Dental Ethics as All Other

Dental Ethics

As all other healthcare professionals, dental hygienists have responsibilities to their patients, employers, associations and, most important, to their own personal integrity. It is therefore critical that they be prepared to make sound decisions and actions based on ethical considerations. The growing importance of enforcing ethical behavior in dental hygiene is observed by seeing the number of dental schools that now have formal ethics courses as part of their curricula. Over the last three decades, dental professionals have emphasized the requisite for ethics training and dialogue. Today, ethics education has moved from mainly traditional instruction to more interactional teaching approaches that promote student introspection and group problem-solving. In addition, various dental hygiene associations have codes of ethics that are expected to follow. With enhanced consumer education and legal constraints, ethics will become a standard aspect of all dental hygienists' work habits.

Gaston, Brown and Waring (1990) surveyed 2, 251 American Dental Hygienists' Association members to classify the types and frequency of ethical problems that dental hygienists face. The three ethical dilemmas they most frequently encountered in dental hygiene practice were (1) observation of behavior in conflict with standard infection control procedures (66%); (2) failure to refer patients to a specialist such as a periodontist (60%); and (3) nondiagnosis of dental disease (58%). This study indicated that serious ethical dilemmas are encountered by the majority of dental hygienists in their regular day-to-day working environment. More recently, a case reported to occur in 2005 describes a dental hygienist who used nitrous oxide while cleaning teeth although she was not licensed to do so. The dentist allowed her to use this approach despite her lack of professional training and she agreed. In another situation, a dental hygienist respected her client's decision, although it differed from the dentist's plan for the best health outcome. A common example of the latter is when a patient with severe subgingival and supragingival calculus requests that the dental hygienist complete the debridement in one appointment, when multiple visits are needed. This presents a moral dilemma. The hygienist knows that fine scaling is necessary for the client's oral health and is responsible for educating the client, reiterating the risks and benefits of the recommended treatment.

The study of ethics, therefore, is necessary before dental hygienists begin their actual employment. In recent years, topics in medical ethics have covered a wide range of areas of student ethical dilemmas such as cheating, alcohol use, and attraction to patients (Fox, 1995, p.761). Surveys show that the number of dental schools addressing issues of ethics and professional conduct at the beginning of a student's coursework has increased (Odom, 2000, p. 772-4). Bertolami (2004, p. 215) however found that "ethics courses are inadequate in content and form to the extent that they do not cultivate an introspective orientation to professional life." Institutions need to redesign the curricula to explore relevant issues related to accessibility, inconsistencies, and competency.

Gadbury-Amyot (2005) examined how well a multifaceted approach to formal ethics instruction that includes community-based service-learning can improve learning and influence the students' attitudes and perceptions about their role as oral healthcare providers in such areas as access to care, disparity, and working in a diverse community. Students noted that service-learning was both professionally and personally enriching and made a significant impact on their person view as providers of health services and community participants. They also reported on the positive aspects of the "hands-on" experience and hoped to have additional opportunities to participate such activities and indicated a desire to address current access to oral health care dilemmas. The combined classroom information with the community-based service-learning component begins a needed dialog for these professionals to meaningfully consider ethical issues and potential resolutions. Immersion is thus found to work best, with hands-on issues. That is, most students will benefit most from an interactive, actual case study teaching methods that analyze ethical dilemmas and discuss options.