- Email: [email protected]
Dry mouth responds to acupuncture
for balancing relevant evidence with patient needs and desires and choosing a clinical course that is in the best interests of the patient. Legal Implications.—If the oral health care professional fails to obtain the necessary information, falling short of the standard of care, and the patient suffers injury associated with the condition, the dentist is legally liable. Many dentists may erroneously assume that they limit their liability by requesting ‘‘medical clearance’’ from the patient’s physician for a procedure. However, liability for the treatment given does not shift to the physician; it remains with the dentist. The physician is accountable for the accuracy of the information he or she provides and the care that he or she renders, but not for the decisions or actions of the treating dentist. Discussion.—Only treating dentists can provide clearance for the treatment they provide. They function as primary caregivers of oral health care so they have the professional autonomy and control of their treatment decisions. As a result, they are accountable for their conduct
and cannot abdicate responsibility for treatment decisions to consulting physicians.
Clinical Significance.—Medical clearance can be used as a crutch or justification for dentists when they feel they do not have enough knowledge or judgment to provide safe, appropriate care for a patient. However, the dentist remains accountable for his or her actions and decisions even when he or she has consulted a physician for information.
Gary CJ, Glick M: Medical clearance: An issue of professional autonomy, not a crutch. J Am Dent Assoc 143:1180-1181, 2012 Reprints available from M Glick, School of Dental Medicine, Univ at Buffalo, 325 Squire Hall, Buffalo, NY 14214-8006; e-mail: [email protected]
EXTRACTS DRY MOUTH RESPONDS TO ACUPUNCTURE A study from the United Kingdom reports that patients who have chronic dry mouth after cancer treatment have found some relief from group acupuncture treatments. Dr Richard Simcock from the Sussex Cancer Centre in Brighton explained that ‘‘These are patients for whom no other treatment has been helpful, and they feel better and their life has been improved as a result of this intervention.’’ Dry mouth often develops after radiation therapy for head and neck cancers, and pilocarpine, the only drug known to treat it, carries side effects. Other treatments don’t always provide relief. The 144 patients came from seven UK cancer centers and were at least 18 months out from radiation therapy for head or neck cancer. One group attended two hour-long educational sessions on oral care, and the other had eight weekly 20-minute group acupuncture sessions focusing on the traditional points in the head and fingers associated with the salivary glands. After one round of treatment, the groups switched their assignments. After acupuncture, patients were 1.65 to 2.08 times more likely to report improved status for five of six dry mouth symptoms than patients who had oral care instruction. About a fourth of the patients noted improvements. The mechanisms by which acupuncture produces effects remain unclear. Some benefit could have resulted from patients’ expectations that acupuncture would help or from their relationship with the acupuncturist rather than from the needle insertions. Even if the placebo effect is at work, as Lorenzo Cohen, a cancer researcher from the University of Texas, MD Anderson Cancer Center in Houston not involved with the study, says, ‘‘. . . the patients reported improvements, and at the end of the day the objective . . . is to improve how people feel.’’ Having the acupuncture done in a group setting makes it a cost-effective option for areas where there is high demand. As long as it is delivered by a qualified practitioner, acupuncture is safe, noninvasive, and seldom results in any harm, so there is no strong reason to deny patients the option. [Pittman G: Acupuncture May Ease Dry Mouth After Cancer. Annals of Oncology, online October 24, 2012]
Volume 59
Issue 1
2014
17
and cannot abdicate responsibility for treatment decisions to consulting physicians.
Clinical Significance.—Medical clearance can be used as a crutch or justification for dentists when they feel they do not have enough knowledge or judgment to provide safe, appropriate care for a patient. However, the dentist remains accountable for his or her actions and decisions even when he or she has consulted a physician for information.
Gary CJ, Glick M: Medical clearance: An issue of professional autonomy, not a crutch. J Am Dent Assoc 143:1180-1181, 2012 Reprints available from M Glick, School of Dental Medicine, Univ at Buffalo, 325 Squire Hall, Buffalo, NY 14214-8006; e-mail: [email protected]
EXTRACTS DRY MOUTH RESPONDS TO ACUPUNCTURE A study from the United Kingdom reports that patients who have chronic dry mouth after cancer treatment have found some relief from group acupuncture treatments. Dr Richard Simcock from the Sussex Cancer Centre in Brighton explained that ‘‘These are patients for whom no other treatment has been helpful, and they feel better and their life has been improved as a result of this intervention.’’ Dry mouth often develops after radiation therapy for head and neck cancers, and pilocarpine, the only drug known to treat it, carries side effects. Other treatments don’t always provide relief. The 144 patients came from seven UK cancer centers and were at least 18 months out from radiation therapy for head or neck cancer. One group attended two hour-long educational sessions on oral care, and the other had eight weekly 20-minute group acupuncture sessions focusing on the traditional points in the head and fingers associated with the salivary glands. After one round of treatment, the groups switched their assignments. After acupuncture, patients were 1.65 to 2.08 times more likely to report improved status for five of six dry mouth symptoms than patients who had oral care instruction. About a fourth of the patients noted improvements. The mechanisms by which acupuncture produces effects remain unclear. Some benefit could have resulted from patients’ expectations that acupuncture would help or from their relationship with the acupuncturist rather than from the needle insertions. Even if the placebo effect is at work, as Lorenzo Cohen, a cancer researcher from the University of Texas, MD Anderson Cancer Center in Houston not involved with the study, says, ‘‘. . . the patients reported improvements, and at the end of the day the objective . . . is to improve how people feel.’’ Having the acupuncture done in a group setting makes it a cost-effective option for areas where there is high demand. As long as it is delivered by a qualified practitioner, acupuncture is safe, noninvasive, and seldom results in any harm, so there is no strong reason to deny patients the option. [Pittman G: Acupuncture May Ease Dry Mouth After Cancer. Annals of Oncology, online October 24, 2012]
Volume 59
Issue 1
2014
17