Familarize Yourself with the ADA’s Principles of Ethics and Code of Professional Conduct

The American Dental Association also know as the ADA, in 2012, update their Principle of Ethics and Code of Professional Conduct document. It is available over at http://www.ada.org/~/media/ADA/About%20the%20ADA/Files/code_of_ethics_2012.ashx. As many Americans make trips to the dentist, it is useful to familiarize yourself with the ADA’s document to better determine if your dentist is being ethical and serving your needs well. If you don’t feel this is the case you have options to report your dentist and of course you can find a new dentist.

Additional comments on the ethics and professional conduct of the ADA and it’s members is over at http://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conduct. It states

“The dental profession holds a special position of trust within society. As a consequence, society affords the profession certain privileges that are not available to members of the public-at-large. In return, the profession makes a commitment to society that its members will adhere to high ethical standards of conduct… The ADA Code is, in effect, a written expression of the obligations arising from the implied contract between the dental profession and society.”

It should be noted that the position is that ADA members voluntarily agree to abide by the code. Further the code falls into three main components: The Principles of Ethics, the Code of Professional Conduct and the Advisory Opinions.  There are five fundamental principles that form the ADA code: patient autonomy, nonmaleficence, beneficence, justice and veracity. The updated 2012 document is 24 pages, so I encourage you to read it, I will just point out a few things below.

Regarding the principle of nonmaleficence (do no harm), there is a description on postexposure, bloodborne pathogens (2E). It states

“All dentists, regardless of their bloodborne 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 postexposure evaluation and follow-up and to immediately refer the patient to a qualified health care practitioner who can provide postexposure services.”

Unfortunately cases have occurred where dentists and/or oral surgeons have exposed patients to bloodbourn pathogens including HIV and hepatitis C. See the Acquired Infection section of the wisdom teeth removal complications page over at http://www.teethremoval.com/complications.html. See also http://blog.teethremoval.com/dental-patients-warned-of-possible-hiv-and-hepatitis-exposure-in-pennsylvania/ for a more recent potential bloodbourn pathogen exposure case occurring in Pennsylvania.

Regarding the principle of nonmaleficence (do no harm), there is a description on patient abandonment (2F). It states

“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.”

Unfortunately, there have been cases where dentists and/or oral surgeons have abandoned the patient during treatment and jeopardizing their health in the process (beyond just their oral health). See the Other Unfortunate Occurrences section of the wisdom teeth removal complications page over at http://www.teethremoval.com/complications.html. As such, in the past I have advocated for video taping any treatment that occurs as patient abandonment can occur with the idea of preventing a lawsuit see http://blog.teethremoval.com/how-to-improve-your-chances-to-win-a-dental-malpractice-lawsuit/. Further, I also have advocated to have a backup oral surgeon or dentist to visit in case the first stops treating you while you still need treatment.

Going back to the ADA code and the principle of veracity (truthfulness) there is a description of advertising (5F). It states

“Although any dentist may advertise, no dentist shall advertise or solicit patients in any form of communication in a manner that is false or misleading in any material respect”

Later in 5.F.2 some examples of what is false and misleading is provided

“…statements shall be avoided which would: a) contain a material misrepresentation of fact, b) omit a fact necessary to make the statement considered as a whole not materially misleading, c) be intended or be likely to create an unjustified expectation about results the dentist can achieve, and d) contain a material, objective representation, whether express or implied, that the advertised services are superior in quality to those of other dentists, if that representation is not subject to reasonable substantiation.”

Of course, as I have mentioned or at least hinted at in a previous blog post and discussions is the definition of what is considered material see http://blog.teethremoval.com/the-well-informed-patient/. In this post it states

“A risk is material if the physician believes that a reasonable person in the patient’s position ‘would be likely to attach significance to the risk or cluster of risks in deciding whether or not to forego the proposed therapy.”

This is rather subjective and hence a large gray area occurs. Hence it is important to remember what one patient may interpret to be false or misleading in a material respect may be different than another. Further, the law may not be on your side here.

The ADA code later states

“Anyone who believes that a member-dentist has acted unethically should bring the matter to the attention of the appropriate constituent (state) or component (local) dental society. Whenever possible, problems involving questions of ethics should be resolved at the state or local level.”

If you suspect  your dentist is not following the ADA code you best familiarize yourself with it to better determine if you are correct or incorrect. It may also help improve your relationship with your current dentist or possibly lead you to a new dentist.

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