Case study

At the first 3-month maintenance appointment for Mrs. Orban, who had had a series of six sextant appointments of deep scaling and root planing with anesthesia, the tissue still showed many areas of inflammation, with probing depths over 4 mm and bleeding upon probing. She had received repeated personal instruction with each of the appointments, and she had never achieved a truly favorable score on her biofilm disclosing tests. Elta, the dental hygienist, showed her maintenance charting and oral tissue review to Dr. Finley, and they both examined the original radiographs.Elta had made two vertical bitewings for the molars at this appointment. Elta told Dr. Finley that she thought the best procedure was for Mrs. Orban to see the periodontist. “I think she will take her condition more seriously. She never acts as though she believes what I tell her” Elta said.. “She still talks as though she just came to have her teeth ‘cleaned.’” Dr. Finley agreed to recommend the periodontist, and he personally explained the treatment options to Mrs. Orban. Mrs. Orban told them she was definitely not going to the periodontist under any circumstance and asked for further treatment from Dr. Finley. 1. What ethical issues may be involved when a patient asks for the general practitioner to take over treatment that is customarily carried out by the dental hygienist? 2. Is this an ethical issue or dilemma for Dr. Finley? Explain the rationale. 3. Select terms from the core values to help in the discussion of this problem.