Bedbugs

THE FRONT OFFICE Bedbugs Background.—Bedbug infestation has become a significant public health concern, affecting many communities worldwide. Should an infestation occur in a dental office, both patients and staff members are exposed to a potential health hazard. As a result, the dentist has both legal and ethical issues to address. Often, the ethical concerns exceed the legal duties of the situation. Legal Issues.—Individual state laws vary; therefore, each dental professional must be aware of all applicable laws. The legal ramifications of a bedbug infestation often involve potential physical, psychological, and monetary damages experienced by patients more than any violation of a state dental practice act. Dentists should be aware of the extent of their malpractice coverage concerning situations that may affect the patient’s welfare. As employers, dentists may also be subject to federal or state obligations stemming from the Occupational Safety and Health Act and other laws designed to protect employees in workplace settings. Ethical Concerns.—Although parasitic infestations are not specifically covered by the American Dental Association Principle of Ethics and Code of Professional Conduct (ADA Code), the ethical principles embodied in the code can be brought to bear on these situations. The introduction to the ADA Code sets forth the aspirational goals of the profession, which provide guidance and offer justification for the code itself. It recognizes that the ADA Code is an evolving document that is bound to change with time. In addition, the dentist has a duty to not only avoid harming the patient but also to protect the patient from harm through the principle of nonmaleficence. Bedbugs have been found to provide temporary harbor for 28 pathogens, including HIV and hepatitis B, although these pathogens fail to thrive in the host long enough to cause disease in people. However, exposure to a known parasitic insect with the potential for an epidemic spread should prompt notification of patients who may have been affected. Dentists also have an ethical duty to inform patients about any possible exposure to blood or other potentially infectious material—and bedbugs would reasonably fall into that category. Service to the patient and the public is the primary obligation of dentists; therefore, the needs of patients and the public should guide the dentist’s actions when there has been an

exposure to a potential health risk at the dental facility. Dentists must also be fair and prudent in their dealings with patients, colleagues, and society; therefore, they should not expose patients to harm without disclosing the potential risk. Finally, dentists must be truthful and trustworthy in their dealings. They must not only respect the position of trust that is inherent in the dentist–patient relationship but also deal honestly and without deception, maintaining a position of integrity. Discussion.—Should a bedbug infestation occur in a dental office, the dentist must take steps to not only rid the facility of the problem but also truthfully inform patients and staff about the potential exposure and possible treatment options. Because bedbugs are highly transmissible, they exact an emotional and physical toll on the body, and there are significant costs for ridding a home or other property of the creatures, patients are likely to track down the source of the problem and may institute legal proceedings to demand that the dentist adheres to all appropriate ethical and legal principles. Following ethical principles first is much preferred to going through a legal adversarial process.

Clinical Significance.—Dental professionals whose offices become infested with bedbugs must carefully evaluate the problem, document everything applicable to its handling, and communicate the relevant information to patients and staff who may have been exposed. The patient’s welfare is the dentist’s ultimate obligation; therefore, he or she must include in the equation the physical and emotional aspects of the situation, as well as any legal or ethical issues.

Henner KA: What are the ethical ramifications and suggested guidelines when a dental office is confirmed as having an active bedbug infestation? J Am Dent Assoc 142:1398-1399, 2011 Reprints available from the American Dental Association Council on Ethics, Bylaws and Judicial Affairs, 211 E Chicago Ave, Chicago, IL 60611; information for reprints: http://www.ada.org/990.aspx

Volume 57



Issue 6



2012

287