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ADA Code of Ethics
Three sections: Principles of Ethics • Code of Professional Conduct • Advisory Opinions

Patient Autonomy

The dentist has a duty to respect the patient’s rights to self-determination and confidentiality

Code of professional conduct: Advisory opinions:

●​ Patient involvement: the patient should be involved in treatment decisions ●​ Furnishing copies of records: the dentist must provide records if the patient requests
●​ Patient records: dentists should keep patient records safe and should provide records them
to the patient upon request ●​ Confidentiality of records: if another provider wants to discuss a patient, the dentist
should first get permission from the patient

Non-Maleficence

The dentist has a duty to refrain from harming the patient

Code of professional conduct: Advisory opinions:

●​ Education: the dentist should keep their skills current ●​ Second opinion: if another dentist is giving an opinion on a treatment plan, they should
●​ Consultation and referral: utilize specialists when indicated not have a vested interest in the provider’s recommended treatment
●​ Use of auxiliary personnel: dentists should use auxiliary personnel appropriately ●​ Ability to practice: if a dentist becomes sick or impaired, they should limit their
●​ Personal impairment: the dentist should not practice under the influence practice only to areas that do not endanger staff or patients
●​ Postexposure, bloodborne pathogens: inform patients and follow the proper protocol
●​ Patient abandonment: dentist should not discontinue treatment without adequate
notice
●​ Personal relationships with patients: dentists should avoid interpersonal
relationships that can affect their professional judgment

Beneficence

The dentist has a duty to promote the patient’s welfare

Code of professional conduct: Advisory opinions:

●​ Community service: dentists should serve their community as a professional ●​ Elective and non-emergent procedures during a public health emergency: dentists
●​ Governance of a profession: dentists should join a professional society and observe should balance the ethical obligations to the patient and the community
its rules of ethics ●​ Reporting abuse and neglect: dentists are obligated to report abuse and neglect and
●​ Research and development: dentists should make the results of their research should become familiar with the legal obligations of reporting in their jurisdiction
available ●​ Disruptive behavior in the workplace: dentists who undermine the professional
●​ Patents and copyrights: allowed as long as they do not restrict research or practice behavior in the office are undermining the public’s trust in the profession
●​ Abuse and neglect: dentists should recognize signs and report
●​ Professional demeanor in the workplace: promote respectful and collaborative space

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Justice

The dentist has a duty to treat people fairly

Code of professional conduct: Advisory opinions:

●​ Patient selection: dentists cannot deny care to patients based on race, creed, color, ●​ Patients with disabilities or bloodborne pathogens: dentists must decide if they
gender, sexual orientation, gender identity, national origin, or disability have the skills to treat or if the patient would be better served by referral to a colleague
●​ Emergency service: reasonable arrangements should be made for patients of record ●​ Meaning of “justifiable”: ​dentist should exercise care that the comments made are
●​ Justifiable criticism: inform patients about oral health status without making truthful, informed, and justifiable when discussing previous dental care
disparaging comments about previous dentists ●​ Contingent fees: dentist shouldn't accept payment that depends on a lawsuit's
●​ Expert testimony: dentists may provide outcome
●​ Rebates and split fees: dentists shall not accept ●​ Split fees in advertising and marketing services: dentists should not split fees with
third-party vendors

Veracity

The dentist has a duty to communicate truthfully

Code of professional conduct: Advisory opinions:

●​ Representation of care: do not represent care in a false or misleading way ●​ Dental amalgam and other restorative materials: do not recommend removal
●​ Representation of fees: do not represent fees in a misleading manner ●​ Unsubstantiated representation: it is unethical to say something will cure a disease if
it is not backed by scientific research
●​ Disclosure of conflict of interest: disclose special interests when presenting any
●​ Waiver of copayment: If a dentist accepts third-party payment as full payment under a
seminars or presentations copayment plan without disclosing that the patient’s portion won’t be collected, it
●​ Devices and therapeutic methods: prescribe or promote devices, drugs, and other constitutes overbilling
agents that are available to the entire dental profession ●​ Overbilling: unethical to increase a fee because the procedure is covered by insurance
●​ Fee differential: the fee for a patient without insurance is the dentist’s full fee
●​ Professional announcement: dentists are not to misrepresent training and
●​ Treatment dates: cannot be modified to help the patient receive money from insurance
competence ●​ Dental procedures: must be accurately described in insurance claims
●​ Advertising: dentists must advertise truthfully ●​ Unnecessary services: do not recommend or provide unnecessary procedures
●​ Name of practice: when a dentist leaves a practice, their name cannot be used in ●​ Reporting adverse reactions: report to dental/medical community and FDA
●​ Marketing or sale of products or procedures: dentists should be honest and
relation to the practice for more than one year
recommend products based on their expertise and research
●​ Announcement of specialization and limitation of practice: specialists in ●​ Published communications: dentists must identify the source for any dental health
ADA-recognized specialties can announce themselves as such if the majority of their article or message that they present
practice is dedicated to that specialty ●​ Examples of “false or misleading”: statements that omit facts that display the truth
●​ Unearned, non-health degrees: dentists may only advertise earned degrees
●​ General practitioner announcement of services: general dentists can announce
●​ Referral services: referral services that involve misleading advertising are unethical
services offered in their practice as long as they do not imply that they have specialty ●​ Infectious disease test results: dental practice should not aim to market to patients
training in these areas based on partial truths that create false impressions, like advertising a negative HIV test
●​ Websites and search engine optimization: dentists should ensure that their websites
are truthful and do not present information false or misleading information
●​ Dentist leaving practice: if a dentist leaves and authorizes the use of their name
beyond one year, they should receive advice on the legal implications of this action
●​ Dual degree dentists: can announce both degrees where they are licensed
●​ Specialist announcement of credentials in non-specialty interest areas: specific
language must be used in these circumstances
●​ General practitioner announcement of credentials in interest areas: general
dentists can announce interest areas in ways that comply with the ADA Code of Ethics
●​ Credentials in general dentistry: general dentists can advertise fellowships or other
credentials as long as they do not imply that they are specialists

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Law and Behavioral Sciences

Dentists are mandated reporters and are required to report any suspected abuse or assault
●​ Reports should include: details about the person being harmed, indicators of harm/reason for reporting, description of injury, maltreatment,
neglect, any known information, name of person suspected for cause, action that was taken to assist
●​ This falls under beneficence
Child abuse and neglect:
●​ Providers are manded reporters and should immediately call Child Protective Services (CPS) if they suspect child abuse or neglect
Abuse
●​ Do not delay calling by asking the child/parent/guardian questions about the suspicion
Witnessed assault:
●​ 911 should immediately be called if a dentist witnesses assault (e.g., a caretaker hitting an elderly patient)
Occupational violence:
●​ Patients are the most likely perpetrators of violence in dental offices

Drug-seeking behaviors: Employee drug use suspicion:

●​ Asking for a drug by name ●​ All employees should be drug tested to ensure fairness and avoid
●​ Requesting an increased dosage of a drug biases in drug use assumptions
●​ Claiming allergies to alternative drugs ●​ If an employee admits to treating patients while intoxicated:
Drugs ○​ Immediately remove them from patient care
●​ Anger when questioned about pain
○​ Report them to their profession’s higher association
●​ Inappropriate self-medicating ○​ Require that they seek treatment
●​ Inappropriate use of office practices (e.g., calling after hours) ○​ Do not immediately fire them
●​ Manipulative or illegal behavior

Treating pregnant patients: Communicating with non-English speaking patients:

●​ If the patient is a minor seeking dental care: ●​ Phone interpreter services/official interpreters should be offered
○​ Patient’s rights vary state by state: some states allow pregnant ○​ Providers should maintain eye contact with the patient when
Special circumstances
minors to consent, others require parental consent speaking with the interpreter services
●​ If the patient endorses alcohol use: ●​ Translator applications and family members should be avoided
○​ Discuss the implications of alcohol and fetal development as modes of interpretation

Breaking confidentiality Proximate cause IV sedation Past provider treatment

●​ Dentists are only allowed to disclose ●​ Proximate cause: an incident that results ●​ A minimum of three individuals must be ●​ If a patient is questioning the ethics of a
patient information if there is: in another event present during IV sedation, including past provider and the treatment provided:
○​ Potential harm to others ○​ The patient’s injury is a direct result of ○​ The dentist ○​ Explain that every dentist has their own
○​ Potential harm to the patient the dentist’s negligence ○​ Two additional staff members trained in opinions of treatment
○​ No alternative method to protect ○​ For example not placing a gauze basic life support ○​ Do not discuss how the previous
those at risk curtain during an extraction and the ●​ Patients must have someone to bring them dentist’s treatment plan was wrong (this
patient aspirates their tooth home after the sedation and cannot be falls under justice)
discharged alone ○​ To fully discuss past treatment plans
and contact previous providers,
patients must provide written consent
that releases medical records
○​ Dentists must discuss all treatment
alternatives with patients upset about
their current condition

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