Ethics and Law in Dental
Hygiene
Chapter 1
Ethics and Professionalism
Nicole Cruz, RDH, BSDH
Email: ncruz@concorde.edu
Introduction
 From inception in the early 1900s, the profession
of dental hygiene has been concerned with the
public good and with advocating methods of
preserving human teeth.
 Hygienists are seen as oral preventive therapists
because of their vision of the day when dental
disease could be prevented by following a system
of treatment and cleanliness.
 ADHA revised and adopted the original dental
hygiene oath in 1979 and it is still in use today.
 Be familiar with the oath (pg.4)
The Dental Hygiene Oath
 IN MY PRACTICE AS A DENTAL HYGIENIST,
 I AFFIRM MY PERSONAL AND PROFESSIONAL COMMITMENT
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TO IMPROVE THE ORAL HEALTH OF THE PUBLIC,
TO ADVANCE THE ART AND SCIENCE OF DENTAL HYGIENE,
AND TO PROMOTE HIGH STANDARDS OF QUALITY CARE.
I PLEDGE CONTINUALLY TO IMPROVE MY PROFESSIONAL
KNOWLEDGE AND SKILLS, TO RENDER A FULL MEASURE OF
SERVICE TO EACH PATIENT ENTRUSTED TO MY CARE,
AND TO UPHOLD THE HIGHEST STANDARDS OF
PROFESSIONAL COMPETENCE AND PERSONAL CONDUCT IN
THE INTEREST OF THE DENTAL HYGIENE PROFESSION AND
THE PUBLIC IT SERVES.
Introduction
 Society recognizes that health care providers, by
virtue of their education and special skills, are
appropriately held to a higher standard than that
expressed by legislative mandate.
 These higher standards are expressed in
professional codes of ethics and are enforced by
those within the profession, this is known as selfregulating.
 Self-regulating or self-policing behavior represents
an increased level of trust on the part of the
public.
Introduction
 In essence, the public is saying that it is not
qualified nor in a position to evaluate the
adequacy of treatment provided by health care
professionals. Therefore, the public TRUSTS the
professions to perform these evaluations.
 An ethical dental hygienist will accept the duty of
self-regulation, both in judging their colleagues
and in submitting to peer review, to ensure quality
care for the public.
The Health Care Provider
 A health care professional: the motive of a patient’s welfare
is placed above the profit motive. Because of this SERVICE
motive, society has granted to the health care professional
a certain status that carries prestige, power, and the right to
apply special knowledge and skill.
Health Care Provider
 *In the delivery of healthcare, trust is the critical
foundation for the relationship that develops
between the person seeking services-the patient or
client, and the healthcare provider-professional.
The Dental Hygienist
 A professional oral health care provider, an individual who
has:
• Completed a required higher-education accredited program
• Demonstrated knowledge, skills, and behaviors required by the college
or university for graduation
• Passed a written national board examination
• Successfully performed certain clinical skills on a state or regional
examination.
The Dental Hygienist
 BECAUSE of all of those requirements the state
grants you a license to practice dental hygiene
because you are deemed competent.
 Thus, the board of dentistry or dental practice act
exists, to protect the public’s health and safety.
Old school dental hygiene!
The Health Care Provider
 Profession is defined as a limited group of persons who
have acquired some special skill and are able to perform
that function in society better than the average person.
 Fig.1-1 states the characteristics of a true profession:
 Specialized body of knowledge of great value to society
 Intensive academic course of study
 Set standards of practice
 External recognition by society
 Code of ethics
 Organized association
 Service orientation
The Dental Hygienist
 What separates the professional from a layperson is the
specialized knowledge, which is exclusive to a professional
group.
 True professions are still considered to be medicine,
dentistry, and law because they possess all the
characteristics listed for a true profession.
 A profession incurs a professional obligation by virtue of its
relationship with society, something that is affirmed and
reaffirmed over time
 The Hippocratic oath, dentist’s pledge, and the dental
hygiene oath are examples of outward signs that reflect
acceptance of the professional obligation.
Hippocratic Oath
Hippocratic-of or
relating to
Hippocrates or the
school of medicine
that took his name;
medical practitioner
who is regarded as
the father of
medicine; author of
the Hippocratic oath
(circa 460-377 BC)
(Video Hippocratic Oath)
The Hippocratic Oath
https://youtu.be/RSXLucXoI54?t=33s
Principles of Professionalism
 Excellence
 Humanism
 Accountability
 Altruism
Professionalism
 Public expectations regarding healthcare have changed
over the years. People have become more knowledgeable,
involved, and active in their own health care decisions. This
is very different from the traditional relationship between
practitioner and patient.
 David Ozar described this evolution by developing three
models of professionalism: the commercial model, the
guild model, and the interactive model.
Professionalism: Commercial Model
 The commercial model describes a relationship in which
dentistry is a commodity, a simple buying and selling of
services.
 The patient is the consumer and the dentist is the
producer.
 Dental needs are not as important as what the patient is
willing to pay for.
 In this model, all dentists are in competition, selling the
same commodity to the public for the best price.
 There is no obligation between the dentist, the patient,
other dentists, or the community.
The Commercial Model
Professionalism: Guild Model
 The guild model presents dentistry as an all-knowing
profession.
 The patient has dental needs and the dentist, as a member
of the profession, provides care to meet the needs of that
patient, who is uninformed and passive in the process.
 The obligation to provide care comes from the dentist’s
membership in his or her chosen profession.
The Guild Model
Professionalism: Interactive Model
 The interactive model has the patient and the dentist as
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equals, with roles of equal moral status in the process of
dental care delivery.
Patients determine their needs and health care choices
based on personal values and priorities, but seek the care
of the dentist because of the knowledge and skill possessed
by the dental professional.
The obligation for care in this relationship holds both
parties as equals because neither can achieve these values
without the other.
The fundamental obligation in this model is for the dentist
to treat each patient well and to support the profession.
Most preferable model because patient and provider
work as partners.
The Interactive Model
Competency in Dental Hygiene
 Competencies are essential skills, requiring knowledge,
skill, and ability, that are performed by a health care
provider.
 For dental hygienists, competencies are skills used
regularly in real practice settings to meet the oral health
needs of the patients.
 The Commission on Dental Accreditation (CODA), is the
authorized agency that accredits all dental hygiene
education programs in the U.S., publishes standards and
competencies that all dental hygiene programs must meet
or exceed in their educational programs. (fig.1-2)
 Accreditation has been developed to protect the public
welfare and provide standards for the evaluation of
educational programs and schools.
Competency in Dental Hygiene
 CODA (Commission On Dental Accreditation) is the
specialized accrediting agency recognized by the U.S.
Department of Education to accredit programs that
provide basic preparation for licensure in dentistry, dental
hygiene, and all related dental disciplines.
 Patient care competencies or graduation competencies, are
the standards that must be met by graduates of any
educational program accredited by CODA.
 In states where mastery of an additional skill is mandated
by the dental practice act, accredited programs offer
additional training opportunities in those competencies.
EX: administration of local anesthesia or nitrous oxide
analgesia.
Competency in Dental Hygiene
 Educational theory categorizes the process of skill
performance into five stages of competency, also called the
expert learning continuum (Figure 1-1 pg. 13). The five
stages are novice, advanced beginner, competency,
proficiency, and expertise.
 When you begin pre-clinic and progress to caring for
clinical patients under the supervision of the faculty is the
novice or advanced beginner stage.
 At or even before graduation, you (the student) will have
achieved competency, or the ability to perform skills
without faculty supervision and with confidence.
Competency in Dental Hygiene
 After graduation, you work towards proficiency
and continue to work throughout your
professional life towards being an expert.
 Becoming an expert is not an end point, it is
something you strive for constantly in practice.
 Professionals constantly seek to perform at
increasingly higher levels, perfecting the art and
science of dental hygiene for every patient treated.
Standards for clinical Dental Hygiene
practice (Pg 15, Box 1-3)
 Assessment: collection, analysis, and documentation
of patient’s health status and needs.
 Dental Hygiene Diagnosis: identifying existing
potential oral health problems.
 Planning: plan of care based on assessments.
 Implementation: delivery of hygiene services
 Evaluation: reviewing and documenting the outcomes
of dental hygiene care.
 Documentation: accurate recording of data, treatment
plan and patient care.
Professional Traits
 Laurence McCullough, an ethicist, states that there are
2 virtues required in a professional person.
 1. Self-effacement, meaning putting aside all notions of
self as better educated, socially superior, or more
economically well off and focusing on the patients
needs.
 2. Self-sacrifice, or putting aside or giving up one’s own
interest and concerns.
Professional Traits of the Dental
Hygienist
 Honesty and integrity
 Caring and compassion
 Reliability and responsibility
 Maturity and self-analysis
 Loyalty
 Interpersonal communication
 Respect for others
 Respect for self
Professional Traits for the Dental
Hygienist
 Honesty/integrity- the patient must feel confident that information
given in written or verbal form is held in confidence and handled
appropriately.
 Caring/compassion- you must demonstrate the empathy necessary to
comfort and guide the patient in the health promotion process.
 Reliability/responsibility- you must perform all services to the best
standard of care. Sound judgment must be used in every patient
encounter, you must stay current on the knowledge and theory of
dental hygiene technique. (CE) requirements
 Maturity/self-analysis- you must work efficiently and effectively
towards the goals of attaining and maintaining oral health for each
patient. You must also self analyze to see what skills need change or
improvement.
Professional Traits for the Dental Hygienist
 Loyalty- all professional decisions must be unencumbered by
conflicting personal interests. Promises should be carefully made and
kept.
 Interpersonal communication- you must listen to the patient to
develop a relationship and build trust. Patients expect that personal,
intimate facts and impressions about them will be kept in confidence
by the dental hygienist.
 Tolerance for others- you must treat all patients without
discrimination of any kind (race, color, creed, age, sex, disability,
occupation, financial status, personality, or oral condition). Basic
ethical and legal requirement.
 Respect for self- you must maintain your own physical and mental
health so that the patient’s needs remain the primary focus. (not under
the influence of drugs or alcohol, lack of sleep, or emotional
disturbance)
Legal Requirements for the Dental Hygienist
 Once your license is granted it is your responsibility to know
and uphold all of the statutes of the law. State dental practice
act or the code of dental practice.
 Licensure is designed to enforce practice codes, establish
standards, and sanction incompetent practitioners, all for the
purpose of protecting the health and safety of the public.
 Scope of practice of a dental hygienist was first established by
law in Connecticut in 1915 at the urging of Dr. Alfred C. Fones.
(The father of dental hygiene). These legal statutes change
over time in response to many factors (to protect the public
and to advance the interests of the health professions)
 Connecticut was the first state to license dental hygienists.
 Texas was the last state in the US to grant dental hygiene
licensure.
Legal Requirements for the Dental
Hygienist
 Some factors that influence legislative changes in a
state are:
 Need and demand for dental care
 Distribution of dental health care providers
 Federal health legislation
 Goals of organized dental and dental hygiene
associations advocacy groups.
Legal Requirements for the Dental
Hygienist
 Increases in the scope of practice for hygienists
have occurred over the years, but have been
accompanied by controversy.
 Some states have expanded functions, but each
state has specific hygiene duties in their dental
statutes that dictate the level of supervision or lack
thereof.
Legal Requirements for the Dental
Hygienist
 Only duties or functions allowed in a particular state may
be performed by the licensed dental hygienist, even if that
individual is trained and licensed in another state where
they can perform more procedures.
 Attaining and maintaining competency in dental hygiene
are among the obligations that dental hygienist accepts in
completing a formal education program and passing the
state licensure examination.
 Placing the needs of the patient first and aiming to provide
the best care to every patient as well as society at large.
 Colorado was the first state to pass legislation permitting
unsupervised dental hygiene practices and expanded
functions.
Let’s get Ethical !!!
THE END