Dental ethics is “a system of principles governing the dental practice, a moral obligation to render the best quality of dental services to the patient and to maintain an honest relationship with other professionals and society.”1 Dental ethics plays an integral role in the daily practice of dental hygiene and infiltrate the “how” to proceed, the “why” to proceed, and the “when” to proceed with treatment. Also, knowledge, presentation, and communication are important concepts in meeting the dental ethics perimeters.
Key Principles in Dental Ethics
The five key principles of dental ethics are patient autonomy, nonmaleficence, beneficence, justice, and veracity.2 Understanding each of these principles will provide the guidance needed to ensure that patient needs are met within the ethical guidelines of the dental license.
1) Patient Autonomy
Patient autonomy or “self-governance” is the primary obligation of the dental provider and “includes involving the patient in treatment decisions in a meaningful way, with due consideration being given to patient needs, desires, abilities, and safeguarding the patient privacy.”2
The main components of patient autonomy require informing the patient, involving the patient, and keeping patient records confidential.2 Informing the patient of disease or defective dental concerns is the first step to patient autonomy.
Next, involving the patient in the decision-making process requires patient understanding of the diagnosis, which is crucial to the patient making an informed consent or refusal of treatment. The use of dental radiographs and intraoral pictures can facilitate patient understanding of the diagnosis. Meeting dental continuing education licensure requirements is critical in enhancing the dental provider’s ability to provide the information in a way the patient can understand the diagnosis and the treatment options being offered.
Nonmaleficence or “to do no harm” means the “professional has a duty to refrain from harm to the patient.”1 Nonmaleficence covers a broad spectrum of dental ethics such as provider skill and knowledge, impairment, post-exposure, patient abandonment, and personal relationships. Nonmaleficence requires the dental professional to have the skill and knowledge to treat within their limitations.
Whenever the scope of treatment exceeds their abilities or training, there is an ethical obligation to refer the patient to a capable dental specialist. Providing inferior treatment that may cause more harm than good should never be considered and is a violation of dental ethics under nonmaleficence.3 Also, maintaining current practice knowledge through continuing dental education as required by state guidelines falls within the nonmaleficence category.
Furthermore, practicing with an impairment (as caused by the use of controlled substances, chemical agents, or alcohol, for example) may inhibit the provider’s full capacity to treat and is important in understanding nonmaleficence.
Lastly, nonmaleficence covers patient abandonment and personal relationships. In reference to patient abandonment, it is the obligation of the dental provider to supply proper notice when discontinuing treatment so that the patient may seek continued treatment elsewhere. The provider requirements set forth for patient abandonment help to ensure that there is “no harm” caused to the patient by allowing their oral health care to be in jeopardy.
Also, a doctor-patient personal relationship, such as dating, which may impair professional judgment, thus placing the patient at risk as well as jeopardizing patient trust.2
Beneficence or “to do good” is the principle that states the “professionals have the duty to act for the benefit of others.”1 Beneficence involves “the competent and timely delivery of services,” the providers presenting themselves in a professional manner to the community and within their practices, the providers observing rules and regulations within their practice, the providers providing their patients with research and development of purposed treatments and mandated reporting.2
In reference to competence and timely dental service, there are two main concepts to embrace. First, providers should consider all the treatment options and prioritize. In most dental situations, options may be provided to enhance the patients’ ability to comply with the treatment recommendations. Second, in any specific situation, it is imperative to determine the best treatment for the patient to obtain optimal dental health. When embracing these concepts, timely dental treatment will be optimized.3
Providers also have an ethical duty to maintain a professional manner in the community and, therefore, they must practice within the rules and regulations of their governing body. For example, “providing competent and timely delivery of dental care with consideration given to the needs, desires, and values of the patient.”3 This also applies in public emergency mandates so that dental practices pose no harm to the public while still maintaining a standard of care for their patients.
Also, optimizing current research in the development of treatment and providing the information to the patient or public is crucial in serving individual and public oral health care needs. Dental research plays a pivotal role in minimizing potential harm while acting in a way to benefit the patient and the public.
Lastly, mandated reporting falls under the principle of beneficence. Familiarity is important to identifying and intervention where neglect or abuse is evident. The failure to comply with mandated reporting is a direct violation of the provider’s ethical obligation.
Justice or “fairness” is “delivering dental care without prejudice.”2 Justice covers an array of topics, such as patient selection, emergency service, justifiable criticism, expert testimony, and rebates or split fees.
Initially, patient selection cannot be determined by race, creed, sex, or disability. However, the dentist may “exercise reasonable discretion” in patient selection.3 One example that falls under the “reasonable discretion” is denying care to a patient with a disability because the office may not be equipped to provide optimal care, or the patient’s health would be hampered by the dental treatment as indicated by the patient’s primary medical provider.
In addition, providing emergent care or facilitating emergent care to patients, returning patients who have been treated under emergent care to their original dentist, as well as reporting another dentist for gross negligence or continual faulty dental treatment are all components of justice.3
Veracity or “truthfulness” is “the professionals’ obligations to be honest and trustworthy in their dealing with patients.”2 Veracity’s key principles involve respect, trust, and intellectual integrity.
Respecting the clinician-patient relationship is a valuable attribute of veracity. In addition, communication with the patient in a truthful and honest way when diagnosing and treating falls into the veracity perimeters.
Lastly, maintaining “intellectual integrity” by providing research-based diagnosis or treatment when communicating to the patient is an important aspect of veracity. This involves using scientific research and not being deceptive to their patients, as well as conforming to the rules and etiquette of insurance authorizations and submissions.2
Application of Five Key Steps
Once the clinician is knowledgeable of the dental ethic key components, these principles can be applied to navigate the patient appointment. When diagnosing a patient, not only do the clinical findings play a role but also the ethics to steer the appointment successfully.
For example, a patient may present with active periodontal disease. The veracity principle is represented using recent scientific research and knowledge in this patient’s diagnosis and treatment. The beneficence principle comes to play by considering all the treatment options available to the patient and representing the most optimal treatment.
However, the patient autonomy principle allows the patient to refuse the treatment options. Thus, informing the patient of the outcomes of nonconforming to any of the treatment options is the ethical duty of the provider. However, the nonmaleficence principle is the understanding that the provider may not be neglectful and should implement a treatment. Otherwise, not treating would be remiss and cause harm to the patient’s oral dental health.
Once treatment has been considered, the justice principle is at the forefront of treating the patient without prejudice (justice), regardless of financial situation, race, creed, or gender, for example.
The five principles of dental ethics apply to all patients and appointments to some degree. The failure to practice within these guidelines not only places the practitioner at risk of malpractice but also affects the patient negatively. These principles will ensure a profitable and ethical practice and pave the way for navigating the patient appointment with a positive outcome.
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- Dental Ethics. (n.d.) The Free Dictionary. Retrieved from https://medical-dictionary.thefreedictionary.com/dental+ethics#
- Principles of Ethics and Code of Professional Conduct (2020, November). American Dental Association. Retrieved from https://www.ada.org/~/media/ADA/Member%20Center/Ethics/ADA_Code_Of_Ethics_November_2020.pdf?la=en
- ADHA Code of Ethics. (2019, June). American Dental Hygiene Association. Retrieved from https://www.adha.org/resources-docs/ADHA_Code_of_Ethics.pdf