Janakiram Chandrashekar, Taha Farheen
Department of Public Health Dentistry; Professor, Amrita School of Dentistry, Amrita Vishwavidhyapeetham, Ponnekkara P O Kochi, Kerala 682 041, India,.
Postgraduate Scholar, Amrita School of Dentistry, Amrita Vishwavidhyapeetham, Ponnekkara P O Kochi, Kerala 682 041, India,.
Indian J Med Ethics. 2016 Jul-Sep;1(3):171-6. doi: 10.20529/IJME.2016.047.
Screening is the detection of disease at a point in its natural history when it is not yet symptomatic. In the natural history of dental caries, for example, the incipient lesions are at a reversible stage, which is a pre-symptomatic or an unrecognised symptomatic disease. Ideally, this is the stage during which screening should identify the risk of dental caries; however, presently, the so-called dental screening employed identifies the clinical cavitation of the tooth, which is very obvious to the individual. The individual already knows that he/she has dental caries and needs treatment, which the screening personnel (dental doctor) explains again during the screening procedure. Is it ethical to call such an event screening? The mushrooming of dental teaching hospitals has promoted regular screening of dental diseases among the communities and schoolchildren through their community dentistry-related activities. More often, it is a dental "check-up" that is carried out on the pretext of screening for dental diseases. Though the basic intention of this activity is to promote awareness of dental diseases and promote good health, there is also a hidden agenda to it. An artificial demand for dental care is created that is easily capitalised on by the dental teaching institutions to enhance its clinical activity. Dental screening is doing more harm than good as patients are made aware of the diseases for which they may not be able to afford treatment. This narrative review gives an account of the scientific evidence on screening for oral diseases, the current practices in screening and the ethical dilemmas of dental screening programmes.
筛查是在疾病自然史中尚未出现症状的阶段对疾病进行检测。例如，在龋齿的自然史中，早期病变处于可逆阶段，这是一种症状前或未被识别的有症状疾病。理想情况下，这正是筛查应识别龋齿风险的阶段；然而，目前所采用的所谓牙齿筛查识别的是牙齿的临床龋洞，这对个人来说非常明显。个人已经知道自己患有龋齿且需要治疗，而筛查人员（牙医）在筛查过程中又会再次解释这一点。把这样的事情称为筛查合乎伦理道德吗？牙科教学医院的迅速增加通过其与社区牙科相关的活动推动了对社区和学童的牙科疾病定期筛查。更多时候，是以牙科疾病筛查为借口进行牙科“检查”。尽管这项活动的基本意图是提高对牙科疾病的认识并促进健康，但它也有一个隐藏的目的。制造了对牙科护理的人为需求，牙科教学机构很容易利用这一点来增加其临床活动。牙齿筛查弊大于利，因为患者了解到了他们可能无力治疗的疾病。这篇叙述性综述阐述了关于口腔疾病筛查的科学证据、当前的筛查做法以及牙科筛查项目的伦理困境。
