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Ethical Dilemmas

Presented through our partnership with the American Society for Dental Ethics and Indiana University School of Dentistry.

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Changing Private Practice Ownership Guidelines: A Response to Increasing Dental School Debt

This text is written for dental students and residents. While other readers may find it useful, its purpose is to provide a brief and clear introduction to the ethics of the profession of dentistry.

Dr. Peltier is Professor of Psychology and Ethics at the Dugoni School of Dentistry, University of the Pacific in San Francisco, where he has taught for 25 years.

Dr. Jenson served as Clinical Professor of Dentistry and Lecturer at the University of California, San Francisco for 23 years and practiced in Nevada and California for 30 years. His Master’s degree is in Philosophy.

The authors of this text are dental educators and ethicists, not attorneys. Please do not construe the contents of this document to be legal advice.
This version is a working draft and will be adjusted and edited in the future. Please do not forward or publish it without permission. Use [email protected] to contact the authors.

Dental Ethics Primer 2017_Peltier and Jensen

Collaboratively, the American College of Dentists, the American Society for Dental Ethics, and the Academy of General Dentistry publish a column several times a year on dental ethics in AGD Impact, a publication of the Academy of General Dentistry.

  • Purpose. These ethics articles are only meant to further your knowledge and understanding of dental ethics by presenting, discussing, and analyzing ethical issues, situations, and dilemmas that may occur in dental settings. Thes articles are not intended to: a) provide legal advice; b) provide advice or assistance in the diagnosis or treatment of dental diseases or conditions; or c) provide advice or assistance in the management of dental patients, practices, or personnel.
  • By using any or all of the articles you are affirming your acceptance of the Terms of Use
  • Permission. The ethical articles are used with the permission of the AGD Impact and the Academy of General Dentistry.
  • Appreciation. The American College of Dentists extends its sincere appreciation to AGD Impact and the Academy of General Dentistry for permitting these articles to be included on this website, Dental Ethics, and used by the website’s users. Great appreciation is also extended to our ASDE colleagues, who are the primary contributors.

Professionalism in the Dental Office, Part One: What it Means to Your Practice

Donald Patthoff, DDS, MAGD and David Ozar, PhD

September 2012, pp. 16-18

AGD Impact Professionalism in the Dental Office Part 1

Professionalism in the Dental Office, Part Two: Understanding Staff Roles and Working Together

Donald Patthoff, DDS, MAGD and David Ozar, PhD

April 2013, pp. 25-28

AGD Impact Professionalism in the Dental Office Part 2

Moral Distress: When Others’ Decisions Trouble Us

Donald Patthoff, DDS, MAGD and David Ozar, PhD

August 2013, pp. 22-24

AGD Impact Moral Distress

How to Limit Unintended Outcomes: Taking Action and Promoting Ethical Communication

Donald Patthoff, DDS, MAGD and David Ozar, PhD

January 2014, pp. 26-29

AGD Impact Limit Unintended Outcomes

Putting Premortem Ethics Into Practice: Improving Colleague Relations by Thinking Ahead

Donald Patthoff, DDS, MAGD and David Ozar, PhD

August 2014, pp. 26-29

AGD Impact Putting Premortem Ethics into Practice

Exploring Preventive Ethics in Dentistry: Viewing Colleagues in a Competitive World

Donald Patthoff, DDS, MAGD and David Ozar, PhD

August 2015, pp. 21-23

AGD Impact Preventative Ethics in Dentistry

Needs, Wants, and Dialogue: Doctor-Patient Collaboration Is Key for Ideal Care

Donald Patthoff, DDS, MAGD and David Ozar, PhD

October 2015, pp. 28-31

AGD Impact Needs, Wants, and Dialogue

Looking Inward: Determining What Professionalism and Self-Formation Mean to Us

David Ozar, PhD and Donald Patthoff, DDS, MAGD

February 2016, pp. 20-23

AGD Impact Looking Inward

Creating Opportunities for Meaningful Ethics Dialogue: What Dentists Should Know about Effective Ethics Conversations

David T. Ozar, PhD and Donald Patthoff, DDS, MAGD

March 2016, pp. 29-31

AGD Impact Creating Opportunities for Meaningful Ethics Dialogue

A series of ethical dilemmas was published in the Texas Dental Journal between 1993 and 2005. The lead author of these dilemmas, Dr. Thomas K. Hasegawa, died tragically in 2005. The dilemmas remain an important legacy for dentistry. Use the index below for links to PDF files of each dilemma.
  • Format. Each ethical dilemma was originally introduced in one issue of the Texas Dental Journal with the question, “What would you do?” The more expansive analysis of the dilemma was presented in a subsequent issue. The second page of each dilemma file depicts the cover of the issue containing the analysis of the dilemma, not the issue containing the briefer introduction to the dilemma. The ethical dilemmas were compiled for digital use by the American College of Dentists in 2008. The ethical dilemmas are no longer available on compact disc (CD), see the download links below.
  • Purpose. These ethical dilemma are only meant to further your knowledge and understanding of dental ethics by presenting, discussing, and analyzing hypothetical ethical dilemmas that may occur in dental settings. The dilemmas are not intended to: a) provide legal advice; b) provide advice or assistance in the diagnosis or treatment of dental diseases or conditions; or c) provide advice or assistance in the management of dental patients, practices, or personnel.
  • Terms of Use. To use the digital ethical dilemmas in the series you must first agree to the Terms of Use. By using the dilemmas, any or all in the series, you are affirming your acceptance of said Terms of Use and your concurrence with the Purpose presented immediately above.
  • Permission. The ethical dilemmas are used with the permission of the Texas Dental Journal.
  • Support. Support the American College of Dentists for more information about this digital series of ethical dilemmas.

Index of Ethical Dilemmas

Click on the links below for PDF files of the individual dilemmas. Please note—the files are somewhat large and may take a few minutes to open.
No. Dilemma Title Author(s) Issue
1 Is Mom Losing It? Thomas K. Hasegawa, Jr., DDS (September 1993), 110(9), 17-18
2 Dr. Boley’s Dilemma Thomas K. Hasegawa, Jr., DDS (October 1993), 110(10), 47-49
3 “Let’s pull it, Mom” Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Gary Coleman, DDS, MS, consultant (December 1993), 110(12), 27-29
5 Confidentiality for a Pregnant Adolescent? Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (February 1994), 111(2), 23-25
6 “…the pain is really bad and I need something (Percodan) NOW!” Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Tommy Gage, DDS, PhD, consultant (March 1994), 111(3), 39-42
7 “I want the whitest teeth!” Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (April 1994), 111(4), 37-40
8 “I don’t want to lose my tooth” Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (May 1994), 111(5), 48-50
9 Will You Stand Behind Your Work? Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (June 1994), 111(6), 52-54
10 The Patient’s (Fraudulent) Request Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Carl D. Ellis, DDS, consultant (July 1994), 111(7), 35-37
11 “Skip the gum work and start the bridges” Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Carl D. Ellis, DDS, consultant (September 1994), 111(9), 49-51
12 Conflict, Collusion or Collaboration: Who Benefits from a Referral? Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Carl D. Ellis, DDS, consultant (October 1994), 111(10), 43-45
13 The Dental Assistant and Substance Abuse Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Carl D. Ellis, DDS, consultant (November 1994), 111(11), 60-63
14 Radiation Treatment Dilemma Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Neil L. Frederiksen, DDS, PhD, consultant (December 1994), 111(12), 42-45
15 The Painful Diagnostic Dilemma Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant John W. Harrison, DMD, MS (January 1995), 112(1), 50-53
16 Carole’s Unexpected Pulpitis Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant E. Steven Duke, DDS, MSD, consultant (February 1995), 112(2), 81-85
17 “Crank it up!” Patient Seeks a “High” from Nitrous Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Bryan N. Henderson II, DDS, consultant (March 1995), 112(3), 56-59
18 The Friendly, Litigious Patient Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Mark J. Hanna, JD, consultant (April 1995), 112(4), 43-47
19 Overtreatment or Appropriate Treatment? Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (May 1995), 112(5), 37-41
20 The Patient Who Sexually Harasses the Dental Staff Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (June 1995), 112(6), 35-39
21 Clinical Requirements and Dental School Blues Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (July 1995), 112(7), 47-51
22 Ethics of Managed Dental Care Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (September 1995), 112(9), 45-48
23 “I Just Can’t Bear to See Him Anymore” Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (October 1995), 112(10), 69-72
24 Confidentiality for an Eating Disorders Patient Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Barbara Altshuler, RDH, MS (November 1995), 112(11), 72-75
25 Dental Clinical Examining Board Dilemma Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (December 1995), 112(12), 44-46
26 “Should we throw this (avulsed) tooth away?” Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Eddy Tidwell, DMD, MS, consultant (February 1996), 113(2), 62-64
27 Trade or Profession—The Ethics of Advertising Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (March 1996), 113(3), 70-72
28 “You’re the Doc, I trust you…just do it!” Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (April 1996), 113(4), 113-114
29 The Patient Fractures His (RCT) Tooth—Who Is Responsible? Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant John W. Harrison, DMD, MS (May 1996), 113(5), 47-48
30 Headache/Orofacial Pain Diagnostic Dilemma Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Richard Harper, DDS, FRCD(C), consultant (June 1996), 113(6), 71-74
31 “Is it cancer?” Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant John M. Wright, DDS, MS, consultant (July 1996), 113(7), 45-47
32 Retailing Vitamins in the Dental Office Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant Jeffry R. Hill, JD, consultant (September 1996), 113(9), 60-62
33 Bad News Bearers Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant John M. Wright, DDS, MS, consultant (October 1996), 113(10), 32-62
34 The Specialist’s Gift Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD, consultant (January/February 2001), 118(1), 84-87
35 The Patient’s Errant Checkbook Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD Lloyd A. George, DDS, Med, JD (April 2001), 118(3), 273-276
36 The Endodontist’s Painful Dilemma Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD Bruce Peltier, PHD David Witherspoon, BDSc, MS, BEcon (July 2001), 118(7), 559-562
37 Ethical Issues of Domestic Violence Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD Marylou Gutmann, BSDH, MA (October 2001), 118(10), 988-992
38 Sensitive (Ethical) Issues for the Periodontist Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD Thomas W. Stanford, Jr. DDS, MS (January 2002), 119(1), 85-87
39 Caring for the Child—The Pediatric Dentist’s Dilemma Thomas K. Hasegawa, Jr., DDS Merrill Matthews, Jr., PhD Alton McWhorter, DDS, MS (April 2002), 119(4), 359-361
40 Plaque, Puberty, and Noncompliance—the Orthodontic Dilemma Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD Reginald Taylor, DMD, DMSc (July 2002), 119(7), 645-647
41 Pregnancy, X-rays and Risks—The Radiology Dilemma Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD Neil Frederiksen, DDS, PhD (October 2002), 119(10), 1049-1051
42 “Grin and Bear It”—The Frustrated Denture Wearer Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD Ronald D. Woody, DDS (January 2003), 120(1), 101-103
43 Anxious (Patient) About Amalgam Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD Marvin Hirsh, DDS (April 2003), 120(4), 365-367
44 When the File Breaks Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD Gerald Glickman, DDS, MS (July 2003), 120(7), 607-609
45 “Doc, if you can’t stop smoking, why should I?” Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD Vendrell Rankin, DDS Sarah S. Pollex, MPH (October 2003), 120(10), 991-993
46 “I’m sure it’s all right (swallowed/aspirated casting?)” Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD David M. Grogan, DDS, MSD (January 2004), 121(1), 99-101
47 Friend or Patient…or Both? Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD David M. Grogan, DDS, MSD (April 2004), 121(4), 329-331
48 Who Cares for the Incompetent Patient? Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD Michael Reed, DDS (July 2004), 121(7), 616-619
49 Extreme Makeover—We Want Her to Be a Winner Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD Charles W. Wakefield, DDS (October 2004), 121(10), 995-998
50 The Impaired Practitioner—Intervene or Report Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD JoAnn Scofield, RDH, MS Holly Johnston, LMSW (January 2005), 122(1), 101-103
51 Dealing with Uncertainty—Bisphosphonate-related Osteonecrosis Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD David M. Grogan, DDS, MSD (April 2005), 122(4), 385-387
52 Transferring Records of the Demanding Patient Thomas K. Hasegawa, Jr., DDS, MA Merrill Matthews, Jr., PhD Bruce Peltier, PhD, MBA (July 2005), 122(7), 683-685
The Dental Ethics Survey was created for professors to use with their students in dental school.
  • For professors–in order to receive your students’ responses, please complete the course registration form below.
  • For students–please click here to register for and enter the survey.

Click here to take the Dental Ethics Course Registration.

Influencers in Dentistry_Gravholt, et al

The Ethics Library was established at the Kennedy Institute of Ethics in 1973 with funding from the Joseph P. Kennedy, Jr. Foundation to support research projects at the Institute, such as the first edition of the Encyclopedia of Bioethics and the NLM-sponsored compilation of the annual Bibliography of Bioethics and its counterpart database, BIOETHICSLINE®.

bioethics.georgetown.edu

Reopening, Risks, Responsibilities, and Re-evaluation
Pandemics and Dental Practices: Ethical Challenges

The Core Values and Aspirational Code of Ethics of the American College of Dentists were first developed in 1996 and can be saved to your computer or printed.

Aspirational Code of Ethics