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Ethics & Law · patient case with 5 questions

Ethics and Occupational Exposure

demo: Multiple scenarios in one practice day

chief: Ethical and occupational issues arising during clinic

history: Scenario 1: a patient in pain demands extraction of two restorable teeth; the dentist believes root canal therapy is the better option. Scenario 2: a different patient with a periapical lesion refuses the recommended extraction. Scenario 3: an HIV-positive patient presents with a parulis on the buccal gingiva of #29. Scenario 4: the dentist sustains a needlestick from a used anesthetic needle.

meds: Not applicable

findings: See individual scenarios.

Question 1

In Scenario 1, which two ethical principles are in tension?

  1. Confidentiality and veracity
  2. Autonomy and beneficence
  3. Veracity and justice
  4. Nonmaleficence and justice
Show answer and explanation

Correct answer: B. Autonomy and beneficence

  • A. Confidentiality is not in question in this scenario.
  • B. Correct. The patient's right to direct their own care (autonomy) conflicts with the dentist's obligation to act in the patient's best interest (beneficence) by preserving restorable teeth.
  • C. Veracity concerns truthfulness and justice concerns fair distribution of care; neither is at issue here.
  • D. Nonmaleficence — doing no harm — is relevant in the background but the named conflict is autonomy versus beneficence.

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Question 2

In Scenario 2, where the patient refuses the recommended extraction, which principles are involved?

  1. Justice against veracity
  2. The same conflict — autonomy against beneficence — with the dentist obliged to document informed refusal
  3. No ethical principle is engaged if the patient signs a waiver
  4. Only nonmaleficence applies
Show answer and explanation

Correct answer: B. The same conflict — autonomy against beneficence — with the dentist obliged to document informed refusal

  • A. Neither justice nor veracity is the core tension here.
  • B. Correct. A competent patient may refuse treatment. The dentist's duty is to ensure the refusal is genuinely informed — explaining consequences — and to document it. Autonomy prevails, but beneficence obliges thorough disclosure.
  • C. A signature does not extinguish the ethical obligation to inform, and a waiver alone is not informed refusal.
  • D. Nonmaleficence is engaged, but it does not describe the central autonomy–beneficence conflict.

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Question 3

In Scenario 3, what is the most important point to convey about the HIV-positive patient's care?

  1. The parulis should be managed only after infectious disease consultation
  2. HIV is not transmitted by fomites; standard precautions are sufficient and treatment proceeds normally
  3. The operatory requires terminal sterilization beyond standard protocol
  4. Treatment should be scheduled at the end of the day for infection control reasons
Show answer and explanation

Correct answer: B. HIV is not transmitted by fomites; standard precautions are sufficient and treatment proceeds normally

  • A. A parulis is a sinus tract from an endodontic or periodontal infection and is managed by ordinary dental means.
  • B. Correct. HIV is a fragile enveloped virus not transmitted through inanimate objects. Standard precautions, applied to every patient, are sufficient, and refusing or segregating care is both clinically unjustified and discriminatory.
  • C. There is no separate elevated protocol for HIV; standard precautions already assume every patient may be infectious.
  • D. End-of-day scheduling for HIV patients is a discredited practice with no infection control basis.

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Question 4

In Scenario 4, what is the first action after the needlestick?

  1. Begin post-exposure prophylaxis before any other step
  2. Apply a caustic agent such as bleach to the wound
  3. Wash the wound immediately with soap and water
  4. Report to the state dental board
Show answer and explanation

Correct answer: C. Wash the wound immediately with soap and water

  • A. PEP may follow, but it comes after wound care and risk assessment, not before.
  • B. Caustic agents damage tissue and do not reduce transmission risk.
  • C. Correct. Immediate washing with soap and water is the first step, followed by reporting to the designated infection control officer, source patient evaluation, baseline testing, and prophylaxis if indicated.
  • D. The dental board is not the reporting pathway for an occupational exposure.

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Question 5

A parulis on the buccal vestibule adjacent to tooth #9 represents:

  1. The intraoral opening of a sinus tract draining a chronic infection
  2. A fibroma from chronic mechanical irritation
  3. A mucocele from a severed minor salivary duct
  4. A pyogenic granuloma of hormonal origin
Show answer and explanation

Correct answer: A. The intraoral opening of a sinus tract draining a chronic infection

  • A. Correct. A parulis — gum boil — is the soft tissue opening of a sinus tract from a necrotic pulp or a periodontal abscess. Tracing it with a gutta-percha point on a radiograph identifies the source tooth.
  • B. A fibroma is a firm, pale, sessile nodule at a site of chronic irritation with no drainage.
  • C. A mucocele is a fluctuant, bluish, mucin-filled swelling most common on the lower lip.
  • D. A pyogenic granuloma is a vascular proliferation, red and friable, that bleeds readily and is not a drainage point.

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