Principles of Ethics & Code
of Professional Conduct
I. INTRODUCTION
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.
These standards are embodied in the ADA Principles of Ethics
and Code of Professional Conduct (ADA Code). The ADA Code is,
in effect, a written expression of the obligations arising from
the implied contract between the dental profession and society.
Members of the ADA voluntarily agree to abide by the ADA Code
as a condition of membership in the Association. They recognize
that continued public trust in the dental profession is based
on the commitment of individual dentists to high ethical standards
of conduct.
The ADA Code has three main components: The Principles of Ethics,
the Code of Professional Conduct and the Advisory Opinions.
The Principles of Ethics are the aspirational goals of the profession.
They provide guidance and offer justification for the Code of
Professional Conduct and the Advisory Opinions. There are five
fundamental principles that form the foundation of the ADA Code:
patient autonomy, nonmaleficence, beneficence, justice and veracity.
Principles can overlap each other as well as compete with each
other for priority. More than one principle can justify a given
element of the Code of Professional Conduct. Principles may at
times need to be balanced against each other, but, otherwise,
they are the profession's firm guideposts.
The Code of Professional Conduct is an expression of specific
types of conduct that are either required or prohibited. The
Code of Professional Conduct is a product of the ADA's
legislative system. All elements of the Code of Professional
Conduct result from resolutions that are adopted by the ADA's
House of Delegates. The Code of Professional Conduct is binding
on members of the ADA, and violations may result in disciplinary
action.
The Advisory Opinions are interpretations that apply the Code
of Professional Conduct to specific fact situations. They are
adopted by the ADA's Council on Ethics, Bylaws and Judicial
Affairs to provide guidance to the membership on how the Council
might interpret the Code of Professional Conduct in a disciplinary
proceeding.
The ADA Code is an evolving document and by its very nature
cannot be a complete articulation of all ethical obligations.
The ADA Code is the result of an on-going dialogue between the
dental profession and society, and as such, is subject to continuous
review.
Although ethics and the law are closely related, they are not
the same. Ethical obligations may-and often do-exceed legal duties.
In resolving any ethical problem not explicitly covered by the
ADA Code, dentists should consider the ethical principles, the
patient's needs and interests, and any applicable laws.
II. PREAMBLE
The American Dental Association calls upon dentists to follow
high ethical standards which have the benefit of the patient
as their primary goal. Recognition of this goal, and of the education
and training of a dentist, has resulted in society affording
to the profession the privilege and obligation of self-government.
The Association believes that dentists should possess not only
knowledge, skill and technical competence but also those traits
of character that foster adherence to ethical principles. Qualities
of compassion, kindness, integrity, fairness and charity complement
the ethical practice of dentistry and help to define the true
professional.
The ethical dentist strives to do that which is right and good.
The ADA Code is an instrument to help the dentist in this quest.
III. PRINCIPLES, CODE OF PROFESSIONAL CONDUCT AND ADVISORY OPINIONS
PRINCIPLE - SECTION 1
Patient Autonomy ("self-governance")
The dentist has a duty to respect the patient's rights
to self-determination and confidentiality.
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.
CODE OF PROFESSIONAL CONDUCT
1.A. PATIENT INVOLVEMENT
The dentist should inform the patient of the proposed treatment,
and any reasonable alternatives, in a manner that allows the
patient to become involved in treatment decisions.
1.B. PATIENT RECORDS
Dentists are obliged to safeguard the confidentiality of patient
records. Dentists shall maintain patient records in a manner
consistent with the protection of the welfare of the patient.
Upon request of a patient or another dental practitioner, dentists
shall provide any information that will be beneficial for the
future treatment of that patient. ADVISORY OPINIONS
1.B.1 FURNISHING COPIES OF RECORDS
A dentist has the ethical obligation on request of either the
patient or the patient's new dentist to furnish, either
gratuitously or for nominal cost, such dental records or copies
or summaries of them, including dental X-rays or copies of them,
as will be beneficial for the future treatment of that patient.
This obligation exists whether or not the patient's account
is paid in full.
1.B.2. CONFIDENTIALITY OF PATIENT RECORDS
The dominant theme in the Code Section 1-B is the protection
of the confidentiality of a patient's records. The statement
in this section that relevant information in the records should
be released to another dental practitioner assumes that the dentist
requesting the information is the patient's dentist. The
former dentist should be free to provide the present dentist
with relevant information from the patient's records.
This may often be required for the protection of both the patient
and the present dentist. There may be circumstances where the
former dentist has an ethical obligation to inform the present
dentist of certain facts. Dentists should be aware, however,
that the laws of the various jurisdictions in the United States
are not uniform, and some confidentiality laws appear to prohibit
the transfer of pertinent information, such as HIV seropositivity.
Absent certain knowledge that the laws of the dentist's
jurisdiction permit the forwarding of this information, a dentist
should obtain the patient's written permission before
forwarding health records which contain information of a sensitive
nature, such as HIV seropositivity, chemical dependency or sexual
preference. If it is necessary for a treating dentist to consult
with another dentist or physician with respect to the patient,
and the circumstances do not permit the patient to remain anonymous,
the treating dentist should seek the permission of the patient
prior to the release of data from the patient's records
to the consulting practitioner. If the patient refuses, the treating
dentist should then contemplate obtaining legal advice regarding
the termination of the dentist/patient relationship.
PRINCIPLE - SECTION 2
Nonmaleficence ("do no harm")
The dentist has a duty to refrain from harming the patient.
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.
CODE OF PROFESSIONAL CONDUCT
2.A. EDUCATION
The privilege of dentists to be accorded professional status
rests primarily in the knowledge, skill and experience with which
they serve their patients and society. All dentists, therefore,
have the obligation of keeping their knowledge and skill current.
2.B. CONSULTATION AND REFERRAL
Dentists shall be obliged to
seek consultation, if possible, whenever the welfare of patients
will be safeguarded or advanced by utilizing those who have special
skills, knowledge, and experience. When patients visit or are
referred to specialists or consulting dentists for consultation:
- The specialists or consulting dentists upon completion of
their care shall return the patient, unless the patient expressly
reveals a different preference, to the referring dentist, or,
if none, to the dentist of record for future care.
- The specialists
shall be obliged when there is no referring dentist and upon
a completion of their treatment to inform patients when there
is a need for further dental care.
ADVISORY OPINION
2.B.1. SECOND OPINIONS
A dentist who has a patient referred by a third party for a "second
opinion" regarding a diagnosis or treatment plan recommended
by the patient's treating dentist should render the requested
second opinion in accordance with this Code of Ethics. In the
interest of the patient being afforded quality care, the dentist
rendering the second opinion should not have a vested interest
in the ensuing recommendation.
2.C. USE OF AUXILIARY PERSONNEL
Dentists shall be obliged to protect the health of their patients
by only assigning to qualified auxiliaries those duties which
can be legally delegated. Dentists shall be further obliged to
prescribe and supervise the patient care provided by all auxiliary
personnel working under their direction.
2.D. PERSONAL IMPAIRMENT
It is unethical for a dentist to practice while abusing controlled
substances, alcohol or other chemical agents which impair the
ability to practice. All dentists have an ethical obligation
to urge chemically impaired colleagues to seek treatment. Dentists
with first-hand knowledge that a colleague is practicing dentistry
when so impaired have an ethical responsibility to report such
evidence to the professional assistance committee of a dental
society.
ADVISORY OPINION
2.D.1 ABILITY TO PRACTICE
A dentist who contracts any disease or becomes impaired in any
way that might endanger patients or dental staff shall, with
consultation and advice from a qualified physician or other authority,
limit the activities of practice to those areas that do not endanger
patients or dental staff. A dentist who has been advised to limit
the activities of his or her practice should monitor the aforementioned
disease or impairment and make additional limitations to the
activities of the dentist's practice, as indicated.
2.E. PATIENT ABANDONMENT
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.
PRINCIPLE - SECTION 3
Beneficence ("do good")
The dentist has a duty to promote the patient's welfare.
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 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.
CODE OF PROFESSIONAL CONDUCT
3.A. COMMUNITY SERVICE
Since dentists have an obligation to use their skills, knowledge
and experience for the improvement of the dental health of the
public and are encouraged to be leaders in their community, dentists
in such service shall conduct themselves in such a manner as
to maintain or elevate the esteem of the profession.
3.B. GOVERNMENT OF A PROFESSION
Every profession owes society the responsibility to regulate
itself. Such regulation is achieved largely through the influence
of the professional societies. All dentists, therefore, have
the dual obligation of making themselves a part of a professional
society and of observing its rules of ethics.
3.C. RESEARCH AND DEVELOPMENT
Dentists have the obligation of making the results and benefits
of their investigative efforts available to all when they are
useful in safeguarding or promoting the health of the public.
3.D. PATENTS AND COPYRIGHTS
Patents and copyrights may be secured by dentists provided that
such patents and copyrights shall not be used to restrict research
or practice.
3.E. CHILD ABUSE
Dentists shall be obliged to become familiar
with the perioral signs of child abuse and to report suspected
cases to the proper authorities consistent with state laws.
PRINCIPLE - SECTION 4
Justice ("fairness") The dentist has a duty to treat
people fairly.
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.
CODE OF PROFESSIONAL CONDUCT
4.A. PATIENT SELECTION
While dentists, in serving the public, may exercise reasonable
discretion in selecting patients for their practices, dentists
shall not refuse to accept patients into their practice or deny
dental service to patients because of the patient's race,
creed, color, sex or national origin.
ADVISORY OPINION
4.A.1. HIV POSITIVE PATIENTS
A dentist has the general obligation to provide care to those
in need. A decision not to provide treatment to an individual
because the individual has AIDS or is HIV seropositive, based
solely on that fact, is unethical. Decisions with regard to the
type of dental treatment provided or referrals made or suggested,
in such instances should be made on the same basis as they are
made with other patients, that is, whether the individual dentist
believes he or she has need of another's skills, knowledge,
equipment or experience and whether the dentist believes, after
consultation with the patient's physician if appropriate,
the patient's health status would be significantly compromised
by the provision of dental treatment.
4.B. EMERGENCY SERVICE
Dentists shall be obliged to make reasonable arrangements for
the emergency care of their patients of record. Dentists shall
be obliged when consulted in an emergency by patients not of
record to make reasonable arrangements for emergency care. If
treatment is provided, the dentist, upon completion of treatment,
is obliged to return the patient to his or her regular dentist
unless the patient expressly reveals a different preference.
4.C. JUSTIFIABLE CRITICISM
Dentists shall be obliged to report to the appropriate reviewing
agency as determined by the local component or constituent society
instances of gross or continual faulty treatment by other dentists.
Patients should be informed of their present oral health status
without disparaging comment about prior services. Dentists issuing
a public statement with respect to the profession shall have
a reasonable basis to believe that the comments made are true.
ADVISORY OPINION
4.C.1. MEANING OF "JUSTIFIABLE"
A dentist's duty to the public imposes a responsibility
to report instances of gross or continual faulty treatment. However,
the heading of this section is "Justifiable Criticism." Therefore,
when informing a patient of the status of his or her oral health,
the dentist should exercise care that the comments made are justifiable.
For example, a difference of opinion as to preferred treatment
should not be communicated to the patient in a manner which would
imply mistreatment. There will necessarily be cases where it
will be difficult to determine whether the comments made are
justifiable. Therefore, this section is phrased to address the
discretion of dentists and advises against disparaging statements
against another dentist. However, it should be noted that, where
comments are made which are obviously not supportable and therefore
unjustified, such comments can be the basis for the institution
of a disciplinary proceeding against the dentist making such
statements.
4.D. EXPERT TESTIMONY
Dentists may provide expert testimony when that testimony is
essential to a just and fair disposition of a judicial or administrative
action.
ADVISORY OPINION
4.D.1. CONTINGENT FEES
It is unethical for a dentist to agree to a fee contingent upon
the favorable outcome of the litigation in exchange for testifying
as a dental expert.
4.E. REBATES AND SPLIT FEES
Dentists shall not accept or tender "rebates" or "split
fees."
PRINCIPLE - SECTION 5 Veracity ("truthfulness")
The dentist has a duty to communicate truthfully.
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.
CODE OF PROFESSIONAL CONDUCT
5.A. REPRESENTATION OF CARE
Dentists shall not represent the care being rendered to their
patients in a false or misleading manner.
ADVISORY OPINIONS
5.A.1. DENTAL AMALGAM
Based on available scientific date the ADA has determined through
the adoption of Resolution 42H-1986 (Trans.1986:536) that the
removal of amalgam restorations from the non-allergic patient
for the alleged purpose of removing toxic substances from the
body, when such treatment is performed solely at the recommendation
or suggestion of the dentist, is improper and unethical.
5.A.2. UNSUBSTANTIATED REPRESENTATIONS
A dentist who represents
that dental treatment recommended or performed by the dentist
has the capacity to cure or alleviate diseases, infections or
other conditions, when such representations are not based upon
accepted scientific knowledge or research, is acting unethically.
5.B. REPRESENTATION OF FEES
Dentists shall not represent the fees being charged for providing
care in a false or misleading manner.
ADVISORY OPINIONS
5.B.1. WAIVER OF COPAYMENT
A dentist who accepts a third party* payment under a copayment
plan as payment in full without disclosing to the third party*
that the patient's payment portion will not be collected,
is engaged in overbilling. The essence of this ethical impropriety
is deception and misrepresentation; an overbilling dentist makes
it appear to the third party* that the charge to the patient
for services rendered is higher than it actually is.
5.2.B. OVERBILLING
It is unethical for a dentist to increase
a fee to a patient solely because the patient is covered under
a dental benefits plan.
5.B.3. FEE DIFFERENTIAL
Payments accepted by a dentist under
a governmentally funded program, a component or constituent dental
society sponsored access program, or a participating agreement
entered into under a program of a third party* shall not be considered
as evidence of overbilling in determining whether a charge to
a patient, or to another third party* in behalf of a patient
not covered under any of the aforecited programs constitutes
overbilling under this section of the Code.
5.B.4. TREATMENT DATES
A dentist who submits a claim form to
a third party* reporting incorrect treatment dates for the purpose
of assisting a patient in obtaining benefits under a dental plan,
which benefits would otherwise be disallowed, is engaged in making
an unethical, false or misleading representation to such third
party.*
5.B.5 DENTAL PROCEDURES
A dentist who incorrectly describes
on a third party* claim form a dental procedure in order to receive
a greater payment or reimbursement or incorrectly makes a non-covered
procedure appear to be a covered procedure on such a claim form
is engaged in making an unethical, false or misleading representation
to such third party.*
5.B.6. UNNECESSARY SERVICES
A dentist who recommends and performs
unnecessary dental services or procedures is engaged in unethical
conduct. *A third party is any party to a dental prepayment contract
that may collect premiums, assume financial risks, pay claims,
and/or provide administrative services.
5.C. DISCLOSURE OF CONFLICT OF INTEREST
A dentist who presents educational or scientific information
in an article, seminar or other program shall disclose to the
readers or participants any monetary or other special interest
the dentist may have with a company whose products are promoted
or endorsed in the presentation. Disclosure shall be made in
any promotional material and in the presentation itself.
5.D. DEVICES AND THERAPEUTIC METHODS
Except for formal investigative studies, dentists shall be obliged
to prescribe, dispense, or promote only those devices, drugs
and other agents whose complete formulae are available to the
dental profession. Dentists shall have the further obligation
of not holding out as exclusive any device, agent, method or
technique if that representation would be false or misleading
in any material respect.
ADVISORY OPINIONS
5.D.1 REPORTING ADVERSE REACTIONS
A dentist who suspects the occurrence of an adverse reaction
to a drug or dental device has an obligation to communicate that
information to the broader medical and dental community, including,
in the case of a serious adverse event, the Food and Drug Administration
(FDA).
5.D.2. MARKETING OR SALE OF PRODUCTS OR PROCEDURES
Dentists who, in the regular conduct of their practices, engage
in or employ auxiliaries in the marketing or sale of products
or procedures to their patients must take care not to exploit
the trust inherent in the dentist-patient relationship for their
own financial gain. Dentists should not induce their patients
to purchase products or undergo procedures by misrepresenting
the product's therapeutic value, the necessity of the
procedure or the dentist's professional expertise in recommending
the product or procedure In the case of a health-related product,
it is not enough for the dentist to rely on the manufacturer's
or distributor's representations about the product's
safety and efficacy. The dentist has an independent obligation
to inquire into the truth and accuracy of such claims and verify
that they are founded on accepted scientific knowledge or research.
Dentists should disclose to their patients all relevant information
the patient needs to make an informed purchase decision, including
whether the product is available elsewhere and whether there
are any financial incentives for the dentist to recommend the
product that would not be evident to the patient.
5.E. PROFESSIONAL ANNOUNCEMENT
In order to properly serve the public, dentists should represent
themselves in a manner that contributes to the esteem of the
profession. Dentists should not misrepresent their training and
competence in any way that would be false or misleading in any
material respect.*
5.F. ADVERTISING
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.*
ADVISORY OPINIONS
5.F.1. ARTICLES AND NEWSLETTERS
If a dental health article, message or newsletter is published
under a dentist's byline to the public without making
truthful disclosure of the source and authorship or is designed
to give rise to questionable expectations for the purpose of
inducing the public to utilize the services of the sponsoring
dentist, the dentist is engaged in making a false or misleading
representation to the public in a material respect.
5.F.2. EXAMPLES OF "FALSE OR MISLEADING"
The following examples are set forth to provide insight into
the meaning of the term "false or misleading in a material
respect." These examples are not meant to be all-inclusive.
Rather, by restating the concept in alternative language and
giving general examples, it is hoped that the membership will
gain a better understanding of the term. With this in mind, 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. Subjective statements
about the quality of dental services can also raise ethical concerns,
In particular, statements of opinion may be misleading if they
are not honestly held, if they misrepresent the qualifications
of the holder, or the basis of the opinion, or if the patient
reasonably interprets them as implied statements of fact. Such
statements will be evaluated on a case by case basis, considering
how patients are likely to respond to the impression made by
the advertisement as a whole. The fundamental issue is whether
the advertisement, taken as a whole, is false or misleading in
a material respect.
5.F.3. UNEARNED, NONHEALTH DEGREES
The use of an unearned or nonhealth degree in any general announcements
to the public by a dentist may be a representation to the public
which is false or misleading in a material respect. A dentist
may use the title Doctor, Dentist, DDS, or DMD, or any additional
earned advanced degrees in health service areas. The use of unearned
or nonhealth degrees could be misleading because of the likelihood
that it will indicate to the public the attainment of a specialty
or diplomate status. For purposes of this advisory opinion, an
unearned academic degree is one which is awarded by an educational
institution not accredited by a generally recognized accrediting
body or is an honorary degree. Generally, the use of honorary
degrees or nonhealth degrees should be limited to scientific
papers and curriculum vitae. In all instances state law should
be consulted. In any review by the council of the use of nonhealth
degrees or honorary degrees the council will apply the standard
of whether the use of such is false or misleading in a material
respect.
5.F.4 REFERRAL SERVICES
There are two basic types of referral services for dental care:
not-for-profit and the commercial. The not-for-profit is commonly
organized by dental societies or community services. It is open
to all qualified practitioners in the area served. A fee is sometimes
charged the practitioner to be listed with the service. A fee
for such referral services is for the purpose of covering the
expenses of the service and has no relation to the number of
patients referred. In contrast, some commercial referral services
restrict access to the referral service to a limited number of
dentists in a particular geographic area. Prospective patients
calling the service may be referred to a single subscribing dentist
in the geographic area and the respective dentist billed for
each patient referred. Commercial referral services often advertise
to the public stressing that there is no charge for use of the
service and the patient may not be informed of the referral fee
paid by the dentist. There is a connotation to such advertisements
that the referral that is being made is in the nature of public
service. A dentist is allowed to pay for any advertising permitted
by the Code, but is generally not permitted to make payments
to another person or entity for the referral of a patient for
professional services. While the particular facts and circumstances
relating to an individual commercial referral service will vary,
the council believes that the aspects outlined above for commercial
referral services violate the Code in that it constitutes advertising
which is false or misleading in a material respect and violates
the prohibitions in the Code against fee splitting.
5.F.5. INFECTIOUS DISEASE TEST RESULTS
An advertisement or other communication intended to solicit
patients which omits a material fact or facts necessary to put
the information conveyed in the advertisement in a proper context
can be misleading in a material respect. A dental practice should
not seek to attract patients on the basis of partial truths which
create a false impression. For example, an advertisement to the
public of HIV negative test results, without conveying additional
information that will clarify the scientific significance of
this fact contains a misleading omission. A dentist could satisfy
his or her obligation under this advisory opinion to convey additional
information by clearly stating in the advertisement or other
communication: "This negative HIV test cannot guarantee
that I am currently free of HIV."
5.G. NAME OF PRACTICE
Since the name under which a dentist conducts his or her practice
may be a factor in the selection process of the patient, the
use of a trade name or an assumed name that is false of misleading
in any material respect is unethical. Use of the name of a dentist
no longer actively associated with the practice may be continued
for a period not to exceed one year.*
ADVISORY OPINION
5.G.1. DENTIST LEAVING PRACTICE
Dentists leaving a practice who authorize continued use of their
names should receive competent advice on the legal implications
of this action. With permission of a departing dentist, his or
her name may be used for more than one year, if, after the one
year grace period has expired, prominent notice is provided to
the public through such mediums as a sign at the office and a
short statement on stationary and business cards that the departing
dentist has retired from the practice.
5.H. ANNOUNCEMENT OF SPECIALIZATION AND LIMITATION OF PRACTICE
This section and Section 5-1 are designed to help the public
make an informed selection between the practitioner who has completed
an accredited program beyond the dental degree and a practitioner
who has not completed such a program. The special areas of dental
practice approved by the American Dental Association and the
designation for ethical specialty announcement and limitation
of practice are: dental public health, endodontics, oral and
maxillofacial pathology, oral and maxillofacial surgery, orthodontics
and dentofacial orthopedics, pediatric dentistry, periodontics,
and prosthodontics. Dentists who choose to announce specialization
should use "specialist in" or "practice limited
to" and shall limit their practice exclusively to the announced
special area(s) of dental practice, provided at the time of the
announcement such dentists have met in each approved specialty
for which they announce the existing educational requirements
and standards set forth by the American Dental Association. Dentists
who use their eligibility to announce as specialists to make
the public believe that specialty services rendered in the dental
office are being rendered by qualified specialists when such
is not the case are engaged in unethical conduct. The burden
of responsibility is on specialists to avoid any inference that
general practitioners who are associated with specialists are
qualified to announce themselves as specialists.
GENERAL STANDARDS
The following are included within the standards of the American
Dental Association for determining the education, experience
and other appropriate requirements for announcing specialization
and limitation of practice:
- The special area(s) of dental practice and an appropriate
certifying board must be approved by the American Dental Association.
- Dentists who announce as specialists must have successfully
completed an educational program accredited by the Commission
on Dental Accreditation, two or more years in length, as specified
by the Council on Dental Education and Lincensure or be diplomates
of an American Dental Association recognized certifying board.
The scope of the individual specialist's practice shall
be governed by the educational standards for the specialty in
which the specialist is announcing.
- The practice carried on by dentists who announce as specialists
shall be limited exclusively to the special area(s) of dental
practice announced by the dentist.
STANDARDS FOR MULTIPLE-SPECIALTY ANNOUNCEMENTS
Educational criteria for announcement by dentists in additional
recognized specialty areas are the successful completion of an
educational program accredited by the Commission on Dental Accreditation
in each area for which the dentist wishes to announce. Dentists
who completed their advanced education in programs listed by
the Council on Dental Education and Lincensure prior to the initiation
of the accreditation process in 1967 and who are currently ethically
announcing as specialists in a recognized area may announce in
additional areas provided they are educationally qualified or
are certified diplomates in each area for which they wish to
announce. Documentation of successful completion of the educational
program(s) must be submitted to the appropriate constituent society.
The documentation must assure that the duration of the program(s)
is a minimum of two years except for oral and maxillofacial surgery
which must have been a minimum of three years in duration.*
ADVISORY OPINIONS
5.H.1. DUAL DEGREED DENTISTS
Nothing in Section 5.H shall be interpreted to prohibit a dual
degreed dentist who practices medicine or osteopathy under a
valid state license from announcing to the public as a dental
specialist provided the dentist meets the educational, experience
and other standards set forth in the Code for specialty announcement
and further providing that the announcement is truthful and not
materially misleading.
5.H.2. SPECIALIST ANNOUNCEMENT OF CREDENTIALS IN NON-SPECIALTY
INTEREST AREAS
A dentist who is qualified to announce specialization under
this section may not announce to the public that he or she is
certified or a diplomate or otherwise similarly credentialed
in an area of dentistry not recognized as a specialty area by
the American Dental Association unless:
- The organization granting the credential grants certification
or diplomate status based on the following: a) the dentist's
successful completion of a formal, full-time advanced education
program (graduate or postgraduate level) of at least 12 months' duration;
and b) the dentist's training and experience; and c) successful
completion of an oral and written examination based on psychometric
principles; and
- The announcement includes the following language: [Name of
announced area of dental practice] is not recognized as a specialty
area by the American Dental Association. Nothing in this advisory
opinion affects the right of a properly qualified dentist to
announce specialization in an ADA-recognized specialty area(s)
as provided for under Section 5.H of this Code or the responsibility
of such dentist to limit his or her practice exclusively to the
special area(s) of dental practice announced. Specialists shall
not announce their credentials in a manner that implies specialization
in a non-specialty interest area.
5.I. GENERAL PRACTITIONER ANNOUNCEMENT OF SERVICES
General dentists who wish to announce the services available
in their practices are permitted to announce the availability
of those services so long as they avoid any communications that
express or imply specialization. General dentists shall also
state that the services are being provided by general dentists.
No dentist shall announce available services in any way that
would be false or misleading in any material respect.*
ADVISORY OPINIONS
5.I.1. GENERAL PRACTITIONER ANNOUNCEMENT OF CREDENTIALS
A general dentist may not announce to the public that he or
she is certified or a diplomate or otherwise similarly credentialed
in an area of dentistry not recognized as a specialty area by
the American Dental Association unless:
- The organization granting the credential grants certification
or diplomate status based on the following: a) the dentist's
successful completion of a formal, full-time advanced education
program (graduate or postgraduate level) of at least 12 months' duration;
and b) the dentist's training and experience; and c) successful
completion or an oral and written examination based on psychometric
principles;
- The dentist discloses that he or she is a general dentist;
and
- The announcement includes the following language: [Name of
announced area of dental practice] is not recognized as a specialty
area by the American Dental Association.
5.I.2. FELLOWSHIPS
General dentists may announce fellowships or other credentials
earned in the area of general dentistry so long as they avoid
any communications that express or imply specialization and the
announcement includes the disclaimer that the dentist is a general
dentist. The use of abbreviations to designate credentials shall
be avoided when such use would lead the reasonable person to
believe that the designation represents an academic degree, when
such is not the case.
*Advertising, solicitation of patients or business or other
promotional activities by dentists or dental care delivery organizations
shall not be considered unethical or improper, except for those
promotional activities which are false or misleading in any material
respect. Notwithstanding any ADA Principles of Ethics and Code
of Professional Conduct or other standards of dentist conduct
which may be differently worded, this shall be the sole standard
for determining the ethical propriety of such promotional activities.
Any provision of an ADA constituent or component society's
code of ethics or other standard of dentist conduct relating
to dentists' or dental care delivery organizations' advertising,
solicitation, or other promotional activities which is worded
differently from the above standard shall be deemed to be in
conflict with the ADA Principles of Ethics and Code of Professional
Conduct.
IV. INTERPRETATION AND APPLICATION OF PRINCIPLES OF ETHICS AND
CODE OF PROFESSIONAL CONDUCT
The foregoing ADA Principles of Ethics and Code of Professional
Conduct set forth the ethical duties that are binding on members
of the American Dental Association. The component and constituent
societies may adopt additional requirements or interpretations
not in conflict with the ADA Code.
Anyone who believes that a member-dentist has acted unethically
may 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 a satisfactory resolution cannot
be reached, the dental society may decide, after proper investigation,
that the matter warrants issuing formal charges and conducting
a disciplinary hearing pursuant to the procedures set forth in
the ADA Bylaws, Chapter XII. PRINCIPLES OF ETHICS AND CODE OF
PROFESSIONAL CONDUCT AND JUDICIAL PROCEDURE. The Council on Ethics,
Bylaws and Judicial Affairs reminds constituent and component
societies that before a dentist can be found to have breached
any ethical obligation the dentist is entitled to a fair hearing.
A member who is found guilty of unethical conduct proscribed
by the ADA Code or code of ethics of the constituent or component
society, may be placed under a sentence of censure or suspension
or may be expelled from membership in the Association. A member
under a sentence of censure, suspension or expulsion has the
right to appeal the decision to his or her constituent society
and the ADA Council on Ethics, Bylaws and Judicial Affairs, as
provided in Chapter XII of the ADA Bylaws.
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