Quackery and Fraud

Ethical dental practice meets all of the following standards. Where one or two of the standards are imperfectly met, the practice is ethically questionable. Quackery and fraud are marked by clear and regular failure to meet any of these standards.

1. Informed consent: patients make free choices from among alternatives that are explained impartially in language they understand.
2. Benefit and risk: net expected benefit to patients must outweigh anticipated risks.
3. Competence: practitioners have the knowledge and skill expected by patients and the public to be able to produce results that meet the standard of care and the expectations created by dentists.
4. Professional integrity: practitioners maintain the trust patients and society have placed in the profession.
5. Reasonable scientific base: practitioners should be able to give reasons for their actions that are acceptable to their peers.

The accompanying table shows the characteristics, consequences, and some examples of ethical and questionable practice, and of quackery and fraud. Among the types of quackery and fraud, it is possible to identify distinct patterns of practice that damage patients and the profession, including:

1. Incompetence: practicing beyond one’s capabilities.
2. Using patients as a means rather than an end: overtreatment to enhance one’s reputation or income and undertreatment to increase profit.
3. Unqualified practice: practicing beyond one’s license, including the practice of medicine on a dental license.
4. Quackery: risky and inappropriate treatment caused by practitioners who mislead patients because they mistakenly believe the treatment is appropriate.
5. Charlatanism: risky and inappropriate treatment caused by practitioners who intentionally mislead patients for personal benefit.
6. Fraud: purposeful and knowing misrepresentation, withholding of information, or selective reporting of information for personal gain.

Quackery and fraud can be the result of several motives, most commonly a desire (whether recognized or not) for status or income on the part of the dentist. Even when quacks and frauds believe they are acting in the best interests of their patients, they make the mistake of setting themselves up as the sole judge of their actions.

Although quacks and frauds are directly compromising patients, certain actions are required of ethical dentists. These responses are the result of dentistry’s obligation to protect patients and to preserve the reputation of the profession. Because quacks and frauds damage both individual patient’s and the public’s trust in dentistry, specific actions are necessary on the part of individual dentists toward their patients and toward their colleagues, of the profession generally, and of the research community.

1. Ethical dentists should practice at an ever advancing level of knowledge and skill but maintain an acceptable level of risk to benefit their patients.
2. Ethical dentists should be familiar with popular unsubstantiated practices in order to discuss these intelligently with patients.
3. Ethical dentists should provide the most positive available approaches, even when unfavorable prognoses are found, in order to discourage patients from seeking unsubstantiated care out of a sense of hopelessness.
4. Ethical dentists should seek to maintain the relationship of primary care provider, even if patients consult others of whom the dentist disapproves.

1. Ethical dentists have a responsibility to understand the approaches and capabilities of practitioners whom their patients are likely to see.
2. Ethical dentists have a responsibility to discuss their concerns with other caregivers if there is a suspicion about questionable practice, quackery, or fraud.
3. Ethical dentists should alert their colleagues to unconventional practice.

1. The profession has a responsibility to protect patients by taking actions against the licenses of practitioners whose habitual mode of practice damages patients.
2. The profession has a responsibility to encourage a broad understanding of risk, risk factors, and practices that expose patients to unnecessary risk.
3. The profession should promote means of sharing, within dentistry, information that promotes quality care.
4. The profession has a responsibility to inform the public regarding the benefits of good oral care, properly provided.
5. The profession has a responsibility to inform policy makers about the standards of oral health care, the dangers of inappropriate care, and ways of distinguishing quality care.

1. 1. Research should be conducted only in a manner widely understood as exposing patients to an acceptable level of risk.
   2. Research should be reported in a manner that promotes free exchange of valid information, accurately communicated.
   3. All professional journals should use the form and conventions appropriate for reporting research to ensure accuracy and completeness, and never attempt to create an impression of scientific quality for commercial purposes.
   4. Practitioners should be taught to combine scientific evidence with systematic outcomes data from their own practices in order to form accurate estimates of the levels of risk their patients are exposed to in individual practice.

   Categorizing Ethical Practice, Questionable Practice, and Quackery and Fraud
   Ethical Practice	Questionable Practice	Quackery and Fraud
   Consequences
   Improving the patient’s overall oral health and well-being through means understood and approved by the patient, other dentists, and society	Placing the patient at risk for decreased overall oral health and well-being for the dentist’s benefit	Damaging the patient’s overall oral health and well-being, undermining the public’s trust in dentistry as a profession, or breaking applicable laws
   Characteristics
   Quality, patient-centered treatment within standard of care  Innovative aspects of practice that meet the five standards of ethical practice Experimental practice (research) that meets Institutional Review Board standards	Performing procedures that the patient, other dentists, or society would not choose if well informed  Performing procedures at marginal levels of quality or failing to provide necessary treatment Failure to take reasonable steps remain current in knowledge and skill and awareness of prevailing standards of care	Withholding or distorting relevant information about treatment options, probable outcomes, or history of previous outcomes from patients, colleagues, or society for personal gain  Knowingly performing procedures that do not meet the standard of care
   Examples
   Almost all established dental practices, those that remain on the leading edge through professional procedures development, approved research programs	Overtreatment, undertreatment, poor quality care, lack of comprehensive care, failure to diagnose, misrepresentation of patient benefits, failure to refer when case exceeds skill	Practicing without a license, practicing medicine or other health profession on a dental license, billing for procedures not performed, gross continuous substandard care, misrepresentation of one’s qualifications, distorting the scientific basis of dentistry