Principles and

codes of
ETHICS
Of professional conduct
The ADA Code is, in effect, a written expression of the obligations arising from the
implied contract between the dental profession and society.
The ADA Code has three main components:

● the Principles of Ethics

● the Code of Professional Conduct
● the Advisory Opinions.
Principles of ethics
are the aspirational goals of the profession. They provide guidance and offer
justification for the Code of Professional Conduct and the Advisory Opinions.
5 fundamentals
principles
Code of professional conduct
is an expression of specific types of conduct that are either required or prohibited.
Advisory opinions
are interpretations that apply the Code of Professional Conduct to specific fact
situations.
Although ethics and the law are closely related, they are not the same. Ethical
obligations may — and often do — exceed legal duties. In resolving any ethical
problem not explicitly covered by the ADA Code, dentists should consider the
ethical principles, the patient’s needs and interests, and any applicable laws.
The Association believes that dentists should possess not
only knowledge, skill and technical competence but also
those traits of character that foster adherence to ethical
principles. Qualities of honesty, compassion, kindness,
integrity, fairness and charity are part of the ethical education
of a dentist and practice of dentistry and help to define the
true professional.
 Principle I. patient autonomy
The dentist has a duty to respect the patient’s
rights to self-determination and confidentiality
This principle expresses the concept that professionals have a duty to treat the
patient according to the patient’s desires, within the bounds of accepted treatment,
and to protect the patient’s confidentiality.
How this principle is conducted?
1.A. PATIENT INVOLVEMENT.
The dentist should inform the patient of the
proposed treatment, and any reasonable
alternatives
1.B. PATIENT RECORDS

- Furnishing copies of records

Upon request of a patient or another dental practitioner, dentists shall
provide any information in accordance with applicable law that will be
beneficial for the future treatment of that patient.

- confidentiality of patient’s records

| dentist should obtain the patient’s written permission before

forwarding health records which contain information of a sensitive
nature, such as HIV Seropositivity,
If it is necessary the treating dentist should seek the permission of the
patient prior to the release of data from the patient’s records to the
consulting practitioner
Challenges
Principle 2 : nonmaleficence (“do no
harm”)
2.A. Education

Staying Current (Continuing Education):

Dentists are required to continuously learn and update their
knowledge and skills. This ensures they're equipped with
the latest techniques and treatments that minimize risks for
patients. “All dentists, therefore, have the obligation of
keeping their knowledge and skill current.
2.B. consultation and Referral
2.B. consultation and Referral

Knowing When to Refer (Consultation and

Referral): Dentists need to recognize their limitations.
When a case is complex or requires specialized expertise,
they have an obligation to refer the patient to a specialist .
This ensures patients receive the best possible care from
someone with the specific skills and experience needed.
2.B. consultation and Referral
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
2.B.1. Second opinions
 2.B.1. Second opinions
When a dentist gets a patient referred for a
second opinion on a diagnosis or treatment
plan, they should follow these ethical
guidelines:
● Patient's Best Interest First: The dentist
giving the second opinion shouldn't be
influenced by personal gain or any outside
factors. Their main focus should be on what's
best for the patient's dental health.
2.B.1. Second opinions
Objective Evaluation: The dentist should
carefully review the patient's situation and all
available information (like X-rays) without
any bias. Their recommendation should be
based solely on their professional judgment.
This ensures the patient receives a fair and
independent assessment, helping them
make informed decisions about their dental
care.
2.C. USE OF AUXILIARY PERSONNEL
Dentists shall be obliged to protect the health of their
patients by only assigning to qualified auxiliaries those
duties which can be legally delegated. Dentists shall
be further obliged to prescribe and supervise the
patient care provided by all auxiliary personnel
working under their direction.
2.C. USE OF AUXILIARY PERSONNEL
2.D. PERSONAL IMPAIRMENT
2.D. PERSONAL IMPAIRMENT
It is unethical for a dentist to practice while abusing controlled
substances, alcohol or other chemical agents which impair the ability
to practice. All dentists have an ethical obligation to urge chemically
impaired colleagues to seek treatment. Dentists with first-hand
knowledge that a colleague is practicing dentistry when so impaired
have an ethical responsibility to report such evidence to the
professional assistance committee of a dental society.
2.D. PERSONAL IMPAIRMENT
ADVISORY OPINION
2.D.1. ABILITY TO PRACTICE
2.D.1. ABILITY TO PRACTICE
A dentist who contracts any disease or becomes impaired in any way
that might endanger patients or dental staff shall, with consultation and
advice from a qualified physician or other authority, limit the activities
of practice to those areas that do not endanger patients or dental staff.
A dentist who has been advised to limit the activities of their practice
should monitor the aforementioned disease or impairment and make
additional limitations to the activities of the dentist’s practice, as
indicated.
2.D.1. ABILITY TO PRACTICE
Post exposure blood borne pathogen
All dentists, regardless of their blood borne pathogen status, have an ethical obligation to immediately
inform any patient who may have been exposed to blood or other potentially infectious material in the
dental office of the need for post exposure evaluation and follow-up and to immediately refer the patient to
a qualified health care practitioner who can provide post exposure services. The dentist’s ethical obligation
in the event of an exposure incident extends to providing information concerning the dentist’s own blood
borne pathogen status to the evaluating health care practitioner, if the dentist is the source individual, and
to submitting to testing that will assist in the evaluation of the patient. If a staff member or other third
person is the source individual, the dentist should encourage that person to cooperate as needed for the
patient’s evaluation.
 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
 PATIENT ABANDONMENT.
Once a dentist has undertaken a course of
treatment, the dentist should not discontinue that
treatment without giving the patient adequate notice
and the opportunity to obtain the services of another
dentist. Care should be taken that the patient’s oral
health is not jeopardized in the process.
Principle III.
Beneficence (“do good”)

Every patient deserves a

“good” dental care.
This principle expresses the
concept that:
● Professionals have a duty
to prioritize the well-being
of their patients and the
public.
● Providing competent and
timely dental care while
considering the patient’s
needs, desires, and values.
What do you think of this case ?
● Do ethical considerations apply to fee-for-service,
managed care, and contracts either way ?
How this principle is conducted?
 3.A.COMMUNITY SERVICE

● Use your skills for the improvement of dental health of the

public
● Maintain and elevate the esteem of profession
ADVISORY OPINION
3.A.1.ELECTIVE AND NON-EMERGENT PROCEDURES

● Public health crisis…..How to deal with ?! Am I violating

ethics
principles ?
 3.B. GOVERNANCE OF A PROFESSION

● Join a professional dental society and observe its rules

3.B. GOVERNANCE OF A PROFESSION.
Every profession owes society the responsibility to regulate itself. Such regulation is
achieved largely through the influence of the professional societies. All dentists, therefore,
have the dual obligation of making themselves a part of a professional society and of
observing its rules of ethics.
3.C. RESEARCH AND DEVELOPMENT.
Dentists have the obligation of making the results and benefits of their investigative
efforts available to all when they are useful in safeguarding or promoting the health of the
public.
3.D. Patent and Copyrights
 Patents protect novel inventions
like new dental tools or
Patent
techniques, giving the inventor
exclusive rights for a set period.

Copyright safeguards original

artistic or written works, such as
Copyright dental textbooks or educational
materials.
3.E. Abuse Neglect
 Abuse refers to intentional
actions that cause harm, injury,
Abuse
or distress to another person,
whether physical, emotional, or
psychological.

Neglect involves the failure to

provide adequate care or meet
Neglect the basic needs of an individual,
leading to physical or emotional
harm.
3.F. PROFESSIONAL DEMEANOR IN THE WORKPLACE

Dentists have the

obligation to provide a
workplace environment
that supports respectful
and collaborative
relationships for all those
involved in oral health care.
ADVISORY OPINION
3.F.1. DISRUPTIVE BEHAVIOR IN THE WORKPLACE.
Dentists are the leaders of the
oral healthcare team. As such,
their behavior
in the workplace is instrumental
in establishing and maintaining a
practice environment that
supports the mutual respect,
good communication, and high
levels of collaboration among
team members required to
optimize the quality of patient
care provided.
Dentists who engage in
disruptive behavior in the
workplace risk undermining
professional relationships
among team members,
decreasing the quality of
patient care provided, and
undermining the public’s
trust and confidence in the
profession.
Justice
Dentists have a duty to treat people fairly in all aspects of their professional conduct,
including interactions with patients, colleagues, and society.
● Dentists must deliver dental care without prejudice or discrimination
based on factors such as race, creed, color, gender, sexual
orientation, gender identity, national origin, or disability.

● Patient selection should be based on reasonable discretion, but

dentists must not refuse treatment or deny services based on
discriminatory reasons.
● Treatment decisions for patients with disabilities or bloodborne pathogens should be
made based on individual needs, similar to other patients.

● Dentists are obliged to make reasonable arrangements for emergency care for both
regular and non-regular patients.
Objectives :
Ensure Fairness,Equality and inclusivity in the delivery of the dental care
and professional interactions within the dental community and society.
 How justice can be conducted in dentistry in
general
by ensuring fair and equal treatment for all patients,
colleagues, and society.
This involves providing dental care without prejudice, making reasonable
arrangements for emergency care, and reporting instances of faulty treatment by
other dentists
Dentists should communicate truthfully with patients about their oral health status
and avoid unjustifiable criticism of other professionals
and in esthetics practice
.In esthetics practice within dentistry, justice can be upheld by offering aesthetic
treatments in a fair and unbiased manner
should provide accurate information to patients about esthetic procedures,
potential outcomes, and associated risks
It is essential to respect patient autonomy and preferences while ensuring that the
treatments offered are based on professional judgment and expertise
Overall, justice in dentistry, including esthetics practice, involves treating patients
with fairness, honesty, and respect, while upholding professional standards and
ethical guidelines outlined in documents like the ADA Code of Ethic
Ethical rule for dentist
Duties of dentist toward patient

Duties of dentist toward one another

Duties of dentist toward the public

Duties of dentist toward patient

the dentist’s primary obligations include

dealing with people justly and delivering
dental care without prejudice
dentists shall not refuse to accept patients into their
practice or deny dental service to patients because of the
patient’s race, creed, color, gender, sexual orientation,
gender identity, national origin or disability.
the dentist should exercise care that the comments
made are truthful, informed and justifiable.
 Patients should be informed of their present
oral health status without disparaging
comment about prior services.

A difference of opinion as to preferred

treatment should not be communicated to
the patient in a manner which would
unjustly imply mistreatment.
Duties of dentist toward one another

If a another dentist refer the patient to you , the dentist, upon

completion of treatment, is obliged to return the patient to the
patient’s regular dentist unless the patient expressly reveals a
different preference
if possible,consult with previous treating
dentist(s), to determine the full story under what
circumstances and conditions the treatment was
performed before reporting as mistreatment

Do not slander on the other

dentist
Duties of dentist toward the public

Dentists shall be obliged to report to the

appropriate reviewing agency of gross or
continual faulty treatment by other dentists
provide expert testimony as dental expert when that
testimony is essential to a just and fair disposition of a
judicial or administrative action.

Do not offer or accept

rebates or split fees

Do not agree to a contingent fee

Such basic patients’ rights must be balanced by their responsibilities to
help safe, quality, efficient and ethical oral care to be provided for all
members of society, and to acknowledge their responsibility for
safeguarding their own oral health. These responsibilities arise their
general ethical obligations and public responsibilities and include their
obligation to:
● show respect for the well-being and needs of others;
● understand that dentists desire to be reasonably effective and
equitable in providing appropriate care to all members of the
community;
● give the necessary priority to oral health and accept their responsibility
for their own oral health;
● acknowledge the reality and limits of individual oral health
care;
● understand the variance in how oral health care can be
legitimately delivered; and
● know their rights as patients and the limitations of these
rights.
What challenges can face dentist while conducting
principle of justice and how to manage?
1) allocating resources:

• Dentist may face difficulties in allocating resources like equipments ,

materials ,appointments slots among patients, money, making it difficult to
treat all patients equally.

• This can be managed by giving priority according to needs , urgency and

seeking to manage resources efficiently, also considering a sliding scale for
payment to accommodate different financial situations.
2) insurance limitations:

• Insurance may not cover all needed treatments leading to disparities in the
level of care received by insured vs uninsured patients.

• Managed by assisting patients in understanding their insurance coverage

and help them find alternative financial assistance and payment plans.
3) special needs patients:
• Providing equitable care for patients with special needs such as physical,or
cognitive disabilities can be difficult.

• This can be managed by by investing in training staff and providing

equipments to accommodate these patients, schedule longer appointment
times and work collaboratively with caregiver for optimal treatment plan.
4) BIAS & discrimination:

• Unconscious biases may influence tt decision.

• Dentist should work on self awareness & training to overcome personal

prejudices, implement standardized ttt protocol that apply equally to all
patients.
5) Fear of damaging and affecting personal relationships when reporting
unethical practices:

Raising concerns about personal and professional privacy, Reporting should

be done anonymously.
6) Informed Consent:

• Ensuring that patients fully understand their treatment options and give
informed consent can be challenging, especially when patients have
limited health literacy or language barriers. Dentists can address this by
using plain language, visual aids, and interpreter services to improve
communication with patients and their families.
Veracity

This principle expresses the

concept that professionals
have a duty to be honest
and trustworthy in their
dealings with people
respecting the position of
trust in the dentist-patient
relationship,
communicating truthfully
and without deception
5.A. REPRESENTATION OF CARE.
Dentists shall not represent the care being rendered to their patients in a false or
misleading manner.
ADVISORY OPINIONS

5.A.1. DENTAL AMALGAM AND OTHER RESTORATIVE MATERIALS.

Based on current scientific data, the ADA has determined that the removal

of amalgam restorations from the non-allergic patient for the alleged purpose

of removing toxic substances from the body, when such treatment is performed
solely at the recommendation of the dentist, is improper and unethical. The
same principle of veracity applies to the dentist’s recommendation concerning
the removal of any dental restorative material.
. UNSUBSTANTIATED REPRESENTATIONS.

● A dentist who represents that dental treatment or

diagnostic techniques recommended or performed by
the dentist has the capacity to diagnose, cure or
alleviate diseases, infections or other conditions, when
such representations are not based upon accepted
scientific knowledge or research, is acting unethically.
5.B. REPRESENTATION OF FEES.
● Do not lie or mislead about treatment fees.
● Do not waive copayments and lie to an insurance company.
● Do not overbill just because patient has insurance.
● Submit correct fee to insurance company.
● Submit correct treatment date to insurance company.
● Submit correct dental procedure to insurance company.
● Do not recommend or perform unnecessary treatment.
5.C. DISCLOSURE OF CONFLICT OF INTEREST.
● Reveal any monetary or special interests during presentations .
If a dentist is presenting information in an article or a seminar ,let's say
on invisalign, if they're endorsed and getting paid by invisalign to give that
talk or to write that article they would have to disclose that as part of that
presentation.
5.D. DEVICES AND THERAPEUTIC METHODS.
5.D.1. REPORTING ADVERSE REACTIONS.

A dentist who suspects the occurrence of an adverse reaction to a drug or dental

device has an obligation to communicate that information to the broader medical
and dental community, including, in the case of a serious adverse event, the Food and
Drug Administration (FDA).
5.D.2. MARKETING OR SALE OF PRODUCTS OR
PROCEDURES.

In the case of a health-related product, it is not enough for

the dentist to rely on the manufacturer’s or distributor’s
representations about the product’s safety and efficacy. The
dentist has an independent obligation to inquire into the
truth and accuracy of such claims and verify that they are
founded on accepted scientific knowledge or research.

Dentists should disclose to their patients all relevant

information the patient needs to make an informed purchase
decision, including whether the product is available
elsewhere and whether there are any financial incentives for
the dentist to recommend the product that would not be
evident to the patient.
5.E. PROFESSIONAL ANNOUNCEMENT.
5.E. PROFESSIONAL ANNOUNCEMENT.
In order to properly serve the public, dentists should represent
themselves in a
manner that contributes to the esteem of the profession. Dentists
should not
misrepresent their training and competence in any way that
would be false or
misleading in any material respect.
5.F. ADVERTISING.
Although any dentist may advertise, no dentist shall advertise in a manner
that is false or misleading in any material respect
5.F. ADVERTISING.
5.f.1 published communication
truthful disclosure of the source and authorship
for the purpose of inducing the public to utilize the services of the sponsoring
dentist, the dentist is engaged in making a false or misleading representation
to the public in a material respect.
 5.F. ADVERTISING.
5.F.2. EXAMPLES OF “FALSE OR MISLEADING
Rather, by restating the concept in alternative language and giving general examples, it is
hoped that the membership will gain a better understanding of the term.
n particular, statements of opinion may be misleading if they are not honestly held
The fundamental issue is whether the advertisement, taken as a whole, is false or misleading in
a material respect
 5.F. ADVERTISING.
5.F.3. UNEARNED, NON HEALTH DEGREES.
The announcement of an unearned academic degree may be misleading
unearned academic degree is one which is awarded by an educational institution
not accredited by a generally recognized accrediting body
 5.F. ADVERTISING.
5.F.4. REFERRAL SERVICES

There are two basic types of referral services for dental care: not-for-profit and the
commercial.
e. A dentist is allowed to pay for any advertising permitted by the Code, but is
generally not permitted to make payments to another person or entity for the
referral of a patient for professional services
 5.F. ADVERTISING.
5.F.5. INFECTIOUS DISEASE TEST RESULTS.
A dental practice should not seek to attract patients on the basis of partial truths which
create a false impression
an advertisement to the public of HIV negative test results, without conveying
additional information that will clarify the scientific significance of this fact contains a
misleading omission
 5.F. ADVERTISING.
5.F.6. WEBSITES AND SEARCH ENGINE OPTIMIZATION.
Dentists may use services to increase the visibility of their web sites when consumers
perform searches for dentally-related content.

Dentists have an ethical obligation to ensure that their web sites, like their other
professional announcements, are truthful and do not present information in a manner
that is false and misleading in a material respect.
 5.g. NAME OF PRACTICE
The use of a trade name or an assumed name that is false or misleading in any
material respect is unethical. Use of the name of a dentist no longer actively
associated with the practice may be continued for a period not to exceed one year
 5.g. NAME OF PRACTICE
5.G.1. DENTIST LEAVING PRACTICE.
Dentists leaving a practice who authorize continued use of their names should receive
competent advice on the legal implications of this action.
With permission of a departing dentist, his or her name may be used for more than one year
if, after the one year grace period has expired, prominent notice is provided to the public that
the departing dentist has retired from the practice.
5.H: ANNOUNCEMENT OF SPECIALIZATION
AND LIMITATION OF PRACTICE.
● Provided that dentist meets the educational requirements required for
recognition as a specialist adopted by ADA.
● A dentist may ethically obligated to announce as a specialist to the public in
any of the dental specialties recognized by Certifying Boards.
● Dentists who choose to announce specialization should use “specialist in” / “is
limited to”.
● and shall devote a sufficient portion of their practice to the announced
specialty or specialties to maintain expertise in that specialty.
● Dentists should not use their eligibility to announce that they are or someone
on the team is a specialist when it is not true otherwise, it would be not ethical.
● GP should not announce themselves as specialists .
● If the dentist is certified in 2 specialities, then it is called a dual degreed dentist
and only at such case the dentist can announce himself/herself as an expert in 2
majors and legally autherized to practice them.
Is that always the case ?
Yes
The organization granting the credential grants certification or diplomate status
based on the following :

1. the dentist successfully completes a formal, fulltime, advanced education

program of 12 months duration.
2. the dentist’s training and experience.
3. Successful completion of an oral and written examination.

4. The announcement includes the name of the announced area of practice and the
name of the jurisdiction in which the dentist practices.
5. A disclaimer that despite the earned certificates, the clinician is a GP has to be
stated.
Nothing in this advisory opinion affects the right of a properly qualified dentist to
announce specialization in a recognized specialty area as long as the specialists shall
not announce their credentials in a manner that implies specialization in a
nonspecialty interest area.
5.I. GENERAL PRACTITIONER ANNOUNCEMENT
OF SERVICES.
● General dentists who wish to announce the services available in their practices
are permitted to announce the availability of those services so long as they
avoid any communications that express or imply specialization.
● General dentists shall also state that the services are being provided by
general dentists.
● GP should announce their credential interest following the previous conditions.
● The use of abbreviations to designate credentials shall be avoided when such
use would lead the reasonable person to believe that the designation
represents an academic degree, when such is not the case.