Effectiveness of Codes

Evidence suggests that patients recognize and value professional codes of ethics. In 2015, the ADA Council on Ethics, Bylaws and Judicial Affairs (CEBJA) commissioned a consumer survey regarding the ADA Principles of Ethics and Code of Professional Conduct. The results of the survey supports the belief that the ADA Code is noticed, acknowledged, and elevates the reputation of the dentist in the community. According to the survey of 1000 people, nearly 75% of patients reported they are more likely to choose an ADA member dentist knowing that those dentists follow an ethical code.¹²

Dentistry continues to benefit from strong public trust with patients expecting high standards of honesty, integrity and professionalism. At the same time, ethical challenges do occur in practice and are often linked to the financial and operational demands of running a dental practice. Common concerns identified in the literature include overtreatment, pressures from third-party payers that may influence treatment decisions, and failure to refer when a case exceeds a a clinician’s level of expertise. Additional issues include misleading advertising and concerns related to impaired practitioners.¹³ These situations often arise when professional responsibilities are weighed against financial pressures or other competing or self- interests.

The goal of the greater profession is to cultivate a culture of ethical excellence. To that end, ethics education is required in dental and dental hygiene schools. The dental and dental hygiene student learns about the ethical and professional responsibilities in numerous formal and informal ways. Ethics and professionalism content is required by the Commission on Dental Accreditation in the predoctoral dental and dental hygiene educational curricula. Currently, the Commission on Dental Accreditation addresses ethics training in Standard 2-21 for the dental standards and 2-19 for the dental hygiene standards. The standard for predoctoral dental students states that “graduates must be competent in the application of the principles of ethical decision making and professional responsibility.” The standard for dental hygiene students indicates that “dental hygienists should understand and practice ethical behavior consistent with the professional code of ethics throughout their educational experience.” Part of that education process is learning and applying the code of ethics. The two main goals of dental education programs in regard to ethics are that students gain the awareness to discern ethical issues and the commitment to act appropriately on a decision when necessary.

Contemporary Ethical Considerations in Dental Practice

Advances in technology and changes in how patients interact with health care providers have introduced new ethical challenges for dental professionals. While traditional ethical principles still apply, modern situations, such as those listed below, often require additional consideration.

• Digital Dentistry and Technology

The use of digital imaging, computer-aided design (CAD/CAM), and emerging artificial intelligence tools can improve diagnosis and treatment planning. However, clinicians remain as the paramount ‘human in the loop’ and are ultimately responsible for verifying the accuracy of these tools and ensuring that patients are fully informed when technology influences clinical decisions. Clinicians should also be aware of the limitations of these technologies and avoid overreliance on automated outputs, ensuring that clinical judgment remains the primary basis for patient care.¹⁴

• Teledentistry and Informed Consent

The ethical obligation to obtain informed consent applies whether care is delivered in person or through teledentistry. Patients should understand the nature and limitations of remote consultations, including any diagnostic limitations and privacy considerations associated with electronic communication. Clinicians should document the consent discussion and respect informed refusal when patients decline recommended care or teledentistry services.

• Electronic Records and Data Privacy and Patient Access

Patient information is increasingly stored and shared electronically, requiring secure handling of records and compliance with privacy regulations. Clinicians must ensure that electronic health records are accurate, objective, and professional, recognizing that many systems now allow patients direct access to their clinical notes. Documentation should reflect factual observations without judgmental language, even when describing non-compliant or challenging patient interactions. Clear, accurate documentation also supports continuity of care and may be critical in legal or regulatory reviews, further underscoring the importance of maintaining professional and objective records.

• Digital Communication, Social Media, and Reputation Management

The use of social media, online reviews, and other digital communication platforms may present ethical challenges related to professionalism, reputation management, and patient confidentiality. Clinicians must maintain appropriate professional boundaries, obtain proper consent before sharing patient information or images, and avoid disclosing protected health information when responding to online reviews or engaging in public communication. Online communication and reputation management not only reflect the conduct of the individual clinician but also shape public perception and trust in the dental profession. Maintaining professionalism, honesty, and respect in digital interactions helps protect both the clinician’s reputation and the integrity of the profession as a whole.