Dr. Ammar Jarrad

BDS- MFDRCSI- GBOI – BLS/ ACLS Instructor

Professional Ethics for Dentists.� Building Trust

Introduction to Dental Ethics�

Main Ideas

Professional ethics refers to the rules that govern behavior within a specific profession.

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• Ethics in dentistry is a combination of moral values, duties, and professional behaviors expected from dental practitioners.
• Ethics is essential because dentistry involves close personal contact, sensitive procedures, and a relationship of trust between dentist and patient.
• Dentistry is described as a combination of:
• Science
• Art
• A social responsibility ( promote health , fair , infection control, accountable, professional skills to help others)

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Purpose of Ethics�

• To distinguish between right and wrong in clinical practice.
• To guide dentists in making decisions that protect patients and maintain professionalism.
• To ensure that dentists do not misuse their knowledge or authority.

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Do not exploit patients financially or emotionally

Do not perform unnecessary treatments

Do not misuse confidential information

Do not abuse their position of trust

Do not act beyond their competence

Follow professional standards to ensure patient safety

ETHICS

integrity

conscience

right

principles

honesty

Justice

choice

responsibility

honor

value

moral

Accountability

Autonomy

veracity

Confidentiality

Beneficence

The Nature and Importance of Professional Ethics

• Main Ideas
• Dentists must adhere to ethical codes because their decisions directly influence patient health and well-being.
• Ethics ensures:
• Accountability
• Transparency ( treatment options )
• Respect for patient rights ( Napkin / bibs )
• Safe and High-quality patient care

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Why Dental Ethics Is Important�

1. Patients place great trust in dentists.
2. Dental work involves irreversible procedures.
3. The profession has both medical and commercial aspects — ethics prevents exploitation.
1. Ethical behavior strengthens community trust in the profession.

Ethical Principles in Dentistry�

1. Autonomy

• Patients have the right to make decisions about their own treatment.
• Dentists must provide full information and respect patient choices.

2. Beneficence

• Dentists must act in the best interest of the patient.
• Provide treatments that improve oral health and overall well-being.

3. Non-maleficence

• “Do no harm.”
• Avoid unnecessary procedures, unsafe techniques, and treatments beyond one’s skill level.

4. Justice

• Fairness in providing care.
• No discrimination based on age, gender, financial status, nationality, or background.

5. Veracity

• Truthfulness in diagnosis, prognosis, and advertising.

6. Confidentiality

• Protecting patient information.
• Not sharing patient details without consent unless legally required.

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Duties and Responsibilities of the Dentist�

A. Duties Toward Patients

• Maintain respect, and privacy.
• Obtain informed consent before treatment.
• Provide safe, high-quality care.
• Refer patients when the case is beyond the dentist’s expertise.
• Avoid overtreatment
• Follow laws and regulations governing dental practice.

B. Duties Toward the Profession

• Maintain honesty and integrity.
• Contribute to raising the standards of dentistry.
• Avoid damaging the reputation of colleagues.
• Continue professional development and education.

C. Duties Toward Society

• Participate in oral health education.
• Support community dental programs.

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Ethical Issues in Daily Dental Practice�

• 1. Treatment Planning
• Providing multiple treatment options.
• Explaining risks versus benefits.
• Respecting patient preferences even when they differ from the dentist’s opinion.
• 2. Financial Ethics
• Transparency.
• Avoiding unnecessary procedures for profit.
• Offering fair payment solutions when possible.
• 3. Confidentiality Challenges
• Handling patient records securely.
• Obtaining consent for clinical photographs.
• Avoiding disclosure to family members without permission.

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• 4. Cosmetic Dentistry Dilemmas
• Patients may request treatments without medical justification.
• Dentist must balance aesthetic wishes with long-term dental health.

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• 5. Over-treatment and Under-treatment
• Over-treatment harms patients and increases cost.
• Under-treatment risks disease progression.
• Ethical practice requires evidence-based decisions.

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Informed / Written Consent�

• Main Elements
• Clear explanation of diagnosis
• Available treatment options
• Possible complications
• Benefits and risks
• Costs
• The patient’s right to accept or refuse

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• Importance
• Protects both patient and dentist
• Builds trust
• Ensures legal and ethical compliance

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Professionalism in Dentistry

Key Characteristics

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• Integrity
• Compassion
• Respect
• Lifelong learning

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Professional Boundaries

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• Avoiding relationships that compromise judgment
• Maintaining appropriate communication
• Not using patient vulnerability to influence decisions

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Dentist–Patient Relationship

• Built on:
• Trust
• Honesty
• Respect
• Communication
• Common Problems
• Unrealistic patient expectations
• Fear and anxiety
• Miscommunication
• Social or cultural differences

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• Ethical Management
• Listening actively
• Providing clear explanations
• Showing empathy
• Setting realistic expectations

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Legal Aspects Related to Ethics

• Includes:
• Licensing requirements
• Clinical documentation standards
• Patient record confidentiality
• Infection control regulations
• Professional liability and malpractice (negligence in duties that causes harm )

• Why Law Matters
• Law provides minimum standards.(you must do to avoid punishment)
• Ethics provides higher moral standards.(What is the right thing to do? even if the law doesn’t require it.)
• Dentists must follow both for safe and accountable practice.

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Ethical Issues in Clinical Documentation�

• Main Points
• Records must be accurate and complete.
• Altering or destroying records is unethical and illegal.
• Digital records must be protected with secure systems.
• Documentation should reflect all discussions, consent, and treatment steps.

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Ethical Challenges in Modern Dentistry�

• Examples
• Use of social media (before/after photos).
• Digital scanners and patient data privacy.
• Pressure from patients seeking perfect aesthetics.
• Corporate dentistry and commercial pressures.
• High costs of advanced treatments.

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• Ethical Approach
• Prioritize patient welfare
• Maintain transparency
• Respect privacy
• Avoid misleading marketing

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Patient welfare is a central principle in healthcare that goes beyond successful treatment result .

Summary

• Putting the patient's interests first
• Respecting patient autonomy.
• Valid informed consent must be obtained and documented before any procedures.
• Doing no harm (Non-maleficence.
• Promoting patient welfare (Beneficence)
• Treating patients with fairness and respect (Justice).

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• Being truthful and honest (Veracity)
• Maintaining patient confidentiality
• Maintaining professional competence
• Ensuring proper conduct, this includes having effective complaints procedures.

Summary

• Be aware of conflicts of interest, the influence of third parties on the patient-dentist relationship (especially through financial pressure or incentives).
• Patients and, where appropriate, their approved representative and/or their families should be fully informed about the diagnosis, benefits and risks of any treatment or no treatment.

• Ensure that treatments provided are patient-centered, evidence-based and within the dentist’s expertise and experience.
• Ensure appropriate policies for addressing patient concerns, complaints, as well as maintaining appropriate clinical negligence indemnity.

Summary

• Keep knowledge and skills current.
• Maintain awareness of competency limitations and refer patients when treatment exceeding those limitations.
• Treat patients with dignity and respect at all times.
• Patients’ personal data shall remain strictly confidential.

• Promote the undertaking of regular continuous professional development (CPD) courses on ethics, recognizing ethics as being at the core of everything we do.

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• Case Scenario 1 — Overtreatment Request�A 23-year-old patient with healthy, natural teeth asks for 20 porcelain veneers because she wants a “perfect Hollywood smile.” Clinical examination shows no medical indication for veneers.�

• Ethical Principles
• Autonomy
• Non-maleficence
• Beneficence
• Professional integrity
• Ethical Questions
• Should the dentist accept the patient’s request?
• How should the dentist balance patient autonomy with non-maleficence?
• What are safer alternatives?

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• Professional Ethical Response
• Explain long-term risks: enamel removal, sensitivity, future replacements.
• Offer alternatives like whitening or minor orthodontics.
• Decline harmful treatment politely if patient insists.
• Document the discussion.

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• Case Scenario 2 — Financial Pressure�A 45-year-old male with severe dental pain needs root canal treatment. He cannot afford it and asks for extraction, although the tooth can be saved.�

• Ethical Principles
• Autonomy
• Beneficence
• Justice
• Informed consent
• Ethical Questions
• Should the dentist accept extraction even if it’s not ideal?
• How can the dentist support the patient ethically?
• Is cost influencing the patient’s decision?

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• Professional Ethical Response
• Explain consequences of extraction vs RCT.
• Offer staged payment plans or temporary treatment.
• Respect the patient’s decision if fully informed.
• Ensure decision is voluntary, not forced by financial stress

• Case Scenario 3 — Confidentiality Conflict�A teenager (16 years old) receives orthodontic treatment. Her mother calls the clinic and asks for detailed information about the daughter’s dental condition and progress. The daughter previously asked the dentist not to share certain details with her parents.�

• Ethical Principles
• Confidentiality
• Autonomy
• Legal considerations (minor age varies by country)
• Ethical Questions
• Does the dentist have the right to share information with the parent?
• When does confidentiality override parental rights?
• What if the information affects health or safety?

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• Professional Ethical Response
• Respect patient confidentiality unless disclosure is necessary for safety.
• Encourage open communication between patient and parent.
• Check local laws regarding minors’ privacy rights.
• Document the discussion carefully

Case Scenario 4 — Treating Beyond Competence�A general dentist wants to perform complex implant surgery with sinus lifting but has no specialized training. He feels confident after watching online videos�

• Ethical Principles
• Non-maleficence
• Beneficence
• Professional responsibility
• Integrity
• Ethical Questions
• Is it ethical to attempt the surgery?
• When should a dentist refer to a specialist?
• What risks may occur?

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• Professional Ethical Response
• A dentist must not perform procedures beyond their competence.
• Refer to an oral surgeon or implant specialist.
• Expand skills through certified courses before performing advanced surgeries.

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• Case Scenario 5 — Child Abuse Suspicion�A 6-year-old child presents with repeated oral injuries and bruises inconsistent with the parent's explanation. The dentist suspects possible abuse.�

• Ethical Principles
• Beneficence
• Non-maleficence
• Legal responsibility
• Protection of vulnerable populations
• Ethical Questions
• Should the dentist report suspected abuse?
• How can the dentist protect the child ethically?
• What documentation is necessary?

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• Professional Ethical Response
• Report suspicion to appropriate child protection authorities (mandatory in most countries).
• Document injuries thoroughly with photos and notes.
• Provide necessary treatment gently and with sensitivity.

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• Case Scenario 6 — Advertising and Social Media�A dentist posts “before and after” cosmetic cases on Instagram. Some photos show patient faces clearly. Consent forms are signed, but patients later complain that the photos attract unwanted attention.�

• Ethical Principles
• Confidentiality
• Veracity
• Patient autonomy
• Digital professionalism
• Ethical Questions
• Is signed consent alone enough?
• What are the risks of public exposure?
• Should the dentist remove the photos?

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• Professional Ethical Response
• Consent must be informed and revocable.
• Remove photos upon request.
• Always protect patient identity online.

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Case Scenario 7 — Cultural and Religious Considerations�A female patient prefers treatment only from a female dentist due to cultural or religious beliefs. The only available dentist at that time is male.��

• Ethical Principles
• Autonomy
• Respect for cultural values
• Justice
• Ethical Questions
• Should the male dentist insist on treating her?
• How to respect cultural or religious preferences?
• What if it's a dental emergency?

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• Professional Ethical Response
• Respect her preference if possible.
• Offer to schedule her with a female dentist at another time.
• In emergencies: explain necessity and proceed with sensitivity and consent.

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Case Scenario 8 — Error Disclosure�During an extraction, a dentist accidentally fractures a root tip without realizing it until the postoperative X-ray. The patient believes everything went perfectly

• Ethical Principles
• Veracity
• Integrity
• Professional responsibility
• Ethical Questions
• Should the dentist disclose the mistake?
• How to manage the clinical situation ethically?
• What is the legal expectation?

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• Professional Ethical Response
• Disclose the error honestly.
• Explain consequences and next steps.
• Offer correction or referral without extra cost.
• Document the incident.

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• Case Scenario 9 — Refusal of Treatment�A patient with severe periodontitis refuses periodontal therapy and requests only scaling “to clean the teeth,” ignoring the underlying disease.�

• Ethical Principles
• Autonomy
• Beneficence
• Non-maleficence
• Ethical Questions
• Can a dentist refuse the patient’s request?
• Does minimal treatment risk harm?
• How to educate the patient?

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• Professional Ethical Response
• Explain risks and long-term consequences of untreated periodontitis.
• Provide written education and charts.
• If patient still refuses, dentist may decline treatment that is inadequate or harmful.
• Document informed refusal.

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• Case Scenario 10 — Discrimination�A dentist refuses to treat a patient with HIV, claiming “it is too risky.”��

• Ethical Principles
• Justice
• Non-maleficence
• Professional duty
• Anti-discrimination
• Ethical Questions
• Is refusing treatment ethical?
• Does HIV status justify denial?
• Are universal precautions sufficient?

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• Professional Ethical Response
• Discrimination is unethical and illegal.
• Universal infection control protects both patient and provider.
• Treat the patient safely and respectfully.
• Provide correct information to reduce stigma.

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MCQ 1

• Scenario

A patient agrees to a dental procedure, but the dentist did not explain the risks or alternatives.

• Question:�Which ethical principle was violated?

A. Justice�B. Autonomy�C. Veracity�D. Confidentiality

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• ✅ Correct Answer: B. Autonomy�Explanation: Autonomy requires full information for patients to make decisions. Without explanation, consent is not valid.

MCQ 2

• Scenario

A dentist recommends 10 crowns even though only 2 teeth are damaged.

• Question:�This situation violates mainly:

A. Beneficence�B. Non-maleficence�C. Justice�D. Veracity

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• ✅ Correct Answer: B. Non-maleficence�Explanation: Overtreatment causes harm and is against the principle of “do no harm.”

MCQ 3

• Scenario

A patient’s brother calls the clinic asking for dental X-ray results. The dentist shares the report without consent.

• Question:�Which principle is violated?

A. Beneficence�B. Confidentiality�C. Professional integrity�D. Autonomy

• ✅ Correct Answer: B. Confidentiality�Explanation: Patient information cannot be shared without authorization

MCQ 4

• Scenario

A general dentist attempts a complex implant surgery without proper training.

• Question:�This violates which ethical responsibility?

A. Justice�B. Professional competence�C. Veracity�D. Confidentiality

• ✅ Correct Answer: B. Professional competence�Explanation: Dentists must not perform procedures beyond their skills.

MCQ 5

• Scenario

A dentist advertises a whitening product as “permanent,” although it lasts only 6 months.

• Question:�This violates which principle?

A. Veracity�B. Justice�C. Autonomy�D. Beneficence

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• ✅ Correct Answer: A. Veracity�Explanation: Veracity = honesty. False advertising violates truthfulness.

MCQ 6

• Scenario

A dentist refuses to treat a patient with severe pain because the patient cannot pay immediately.

• Question:�Which principle is violated?

A. Non-maleficence�B. Beneficence�C. Justice�D. Fidelity

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• ✅ Correct Answer: B. Beneficence�Explanation: Ethical duty requires providing emergency care regardless of financial status.

MCQ 7

• Scenario

A female patient requests a female dentist for cultural reasons, but the clinic forces her to see a male dentist.

• Question:�Which principle is most compromised?

A. Autonomy�B. Veracity�C. Non-maleficence�D. Justice

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• ✅ Correct Answer: A. Autonomy�Explanation: Respecting patient preferences is part of autonomy.

MCQ 8

• Scenario

Parents refuse fluoride preventive program for their child despite high caries risk.

• Question:�Which principle should the dentist prioritize?

A. Autonomy of parents�B. Beneficence toward the child�C. Veracity�D. Justice

• ✅ Correct Answer: B. Beneficence toward the child�Explanation: Dentist must prioritize the child’s health and well-being.

MCQ 9

• Scenario

A dentist changes a patient’s chart after a complication to avoid legal issues.

• Question:�This violates:

A. Confidentiality�B. Justice�C. Integrity and veracity�D. Beneficence

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• ✅ Correct Answer: C. Integrity and veracity�Explanation: Altering records is dishonest and unethical.

MCQ 10

• Scenario

A dentist refuses to treat an HIV-positive patient.

• Question:�Which principle is most clearly violated?

A. Justice�B. Autonomy�C. Non-maleficence�D. Beneficence

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• ✅ Correct Answer: A. Justice�Explanation: Refusing treatment based on medical status is discriminatory and unfair.

MCQ 11 �

A 55-year-old patient needs extraction of an upper molar. You explain the procedure but forget to mention the risk of oroantral communication because it is “rare.” The patient later develops it and complains.

• What ethical principle was MOST violated?

A. Beneficence�B. Non-maleficence�C. Autonomy�D. Veracity

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• Correct Answer: C — Autonomy�Explanation: The patient’s right to make an informed decision was compromised because a risk was withheld.

• Scenario

MCQ 12�

A patient arrives with severe swelling compromising the airway. During treatment you need past medical information but the patient is unconscious. You call his wife without permission.

• Is this ethically acceptable?

A. Yes, because confidentiality can be broken in life-threatening emergencies�B. No, confidentiality must never be breached�C. No, you should call the police instead�D. Yes, only if the patient has a signed release form

• Correct Answer: A�Explanation: Confidentiality exceptions apply when needed to prevent serious harm

• Scenario

MCQ 13 �

Two patients need root canal therapy. One is wealthy and one receives government insurance. You offer advanced rotary instrumentation to the wealthy patient but only manual RCT to the other, though both require the same standard of care.

• Which ethical principle is violated?

A. Justice�B. Fidelity�C. Beneficence�D. Competence

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• Correct Answer: A — Justice�Explanation: Equal conditions should receive equal care.

• Scenario

MCQ 14 �

A patient insists on extracting a tooth that can be saved with RCT and crown. You agree because “the patient requested it.”

• Is this ethically correct?

A. Yes, patient autonomy always overrides other principles�B. No, because autonomy does not justify harmful or unnecessary treatment�C. Yes, because extraction is cheaper�D. Yes, if patient signs consent

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• Correct Answer: B�Explanation: Dentists must avoid harm; unnecessary extraction violates non-maleficence.

• Scenario

MCQ 15 �

A clinic advertises “Guaranteed perfect Hollywood smile in one visit.”

• What principle is violated?

A. Complaisance�B. Veracity�C. Non-maleficence�D. Respect for autonomy

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• Correct Answer: B — Veracity�Explanation: Claims must be truthful and not misleading.

• Scenario

MCQ 16 �

You notice your assistant skipping hand hygiene between patients because the clinic is “too busy” today.

• What is the dentist’s ethical obligation?

A. Do nothing; it’s her responsibility�B. Document it but continue�C. Stop treatment and correct unsafe practice immediately�D. Discuss it at the end of the day

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• Correct Answer: C�Explanation: Patient safety overrides workflow.

• Scenario

MCQ 17 �

A 7-year-old needs pulpotomy. The mother refuses all radiographs due to “radiation fear,” even after adequate explanation.

• What is the best action?

A. Proceed without radiographs�B. Report the parent�C. Refuse treatment that compromises safety�D. Persuade the child directly

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• Correct Answer: C�Explanation: Providing unsafe care violates non-maleficence and standard of care.

• Scenario

MCQ 18 �

You accidentally perforate during RCT. You manage the complication correctly but consider hiding it to avoid upsetting the patient.

• What is the ethical response?

A. Do not disclose unless the patient asks�B. Disclose immediately with honesty and management plan�C. Disclose only after consulting a lawyer�D. Hide it if there is no harm

• Correct Answer: B�Explanation: Ethical practice requires transparency and veracity.

• Scenario

Thank you all�

In the end, professional ethics are what elevate the profession and ensure the trust of society, so let us always strive to apply them with sincerity and integrity.”