Ethics in Dentistry

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk,
and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those
twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth,
sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the
skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that
the world may know. Most especially must I tread with care in matters of life and death.
If it is given me to save a life, all thanks. But it may also be within my power to take a
life; this awesome responsibility must be faced with great humbleness and awareness
of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human
being, whose illness may affect the person's family and economic stability. My
responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my
fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and
remembered with affection thereafter. May I always act so as to preserve the finest
traditions of my calling and may I long experience the joy of healing those who seek my
help.
 Ethics

A branch of philosophy and theology, is

the systematic study of what is right and
good with respect to conduct and
character.
ETHICS=Moral Responsible.

John Seear wrote the first edition of Law

and Ethics in dentistry in 1975.
 Ethics

 Ethics is a part of philosophy that deals with

moral conduct and judgment.
Or Ethics are guidelines derived from values
and principles intended for the appropriate
behavior while practicing various
professional activities.
 Dental ethics would mean moral duties and
obligations of the dentist towards his
patients, professional colleagues and to the
Codes of Ethics:

All professional organisations should have

published code to which all members of the
profession are expected to adhere.
ADA’s principles of Ethics and Code contains-
1.SERVICE OF PROFESSION
2.EDUCATION
3.RESEARCH AND DEVELOPMENT
 6
Principles of Ethics

There are several principles that health care professionals

must aware of in the practice of their profession.
The principles of Ethics are as:
1. To do no harm (Non-maleficence)
2. To do good (Beneficence)
3. Respect for persons
4. Justice (Fairness)
5. Truthfulness (Veracity)
6. Confidentiality
Beneficence: which basically means
to do no harm and promote good for
others.
Autonomy: which is respect for all
persons and all points of view.
Justice: providing a person with what
is due.
 1. To Do No Harm (Non-maleficence)

 The first and foremost duty of the

health care professional is to
ensure that his actions do not
harm to the patient in any way.
“Either help or do not harm the
patient”
 2. To Do Good (Beneficence)

 The role of all health care professional is to

benefit patients.
 A healthcare professional has to place the
interest of the patient above his own
interest.
 3. Respect for Persons

 The patient (and the person treating the

patient) have the right to be treated with
dignity.
 Respect for persons incorporates at least
two other ethical principles;
I. Autonomy
II. Informed Consent
 I. Autonomy

 A patient has the right to make decisions and

is free to determine what will happen on his/
her body.
 Autonomy is a principle that dictates that
health care professionals respect the
patients right to make decisions concerning
the treatment plan.
 Health care professional have a duty to treat
the patient according to the patients need
within the limits of accepted treatment.
II. Informed Consent
12
 The health care professional has to ensure
that consent is obtained before any
treatment.
 Patients are provided with relevant
information such as different modes of
treatment, their risks and benefits, so patient
can make voluntary consent.
 In case of minors, parents or legal guardians
can give consent for treatment.
4. Justice (Fairness) 13

 The primary duty of the health care

professional is to give the services
irrespective of class, creed, etc.
 Justice demands that a health care
professional should treat people fairly that
means provide equal treatment to all, giving
to each patient what he/she needs.
 14
5. Truthfulness (Veracity)
 Patient–doctor relationship is based on
mutual trust. Patient expect the dentist is to
be truthful about the information given,
treatment rendered, and the prognosis.
 A health care professional have a duty to be
honest and trustworthy in their dealings
with people and communicating truthfully
without deception.
6. Confidentiality 15

 Health care professional have a legal and

ethical duty to keep patient information
confidential.
 Patient have the right to expect that all
communications and records pertaining to
their care will be treated as confidential.
 Confidential information should be kept in a
secure place at all times to prevent
unauthorized or accidental disclosure.
Professional liability
In a doctor patient relationship, the
doctor owes a duty to take care of
the patient as much as possible.
Failure to take proper care results
in breach of contract and on
sufficient proof of the same, the
doctor becomes liable for criminal
punishment.
 Negligence Liability
Negligence is defined as a “ failure to exercise
reasonable skill and care”.
The three essential elements of negligence are:
a. Duty: The defendant (doctor) owes a duty of
care to the plaintiff (patient).
b. Breach: the defendant has breached this duty of
care.
c. injury: The plaintiff has suffered an injury due to
the defendant’s breach of duty.
Liability

Liability of a doctor arises when the patient has

suffered an injury which is a consequence of a
breach in his or her own duty.
To show that the breach of duty has been done by
the doctor, it is important :
a. To show, what is considered as reasonable under
those circumstances.
b. That the conduct of the doctor was below this
reasonable degree.
Important factors:
1. Once a doctor-patient relationship is
established, the law imposes duty of proper care
and treatment on the part of the doctor.

2. The law does not expect the doctor to cure all

the cases or even the given case. It only expects
him to make a reasonable attempt and take
reasonable care under the circumstances.
3. The duty owed by a doctor cannot be altered
so as to reduce it from the standard of
reasonableness.

Liability of a doctor does not arise in all cases

even where the patient is injured by the act of the
doctor. He/she is liable only if he/she has
committed a breach of duty in the process.
 Consent

The doctor is expected to obtain consent from the patient

with regard to treatment, preoperative care, postoperative
care and surgical intervention.

A. Consent and informed consent:

Consent to treatment:

The consent is a process which involves a treatment

relationship with effective agreement and communication.
The patient agrees to submit to specific
diagnostic, medical or surgical measures to be
carried out by the doctor.
In turn, the doctor agrees to perform the
specified treatment within the limitations set
down by both the parties.
Consent can be implied, verbal or written.
b. Consent to surgical operations:
All surgical operations involve bodily touching
and this breaches a person’s right to bodily
integrity.
Individual Consent:
It refers to a situation where the particular
person in question can give legally effective
consent or not.
There are two basic factors to be considered :
1. Status of the person:
If the person is above 18yrs of age and is
mentally sound, he/she has the capacity to
consent.
2.Understanding of the person:
It all depends on whether the minor can
understand what is involved in the procedure
in question for which consent is required.
Criminal Aspects

A surgical operation performed by a doctor

without legally effective consent results in an
offence being committed by the doctor.
Exceeding consent:
A surgeon who has taken consent from a patient
for a particular operation cannot depart from it
and perform a bigger or different operation. He
cannot do anything more than what the patient
has consented to only if it is to save the life or
preserve the health of the patient.
 Treatment without consent

There are many situations in which a patient can be

treated without consent. This can be justified in law
on two grounds.
a. Necessity
b. Implied consent.
Necessity is probably a better legal basis than
implied consent, especially in operating on mentally ill
patient.
Implied Consent: If a patient enters the clinic, sits on
the dental chair and opens his/her mouth, the
consent is implied.
The principle of treating without
consent in emergencies is simple. A
doctor can do all acts to save life or
preserve health of the patient.
 Eg. Of a Consent Form
1. I………….of……………..(name and address of person giving consent)
Hereby consent to undergo
OR
Hereby consent to ………………undergoing
(name of the patient)
the operation/treatment of …………………
the nature and purpose of which has been explained to me by
Dr…………………………
I also consent to such further or alternative operative measures
or treatment as may be found necessary during the course of the
operation/treatment and to the administration of general or other
anaesthetics for any
of these purposes.
No assurance has been given to me that the
operation/treatment will be performed or
administered by any particular practitioner.
Date…………………Signature……………………
(patient/parent/guardian)
2. I confirm that I have explained the nature and
purpose of this operation/treatment to the
person(s) who signed the above form of
consent.
Date………………………signature……………….
(physician/surgeon)
For permanently mentally ill and mentally
retarded persons, any treatment which is clearly
for the medical benefit of the patient could be
given and the consent of the guardian of the
patient should be taken.
Confidentially: One of the most fundamental
ethical obligations owed by a doctor to his/her
patient is to respect the confidences of his/her
patient.
Case involving allegations of
negligence

Burns:
A. Due to instruments:
It has been occasionally observed that burns
to the face, lips and oral tissues occur from
overheated appliances and when instruments
are insufficiently cooled after sterilisation.
B. Due to chemicals:
1. Use of excessive quantity of chemical
in the mouth causing spreading to areas
other than requiring the application.
2. Inadvertent use of stronger solution.
3. Accidental dripping or spilling of a
caustic or acidic solution on to exposed
areas.
Hazards of local anaesthesia

The most common problems with the injection of

local anaesthesia which give rise to allegations of
negligence are:
1. Fracture of needle in situ.
2. The production of haematoma.
3. Fainting of a patient.
4. Trismus.
5. Injection of an incorrect fluid.
6. Anaphylactic shock.
Consent form: the use of a printed slip fro signature by a
patient. A copy of the slip can be given to the patient and
the original is retained with the patient’s records.

Use of Radiographs:
Most dental diseases cannot be properly diagnosed
without the assistance of radiographic evidence. Failure
to obtain radiographs in some instances coupled with
consequential damage to the patient, can be proved as a
failure to exercise reasonable skill and care. It can also
provide grounds for negligence.
AVOIDNCE OF NEGLIGENCE.

1.Keeping knowledge and skills updated.

2.Taking all reasonable care to maintain standard.
3.Develop doctor-patient relationship.
4.Maintenance of records.
5.Employ qualified assistants.
6.Professional indemnity insurance.
Record keeping

Good record keeping is and integral part of the use of

reasonable skill and care.
One of the most important factors in self protection for a
doctor is the maintenance of accurate, full and complete
records of all treatments provided, pre and post
operative advice given, unusual sequelae, drugs
prescribed and any treatment advice given to the patient.
Ownership of Records

Dental records are the property of the practitioner

concerned.
Sometimes, a patient moving to another area may
request for his records and radiographs. Practitioners
are advised not to accede to such requests but to
inform the person concerned that these items will be
available to the patient’s next practitioner upon the
latter's request.
Preservation of records

All treatment records and relevant documents and

radiographs, and in certain cases ,models should be
preserved as long as possible and a minimum of 7
years from the date of last entry is recommended. In
case of minors, it is advisable to retain the records until
at least 7 years after the child has reached the age of
maturity.
Careers in Dentistry
Careers in Dentistry

The goal of the dental team is to provide optimal

care of the oral cavity for all patients
Dental team members can work in:
– Group or specialty(solo) practice
– Schools with dental clinics
– Government or community clinics
– Dental insurance companies
 Dentist
Education
4-5year degree from college or university
Degrees:
Bachelor of Dentistry (BDS)
Doctor of dental surgery (DDS)
Doctor of medical dentistry (DMD)
– A years of dental school training – Internship (12 months)
– 2-3 years of additional training for specialty (Msc-Clinical
Speciality)
MDS
PhD
– National examination required for licensure.
What Does a Dentist Do?

Diagnose and Treat diseases, injury and

malformations of the teeth and mouth
Improve a patient’s appearance by using a variety
of cosmetic procedures
Perform surgical procedures such as implants,
tissue grafts, and extractions
Educate patients
Perform research – improving oral health and
developing new treatments
Specialties of Practice

• Endodontics
• concerned with the human dental pulp and
periradicular tissues
• Oral and maxillofacial pathology
• deals with the nature, identification, and management
of diseases affecting the oral and maxillofacial regions.
• includes research and diagnosis of diseases using
clinical, radiographic, microscopic, biochemical, or other
examinations.
• Oral and Maxillofacial Radiology
• concerned with the production and interpretation of
images that are used for the diagnosis and
management of diseases, disorders and conditions of
the oral and maxillofacial region.
Specialties of Practice
Pediatric dentistry is a branch of dentistry that deals with the examination
and management of dental health in children.
Periodontics
encompasses the prevention, diagnosis and treatment of diseases of the
supporting and surrounding tissues of the teeth - Gums
Prosthodontics
specialty pertaining to the diagnosis, treatment planning, rehabilitation
and maintenance of the oral function, comfort, appearance and health of
patients with missing or deficient teeth and/or oral and maxillofacial
tissues
Public health dentistry
form of dental practice which serves the community as a patient rather
than the individual
concerned with the dental health education of the public, with applied
dental research, and with the administration of group dental care
programs