Principlesof Ethics

Codeof Professional Conduct&

With official advisory opinions revised to November 2018.

PatientAutonomy

Non-maleficenceVeracity

Justice Beneficence

DentalEthics

Principles of EthicsCouncil on Ethics, Bylaws and Judicial Affairs

I. INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

II. PREAMBLE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

III.PRINCIPLES,CODEOFPROFESSIONALCONDUCTANDADVISORYOPINIONS. . . . 4 TheCodeofProfessionalConductisorganizedintofivesections.Eachsectionfalls

underthePrincipleofEthicsthatpredominatelyappliestoit.AdvisoryOpinionsfollowthesectionoftheCodethattheyinterpret.

SECTION1–PRINCIPLE:PATIENTAUTONOMY(“self-governance”). . . . . . . . . . . . . . . . . . . . . . . . . 4 CodeofProfessionalConduct 1.A.PatientInvolvement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.B.PatientRecords. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 AdvisoryOpinions 1.B.1.FurnishingCopiesofRecords. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.B.2.ConfidentialityofPatientRecords. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

SECTION2–PRINCIPLE:NONMALEFICENCE(“donoharm”). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 CodeofProfessionalConduct 2.A.Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.B.ConsultationandReferral. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 AdvisoryOpinion 2.B.1.SecondOpinions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.C.UseofAuxiliaryPersonnel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2.D.PersonalImpairment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 AdvisoryOpinion 2.D.1.AbilityToPractice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2.E.Postexposure,BloodbornePathogens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2.F. PatientAbandonment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2.G.PersonalRelationshipswithPatients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

SECTION3–PRINCIPLE:BENEFICENCE(“dogood”). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 CodeofProfessionalConduct 3.A.CommunityService. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3.B.GovernmentofaProfession. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3.C.ResearchandDevelopment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3.D.PatentsandCopyrights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3.E.AbuseandNeglect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 AdvisoryOpinion 3.E.1.ReportingAbuseandNeglect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3.F.ProfessionalDemeanorInTheWorkplace.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 AdvisoryOpinion 3.F.1.DisruptiveBehaviorInTheWorkplace. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

SECTION4–PRINCIPLE:JUSTICE(“fairness”). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 CodeofProfessionalConduct 4.A.PatientSelection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 AdvisoryOpinion 4.A.1.PatientswithDisabilitiesorBloodbornePathogens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 4.B.EmergencyService. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 4.C.JustifiableCriticism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 AdvisoryOpinion 4.C.1.Meaningof“Justifiable”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

CONTENTS

4.D.ExpertTestimony. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 AdvisoryOpinion 4.D.1.ContingentFees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 4.E.RebatesandSplitFees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 AdvisoryOpinion 4.E.1.SplitFeesinAdvertisingandMarketingServices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

SECTION5–PRINCIPLE:VERACITY(“truthfulness”). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 CodeofProfessionalConduct 5.A.RepresentationofCare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 AdvisoryOpinions 5.A.1.DentalAmalgamandOtherRestorativeMaterials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 5.A.2.UnsubstantiatedRepresentations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 5.B.RepresentationofFees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10AdvisoryOpinions 5.B.1.WaiverofCopayment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 5.B.2.Overbilling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 5.B.3.FeeDifferential. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 5.B.4.TreatmentDates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 5.B.5.DentalProcedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 5.B.6.UnnecessaryServices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 5.C.DisclosureofConflictofInterest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 5.D.DevicesandTherapeuticMethods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 AdvisoryOpinions 5.D.1.ReportingAdverseReactions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 5.D.2.MarketingorSaleofProductsorProcedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 5.E.ProfessionalAnnouncement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 5.F. Advertising. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 AdvisoryOpinions 5.F.1.PublishedCommunications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 5.F.2.Examplesof“FalseorMisleading”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 5.F.3.Unearned,NonhealthDegrees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 5.F.4.ReferralServices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 5.F.5.InfectiousDiseaseTestResults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 5.F.6.WebsitesandSearchEngineOptimization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 5.G.NameofPractice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 AdvisoryOpinion 5.G.1.DentistLeavingPractice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 5.H.AnnouncementofSpecializationandLimitationofPractice. . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 AdvisoryOpinions 5.H.1.DualDegreedDentists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 5.H.2.SpecialistAnnouncementofCredentialsInNon-SpecialtyInterestAreas. . . 15 5.I. GeneralPractitionerAnnouncementofServices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 AdvisoryOpinions 5.I.1.GeneralPractitionerAnnouncementofCredentials

InInterestAreasInGeneralDentistry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 5.I.2.CredentialsInGeneralDentistry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 NOTES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

IV. INTERPRETATIONANDAPPLICATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

V. INDEX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

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I. INTRODUCTIONThedentalprofessionholdsaspecialpositionoftrustwithinsociety.Asaconse-quence,societyaffordstheprofessioncertainprivilegesthatarenotavailabletomembersofthepublic-at-large.Inreturn,theprofessionmakesacommitmenttosocietythatitsmemberswilladheretohighethicalstandardsofconduct.ThesestandardsareembodiedintheADA Principles of Ethics and Code of Professional Conduct (ADA Code).The ADA Codeis,ineffect,awrittenexpressionoftheobliga-tionsarisingfromtheimpliedcontractbetweenthedentalprofessionandsociety.

MembersoftheADAvoluntarilyagreetoabidebytheADA CodeasaconditionofmembershipintheAssociation.Theyrecognizethatcontinuedpublictrustinthedentalprofessionisbasedonthecommitmentofindividualdentiststohighethicalstandardsofconduct.

TheADA Codehasthreemaincomponents:ThePrinciples of Ethics,theCode of Professional ConductandtheAdvisory Opinions.

ThePrinciples of Ethicsaretheaspirationalgoalsoftheprofession.TheyprovideguidanceandofferjustificationfortheCode of Professional Conductandthe Advisory Opinions.Therearefivefundamentalprinciplesthatformthefoundationofthe ADA Code:patientautonomy,nonmaleficence,beneficence,justiceandveracity.Principlescanoverlapeachotheraswellascompetewitheachotherforpriority.MorethanoneprinciplecanjustifyagivenelementoftheCode of Professional Conduct.Principlesmayattimesneedtobebalancedagainsteachother,but,otherwise,theyaretheprofession’sfirmguideposts.

TheCode of Professional Conductisanexpressionofspecifictypesofconductthatareeitherrequiredorprohibited.TheCode of Professional ConductisaproductoftheADA’slegislativesystem.AllelementsoftheCode of Professional ConductresultfromresolutionsthatareadoptedbytheADA’sHouseofDelegates.The Code of Professional ConductisbindingonmembersoftheADA,andviolationsmayresultindisciplinaryaction.

TheAdvisory OpinionsareinterpretationsthatapplytheCode of Professional Conducttospecificfactsituations.TheyareadoptedbytheADA’sCouncilonEthics,BylawsandJudicialAffairstoprovideguidancetothemembershiponhowtheCouncilmightinterprettheCode of Professional Conductinadisciplinaryproceeding.

TheADA Codeisanevolvingdocumentandbyitsverynaturecannotbeacompletearticulationofallethicalobligations.TheADA Codeistheresultofanon-goingdialoguebetweenthedentalprofessionandsociety,andassuch,issubjecttocontinuousreview.

Althoughethicsandthelawarecloselyrelated,theyarenotthesame.Ethicalobligationsmay–andoftendo–exceedlegalduties.InresolvinganyethicalproblemnotexplicitlycoveredbytheADA Code,dentistsshouldconsidertheethicalprinciples,thepatient’sneedsandinterests,andanyapplicablelaws.

II.PREAMBLETheAmericanDentalAssociationcallsupondentiststofollowhighethicalstandardswhichhavethebenefitofthepatientastheirprimarygoal.Inrecognitionofthisgoal,theeducationandtrainingofadentisthasresultedinsocietyaffordingtotheprofessiontheprivilegeandobligationofself-government.Tofulfillthisprivilege,thesehighethicalstandardsshouldbeadoptedandpracticedthroughoutthedentalschooleducationalprocessandsubsequentprofessionalcareer.

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TheAssociationbelievesthatdentistsshouldpossessnotonlyknowledge,skillandtechnicalcompetencebutalsothosetraitsofcharacterthatfosteradherencetoethicalprinciples.Qualitiesofhonesty,compassion,kindness,integrity,fairnessandcharityarepartoftheethicaleducationofadentistandpracticeofdentistryandhelptodefinethetrueprofessional.Assuch,eachdentistshouldshareinprovidingadvocacytoandcareoftheunderserved.Itisurgedthatthedentistmeetthisgoal,subjecttoindividualcircumstances.

Theethicaldentiststrivestodothatwhichisrightandgood.TheADA Codeisaninstrumenttohelpthedentistinthisquest.

III.PRINCIPLES,CODEOFPROFESSIONALCONDUCTANDADVISORYOPINIONS

Section1PRINCIPLE:PATIENTAUTONOMY(“self-governance”).Thedentisthasadutytorespectthepatient’srightstoself-determinationandconfidentiality.

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. Under this principle, the dentist’s primary obligations include involving patients in treatment decisions in a meaningful way, with due consideration being given to the patient’s needs, desires and abilities, and safeguarding the patient’s privacy.

CODEOFPROFESSIONALCONDUCT1.A. PATIENT INVOLVEMENT. Thedentistshouldinformthepatientoftheproposedtreatment,andanyreasonablealternatives,inamannerthatallowsthepatienttobecomeinvolvedintreatmentdecisions.

1.B. PATIENT RECORDS. Dentistsareobligedtosafeguardtheconfidentialityofpatientrecords.Dentistsshallmaintainpatientrecordsinamannerconsistentwiththeprotectionofthewelfareofthepatient.Uponrequestofapatientoranotherdentalpractitioner,dentistsshallprovideanyinformationinaccordancewithapplicablelawthatwillbebeneficialforthefuturetreatmentofthatpatient.

ADVISORYOPINIONS1.B.1. FURNISHING COPIES OF RECORDS. Adentisthastheethicalobligationonrequestofeitherthepatientorthepatient’snewdentisttofurnishinaccordancewithapplicablelaw,eithergratuitouslyorfornominalcost,suchdentalrecordsorcopiesorsummariesofthem,includingdentalX-raysorcopiesofthem,aswillbebeneficialforthefuturetreatmentofthatpatient.Thisobligationexistswhetherornotthepatient’saccountispaidinfull.

1.B.2. CONFIDENTIALITY OF PATIENT RECORDS. ThedominantthemeinCodeSectionl.Bistheprotectionoftheconfidentialityofapatient’srecords.Thestatementinthissectionthatrelevantinformationintherecordsshouldbereleasedtoanotherdentalpractitionerassumesthatthedentistrequestingtheinformationisthepatient’spresentdentist.Theremaybecircumstanceswheretheformerdentisthasanethicalobligationtoinformthepresentdentistofcertainfacts.CodeSection1.Bassumesthatthe

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dentistreleasingrelevantinformationisactinginaccordancewithapplicablelaw.DentistsshouldbeawarethatthelawsofthevariousjurisdictionsintheUnitedStatesarenotuniformandsomeconfidentialitylawsappeartoprohibitthetransferofpertinentinformation,suchasHIVseropositivity.Absentcertainknowledgethatthelawsofthedentist’sjurisdictionpermittheforwardingofthisinformation,adentistshouldobtainthepatient’swrittenpermissionbeforeforwardinghealthrecordswhichcontaininformationofasensitivenature,suchasHIVseropositivity,chemicaldependencyorsexualpreference.Ifitisnecessaryforatreatingdentisttoconsultwithanotherdentistorphysicianwithrespecttothepatient,andthecircumstancesdonotpermitthepatienttoremainanonymous,thetreatingdentistshouldseekthepermissionofthepatientpriortothereleaseofdatafromthepatient’srecordstotheconsultingpractitioner.Ifthepatientrefuses,thetreatingdentistshouldthencontemplateobtaininglegaladviceregardingtheterminationofthedentist-patientrelationship.

Section2PRINCIPLE:NONMALEFICENCE(“donoharm”).Thedentisthasadutytorefrainfromharmingthepatient.

This principle expresses the concept that professionals have a duty to protect the patient from harm. Under this principle, the dentist’s primary obligations include keeping knowledge and skills current, knowing one’s own limitations and when to refer to a specialist or other professional, and knowing when and under what circumstances delegation of patient care to auxiliaries is appropriate.

CODEOFPROFESSIONALCONDUCT2.A. EDUCATION.Theprivilegeofdentiststobeaccordedprofessionalstatusrestsprimarilyintheknowledge,skillandexperiencewithwhichtheyservetheirpatientsandsociety.Alldentists,therefore,havetheobligationofkeepingtheirknowledgeandskillcurrent.

2.B. CONSULTATION AND REFERRAL.Dentistsshallbeobligedtoseekconsultation,ifpossible,wheneverthewelfareofpatientswillbesafeguardedoradvancedbyutilizingthosewhohavespecialskills,knowledge,andexperience.Whenpatientsvisitorarereferredtospecialistsorconsultingdentistsforconsultation:1.Thespecialistsorconsultingdentistsuponcompletionoftheircareshallreturnthepatient,unlessthepatientexpresslyrevealsadifferentpreference,tothereferringdentist,or,ifnone,tothedentistofrecordforfuturecare.2.Thespecialistsshallbeobligedwhenthereisnoreferringdentistanduponacompletionoftheirtreatmenttoinformpatientswhenthereisaneedforfurtherdentalcare.

ADVISORYOPINION2.B.1. SECOND OPINIONS. Adentistwhohasapatientreferredbyathirdparty1fora“secondopinion”regardingadiagnosisortreatmentplanrecommendedbythepatient’streatingdentistshouldrendertherequestedsecondopinioninaccordancewiththisCode of Ethics.Intheinterestofthepatientbeingaffordedqualitycare,thedentistrenderingthesecondopinionshouldnothaveavestedinterestintheensuingrecommendation.

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2.C. USE OF AUXILIARY PERSONNEL.Dentistsshallbeobligedtoprotectthehealthoftheirpatientsbyonlyassigningtoqualifiedauxiliariesthosedutieswhichcanbelegallydelegated.Dentistsshallbefurtherobligedtoprescribeandsupervisethepatientcareprovidedbyallauxiliarypersonnelworkingundertheirdirection.

2.D. PERSONAL IMPAIRMENT.Itisunethicalforadentisttopracticewhileabusingcontrolledsubstances,alcoholorotherchemicalagentswhichimpairtheabilitytopractice.Alldentistshaveanethicalobligationtourgechemicallyimpairedcolleaguestoseektreatment.Dentistswithfirst-handknowledgethatacolleagueispracticingdentistrywhensoimpairedhaveanethicalresponsibilitytoreportsuchevidencetotheprofessionalassistancecommitteeofadentalsociety.

ADVISORYOPINION2.D.1. ABILITY TO PRACTICE. Adentistwhocontractsanydiseaseorbecomesimpairedinanywaythatmightendangerpatientsordentalstaffshall,withconsultationandadvicefromaqualifiedphysicianorotherauthority,limittheactivitiesofpracticetothoseareasthatdonotendangerpatientsordentalstaff.Adentistwhohasbeenadvisedtolimittheactivitiesofhisorherpracticeshouldmonitortheaforementioneddiseaseorimpairmentandmakeadditionallimitationstotheactivitiesofthedentist’spractice,asindicated.

2.E. POSTEXPOSURE, BLOODBORNE PATHOGENS.Alldentists,regardlessoftheirbloodbornepathogenstatus,haveanethicalobligationtoimmediatelyinformanypatientwhomayhavebeenexposedtobloodorotherpotentiallyinfectiousmaterialinthedentalofficeoftheneedforpostexposureevaluationandfollow-upandtoimmediatelyreferthepatienttoaqualifiedhealthcarepractitionerwhocanprovidepostexposureservices.Thedentist’sethicalobligationintheeventofanexposureincidentextendstoprovidinginformationconcerningthedentist’sownbloodbornepathogenstatustotheevaluatinghealthcarepractitioner,ifthedentististhesourceindividual,andtosubmittingtotestingthatwillassistintheevaluationofthepatient.Ifastaffmemberorotherthirdpersonisthesourceindividual,thedentistshouldencouragethatpersontocooperateasneededforthepatient’sevaluation.

2.F. PATIENT ABANDONMENT.Onceadentisthasundertakenacourseoftreatment,thedentistshouldnotdiscontinuethattreatmentwithoutgivingthepatientadequatenoticeandtheopportunitytoobtaintheservicesofanotherdentist.Careshouldbetakenthatthepatient’soralhealthisnotjeopardizedintheprocess.

2.G. PERSONAL RELATIONSHIPS WITH PATIENTS.Dentistsshouldavoidinterpersonalrelationshipsthatcouldimpairtheirprofessionaljudgmentorriskthepossibilityofexploitingtheconfidenceplacedinthembyapatient.

Section3PRINCIPLE:BENEFICENCE(“dogood”).Thedentisthasadutytopromotethepatient’swelfare.

This principle expresses the concept that professionals have a duty to act for the benefit of others. Under this principle, the dentist’s primary obligation is service to

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the patient and the public-at-large. The most important aspect of this obligation is the competent and timely delivery of dental care within the bounds of clinical circumstances presented by the patient, with due consideration being given to the needs, desires and values of the patient. The same ethical considerations apply whether the dentist engages in fee-for-service, managed care or some other practice arrangement. Dentists may choose to enter into contracts governing the provision of care to a group of patients; however, contract obligations do not excuse dentists from their ethical duty to put the patient’s welfare first.

CODEOFPROFESSIONALCONDUCT3.A. COMMUNITY SERVICE. Sincedentistshaveanobligationtousetheirskills,knowledgeandexperiencefortheimprovementofthedentalhealthofthepublicandareencouragedtobeleadersintheircommunity,dentistsinsuchserviceshallconductthemselvesinsuchamannerastomaintainorelevatetheesteemoftheprofession.

3.B. GOVERNMENT OF A PROFESSION.Everyprofessionowessocietytheresponsibilitytoregulateitself.Suchregulationisachievedlargelythroughtheinfluenceoftheprofessionalsocieties.Alldentists,therefore,havethedualobligationofmakingthemselvesapartofaprofessionalsocietyandofobservingitsrulesofethics.

3.C. RESEARCH AND DEVELOPMENT. Dentistshavetheobligationofmakingtheresultsandbenefitsoftheirinvestigativeeffortsavailabletoallwhentheyareusefulinsafeguardingorpromotingthehealthofthepublic.

3.D. PATENTS AND COPYRIGHTS. Patentsandcopyrightsmaybesecuredbydentistsprovidedthatsuchpatentsandcopyrightsshallnotbeusedtorestrictresearchorpractice.

3.E. ABUSE AND NEGLECT.Dentistsshallbeobligedtobecomefamiliarwiththesignsofabuseandneglectandtoreportsuspectedcasestotheproperauthorities,consistentwithstatelaws.

ADVISORYOPINION3.E.1. REPORTING ABUSE AND NEGLECT.Thepublicandtheprofessionarebestservedbydentistswhoarefamiliarwithidentifyingthesignsofabuseandneglectandknowledgeableabouttheappropriateinterventionresourcesforallpopulations. Adentist’sethicalobligationtoidentifyandreportthesignsofabuseandneglectis,ataminimum,tobeconsistentwithadentist’slegalobligationinthejurisdictionwherethedentistpractices.Dentists,therefore,areethicallyobligedtoidentifyandreportsuspectedcasesofabuseandneglecttothesameextentastheyarelegallyobligedtodosointhejurisdictionwheretheypractice.Dentistshaveaconcurrentethicalobligationtorespectanadultpatient’srighttoself-determinationandconfidentialityandtopromotethewelfareofallpatients.Careshouldbeexercisedtorespectthewishesofanadultpatientwhoasksthatasuspectedcaseofabuseand/orneglectnotbereported,wheresuchareportisnotmandatedbylaw.Withthepatient’spermission,otherpossiblesolutionsmaybesought.

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Dentistsshouldbeawarethatjurisdictionallawsvaryintheirdefinitionsofabuseandneglect,intheirreportingrequirementsandtheextenttowhichimmunityisgrantedtogoodfaithreporters.Thevariancesmayraisepotentiallegalandotherrisksthatshouldbeconsidered,whilekeepinginmindthedutytoputthewelfareofthepatientfirst.Thereforeadentist’sethicalobligationtoidentifyandreportsuspectedcasesofabuseandneglectcanvaryfromonejurisdictiontoanother. Dentistsareethicallyobligatedtokeepcurrenttheirknowledgeofbothidentifyingabuseandneglectandreportingitinthejurisdiction(s)wheretheypractice.

3.F. PROFESSIONAL DEMEANOR IN THE WORKPLACE.Dentistshavetheobligationtoprovideaworkplaceenvironmentthatsupportsrespectfulandcollaborativerelationshipsforallthoseinvolvedinoralhealthcare.

ADVISORYOPINION3.F.1. DISRUPTIVE BEHAVIOR IN THE WORKPLACE. Dentistsaretheleadersoftheoralhealthcareteam.Assuch,theirbehaviorintheworkplaceisinstrumentalinestablishingandmaintainingapracticeenviron-mentthatsupportsthemutualrespect,goodcommunication,andhighlevelsofcollaborationamongteammembersrequiredtooptimizethequalityofpatientcareprovided.Dentistswhoengageindisruptivebehaviorintheworkplaceriskunderminingprofessionalrelationshipsamongteammembers,decreasingthequalityofpatientcareprovided,andunderminingthepublic’strustandconfi-denceintheprofession.

Section4PRINCIPLE:JUSTICE(“fairness”).Thedentisthasadutytotreatpeoplefairly.This principle expresses the concept that professionals have a duty to be fair in their dealings with patients, colleagues and society. Under this principle, the dentist’s primary obligations include dealing with people justly and delivering dental care without prejudice. In its broadest sense, this principle expresses the concept that the dental profession should actively seek allies throughout society on specific activities that will help improve access to care for all.

CODEOFPROFESSIONALCONDUCT4.A. PATIENT SELECTION. Whiledentists,inservingthepublic,mayexercisereasonablediscretioninselectingpatientsfortheirpractices,dentistsshallnotrefusetoacceptpatientsintotheirpracticeordenydentalservicetopatientsbecauseofthepatient’srace,creed,color,gender,sexualorientation,genderidentity,nationaloriginordisability.

ADVISORYOPINION4.A.1. PATIENTS WITH DISABILITIES OR BLOODBORNE PATHOGENS. Asisthecasewithallpatients,whenconsideringthetreatmentofpatientswithaphysical,intellectualordevelopmentaldisabilityordisabilities,includingpatientsinfectedwithHumanImmunodeficiencyVirus,HepatitisBVirus,HepatitisCVirusoranotherbloodbornepathogen,orareotherwisemedicallycompromised,theindividualdentistshoulddetermineifheorshehastheneedofanother’sskills,knowledge,equipmentorexpertise,andifso,consultationorreferralpursuanttoSection2.Bhereofisindicated.Decisionsregardingthetypeofdentaltreatment

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provided,orreferralsmadeorsuggested,shouldbemadeonthesamebasisastheyaremadewithotherpatients.Thedentistshouldalsodetermine,aftercon-sultationwiththepatient’sphysician,ifappropriate,ifthepatient’shealthstatuswouldbesignificantlycompromisedbytheprovisionofdentaltreatment.

4.B. EMERGENCY SERVICE.Dentistsshallbeobligedtomakereasonablearrangementsfortheemergencycareoftheirpatientsofrecord.Dentistsshallbeobligedwhenconsultedinanemergencybypatientsnotofrecordtomakereasonablearrangementsforemergencycare.Iftreatmentisprovided,thedentist,uponcompletionoftreatment,isobligedtoreturnthepatienttohisorherregulardentistunlessthepatientexpresslyrevealsadifferentpreference.

4.C. JUSTIFIABLE CRITICISM. Dentistsshallbeobligedtoreporttotheappropriatereviewingagencyasdeterminedbythelocalcomponentorconstituentsocietyinstancesofgrossorcontinualfaultytreatmentbyotherdentists.Patientsshouldbeinformedoftheirpresentoralhealthstatuswithoutdisparagingcommentaboutpriorservices.Dentistsissuingapublicstatementwithrespecttotheprofessionshallhaveareasonablebasistobelievethatthecommentsmadearetrue.

ADVISORYOPINION4.C.1. MEANING OF “JUSTIFIABLE.” Patientsaredependentontheexpertiseofdentiststoknowtheiroralhealthstatus.Therefore,wheninformingapatientofthestatusofhisorheroralhealth,thedentistshouldexercisecarethatthecommentsmadearetruthful,informedandjustifiable.Thisshould,ifpossible,involveconsultationwiththeprevioustreatingdentist(s),inaccordancewithapplicablelaw,todetermineunderwhatcircumstancesandconditionsthetreatmentwasperformed.Adifferenceofopinionastopreferredtreatmentshouldnotbecommunicatedtothepatientinamannerwhichwouldunjustlyimplymistreatment.Therewillnecessarilybecaseswhereitwillbedifficulttodeterminewhetherthecommentsmadearejustifiable.Therefore,thissectionisphrasedtoaddressthediscretionofdentistsandadvisesagainstunknowingorunjustifiabledisparagingstatementsagainstanotherdentist.However,itshouldbenotedthat,wherecommentsaremadewhicharenotsupportableandthereforeunjustified,suchcommentscanbethebasisfortheinstitutionofadisciplinaryproceedingagainstthedentistmakingsuchstatements.

4.D. EXPERT TESTIMONY. Dentistsmayprovideexperttestimonywhenthattestimonyisessentialtoajustandfairdispositionofajudicialoradministrativeaction.

ADVISORYOPINION4.D.1. CONTINGENT FEES. Itisunethicalforadentisttoagreetoafeecontingentuponthefavorableoutcomeofthelitigationinexchangefortestifyingasadentalexpert.

4.E. REBATES AND SPLIT FEES. Dentistsshallnotacceptortender“rebates”or“splitfees.”

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ADVISORYOPINION4.E.1. SPLIT FEES IN ADVERTISING AND MARKETING SERVICES. Theprohibitionagainstadentist’sacceptingortenderingrebatesorsplitfeesappliestobusinessdealingsbetweendentistsandanythirdparty,notjustotherdentists.Thus,adentistwhopaysforadvertisingormarketingservicesbysharingaspecifiedportionoftheprofessionalfeescollectedfromprospectiveoractualpatientswiththevendorprovidingtheadvertisingormarketingservicesisengagedinfeesplitting.Theprohibitionagainstfeesplittingisalsoapplicabletothemarketingofdentaltreatmentsorproceduresvia“socialcoupons”ifthebusinessarrangementbetweenthedentistandtheconcernprovidingthemarketingservicesforthattreatmentorthoseproceduresallowstheissuingcompanytocollectthefeefromtheprospectivepatient,retainadefinedpercentageorportionoftherevenuecollectedaspaymentforthecouponmarketingserviceprovidedtothedentistandremittothedentisttheremainderoftheamountcollected.

Dentistsshouldalsobeawarethatthelawsorregulationsintheirjurisdictionsmaycontainprovisionsthatimpactthedivisionofrevenuecollectedfromprospectivepatientsbetweenadentistandathirdpartytopayforadvertisingormarketingservices.

Section5PRINCIPLE:VERACITY(“truthfulness”).Thedentisthasadutytocommunicatetruthfully.

This principle expresses the concept that professionals have a duty to be honest and trustworthy in their dealings with people. Under this principle, the dentist’s primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity.

CODEOFPROFESSIONALCONDUCT5.A. REPRESENTATION OF CARE. Dentistsshallnotrepresentthecarebeingrenderedtotheirpatientsinafalseormisleadingmanner.

ADVISORYOPINIONS5.A.1. DENTAL AMALGAM AND OTHER RESTORATIVE MATERIALS. Basedoncurrentscientificdata,theADAhasdeterminedthattheremovalofamalgamrestorationsfromthenon-allergicpatientfortheallegedpurposeofremovingtoxicsubstancesfromthebody,whensuchtreatmentisperformedsolelyattherecommendationofthedentist,isimproperandunethical.Thesameprincipleofveracityappliestothedentist’srecommendationconcerningtheremovalofanydentalrestorativematerial.

5.A.2. UNSUBSTANTIATED REPRESENTATIONS. Adentistwhorepresentsthatdentaltreatmentordiagnostictechniquesrecommendedorperformedbythedentisthasthecapacitytodiagnose,cureoralleviatediseases,infectionsorotherconditions,whensuchrepresentationsarenotbaseduponacceptedscientificknowledgeorresearch,isactingunethically.

5.B. REPRESENTATION OF FEES. Dentistsshallnotrepresentthefeesbeingchargedforprovidingcareinafalseormisleadingmanner.

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ADVISORY OPINIONS 5.B.1. WAIVER OF COPAYMENT. Adentistwhoacceptsathirdparty1paymentunderacopaymentplanaspaymentinfullwithoutdisclosingtothethirdparty1thatthepatient’spaymentportionwillnotbecollected,isengagedinoverbilling.Theessenceofthisethicalimproprietyisdeceptionandmisrepresentation;anoverbillingdentistmakesitappeartothethirdparty1thatthechargetothepatientforservicesrenderedishigherthanitactuallyis.

5.B.2. OVERBILLING. Itisunethicalforadentisttoincreaseafeetoapatientsolelybecausethepatientiscoveredunderadentalbenefitsplan.

5.B.3. FEE DIFFERENTIAL. Thefeeforapatientwithoutdentalbenefitsshallbeconsideredadentist’sfullfee.2Thisisthefeethatshouldberepresentedtoallbenefitcarriersregardlessofanynegotiatedfeediscount.Paymentsacceptedbyadentistunderagovernmentallyfundedprogram,acomponentorconstituentdentalsociety-sponsoredaccessprogram,oraparticipatingagreemententeredintounderaprogramwithathirdpartyshallnotbeconsideredorconstruedasevidenceofoverbillingindeterminingwhetherachargetoapatient,ortoanotherthirdparty1inbehalfofapatientnotcoveredunderanyoftheaforecitedprogramsconstitutesoverbillingunderthissectionoftheCode.

5.B.4. TREATMENT DATES. Adentistwhosubmitsaclaimformtoathirdparty1reportingincorrecttreatmentdatesforthepurposeofassistingapatientinobtainingbenefitsunderadentalplan,whichbenefitswouldotherwisebedisallowed,isengagedinmakinganunethical,falseormisleadingrepresentationtosuchthirdparty.1

5.B.5. DENTAL PROCEDURES. Adentistwhoincorrectlydescribesonathirdparty1claimformadentalprocedureinordertoreceiveagreaterpaymentorreimbursementorincorrectlymakesanon-coveredprocedureappeartobeacoveredprocedureonsuchaclaimformisengagedinmakinganunethical,falseormisleadingrepresentationtosuchthirdparty.1

5.B.6. UNNECESSARY SERVICES. Adentistwhorecommendsorperformsunnecessarydentalservicesorproceduresisengagedinunethicalconduct.Thedentist’sethicalobligationinthismatterappliesregardlessofthetypeofpracticearrangementorcontractualobligationsinwhichheorsheprovidespatientcare.

5.C. DISCLOSURE OF CONFLICT OF INTEREST. Adentistwhopresentseducationalorscientificinformationinanarticle,seminarorotherprogramshalldisclosetothereadersorparticipantsanymonetaryorotherspecialinterestthedentistmayhavewithacompanywhoseproductsarepromotedorendorsedinthepresentation.Disclosureshallbemadeinanypromotionalmaterialandinthepresentationitself.

5.D. DEVICES AND THERAPEUTIC METHODS. Exceptforformalinvestigativestudies,dentistsshallbeobligedtoprescribe,dispense,orpromoteonlythosedevices,drugsandotheragentswhosecomplete

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formulaeareavailabletothedentalprofession.Dentistsshallhavethefurtherobligationofnotholdingoutasexclusiveanydevice,agent,methodortechniqueifthatrepresentationwouldbefalseormisleadinginanymaterialrespect.

ADVISORYOPINIONS5.D.1. REPORTING ADVERSE REACTIONS. Adentistwhosuspectstheoccurrenceofanadversereactiontoadrugordentaldevicehasanobligationtocommunicatethatinformationtothebroadermedicalanddentalcommunity,including,inthecaseofaseriousadverseevent,theFoodandDrugAdministration(FDA).

5.D.2. MARKETING OR SALE OF PRODUCTS OR PROCEDURES. Dentistswho,intheregularconductoftheirpractices,engageinoremployauxiliariesinthemarketingorsaleofproductsorprocedurestotheirpatientsmusttakecarenottoexploitthetrustinherentinthedentist-patientrelationshipfortheirownfinancialgain.Dentistsshouldnotinducetheirpatientstopurchaseproductsorundergoproceduresbymisrepresentingtheproduct’svalue,thenecessityoftheprocedureorthedentist’sprofessionalexpertiseinrecommendingtheproductorprocedure.

Inthecaseofahealth-relatedproduct,itisnotenoughforthedentisttorelyonthemanufacturer’sordistributor’srepresentationsabouttheproduct’ssafetyandefficacy.Thedentisthasanindependentobligationtoinquireintothetruthandaccuracyofsuchclaimsandverifythattheyarefoundedonacceptedscientificknowledgeorresearch.

Dentistsshoulddisclosetotheirpatientsallrelevantinformationthepatientneedstomakeaninformedpurchasedecision,includingwhethertheproductisavailableelsewhereandwhetherthereareanyfinancialincentivesforthedentisttorecommendtheproductthatwouldnotbeevidenttothepatient.

5.E. PROFESSIONAL ANNOUNCEMENT.Inordertoproperlyservethepublic,dentistsshouldrepresentthemselvesinamannerthatcontributestotheesteemoftheprofession.Dentistsshouldnotmisrepresenttheirtrainingandcompetenceinanywaythatwouldbefalseormisleadinginanymaterialrespect.3

5.F. ADVERTISING. Althoughanydentistmayadvertise,nodentistshalladvertiseorsolicitpatientsinanyformofcommunicationinamannerthatisfalseormisleadinginanymaterialrespect.3

ADVISORYOPINIONS5.F.1. PUBLISHED COMMUNICATIONS. Ifadentalhealtharticle,messageornewsletterispublishedinprintorelectronicmediaunderadentist’sbylinetothepublicwithoutmakingtruthfuldisclosureofthesourceandauthorshiporisdesignedtogiverisetoquestionableexpecta-tionsforthepurposeofinducingthepublictoutilizetheservicesofthesponsor-ingdentist,thedentistisengagedinmakingafalseormisleadingrepresentationtothepublicinamaterialrespect.3

5.F.2. EXAMPLES OF “FALSE OR MISLEADING.” Thefollowingexamplesaresetforthtoprovideinsightintothemeaningoftheterm“falseormisleadinginamaterialrespect.”3Theseexamplesarenotmeantto

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beall-inclusive.Rather,byrestatingtheconceptinalternativelanguageandgivinggeneralexamples,itishopedthatthemembershipwillgainabetterunderstandingoftheterm.Withthisinmind,statementsshallbeavoidedwhichwould:a)containamaterialmisrepresentationoffact,b)omitafactnecessarytomakethestatementconsideredasawholenotmateriallymisleading,c)beintendedorbelikelytocreateanunjustifiedexpectationaboutresultsthedentistcanachieve,andd)containamaterial,objectiverepresentation,whetherexpressorimplied,thattheadvertisedservicesaresuperiorinqualitytothoseofotherdentists,ifthatrepresentationisnotsubjecttoreasonablesubstantiation.

Subjectivestatementsaboutthequalityofdentalservicescanalsoraiseethicalconcerns.Inparticular,statementsofopinionmaybemisleadingiftheyarenothonestlyheld,iftheymisrepresentthequalificationsoftheholder,orthebasisoftheopinion,orifthepatientreasonablyinterpretsthemasimpliedstatementsoffact.Suchstatementswillbeevaluatedonacasebycasebasis,consideringhowpatientsarelikelytorespondtotheimpressionmadebytheadvertisementasawhole.Thefundamentalissueiswhethertheadvertisement,takenasawhole,isfalseormisleadinginamaterialrespect.3

5.F.3. UNEARNED, NONHEALTH DEGREES. AdentistmayusethetitleDoctororDentist,D.D.S.,D.M.D.oranyadditionalearned,advancedacademicdegreesinhealthserviceareasinanannouncementtothepublic.Theannouncementofanunearnedacademicdegreemaybemisleadingbecauseofthelikelihoodthatitwillindicatetothepublictheattainmentofspecialtyordiplomatestatus.

Forpurposesofthisadvisoryopinion,anunearnedacademicdegreeisonewhichisawardedbyaneducationalinstitutionnotaccreditedbyagenerallyrecognizedaccreditingbodyorisanhonorarydegree.

Theuseofanonhealthdegreeinanannouncementtothepublicmaybearepresentationwhichismisleadingbecausethepublicislikelytoassumethatanydegreeannouncedisrelatedtothequalificationsofthedentistasapractitioner.

Someorganizationsgrantdentistsfellowshipstatusasatokenofmembershipintheorganizationorsomeotherformofvoluntaryassociation.Theuseofsuchfellowshipsinadvertisingtothegeneralpublicmaybemisleadingbecauseofthelikelihoodthatitwillindicatetothepublicattainmentofeducationorskillinthefieldofdentistry.

Generally,unearnedornonhealthdegreesandfellowshipsthatdesignateassociation,ratherthanattainment,shouldbelimitedtoscientificpapersandcurriculumvitae.Inallinstances,statelawshouldbeconsulted.Inanyreviewbythecounciloftheuseofdesignationsinadvertisingtothepublic,thecouncilwillapplythestandardofwhethertheuseofsuchisfalseormisleadinginamaterialrespect.35.F.4. REFERRAL SERVICES. Therearetwobasictypesofreferralservicesfordentalcare:not-for-profitandthecommercial.Thenot-for-profitiscommonlyorganizedbydentalsocietiesorcommunityservices.Itisopentoallqualifiedpractitionersintheareaserved.Afeeissometimeschargedthepractitionertobelistedwiththeservice.Afeeforsuchreferralservicesisforthepurposeofcoveringtheexpensesoftheserviceandhasnorelationtothenumberofpatientsreferred.Incontrast,somecommercialreferralservicesrestrictaccesstothereferralservicetoalimitednumberofdentistsinaparticulargeographicarea.Prospectivepatientscalling

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theservicemaybereferredtoasinglesubscribingdentistinthegeographicareaandtherespectivedentistbilledforeachpatientreferred.Commercialreferralservicesoftenadvertisetothepublicstressingthatthereisnochargeforuseoftheserviceandthepatientmaynotbeinformedofthereferralfeepaidbythedentist.Thereisaconnotationtosuchadvertisementsthatthereferralthatisbeingmadeisinthenatureofapublicservice.AdentistisallowedtopayforanyadvertisingpermittedbytheCode,butisgenerallynotpermittedtomakepaymentstoanotherpersonorentityforthereferralofapatientforprofessionalservices.Whiletheparticularfactsandcircumstancesrelatingtoanindividualcommercialreferralservicewillvary,thecouncilbelievesthattheaspectsoutlinedaboveforcommercialreferralservicesviolatetheCodeinthatitconstitutesadvertisingwhichisfalseormisleadinginamaterialrespectandviolatestheprohibitionsintheCodeagainstfeesplitting.3

5.F.5. INFECTIOUS DISEASE TEST RESULTS. Anadvertisementorothercommunicationintendedtosolicitpatientswhichomitsamaterialfactorfactsnecessarytoputtheinformationconveyedintheadvertisementinapropercontextcanbemisleadinginamaterialrespect.Adentalpracticeshouldnotseektoattractpatientsonthebasisofpartialtruthswhichcreateafalseimpression.3

Forexample,anadvertisementtothepublicofHIVnegativetestresults,withoutconveyingadditionalinformationthatwillclarifythescientificsignificanceofthisfactcontainsamisleadingomission.Adentistcouldsatisfyhisorherobligationunderthisadvisoryopiniontoconveyadditionalinformationbyclearlystatingintheadvertisementorothercommunication:“ThisnegativeHIVtestcannotguaranteethatIamcurrentlyfreeofHIV.”

5.F.6. WEBSITES AND SEARCH ENGINE OPTIMIZATION.ManydentistsemployanInternetwebsitetoannouncetheirpractices,introduceviewerstotheprofessionalsandstaffintheoffice,describepracticephilosophiesandimpartoralhealthcareinformationtothepublic.Dentistsmayuseservicestoincreasethevisibilityoftheirwebsiteswhenconsumersperformsearchesfordentally-relatedcontent.Thistechniqueisgenerallyknownas“searchengineoptimization”or“SEO.”Dentistshaveanethicalobligationtoensurethattheirwebsites,liketheirotherprofessionalannouncements,aretruthfulanddonotpresentinformationinamannerthatisfalseandmisleadinginamaterialrespect.3Also,anySEOtechniquesusedinconnectionwithadentist’swebsiteshouldcomportwiththeADAPrinciples of Ethics and Code of Professional Conduct.

5.G. NAME OF PRACTICE. Sincethenameunderwhichadentistconductshisorherpracticemaybeafactorintheselectionprocessofthepatient,theuseofatradenameoranassumednamethatisfalseormisleadinginanymaterialrespectisunethical.Useofthenameofadentistnolongeractivelyassociatedwiththepracticemaybecontinuedforaperiodnottoexceedoneyear.3

ADVISORYOPINION5.G.1. DENTIST LEAVING PRACTICE. Dentistsleavingapracticewhoauthorizecontinueduseoftheirnamesshouldreceivecompetentadviceonthelegalimplicationsofthisaction.Withpermissionofadepartingdentist,hisorhernamemaybeusedformorethanoneyear,if,after

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theoneyeargraceperiodhasexpired,prominentnoticeisprovidedtothepublicthroughsuchmediumsasasignattheofficeandashortstatementonstationeryandbusinesscardsthatthedepartingdentisthasretiredfromthepractice.

5.H. ANNOUNCEMENT OF SPECIALIZATION AND LIMITATION OF PRACTICE. AdentistmayethicallyannounceasaspecialisttothepublicinanyofthedentalspecialtiesrecognizedbytheNationalCommissiononRecognitionofDentalSpecialtiesandCertifyingBoardsincludingdentalpublichealth,endodontics,oralandmaxillofacialpathology,oralandmaxillofacialradiology,oralandmaxillofacialsurgery,orthodonticsanddentofacialorthopedics,pediatricdentistry,periodon-tics,andprosthodontics,andinanyotherareasofdentistryforwhichspecialtyrecognitionhasbeengrantedunderthestandardsrequiredorrecognizedinthepractitioner’sjurisdiction,providedthedentistmeetstheeducationalrequirementsrequiredforrecognitionasaspecialistadoptedbytheAmericanDentalAssociationoracceptedinthejurisdictioninwhichtheypractice.*Dentistswhochoosetoannouncespecializationshoulduse“specialistin”andshalldevoteasufficientportionoftheirpracticetotheannouncedspecialtyorspecialtiestomaintainexpertiseinthatspecialtyorthosespecialties,Dentistswhosepracticeisdevotedexclusivelytoanannouncedspecialtyorspecialtiesmayannouncethattheirpractice“islimitedto”thatspecialtyorthosespecialties.Dentistswhousetheireligibilitytoannounceasspecialiststomakethepublicbelievethatspecialtyservicesrenderedinthedentalofficearebeingrenderedbyqualifiedspecialistswhensuchisnotthecaseareengagedinunethicalconduct.Theburdenofresponsibilityisonspecialiststoavoidanyinferencethatgeneralpractitionerswhoareassociatedwithspecialistsarequalifiedtoannouncethemselvesasspecialists.

ADVISORYOPINIONS5.H.1. DUAL DEGREED DENTISTS. NothinginSection5.Hshallbeinterpretedtoprohibitadualdegreeddentistwhopracticesmedicineorosteopathyunderavalidstatelicensefromannouncingtothepublicasadentalspecialistprovidedthedentistmeetstheeducational,experienceandotherstandardssetforthintheCodeforspecialtyannounce-mentandfurtherprovidingthattheannouncementistruthfulandnotmateriallymisleading.

5.H.2. SPECIALIST ANNOUNCEMENT OF CREDENTIALS IN NON-SPECIALTY INTEREST AREAS.AdentistwhoisqualifiedtoannouncespecializationunderthissectionmaynotannouncetothepublicthatheorsheiscertifiedoradiplomateorotherwisesimilarlycredentialedinanareaofdentistrynotrecognizedasaspecialtyareabytheNationalCommissiononRecognitionofDentalSpecialtiesandCertifyingBoardsorbythejurisdictioninwhichthedentistpracticesunless:

1.Theorganizationgrantingthecredentialgrantscertificationordiplomatestatusbasedonthefollowing:a)thedentist’ssuccessfulcompletionofaformal,full-timeadvancededucationprogram(graduateorpostgraduatelevel)ofat

*InthecaseoftheADA,theeducationalrequirementsincludesuccessfulcompletionofanadvancededucationalprogramaccreditedbytheCommissiononDentalAccreditation,twoormoreyearsinlength,asspecifiedbytheCouncilonDentalEducationandLicensure,orbeingadiplomateofanAmericanDentalAssociationrecognizedcertifyingboardforeachspecialtyannounced.

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least12months’duration;andb)thedentist’strainingandexperience;andc)successfulcompletionofanoralandwrittenexaminationbasedonpsychometricprinciples;and2.Theannouncementincludesthefollowinglanguage:[Nameofannouncedareaofdentalpractice]isnotrecognizedasaspecialtyareabytheNationalCommissiononRecognitionofDentalSpecialtiesandCertifyingBoardsor[thenameofthejurisdictioninwhichthedentistpractices].Nothinginthisadvisoryopinionaffectstherightofaproperlyqualifieddentisttoannouncespecializationinarecognizedspecialtyarea(s)ortheresponsibilityofsuchdentisttomaintainexclusivityinthespecialarea(s)ofdentalpracticeannouncedasprovidedforunderSection5.HofthisCode.Specialistsshallnotannouncetheircredentialsinamannerthatimpliesspecializationinanon-specialtyinterestarea.

5.I. GENERAL PRACTITIONER ANNOUNCEMENT OF SERVICES. Generaldentistswhowishtoannouncetheservicesavailableintheirpracticesarepermittedtoannouncetheavailabilityofthoseservicessolongastheyavoidanycommunicationsthatexpressorimplyspecialization.Generaldentistsshallalsostatethattheservicesarebeingprovidedbygeneraldentists.Nodentistshallannounceavailableservicesinanywaythatwouldbefalseormisleadinginanymaterialrespect.3

ADVISORYOPINIONS5.I.1. GENERAL PRACTITIONER ANNOUNCEMENT OF CREDENTIALS IN INTEREST AREAS IN GENERAL DENTISTRY.AgeneraldentistmaynotannouncetothepublicthatheorsheiscertifiedoradiplomateorotherwisesimilarlycredentialedinanareaofdentistrynotrecognizedasaspecialtyareabytheNationalCommissiononRecognitionofDentalSpecialtiesandCertifyingBoardsorbythejurisdictioninwhichthedentistpracticesunless:1.Theorganizationgrantingthecredentialgrantscertificationordiplomatestatusbasedonthefollowing:a)thedentist’ssuccessfulcompletionofaformal,full-timeadvancededucationprogram(graduateorpostgraduatelevel)ofatleast12monthsduration;andb)thedentist’strainingandexperience;andc)successfulcompletionofanoralandwrittenexaminationbasedonpsychometricprinciples;2.Thedentistdisclosesthatheorsheisageneraldentist;and3.Theannouncementincludesthefollowinglanguage:[Nameofannouncedareaofdentalpractice]isnotrecognizedasaspecialtyareabytheNationalCommissiononRecognitionofDentalSpecialtiesandCertifyingBoardsor[thenameofthejurisdictioninwhichthedentistpractices].5.I.2. CREDENTIALS IN GENERAL DENTISTRY.Generaldentistsmayannouncefellowshipsorothercredentialsearnedintheareaofgeneraldentistrysolongastheyavoidanycommunicationsthatexpressorimplyspecializationandtheannouncementincludesthedisclaimerthatthedentistisageneraldentist.Theuseofabbreviationstodesignatecredentialsshallbeavoidedwhensuchusewouldleadthereasonablepersontobelievethatthedesignationrepresentsanacademicdegree,whensuchisnotthecase.

17

NOTES:

1.Athirdpartyisanypartytoadentalprepaymentcontractthatmaycollectpremiums,assumefinancialrisks,payclaims,and/orprovideadministrativeservices.

2.Afullfeeisthefeeforaservicethatissetbythedentist,whichreflectsthecostsofprovidingtheprocedureandthevalueofthedentist’sprofessionaljudgment.

3.Advertising,solicitationofpatientsorbusinessorotherpromotionalactivitiesbydentistsordentalcaredeliveryorganizationsshallnotbeconsideredunethicalorimproper,exceptforthosepromotionalactivitieswhicharefalseormisleadinginanymaterialrespect.NotwithstandinganyADA Principles of Ethics and Code of Professional Conductorotherstandardsofdentistconductwhichmaybedifferentlyworded,thisshallbethesolestandardfordeterminingtheethicalproprietyofsuchpromotionalactivities.AnyprovisionofanADAconstituentorcomponentsociety’scodeofethicsorotherstandardofdentistconductrelatingtodentists’ordentalcaredeliveryorganizations’advertising,solicitation,orotherpromotionalactivitieswhichiswordeddifferentlyfromtheabovestandardshallbedeemedtobeinconflictwiththeADA Principles of Ethics and Code of Professional Conduct.

4.Completionofthreeyearsofadvancedtraininginoralandmaxillofacialsurgeryortwoyearsofadvancedtraininginoneoftheotherrecognizeddentalspecialtiespriorto1967.

IV. INTERPRETATIONANDAPPLICATIONOFPRINCIPLESOFETHICSANDCODEOFPROFESSIONALCONDUCT.TheforegoingADA Principles of Ethics and Code of Professional ConductsetforththeethicaldutiesthatarebindingonmembersoftheAmericanDentalAssociation.ThecomponentandconstituentsocietiesmayadoptadditionalrequirementsorinterpretationsnotinconflictwiththeADA Code.

Anyonewhobelievesthatamember-dentisthasactedunethicallyshouldbringthemattertotheattentionoftheappropriateconstituent(state)orcomponent(local)dentalsociety.Wheneverpossible,problemsinvolvingquestionsofethicsshouldberesolvedatthestateorlocallevel.Ifasatisfactoryresolutioncannotbereached,thedentalsocietymaydecide,afterproperinvestigation,thatthematterwarrantsissuingformalchargesandconductingadisciplinaryhearingpursuanttotheproceduressetforthinChapterXIoftheADABylaws and Governance and Organizational Manual of the American Dental Association(“Governance Manual”).PRINCIPLESOFETHICSANDCODEOFPROFESSIONALCONDUCT,MEMBERCONDUCTPOLICYANDJUDICIALPROCEDURES.TheCouncilonEthics,BylawsandJudicialAffairsremindsconstituentandcomponentsocietiesthatbeforeadentistcanbefoundtohavebreachedanyethicalobligationthedentistisentitledtoafairhearing.

AmemberwhoisfoundguiltyofunethicalconductproscribedbytheADA Codeorcodeofethicsoftheconstituentorcomponentsociety,maybeplacedunderasentenceofcensureorsuspensionormaybeexpelledfrommembershipintheAssociation.Amemberunderasentenceofcensure,suspensionorexpulsionhastherighttoappealthedecisiontohisorherconstituentsocietyandtheADACouncilonEthics,BylawsandJudicialAffairs,asprovidedinChapterXIoftheADABylawsandGovernance Manual.

18

AAbandonment,6Abilitytopractice(2.D.1.),6Abuseandneglect,7 Abuseandneglect(reporting)(3.E.1.),7Adversereactions(reporting)(5.D.1.),12Advertising,12 Credentials generaldentistry(5.I.2.),16 interestareas,general

dentistry(5.I.1.),16 non-specialtyinterestareas,

specialist(5.H.2.),15 nonhealth(5.F.3.),13 unearned(5.F.3.),13 honorary(5.F.3.),13 membershipandother

affiliations(5.F.3.),13 specialty,15 Dualdegrees(5.H.1.),15 Falseandmisleading(examples)(5.F.2.),12 Generaldentists,16 HIVtestresults(5.F.5.),14 Honorarydegrees(5.F.3.),13 Infectiousdiseasetestresults(5.F.5.),14 Nameofpractice,14 Non-specialtyinterestareas(5.H.2.

and5.I.1.),15,16 Publishedcommunications(5.F.1.),12 Referralservices(5.F.4.),13 Services,16 Specialties,15 Unearned,nonhealthdegrees(5.F.3.),13Advisoryopinions(definition),4Amalgamandotherrestorativematerials(5.A.1.),10Announcementofspecializationandlimitationofpractice,15Autonomy(patient),4Auxiliarypersonnel,6

BBeneficence,6Billing,11Bloodbornepathogens,exposureincident,8Bloodbornepathogens,patientswithdisabilitiesor(4.A.1.),8

CCodeofprofessionalconduct(definition),3Communityservice,7Confidentialityofpatientrecords(1.B.2.),4Conflictofinterest,disclosure,11Consultationandreferral,5Copayment,waiverof(5.B.1.),11Copyrightsandpatents,7Credentials(seeadvertising)

DDegrees(advertising)(5.F.3.and5.H.1.),13,15Dentalamalgamandotherrestorativematerials(5.A.1.),10Dentalprocedures,incorrectlyreporting(5.B.5.),11Dentistleavingpractice(5.G.1.),14Devicesandtherapeuticmethods,11Disabilities,patientswithbloodbornepathogensor(4.A.1.),8Disclosure,conflictofinterest,11Disruptivebehavior(3.F.1.),8Dualdegreeddentists(5.H.1.),15

EEducation,5Emergencyservice,9Experttestimony,9

INDEXADVISORY OPINIONS ARE DESIGNATED BY THEIR RELEVANT SECTION IN PARENTHESES, e.g. (2.D.1.).

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FFalseandmisleadingadvertising,examples(5.F.2.),12Fees contingent(4.D.1.),9 differential(5.B.3.),11 rebates,9 representationof,11 split,10,14Furnishingcopiesofrecords(1.B.1.),4

GGeneralpractitionerannouncementofcredentials(5.I.1.),16Generalpractitionerannouncementofservices,16Generalstandards(forannouncementofspecializationandlimitationofpractice),15Governmentofaprofession,7Grossorcontinualfaultytreatment(reporting),9

HHIVpositivepatients(4.A.1.),8HIVpost-exposureobligations,6HIVtestresults(advertising)(5.F.5.),14

IImpaireddentist,6Infectiousdiseasetestresults(5.F.5.),14InterpretationandapplicationofPrinciplesofEthicsandCodeofProfessionalConduct,17

JJustifiablecriticism,9Justifiablecriticism(meaningof“justifiable”)(4.C.1.),9Justice,8

LLaw(andethics),3Limitationofpractice,15

MMarketingorsaleofproductsorprocedures(5.D.2.),12

NNameofpractice,14Nonhealthdegrees,advertising(5.F.3.),13Nonmaleficence,5

OOverbilling(5.B.2.),11

PPatentsandcopyrights,7Patientabandonment,6Patientautonomy,4Patientinvolvement,4Patientrecords,4 confidentiality(1.B.2.),4 furnishingcopies(1.B.1.),4Patientselection,8Personalimpairment,6Personalrelationshipswithpatients,6Practice abilityto(2.D.1.),6 dentistleaving(5.G.1.),14 nameof,14Preamble,3Principlesofethics(definition),3Principles beneficence,6 justice,8 nonmaleficence,5 patientautonomy,4 veracity,10Procedures(marketingorsale)(5.D.2.),12Products(marketingorsale)(5.D.2.),12Professionalannouncement,12Professionaldemeanor,8Publishedcommunications(5.F.1.),12

20

RRebatesandsplitfees,10Records(patient),4 confidentiality(1.B.2.),4 furnishingcopies(1.B.1.),4Referral,5Referralservices(5.F.4.),13Reporting abuseandneglect(3.E.1.),7 adversereactions(5.D.1.),12 grossandcontinualfaultytreatment,9 personalimpairment,6Representationofcare,10Representationoffees,10Researchanddevelopment,7

SSaleofproductsorprocedures(5.D.2.),12SearchEngineOptimization(S.F.6.),14Secondopinions(2.B.1.),5Specialist(announcementandlimitationofpractice),15Specialist(announcementofcredentialsinnon-specialtyinterestareas)(5.H.2.),15Splitfees,10

TTreatmentdates(5.B.4.),11Therapeuticmethods,11

UUnearned,nonhealthdegrees(5.F.3.),13Unnecessaryservices(5.B.6.),11Unsubstantiatedrepresentations(5.A.2.),10Useofauxiliarypersonnel,6

VVeracity,10

WWaiverofcopayment(5.B.1.),11Websitesandsearchengineoptimization(5.F.6.),14

American Dental Association Council on Ethics, Bylaws and Judicial Affairs

211 East Chicago Avenue Chicago, Illinois 60611

A current electronic version of this document is available at ADA.org/ethics.

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