The document discusses ethical issues in dentistry, outlining key principles such as non-maleficence, beneficence, autonomy, justice, truthfulness, and confidentiality. It also details the responsibilities of dentists towards patients and colleagues, unethical practices, and the legal vulnerabilities associated with dental practice, including criminal and civil liabilities. Additionally, it covers the role of forensic dentistry in identifying unknown deceased individuals through dental records and methods of identification.

1. Ethical Issues
BY
Dr Sana Masood

2. Ethics
• Definition
Ethics is defined as the part of philosophy that
deals with moral conduct and judgement.

3. PRINCIPLES
1. To do no harm (non-maleficence): This principle is attributed to Hippocrates and is
considered to be the foundation of social morality.
2. To do good (beneficence): It should be the role of dentists and dental hygienists to benefit
patients, as well as not to inflict harm. The expectation of the patient is that the care provider
will initiate beneficial action and that there is an agreement between the doctor and the patient
that some good will occur.
3. Autonomy: This principle dictates that healthcare professionals respect the patient’s right to
make decisions concerning the treatment plan. Patients should not be bystanders in their
treatment but active participants. Informed consent both a legal and an ethical concept, is an
essential component of a patient’s right to autonomy. The following elements should be present.
• Disclosure of appropriate information.
• Comprehension of the information by the patient.
• Voluntary consent.
• Competence to consent.

4. 4. Justice: It is described as fairness or equal treatment, giving to each his or her right or
due.
5. Truthfulness: Lying fails to show respect for persons and their autonomy, violates
explicit agreements and threatens relationships based on trust.
6. Confidentiality: Patients have the right to expect that all communications and records
pertaining to their care will be treated as confidential. It is very natural to want to gossip
about a patient, particularly if it is someone famous or possibly a neighbour, but to do so
would break a bond of trust between the dental professional and the patient. Confidentiality
must be maintained at all times

5. Code of Ethics
• All professional organizations have a published code to
which members of the profession are expected to
adhere. These codes have been developed over a
long period of time, they reflect the customs and
beliefs of current members of the profession and
provide a historic link with the past

6. Duties and
Obligations
of Dentists
toward
Patient and
Public
• Treat the welfare of the patient as paramount to all other
considerations and shall conserve it to the utmost of his
ability
• Be courteous, sympathetic, friendly and helpful to and
always ready to respond to the call of his patients, and
should be polite and dignified
• Observe punctuality in fulfilling his appointment.
• Deem it a point of honour to adhere with as much
uniformity as the varying circumstances may admit, to the
remuneration for professional services.
• Not permit consideration of religion, nationality, race,
caste and creed, party politics or social standing to
intervene in his duties towards his patients.
• Keep all the information of a personal nature which he
comes to know about a patient directly or indirectly in the
course of professional practice in utmost confidence.
Dental hygienists and dental mechanics and other staff
employed by him also observe this rule

7. Duties
Toward
Colleague
Cherish a proper pride in his colleagues and shall not
disparage them either by actions, deeds or words
On no account contemplate or do anything harmful to the
interest of the members of the fraternity.
Honour mutual arrangements made regarding
remuneration.
Retire in favour of the regular dentist, after the emergency
is over.
Institute correct treatment at once with the least comment.
Regard it as a pleasure and privilege to render gratuitous
service to another dentist, his wife and family members

8. Unethical Practices
• Employment by a dentist in his professional practice of any professional assistant, not being a registered
dental hygienist or a registered dental mechanic
• Styling by any dentist or a group of dentists his/their ‘dental clinic’ or chambers by the name of dental
hospitals.
• Any contravention of the drugs.
• Signing under his name and authority any certificate which is untrue, misleading or improper, or giving false
certificates or testimonials directly or indirectly concerning the supposed virtues of secret therapeutic agents
or medicines.
• Immorally involving abuse of professional relationship.
• Aiding in any kind of illegal practice.
• Promise of radical cure by the employment of secret methods of treatment.
• Advertising, whether directly or indirectly, for the purpose of obtaining patients of promoting his own
professional advantage.
• Employing any agent or canvasser for the purpose of obtaining patient

9. • Using of signboards larger than 0.9 metric by 0.6 metric and use of such words as teeth, painless
extraction. Other than his name and qualifications as defined under Clause (i) of Section 2 of the Act.
• Insertion of any paragraph and notice in the press.
• Allowing the dentists name to be used to designate commercial articles such as toothpaste,
toothbrush, tooth powder.
• Mentioning after the dentists name any other abbreviation except those indicating dental
qualifications as
RDP: Registered dental practitioner
MIDA: Member Indian Dental Association
FICD: Fellow of International College of Dentists
MICD: Master of International College of Dentists
FACD: Fellow of American College of Dentists
MRSH: Member of Royal Society of Hygiene and the like which are not academic qualifications.

10. Change of address and announcement relating thereto
• A notice for the change of address shall be intimate to the concerned state dental council.
• A dentist may issue a formal announcement in the press, one insertion per paper, regarding the following.
On starting practice
On change of type of practice
On changing address
On temporary absence from duty
On resumption to practice.
Action of unethical conduct: When complaint or information is received by
the state dental council, the concerned state dental council may call upon him
to explain and after giving him a reasonable opportunity of being heard and
after making such enquiries determine the action to be taken against the
dentist under Section 41 of the Act.

11. Legal Vulnerability in Dental Practice
Legal vulnerability in dental
practice may be divided into
two broad categories
1. Criminal
2. Civil

12. 1. Criminal
• Violations of statutory law are termed crimes. They
constitute acts that are deemed by the government to be
against public interest.
• The penalties include:
1. Loss or suspension of license
2. Mandatory psychiatric counselling
3. Drug rehabilitation
4. Mandatory continuing education
5. Fines
6. Jail term
• Violations of administrative laws (state board, state
education department) are termed quasi crimes. The
penalties include all actions under crimes except the
jail term

13. 2. Civil
• Civil Legal Vulnerability in
Dental Practice is divided into
1. Contract
2. Torts

14. Contract
• Definition
A contract is defined “as an agreement between parties”
and can be either verbal or written. In law both are
equally binding, but as the parties may have differing
recollections of what was said, the advantages of a
written agreement are apparent.

15. Types of contract
I. Doctor-patient contract
Duties owed by the doctor
1. Use reasonable care in the provision of services as measured against acceptable
standards set by other practitioners with similar training in a similar community.
2. Be properly licensed and registered and meet all other legal requirements to engage in the
practice of dentistry.
3. Employ competent personnel and provides for their proper supervision. Maintain a level of
knowledge in keeping with current advances in the profession.
4. Obtain informed consent from the patient before instituting an examination or treatment.
5. Charge a reasonable fee for services based on community standards. Keep the patient
informed of her or his progress.

16. 6. Charge a reasonable fee for services based on community standards.
7. Keep the patient informed of her or his progress.
8. Keep accurate records of the treatment rendered by the patient.
9. Maintain confidentiality of information.
10. Make appropriate referrals and request necessary consultations.
11. Comply with all laws regulating the practice of dentistry

17. Duties owed by the Patient
In accepting the care, the patient should
1. Follow home care instructions.
2. Appointments will be kept.
3. Patient will co-operate in case.
4. Bills for services will be paid in a reasonable time.
5. That the patient will notify the dentist of a change in health status.

18. II. Dentist-staff contract
This should include a job description, pay, holiday entitlements, bonuses, loyalty
and sickness allowances, disciplinary rules and termination procedures with details
of notice required by each part

19. 2.Torts
• A tort is a civil wrong or injury,
independent of a contract, that results
from a breach of a duty.
• It is of 2 types
1. An unintentional tort is one in which
harm was not intended as in the case
in tort of negligence.
2. An intentional tort contains the
element of intended harm.
If the negligence involves an act that is
performed in a professional capacity, it
is termed professional negligence or
malpractice.

20. Unintentional tort
• Includes
Professional
Negligence
Criminal
Negligence
Contributory
Negligence
Vicarious
Liability
• it is defined as a
failure to exercise
reasonable care in
one’s professional
capacity
• For criminal proceedings to be
started the negligent action must
be very serious and have some
accentuating factors (e.g.
dentist was drunk or drugged
or disregarded well-known
safety principles).
• When the actions of a
patient have been partially
(or completely) to blame
for the damage that
occurred (e.g. failure to
follow postoperative
instruction).
• A charge of
negligence can be
brought against
both employee
and employer.

21. Intentional tort

22. 1. Trespass to the Person (Assault and Battery) It
constitutes a threat to harm (assault) and
unauthorized touching (battery)
2. Misrepresentation (Deceit) Patient must be kept
informed of their treatment status
3. Defamation It is the publication of false statement
which lowers the reputation of a man. Defamation
can be statements with the intention of discrediting a
person, expressing hatred contempt or ridicule.
4. Breach of Confidentiality Information obtained
from the patients in the course of diagnosis (or)
treatment must remain confidential.

23. Consent
• The general principle that a doctor who treats a patient without the patient’s consent is
guilty of unauthorized touching, for which the doctor can be held liable to the patient in
damage. Treatment without any consent is assault. Therefore to be valid, consent should
be “informed”.

24. Content of Consent
The patient must be informed of all the following:
1. Description of the proposed treatment
2. Material or foreseeable risks
3. Benefits and prognosis of proposed
treatment Alternatives to proposed treatment
4. Risks, benefits and prognosis of the
alternative treatments.

25. Forensic dentistry
• Forensic dentists or odontologists, provide the dental component to determine
the identity of a body when visual identification or methods such as DNA
profiling and fingerprinting are inadequate or not possible. Forensic dentistry
has a major role in the identification process of a diseased person of unknown
identity

26. Forensic Team
There are two types of dental identification team:
• Traditional dental team which consists of chief forensic dentist and includes
dentists, hygienists and dental assistants.
• Disaster mortuary operational response team (DMORT) consists of a dental
team, forensic pathology team, anthropology and laboratory support,
photographic and communication support, logistics team and mortuary science
team

27. Dental Identification
• Teeth are the most durable organs in the body, able to survive temperature of 1600
degree Celsius and remain virtually intact long after other soft or skeletal tissues have
decayed or been incinerated
• Dental identification process involves:
a) Post-mortem assessment (physical characteristics of the diseased) The odontologists
obtains post-mortem dental information which includes,
• Visual examination of the oral structure (endodontic treatment, implants, charting of
existing restoration, tori, unusual anatomic features, etc.)
• Radiograph (full mouth, bitewing and panoramic)
• Photograph (facial and intraoral) Impressions

28. b) Ante-mortem assessment (physical characteristics made prior to death)
Ante-mortem dental information to be gathered includes
• Original radiographs.
• Original complete dental records
• Availability of dental models used for diagnostic purpose or for fabrication of
prosthesis.
• When all post-mortem and ante-mortem information is obtained and charted,
the results can be compared and a conclusion reached with a high degree of
reliability and simplicity

29. Personal Identification
The teeth, jaws and orofacial characteristics are used for personal
identification. The three types of personal identification system are:
• Comparative dental identification: It involves the comparison of post mortem
and ante-mortem dental records to determine if the body is that of the person
of interest.
• Reconstructive post-mortem dental profiling: It is used when there is no
suspicion as to the identity of the decedent.
• Dental DNA profiling: It is used when dental records are unavailable.It
focuses on the application of modern forensic DNA profiling methods to oral
tissues

30. Conclusion
• The increasing use of sealants and composite resins are
challenging the reliability and accuracy of dental identification
methods. Forensic dentistry will, however, remain an important tool
for identifying a diseased person of unknown identity.

31. REFERENCES
• Preventive and Community Dentistry by Joseph John