Al-Azhar University- Gaza

Faculty of Dentistry
Dental Ethics

Introduction in Dental Ethics

Dr. Manar Foura
Master of Dental Implantology
 Objectives of the course
1. To understand what is meant by ethics in dentistry.
2. Focusing on the term “profession” and how it relates to
ethics in dentistry.
3. Become familiar with elements and principles of ethical
decision making.
4. To clarify the ethics of patient relations, delegation of
duties, financial arrangements, and managed care.
5. To know the difference between dental law and dental
ethics.
6. Define the normative theories of ethics and apply them to
ethical issues in practice.
7. Apply the principles of dental ethics to everyday practice
 Overview – Ethics in Dentistry
• Ethics is an intrinsic
component of dental
practice.

• Every day dentists are faced

with situations that call for
ethical judgment and
behavior.
 Overview – Ethics in Dentistry
• The Role of the Dental Professional
• Dentists are granted special rights and responsibilities upon becoming licensed
oral health care professionals.
• In healthcare, unlike the corporate world, patient welfare takes priority over profit
motives.
• This service-driven role earns professionals prestige, trust, and authority to apply
their knowledge and skills.
• Patient expect ethical and professional care rooted in both skills and empathy.
• Key qualities: technical expertise, sound judgment, compassion, and caring.
• Trust forms the foundation of the provider-patient relationship.
• A caring attitude leads to better patient experiences and long-term professional
fulfillment.
• Understanding ethical responsibilities helps dental professionals build strong
relationships with patients and the community.
 What is meant by “Ethics”?

• The word ethics comes from the Greek ethos originally meaning character or
conduct.

• Ethics are the moral principles or virtues that

govern the character and conduct of an
individual or a group.

• Ethics, as a branch of both philosophy and

theology, is the systematic study of what is
right and good with respect to character and
conduct.
• Ethics seeks to answer two fundamental questions:
1. What should we do?
2. Why should we do it?
• The object of ethics is to emphasize spirit (or intent) rather than law.
• Dental ethics applies moral principles and virtues to the practice of dentistry.
 Dental Ethics

• Dental ethics mean moral duties

and obligations of the dentist
towards his patients, professional
colleagues and to the society.
• The terms ethical and moral have been used synonymously and used to mean
only that the issue, question, reflection, or judgment to which they apply
concerns what ought or ought not be done, or what is a matter of someone’s
obligation.

• Obligations: oughts that apply to dentists' conduct by reason of their being

professionals.
• Obligation explained as any one of the following situation:
1. Someone ought to act, or refrain from acting, in some way.
2. There are defensible reasons to support the claim that he, she, or
they ought to act or refrain in that way.
3. These reasons make such acting or refraining relatively important in
comparison with other possible actions in the situation.
 Ethics Vs Morality Vs Laws

• Ethics or moral philosophy

 Ethics is not the same as feelings
 Ethics is not religion
 Ethics is not following the law
 Ethics is not following culturally accepted norms
 Ethics is not science.
Ethics are an unwritten code of conduct that include both professional conduct
and judgment.

• Ethics are
 Moral Principles
 What is good and bad
 What is right and wrong
 Based on value system
 Ethical norms are not universal –
depends on the subculture of the society
 Differences Between The Ethics And Laws

• Dental ethics is also closely related to law. In most countries there are laws that specify
how dentists are required to deal with ethical issues in patient care and research.
• In addition, the dental licensing and regulatory officials in each country can and do
punish dentists for ethical violations.
• Usually the requirements of dental ethics and law are similar. But ethics should not be
confused with law.

 Laws can differ significantly from one country to another while ethics is generally
applicable across national boundaries.
 Ethics quite often prescribes higher standards of behavior than does the law, and
occasionally situations may arise where the two conflict.
• Occasionally situations may arise where the two conflict. In such circumstances
dentists must use their own best judgement whether to comply with the law or
follow ethical principles.
Thank You
Al-Azhar University- Gaza
Faculty of Dentistry
Dental Ethics

Codes of Ethics
Part (2)
Dr. Manar Foura
Master of Dental Implantology
• There are five fundamental principles that form the foundation
of the ADA Code:

1. Patient autonomy.
2. Non maleficence.
3. Beneficence.
4. Justice.
5. Veracity.
 PRINCIPLE 2: Nonmaleficence
(“do no harm”)
• The dentist has a duty to refrain from
harming the patient.
• This principle expresses the concept
that professionals have a duty to protect
the patient from harm. Under this
principle, the dentist’s primary
obligations include keeping knowledge
and skills current, knowing one’s own
limitations and when to refer to a
specialist or other professional, and
knowing when and under what
circumstances delegation of patient care
to auxiliaries is appropriate.
• Code Of Professional Conduct
1. Education
Dentists must maintain up-to-date knowledge and skills to ensure competent care for
patients and society.

2. Consultation And Referral

Dentists shall be obliged to seek consultation, if possible, whenever the welfare of patients
will be safeguarded or advanced by utilizing those who have special skills, knowledge, and
experience. When patients visit or are referred to specialists or consulting dentists for
consultation:
1. The specialists or consulting dentists upon completion of their care shall return the
patient, unless the patient expressly reveals a different preference, to the referring dentist,
or, if none, to the dentist of record for future care.
2. The specialists shall be obliged when there is no referring dentist and upon a completion
of their treatment to inform patients when there is a need for further dental care.
• Advisory Opinion:
Second Opinions:

A dentist who has a patient referred by a third party1 for a “second opinion”
regarding a diagnosis or treatment plan recommended by the patient’s treating
dentist should render the requested second opinion in accordance with this
Code of Ethics.

In the interest of the patient being afforded quality care, the dentist rendering
the second opinion should not have a vested interest in the ensuing
recommendation.
3. Use of Auxiliary Personnel: Only qualified staff may perform delegated tasks,
under the dentist’s direct supervision and responsibility.

4. Personal Impairment: Practicing under the influence is unethical. Dentists

must report and support impaired colleagues seeking help.

• Advisory Opinion: Ability to Practice

• Dentists with a disease or impairment that may endanger patients or staff must:
a) Seek advice from a qualified physician or authority
b) Limit practice activities to avoid risk
c) Continue monitoring their condition and adjust practice accordingly
5. Postexposure – Bloodborne Pathogens:
• Dentists must immediately inform and refer any patient exposed to infectious material.
• If the dentist is the source, they must disclose their status to the evaluating practitioner
and undergo necessary testing.

6. Patient Abandonment:
• Dentists must not end treatment abruptly. Adequate notice and referral must be provided
to protect the patient’s oral health.

7. Personal Relationships With Patients.

Dentists should avoid interpersonal relationships that could impair their professional
judgment or risk the possibility of exploiting the confidence placed in them by a patient.
 PRINCIPLE 3: BENEFICENCE (“do good”)

• Dentists have an ethical obligation to act for

the benefit of patients and the public.
• This includes providing competent and
timely care, respecting the patient's needs,
values, and desires.
• Practice models (fee-for-service, managed
care, etc.) do not alter this duty.
• Contractual agreements must never override
the dentist’s primary obligation to prioritize
patient welfare.
• The dentist has a duty to promote the
patient’s welfare.
• Code Of Professional Conduct

1. Community Service
• Dentists have a duty to use their skills and knowledge to improve public dental health.
• They are encouraged to be leaders in their communities.
• While serving the public, dentists should act in a way that upholds or enhances the
reputation of the dental profession.
• Advisory Opinion

Elective & Non-Emergent Procedures in Public Health Emergencies

• Dentists must balance their duty to individual patients with their duty to protect public
health.
• During public health crises (e.g. pandemics), the public’s safety may take priority.
• Non-urgent procedures should be postponed if they pose unacceptable risk to the
patient or the public.
• However, urgent or emergency care (e.g., pain, infection, risk of tissue damage) should
still be provided.
2. Governance of the Profession
• Dentistry, like all professions, has a duty to self-regulate through professional societies.
• Dentists should participate in professional associations and follow their ethical
guidelines.

3. Research and Development

• Dentists are encouraged to share beneficial research findings that promote public
health and safety.
4. Patents and Copyrights:
Dentists may hold patents or copyrights, but must not use them to block research or limit
clinical practice.

5. Abuse and Neglect:

• Dentists must be trained to recognize signs of abuse or neglect in patients.
• They are ethically and legally obligated to report suspected cases to the proper authorities.
• Advisory Opinion
• Reporting Abuse and Neglect
• Dentists should be familiar with intervention resources and know how to respond
appropriately for all patient populations.
• Adult patients’ autonomy and confidentiality should be respected. If reporting is not
legally required and the patient objects, the dentist should seek alternative solutions with
the patient's permission.
• Laws vary by jurisdiction in terms of:
• Definitions of abuse and neglect
• Mandatory reporting
• Legal protections for those reporting in good faith
• Dentists must stay up to date on both how to identify and how to report abuse and
neglect according to the laws where they practice.
• Ultimately, the welfare of the patient must remain the top ethical priority.
6. Disruptive Behavior in the Workplace
• As leaders of the oral healthcare team, dentists set the tone for professionalism in the
workplace.
• They must promote respect, open communication, and collaboration among all team
members.
• Disruptive behavior (e.g., hostility, disrespect, poor communication) can:
• Damage team dynamics
• Lower the quality of patient care
• Harm the profession’s reputation and public trust
Thank You
Al-Azhar University- Gaza
Faculty of Dentistry
Dental Ethics

Characteristics
Of A Professional Dentist
Dr. Manar Foura
Master of Dental Implantology
 What is “professionalism”?

• Professionalism expands ethics to include the conduct, values, and behaviors

that define a profession.
• It reflects the expected behavior of individuals in learned professions and
includes habits of sound judgment, conduct, and perception.
• Both professionals and their organizations prioritize patient well-being and
autonomy over self-interest.
• It represents the character and integrity that accompany the application of
advanced knowledge and skill in service to others.
 The characteristics of a professional
1. Professional appearance

• Professionals should always strive for a

professional appearance, including
appropriate attire, proper hygiene,
grooming.

• Clothing should always be clean and ironed

properly. Pants, dresses, formal skirts, crisp
white shirts and leather shoes are all
appropriate for a professional's wardrobe.
2. Reliable
• Professionals are dependable and keep
their commitments.
• Professionals respond to colleagues and
customers promptly and follow through
on their commitments in a timely
manner.
3.Punctuality
It's important to clarify any areas of uncertainty when dealing with customers or
members of your team to ensure there are no mistaken assumptions or surprises.

4. Ethical behavior
• Embodying professionalism also means to be committed to doing the right thing.
• Honesty, open disclosure and sincerity are all characteristics of ethical behavior.
Many organizations include a commitment to ethical behavior in their code of
conduct.
• Professionals can adopt a personal code of conduct and make the same
commitment on an individual basis.
5. Organized:
• A professional keeps their workspace neat and
organized so that they can easily find items when they
need them.
• All files and paperwork should be in place and, if they
have to deliver a presentation, all materials should be
ready well in advance so there are no unexpected
delays.
6. Accountable
• Just as a professional accepts credit for having completed a task or achieved a
goal, they also are accountable for their actions when they fail.
• They take responsibility for any mistakes that they make and take whatever steps
necessary to resolve any consequences from mistakes.
• They are accountable and expect accountability from others.
7. Professional Language:
• People who behave with professionalism monitor every area of their behavior,
including how they talk.
• They minimize the use of slang and avoid using inappropriate language in the
workplace.
• They even are conscientious of the language they use in informal settings.

8. Separates Personal And Professional:

• Professionals understand the importance of separating their personal lives from
their professional lives.
• While professionals may experience the same challenges in their personal lives as
others, they maintain a clear separation between their professional lives and
workplace demeanor.
9. Positive Attitude:
• Part of being a professional means maintaining a positive, can- do attitude while
working.
• A positive attitude will improve a professional’s overall performance and increase
the likelihood of a positive outcome.
• It will also impact the behavior and performance of others, improving employee
morale in the office.
10. Emotional control
• Professionals understand the importance of maintaining their composure and
staying calm in all situations.
• By remaining calm, even during challenging moments, others can rely on them to
be rational and of sound judgment.
11. Effective Time Management:
• An employee who knows how to manage their time
well is viewed by their peers as a professional.
• Some characteristics of time management abilities
include
1. Showing up at the office on time in the
morning,
2. Being on time for meetings
3. Letting someone in the office know if they
suspect that they might be late.
12. Focused
• A professional is clear about their goals and understands what they need to accomplish to
achieve them.
• They know how to stay focused on their work to maintain their productivity.
• Professionals recognize the importance of maintaining focus to improve the quality of
their work and be as efficient as possible.
13. Poised:
• Professionals should demonstrate poise, a calm and confident state of being.
• Being poised means
1.Maintaining a straight posture,
2.Making eye contact when communicating
3.Helping establish a friendly and professional presence.
4.Staying calm during times of heightened pressure.
14. Respectful of others
• Professionals always treat others with respect.
• They understand that though humor is appropriate in the workplace, they should
always use it with respect to others.
15. Strong Communicator
• A professional must have strong communication skills.
• This means that they not only can effectively and efficiently convey messages to
others but also that they can actively listen to and understand what others are
telling them.
• By engaging in open and constructive communication with others, professionals
can collaborate more effectively and accomplish a lot.
16. Possesses soft skills
• Soft skills are personal attributes that allow someone to interact effectively with
others.
• Soft skills include things like leadership, critical thinking, teamwork and people
skills.
• Soft skills help professionals to behave courteously when addressing colleagues
and managers, use the right language when communicating and respect the
opinions of others.
17.Teamwork: Ability to collaborate effectively with others to achieve
common goals.

18.Adaptability: Capacity to adjust quickly and efficiently to changing

circumstances.

19.Confidentiality Awareness: Understanding the importance of protecting

sensitive information.

20.Initiative: Proactively taking action without needing direction.

Thank You
Al-Azhar University- Gaza
Faculty of Dentistry
Dental Ethics

Professionalism
Dr. Manar Foura
Master of Dental Implantology
 What is a “profession”?
• A profession is a disciplined group of individuals who adhere to ethical standards.
This group possess special knowledge and skills derived from research, education
and training at a high level.
• The American College of Dentists defines a profession as: an occupation
involving relatively long and specialized preparation on the level of higher
education and governed by a special code of ethics.
• The constructive aim of a profession
is the public good.
• Dentistry recognized as a profession.
• Four key features of a profession:
1. A profession holds specialized and exclusive expertise.
2. It has an internal and external structure, including mutual
recognition among members and formal institutionalization.
3. Its members are granted broad autonomy and often practice self-
regulation.
4. Membership in a profession entails adherence to professional norms
and obligations
 Dentistry as a profession

• Dentistry has long prided itself on being a profession, and dentists routinely
describe themselves as professionals. Dentists can clearly claim for themselves
several of the most common characteristics of professions and professionals:
1. Dentists possess a distinctive expertise that consists of both theoretical
knowledge and skills for applying it in practice,
2. Dentists' expertise is a source of important benefits for those who seek their
assistance
3. Because of their expertise, dentists are accorded, both individually and
collectively, extensive autonomy in matters pertaining to it .
4. A professions and professionals have special obligations and consider this to be
a central feature of their being professions and professionals.
 Self-Regulation and Professional Responsibility

• Every profession owes society the responsibility to regulate itself—

to determine and judge its own members.
• This regulation is achieved largely through the influence of the
professional societies (ADA, NDA).
• All dentists, therefore, have the dual obligation of making
themselves a part of a professional society and of observing its
rules of ethics.
 What is a “professional”?
• A professional is a member of a profession.
• Four qualities have been attributed to those who practice a profession:
1. A professional has respect for human beings;
2. A professional is competent;
3. A professional has integrity;
4. A professional’s primary concern is service, not prestige or profit
• These qualities are consistently reflected in the decisions and actions of a
professional.
• To act professionally is to act as a true professional—to comply with the duties
and obligations expected of a learned professional.
 What is “professionalism”?

" A set of values, behaviors and relationships

that underpins the trust of the public has in
doctors "
• Modern medical professionalism is something
that can, and indeed should be learnt.
• Being aware of the expectations of a
professional can help to improve patient care.
• It is important to continually develop
communication skills, clinical knowledge and
team- working skills in order to help improve
standards.
 Core Values of Professionalism

1. Confidentiality
2. Trust
3. Honesty
4. Compassion.
5. Integrity.
6. Altruism.
7. Continuous improvement.
8. Excellence.
9. Working in partnership with members of the wider healthcare team.
Doing what is right – when the law requires it, as
well as for ethical or moral reasons – should be a
matter of personal pride for the professional person.
 Do we really have obligations to patients?
• By agreeing to take part in the dentist-patient relationship, both patients and
dentists accept certain obligations or duties.
• Both accept a responsibility to disclose information pertinent to the relationship.
• The dentist is obligated to respect patient privacy, maintain patient confidences,
keep promises, be truthful, and consider patient values and personal preferences in
treatment decisions.
 Obligations

• Do we really have obligations to patients?

• Eight categories of professional obligations have been described:
1. Chief Client—The chief client is the person or set of persons whose well-being
the profession and its members are chiefly committed to serving;
2. Ideal Relationship Between Dentist and Patient—An ideal relationship is based
on mutual respect and recognizes that the dentist and patient both bring important
values to the professional setting;
3. Central Values—The focus of each profession’s expertise is a certain set of
values, and each profession is obligated to work to secure these values for its clients;
4. Competence—Every professional is obligated to acquire and maintain the
expertise necessary to undertake professional tasks;
5. Relative Priority of the Patient’s Well-being—While the well-being of the patient
is to be given considerable priority, it is not to be given absolute priority;
6. Ideal Relationships Between Co-professionals—There does not seem to be any
one account of ideal relationships between dentists and their co-professionals
because so many different categories must be considered, but there are professional
obligations to co-professionals;
7. Relationship Between Dentistry and the Larger Community—The activities of
every profession also involve relationships between the profession as a group or its
members and the larger community and nonprofessional groups and others within it;
8. Integrity and Education—These are subtle components of conduct by which a
person communicates what he or she stands for, not only in the acts the person
chooses, but also both in how those acts are chosen and in how the person presents
to others in carrying them out.
Thank You
Al-Azhar University- Gaza
Faculty of Dentistry
Dental Ethics

Codes of Ethics
Part (1)
Dr. Manar Foura
Master of Dental Implantology
 Who Decides What Is Ethical?

1. Society.
2. Human rights.
3. Law.
4. American Dental Association (ADA).
5. World Dental Federation (FDI).
6. Codes of ethics.
 Codes of Dental Ethics

• Definition:
It is a set of principles of professional
conduct that governs all registered
dentists (generalists and specialists) and
establishes the expectations for dentists in
fulfilling duties to their patients, to the
public, to the profession and to their
colleagues.
 ADA Principles of Ethics and Code of
Professional Conduct (ADA Code)

• It is, in effect, aa written expression of the obligations arising from the implied
contract between the dental profession and society.
• Issued by dental organizations to guide ethical practice
• Example: ADA Code of Ethics (since 1866)
• Define moral boundaries for providing professional services
 Objectives

1. Code of dental ethics clarifies the principles that are definitive to

professional and ethical dental care.
a. For those about to enter the profession, this code identifies the basic
moral and ethical commitments of dentists and will serve as a source for
education and reflection.
b. For those within the profession, this code provides direction for ethical
practice.
3. It also serves as a basis for self-evaluation.
4. It provides public identification of the profession's ethical expectations of
its members.
 Core Values Of Dentistry
• To achieve Code of Dental Ethics objectives; dentist must follow these principles:

1 Compassion

2 Competence

3 Autonomy
 1 Compassion

• It defined as understanding and concern for another person's distress.

• Patients respond better to treatment if they perceive that the dentist appreciates
their concerns.
 2 Competence

• Competence means that dentists not only maintain their scientific knowledge and
technical skills, but also their ethical knowledge, and attitudes as well.
• Since new ethical issues arise with changes in dental practice and its social and political
environment.
 3 Autonomy

• Dentist autonomy: Individual dentists have traditionally enjoyed a high degree of clinical
autonomy in deciding where and how to practice.
• Patient autonomy: means that they should be the ultimate decision makers in matters that
affect themselves.
 Components of Dental Ethics Code

• The code of dental ethics has three main components to which dentists must aspire to
fulfill their duties to their patients, society and to their colleagues.

1 Principles of ethics.

2 Code of professional conduct.

3 Advisory opinions.
 1 Principles of ethics.

General Principles Fundamental Principles

1. Trust 1. Respect for autonomy
2. Honesty 2. Beneficence
3. Integrity 3. Non-maleficence
4. Respect for people's rights and dignity 4. Justice
5. Fidelity and responsibility 5. Veracity
• There are five fundamental principles that form the foundation
of the ADA Code:

1. Patient autonomy.
2. Non maleficence.
3. Beneficence.
4. Justice.
5. Veracity.
 PRINCIPLE 1: Patient Autonomy
(“self-governance”)
1. This principle expresses the concept that
professionals have a duty to treat the
patient according to the patient's own
and desires within the bounds of
accepted treatment.
• The dentist is responsible for providing the
patient with all of the available treatment
options, the successes and hardships
associated with those treatments, and
giving the patient the ability to make a
decision that is informed and best suits his
or her needs.
• Code of Professional Conduct
1. Patient Involvement:
• Dentists must inform patients about the proposed treatment and reasonable
alternatives. Information should be shared in a way that allows patients to actively
participate in treatment decisions.
2. Patient Records & Confidentiality
• Dentists are ethically obligated to protect the confidentiality of patient records.
Records must be maintained responsibly and shared, when requested, with the patient
or a new dentist for the benefit of future care — regardless of whether the patient has
settled their account.
• Advisory Opinions
1. Providing Copies of Records
• Upon request, dentists must provide copies or summaries of records (including X-rays),
free or at a minimal cost, to benefit the patient’s future treatment.

2. Confidentiality Considerations
• Sensitive information (e.g., HIV status, substance abuse, sexual orientation) should not be
shared without the patient’s written consent.
• If consultation with another healthcare provider is needed and anonymity isn't possible,
patient permission must be obtained.
• If the patient refuses, the dentist should seek legal advice regarding the possibility of
ending the professional relationship.
Thank You