Table 2 Responses to the different scenarios (expressed in number)

Scenario 1

Amir, a nine-year-old child, arrives at your office, accompanied by his parents. They inform you that their dentist has recommended Amir to visit an orthodontist. Amir has already consulted with another orthodontist in the local area, Dr. Ahmed. They are seeking your expertise for a second evaluation. Upon conducting the initial clinical examination, the results indicate that the individual’s findings are within the expected range for their age and stage of dental development. As you direct your attention towards Amir’s parents to convey your ideas and recommendations, they initiate a conversation about the information shared by Dr. Ahmed during their visit to his office.

 1. Is it morally acceptable to listen to Dr. Ahmed’s suggestions prior to expressing your own?

  a. Yes (28, 76%)

  b. No (9, 24%)

 2. At a certain moment, the parents inform you of Dr. Ahmed’s statements, and you wholeheartedly concur with his diagnosis and suggestions. What is your preference?

  a. It is morally acceptable to persuade Amir’s parents to initiate his treatment at your clinic (1, 3%)

  b. It is advisable to assertively request they come back to Dr. Ahmed (2, 5%)

  c. Let the patient decide where to get treated (34, 92%)

 3. You believe that the only treatment necessary at this point is a fixed lower lingual arch in preparation for eventual non-extraction therapy. The Amir’s insurance does not cover this procedure but will cover a full course of orthodontic treatment. What would you recommend?

  a. Treat right now with lingual holding arch (LHA) (25, 68%)

  b. Wait for the single phase fixed orthodontic treatment (12, 32%)

 4. How likely will you get similar cases in your practice?

(Rating scale from 1 to 10, where 1 denotes less likely and 10 most likely)

Median response: 3

Scenario 2

Fatima, a 10-year-old girl, has experienced numerous dental issues. Upon observation, it is evident that she presents with a Class I malocclusion, characterized by significant crowding in both dental arches. Based on this assessment, it can be concluded that she is a suitable candidate for sequential four-premolar extraction treatment.

 Fatima’s family consented to the suggested treatment plan, and you constructed a meticulously prepared extraction note, officially asking the general practitioner, Dr. Salman, to perform the extraction. Instead of removing the first premolar, he opts to extract the second premolar in a specific quadrant. It is uncertain if this mistake will have an impact on the eventual result of Fatima’s case due to several factors. Nevertheless, it is now too premature to determine. You contact Dr. Salman to notify him of his mistake. While he acknowledges the stated facts, he directly questions if his error will have any impact on the outcome of Fatima’s case. You express uncertainty and state that you will need to assess the situation as it unfolds. Dr. Salman requests that the patient not be informed until it is determined whether his mistake will have an impact on the final outcome. If it does, he suggests either informing the patient or allowing him to do so.

 1. Will you inform Fatima’s parents of Dr. Salman’s mistake?

  a. Yes (28, 76%)

  b. No (9, 24%)

 2. Dr. Salman is not only an excellent source of case referrals; however, he is additionally your brother-in-law. Does this alter your response?

  a. Yes (5, 14%)

  b. No (32, 86%)

 3. How likely will you get similar cases in your practice?

(Rating scale from 1 to 10, where 1 denotes less likely and 10 most likely)

Median response: 3

Scenario 3

You get a phone contact from Sarah, who informs you that her child, Nura, is experiencing a critical issue with her orthodontic treatment. The patient’s primary orthodontist, Dr. Sultan, is currently out for the week, as he is participating in a professional gathering in the field of orthodontics. Unfortunately, the substitute doctor assigned to cover for him is currently unavailable and cannot be contacted. Upon doing a thorough examination of the patient, you engage in a conversation with her dad and mom, who inform you that Nura has been undergoing phase 1 treatment for nearly 2 years. Upon observation, you identify notable periodontal issues, an abundance of unremoved bonding material, inaccurate bracket positioning, and mid-treatment mechanics that give the appearance of a bleak outcome. You address the patient’s immediate issue, which involves a band that has become loose and an arch wire that has become bent.

Upon completion, Nura’s father nonchalantly inquires whether the outcome is satisfactory and if you anticipate the therapy to require more time.

 1. How should you respond to Nura’s father?

  a. Just explain the acute problem and ask to consult back to the treating orthodontist (13, 35%)

  b. Present your views on the patient’s problem (21, 57%)

 c. Explain the acute problem and add your views on the overall progress of the treatment (3, 8%)

 2. Do you serve a duty to communicate with anyone, such as the patient, Dr. Sultan, the local dentistry organization, etc.?

  a. Yes (17, 46%)

  b. No (20, 54%)

You have encountered five patients referred by Dr. Sultan in your office within the past two years. All individuals have exhibited comparable clinical manifestations.

 3. Does this alter your response?

  a. Yes (20, 54%)

  b. No (17, 46%)

 4. Is there a distinction in the impact based on whether Nura’s physician is a pedodontist or a general dentist?

  a. Yes (18, 49%)

  b. No (19, 51%)

 5. If you decide to speak up, to whom should you address your words?

  a. Patient/Guardian (18, 49%)

  b. Treating orthodontist (13, 35%)

  c. Friends (1, 3%)

  d. Local Dental/Orthodontic Society (5, 14%)

 6. How likely will you get similar cases in your practice?

 (Rating scale from 1 to 10, where 1 denotes less likely and 10 most likely)

 Median response: 3.5

Scenario 4

Layla, a girl who is 9 and a half years old, is currently in the middle of a projected 18-month phase 1 therapy. The procedure was initiated for two primary purposes: firstly, to diminish her overjet, since she was being subjected to ridicule by her peers at school; secondly, to pre-empt the need for extraction therapy in the future. Layla’s mother is far overdue in her monthly payments. Furthermore, Layla’s sibling has practically completed his therapy, although his account is currently in arrears by approximately $900.

The orthodontist in charge directs the office manager to refrain from scheduling any additional visits for Layla until her account is up to date. Additionally, he advises the manager to notify Layla that her brother’s braces will not be taken off until his account is completely settled.

 1. Is it morally acceptable to deliberately delay or refuse to remove a patient’s medical devices only due to an unpaid bill?

  c. Yes (15, 41%)

  d. No (22, 59%)

 2. How likely will you get similar cases in your practice?

 (Rating scale from 1 to 10, where 1 denotes less likely and 10 most likely)

 Median response: 3.5

Scenario 5

Reem, the patient, is a 7 ½ -year old girl who exhibits a pleasant smile and does not display any noticeable orthodontic issues. According to her guardian, her chances of securing the role in the film will improve if she wears braces. Ayesha, the mother, explains that the child acting industry is highly competitive, and her motivation for her daughter to receive orthodontic treatment is exclusively focused on securing a role and kickstarting her career. She is convinced that wearing braces will provide her with a competitive edge over all other attractive children in the nation, and that securing this role will guarantee her several future opportunities and ongoing prosperity.

Ayesha, an experienced orthodontic chairside assistant with enlarged duties, comprehends the associated dangers and, due to the exceptional circumstances, is prepared to compensate you generously in order to have the braces installed. She pledges to execute any release that you demand.

 1. Is it morally acceptable to administer treatment given these conditions?

 a. Yes (4, 11%)

 b. No (33, 89%

 2. How likely will you get similar cases in your practice?

(Rating scale from 1 to 10, where 1 denotes less likely and 10 most likely)

Median response: 3