appliances for the replacement of missing part of
oro-facial part of the human body.
Legal is something that is lawful or something that is permitted by Law
Law is defined as a rule intended to guide human behaviour which is laid
down in a given area by authority and which is enforced in that area by
authority.
Ethics are informal or formal rules of behavior that guide individuals or
groups of people
Implication is a possible effect or result of an action or a decision
Legal implications as the name implies are the consequences of being involved
in something, as determined by the law. It can either be positive or negative.
The word ethics comes from the Greek ethos originally meaning character or
conduct. It is typically used interchangeably with the word moral which is derived
from the Latin word mores, which means customs or habits. Together these two
terms refer to conduct, character, and motivations involved in moral acts. Thus,
ethics are not imposed by a profession or by law, but by moral obligation. Ethics are
an unwritten code of conduct that encompass both professional conduct and
judgment. Though the details of the written ethical code may vary from profession to
profession, the underlying principles of ethics remain the same (David and David
,2004)
Dental ethics are the standards of conduct use in dental practices to make decisions
and morality which involves the judgment or evaluation of an ethical system,
decision, or action based on social, cultural, or religious norms. They both
incorporate notions of approval or disapproval and in some cases are also applied to
the character or virtues of the profession (Academy of General Dentistry, 2011)
The five fundamental principles set forth by the American Dental Association
(ADA) require further review so they are applied to the profession properly. To
achieve proper ethical conduct in a dental setting, all the team of dental family must
first begin by treating each patient as an individual and take true interest in the
patient’s dental needs and wants.
Patient
Autonomy. Is the right of the patient to make his or her own decisions
regarding the treatment that he or she will receive. It was not long ago that the
majority of dental decisions were left in the hands of the practitioner only.
Now, it is essential that the patient have the final decision in his or her
treatment. The practitioner is responsible for providing the patient with all of
the available treatment options, the successes and hardships associated with
those treatments, and giving the patient the ability to make a decision that is
informed and best suits his or her needs.
Non-maleficence
essentially states that a dental practitioner must not
cause unnecessary harm to a patient. Obviously in some courses of
treatment some level of pain may be necessary to achieve the desired outcome;
however the decision regarding the level of pain that is acceptable to the
patient must be determined and obliged to by the patient before
commencement of treatment.
Beneficence
refers to the principle of promoting or doing good. It is
essential that the dental practitioner provides competent and timely dental care
with the needs, desires, and values of the patient given due consideration.
Justice.
Dental practitioners have the responsibility to be fair in their
dealings with patients, Colleagues and society. Essentially, the principle of
justice embodies the concept that the dental professions actively pursue the
ability to improve access to care for all throughout society. Practicing justice
includes serving patients without discrimination against race, creed, color,
sex, disease or national origin.
Veracity
revolves around being truthful and respecting the position of
trust that is essential in the dental technologist-patient relationship.
This includes truthful communication without deception and maintaining
intellectual integrity. Areas included under veracity are truthfulness in
billing issues and advertising.
DENTAL TECHNOLOGY OF NIGERIA ETHICS
According to the ethical conducts as specified in the Dental Technologists’
Registration Board of Nigeria (DTRBN) Code of Ethics. It is required of a
Dental Technologist to be acquainted and abide by the various rules which
are specified in the booklet. But for the seek of time, Rule 6 would be
examined here as it relates the Patients.
RULE 6: RELATIONS WITH PATIENTS
(a) No member of the profession may involve himself in the management or
administration of Finances of a patient other than his proven relation
(b) A member must use approved materials in the construction of dental
prostheses and appliances at all time except where for the patients’ comfort
and good health
(c) Members shall always use materials as specified by the patient for whom the
work is being performed or by his dental practitioner except where choice of
material is left to his discretion in which case the Dental Technologist upon
request will accurately inform the other health officers respecting the type and
kind of material used.
(d) The health of the patient shall be of paramount consideration to the Dental
Technologist and nothing shall be done which endangers or likely to endanger
the health of the patient.
(e) Every member of the profession must in relating with his patient be kind,
understanding and never take advantage of the patient in any way.
(f) Members shall not knowingly or recklessly accept for use in construction of
dental prostheses or appliances materials which are substandard, expired or in
any way faulty as to likely endanger the patient’s life.
However, according to the Code of Practice – Dental Technology produced
by the Council for the Professions Complementary to Medicine, a Dental
Technologist should maintain :
(a) Respect for patients and colleagues without prejudice, diversity of
background and opportunity, language and culture
(b) The recognition of patient’s rights, particularly with regards to
confidentiality and informed consent;
(c) An awareness of moral and ethical responsibilities involved in the provision
of care to individual patients and to populations;
(d) A desire to care and provide an effective service to enhance patients’ quality
of life within a holistic view of patient care
(e) An ability to critically review and accept the diversity of designs and
techniques that might be applied by other team members in response to
patients’ needs;
(f) The ability to cope with stress, uncertainty and setback along with the
importance of one’s own health and its impact on the ability to practice as a
dental technologist;
(g) An understanding of audit and clinical governance;
(h) An appreciation of the importance of honesty and trustworthiness;
(i) An appreciation of the importance of continuing professional development
Research is a method of inquiry. It is a way of thinking by which we learn
and know things about all natural phenomena and indeed everything about
the world around us. It is a process of arriving at dependable and empirically
testable solutions to problems through the planned and systemic collection,
analysis, and interpretation of data (Abanobi, 2003)
BASES OF RESEARCH
Describing
Natural Phenomena
Explaining Natural Phenomena
Predicting Natural Phenomena
Evaluating Natural Phenomena
Exploring Natural Phenomena
It would be understood that all research studies generally begin with the
identification and formulation of a problem for which new knowledge, facts
or procedure are needed to resolve it. It is important that the first step to
carrying out a research is recognizing a difficulty or discrepancy, defining
and specifying it; which involves the identifying of the variables which their
interrelatedness must be understood in other to solve challenge.
Dental Technology is not a pure science in the way that mathematics and physics are.
It is evidence based and has many general principles that are valid most of the time,
but every patient is different. What is an effective treatment for 90% of the
population may not work necessarily for the other 10%. Thus, dental Technology is
inherently experimental (practical). Even the most widely accepted treatments need
to be monitored and evaluated to determine whether they are effective for specific
patients and, for that matter, for patients in general. This is one of the functions of
dental research.
All Dental practitioners make use of the results of dental research in their clinical /
laboratory practices. To maintain their competence, they must keep up with the
current research in their area of practice through Continuing Dental
Education/Continuing Professional Development programs, Dental Technology
journals and interaction with knowledgeable colleagues. Even if they do not engage
in research themselves, Dental Technologists must know how to interpret research
result and apply them to improve their practice. Thus, a basic familiarity with
research methods is essential for competent Dental Technology practice. The best
way to gain this familiarity is to take part in a research project, either as a dental
student or following qualification.
Ideally, all aspects of dental technology practices should be validated by
research. Materials such as impression materials, metallic materials, acrylic
monomer and polymers and some other pharmaceutical products etc require
evidence for their safety and efficacy before they are given governmental
approval for their distribution and use. Thus, this is where a dental technologist
is fitted in to Standard Organisation of Nigeria (SON) and National Drug
Law Enforcement Agency (NAFDAC).
However, dental techniques do not require any such approval. Most dental
technologist trusts that the techniques they learn in dental school are
appropriate but are ready to adopt new ones if these appear to be better. Rather
than relying on their own, necessarily limited, experience, dental technologist
need to have recourse to the results of research for determining which materials
and techniques are best for their patients (Williams, 2007).
The most common method of research for comparing and evaluating drugs is
the clinical trial process, which with certain modifications serves for materials
and techniques as well. The process usually begins with laboratory studies
followed by testing on animals. If these prove promising, the four steps. These
Phases are:
Phase One
Phase Two
Phase Three
Phase Four
Phase
one research, usually conducted on a relatively small number
of healthy volunteers, who are often paid for their participation, is
intended to determine what dosage of a drug is required to produce a
response in the human body, how the body processes the drug, and
whether the drug produces toxic or harmful effects.
Phase
two research is conducted on a group of patients who have the
disease that the drug is intended to treat. Its goals are to determine whether
the drug has any beneficial effect on the disease and has any harmful side
effects.
Phase three research is the clinical trial, in which the drug is administered
to a large number of patients and compared to another drug, if there is one
for the condition in question. Where possible, such trials are ‘doubleblinded’, i.e., neither research subjects nor their practitioner know who is
receiving which drug or treatment.
Phase four researches takes place after the drug is licensed and marked.
For the first few years, a new drug is monitored for side effects that did not
show up in the earlier phases. Additionally the pharmaceutical company is
usually interested in how well the drug is being received by the dental
practitioners who prescribe it and patients use it.
These four phases as used in pharmaceutical and material science companies
should be employed by the Dental Technologists in their day to day
treatment of patients which most be documented
The rapid increase in recent years in the number of ongoing trials has
required finding and enrolling ever-larger numbers of patients to meet the
statistical requirements of the trials. For dental research, those in charge of
the trials, whether academic researchers or industry, now rely on many
dental technologists, often in different countries, to enroll patients as
research subjects. Although such participation in research is valuable
experience for dental technologist, there are potential problems that must be
recognized and avoided (Williams, 2007).
In the first place, the role dental technologist in the dental technologists’patient relationship is different from the researcher’s role in the researcherresearch subject relationship, even if the dental technologist and the
researcher are the same person. The dental technologists’ primary
responsibility is the health and well-being of the patient, whereas the
researcher’s primary responsibility is the generation of knowledge, which
may or may not contribute to the research subject’s health and well-being.
Thus, there is a potential for conflict between the two roles. When this
occurs, the dental technologists’ role must take precedence over the
researcher (Williams, 2007).
Another potential problem in combining these two roles is conflict of
interest. Dental research is a well funded enterprise, and dental
technologists’ are sometimes offered considerable rewards for
participating. These can include cash payments for enrolling research
subjects, equipment such as computers to transmit the research data,
invitations to conferences to discuss the research findings, and coauthorship of publications on the results of the research.
The Dental Technologists’ interest in obtaining these benefits can
sometimes conflict with the duty to provide the patient with the best
available treatment. It can also conflict with the right of the patient to
receive all the necessary information to make a fully informed decision
whether or not to participate in a research study. These potential
problems are not insurmountable. The ethical values of the Dental
technologist’s – compassion, competence, autonomy – apply to the
dental researcher as well. As long as Dental technologist understand and
follow the basic rules of research ethics, they can successfully integrate
research into their laboratory/ clinical practices.
It is necessary to conclude that researchers in dentistry and
dental technology have tremendous impact on the
improvement and maintenance of dental status of both
individuals and whole communities. Research which helps to
understand human behaviour, compliance behaviour,
utilization of health and dental services, prophylactic
behaviour, health promotion behaviour etc has some legal
implications which ranges from seeing the ethical principle of
conduct, character and motivation and thus seeing that some
of the patients information are safeguarded and not been
exposed in the course of research work.

Abanobi O.C (2003). Research Methods for Health and Social
Sciences. Opinion Research and Communications Inc Publication,
Owerri. Pp 1- 2.

Academy of General Dentistry (2011). Dental Ethics: A Brief preview.
CME Resources, Sacramento, CA 95899-7571, USA,

American Dental Association(2010), Dentistry Definitions. Available at
http://www.ada.org/495.aspx. Last accessed September 13, 2012.

American Dental Association (2010). Dentistry Definitions. Hosted on
the American Dental Association website, page accessed, 12th
August, 2012. The definition was adopted by associations House of
Delegates in 1997.
Council for the Professions Complementary to Medicine (2006). Code
of Practice – Dental Technology.
David T. Ozar and David J. Sokol (2002). Dental Ethics at
Chairside: Professional Principles and Practical Applications 2nd
edition. Washington, DC: Georgetown University Press.
Dental Technologists’ Registration Board of Nigeria (1987). Code of
Ethics. Seen in the Dental Technologists’ Registration Board of
Nigeria Code of Ethics pgs 5 - 19
Williams, John R (2007). Dental Ethics Manual. FDI World Dental
Federation. Chemin du Lerant, 01210 Ferncy – Voltaire, France.
The following persons are really recognised in one way or the other in my
Life:
 DR NIYI OGUNBOWALE, HOD, DENTAL TECHNOLOGY, FUTO
 MR KEN OKEKE, WAS MY ACADEMIC ADVISER, MENTOR AND
FATHER
 DR CHIJOKE ERONINI, WHO I WORKED UNDER DURING MY
INTERNSHIP PROGRAMMME
 MR EYERAFE STEPHEN, WAS MY ACADEMIC ADVISER 2
 MISS GETRUDE CHIKA WAS MY LECTURER
 MRS NGOZI EKEANYANWU.. MY SUPERVISOR DURING MY
INTERNSHIP PROGRAMME
 DR BEN EPHRAIM, HOD, DENTAL HEALTH SCIENCE,
BAYCOHTECH
 MR APERALLA, HEAD OF UNIT DENTAL
TECHNOLOGY,DENTAL HEALTH SCIENCE,BAYCOHTECH
 MISS CAROLINE CHIDINMA NNAMCHI. THANKS A LOT.
For comments, further information about this paper and
Suggestions, correspondence to:
OKORIE PETER CHIDIEBERE
Department of Dental Health Sciences
School of Allied Medical Sciences
Bayelsa State College of Health Technology
Otuogidi, Ogbia LGA, Bayelsa State
Tel: +2348039546036, 07084824579
E-mail : [email protected]