questions relating to jurisdiction and patients’ preferences for interacting with health care professionals.

In general, the question of access to care is usually conceptualized from the practitioner’s point of view (i.e., how professionals can offer services) rather than from the patient’s point of view (i.e., how are patients most comfortable in receiving these services).

The biggest flaw with volunteer efforts is that the arrangements for and type of care provided are practitioner driven and not necessarily responsive to patient or population needs. (Mouradian, 2006)

WHAT DEFINES THE BASIC STANDARD OF CARE?

There is no standardized definition of oral health that can be used to determine if oral health needs have been met. The 2000 surgeon general’s report states that oral health is more than healthy teeth, but might also include the prevention of the self-consciousness and embarrassment that can ensue with poor appearance or the ability to speak, smile, taste, and chew, “the essence of our humanity” (HHS, 2000). Translating this principle in to a standard of care, however, is challenging due to the breadth of this concern as well as the need to consider the patient’s point of view on the importance of social functions. For example, ethnic and cultural backgrounds may shape one’s definition of a good smile, and so desired outcomes may not be universal.

WHOSE RESPONSIBILITY IS IT TO PROVIDE NEEDED SERVICES?

The main ethical concern in dentistry appears to be instilling a sense of moral responsibility to provide services that will increase access. In the early twentieth century, oral health was already seen as a gateway to general health, and the development of public health dentistry served in part as an economic good to rebuild trust between the dental profession and the public. Throughout the 1900s there were repeated expressions of the need to educate students about their professional responsibilities. In 2006, the Journal of Dental Education devoted a special issue to the ethics of access to oral health care services (Catalanotto et al., 2006) in which the argument is made that while many stakeholders might take it for granted that the health professions have an ethical responsibility to provide services to improve the health of the population, the general public may not share that view:

I believe that most people in our society view the professional ethics of physicians or dentists in a much more limited way, namely, within the



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