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Principles of Ethics with official advisory opinions
reports of councils and bureaus
Principles of Ethics with official advisory opinions
J U D IC IA L C O U N C IL
T h e Association’s Principles of Ethics, although presented in the form of general guides, clearly suggests the conduct which a dentist is expected to follow in carrying out his professional activities whether they be related to his patients or to fellow practitioners. It should be kept in mind that the Principles are aimed primarily at upholding and strengthening dentistry as a full-fledged member of the learned professions. T h e dentist constantly should remind himself that the ethics of dental practice, the basic system for self-regulation of the dental profession, grow out of the obligations inherent in the practice of a profession. The dentist should reflect constantly upon the professional characteristics of his occupation. They are: 1.
T h e provision of a service (usually personal) which is essential to the health
and well-being of society. 2. T h e necessity of intensive education and training to qualify as competent to provide the essential service. 3. The need for continuing education and training to maintain and improve pro fessional knowledge and skills. 4. The need for j’ oining with professional colleagues in organized efforts to share new knowledge and new developments of professional practice. 5. Dedication to service rather than to gain or profit from service. Following are the Principles of Ethics, as revised November 1962, integrated with the advisory opinions of the Judicial Council handed down between October 1951 and June 1962.
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Section 1. Education Beyond the Usual Level.— T h e right of a dentist to profes sional status rests in the knowledge, skill and experience with which he serves his patients and society. Every dentist has the obligation of keeping his knowledge and skill freshened by continuing educa tion through all of his professional life. A D V IS O R Y O P IN IO N
T h e a w a rd in g o f certificates to dentists w h o co m p le te p ostg ra d u a te courses does n o t b rin g the c o m p o n e n t society o r the recip ien t dentists in co n flict w ith the Principles o f Ethics. D e n tists sh ou ld b e en co u ra g e d to con tin u e their p rofession a l ed u ca tion .
Section 2. Service to the Public.— The dentist has a right to win for himself those things which give him and his family the ability to take their proper place in the community which he serves, but there is no alternative for the pro fessional man in that he must place first his service to the public. The dentist’ s primary duty of serving the public is discharged by giving the highest type of service of which he is capable and by avoiding any conduct which leads to a lowering of esteem of the profession of which he is a member. A D V IS O R Y O P IN IO N S
1. Im p r in tin g o f a dentist’ s nam e o n favors d istribu ted to p atien ts m ig h t ten d to low er p u b lic esteem fo r the p rofession an d sh ould be d iscou rag ed. 2. I t is u n eth ica l fo r a dentist to display his fees o n a fo r m in his w a itin g r o o m . T h is p ra ctice is u n d ig n ifie d an d w ill lo w e r p u b lic esteem fo r the profession. 3. T h e use o f profession a l letterheads in c o n n e ctio n w ith a dentist’s efforts to p ro m o te a com m ercia l end eav or, such as the sale o f oil leases, is u n d ig n ified an d m igh t ten d to low er p u b lic esteem fo r the p rofession. 4. A lo c a l so cie ty ’s an n ou n cem en t in the p u b lic press o f the availability o f a b u d g et p aym en t d en tal care p lan sh ou ld be dignified. It w o u ld be u n dig n ified fo r the a n n ou n ce
m en t to list the nam es o f the dentists p a rtici p a tin g in th e plan. 5. It is u n eth ica l fo r a dentist to in form his p atien ts o n reca ll cards o r otherw ise that he w ill ren d er certain services free o f ch arge. T h is p ra ctic e m ay w ell lead to a low erin g o f p u b lic esteem . In ad d ition , the o ffe r o f any typ e o f free service is a m isrepresentation if the cost o f such service is re co v e re d in d irectly by a d d in g that cost to fees ch arg ed fo r other services. 6. I t w o u ld b e u n eth ica l fo r a dentist to sell to his p atien ts at a p rofit articles such as tooth brush es. S ection 2 o f the Principles of Ethicss en titled “ S ervice to the P u b lic,” g o v erns this situation b y its general p roh ib ition against c o n d u c t that m ay lea d to the low erin g o f th e d en ta l profession ’ s esteem. 7. A dentist w h o perm its his professional id en tifica tion to b e a p rom in en t p art o f an ad vertisem en t in co n n e ctio n w ith a n o n p rofes sion al co m m e rcia l en d ea v or is in v iola tion o f S ection 2 o f the Principles of Ethics. S u ch c o n d u c t w o u ld certain ly ten d to low er the dental p ro fe ssio n ’ s esteem . 8. It is the o p in io n o f the J u d icia l C o u n cil that a dentist w h o allow s use o f his o ffice or his p e rso n as part o f a television advertisem ent is a c tin g co n tra ry to the spirit o f this section, if n o t in d irect v io la tion o f it.
Section 3. Government of a Profession. — Every profession receives from society the right to regulate itself, to determine and judge its own members. Such regula tion is achieved largely through the in fluence of the professional societies, and every dentist has the dual obligation of making himself a part of a professional society and of observing its rules of ethics. A D V IS O R Y O P IN IO N
N one.
Section 4. Leadership.— The dentist has the obligation of providing freely of his skills, knowledge and experience to so ciety in those fields in which his qualifica tions entitle him to speak with profes sional competence. T h e dentist should be a leader in his community, especially in all efforts leading to the improvement of the dental health of the public.
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A D V ISO R Y O P IN IO N
N on e.
Section 5. Emergency Service.— T h e dentist has an obligation when consulted in an emergency by the patient of an other dentist to attend to the conditions leading to the emergency and to refer the patient to his regular dentist who should be informed of the conditions found and treated. A D V ISO R Y O P IN IO N
N on e.
Section 6. Use of Auxiliary Personnel.— The dentist has an obligation to protect the health of his patient by not delegat ing to a person less qualified any service or operation which requires the profes sional competence of a dentist. The den tist has a further obligation of prescrib ing and supervising the work of all auxiliary personnel in the interests of rendering the best service to the patient. A D V ISO R Y O P IN IO N
I t is u n eth ica l fo r a dentist to d elega te to a lay person the fu n c tio n o f taking im pressions o f the m o u th in cid e n t to the co n stru ctio n o f ath letic m o u th guards.
Section 7. Consultation.— The dentist has the obligation of seeking consultation whenever the welfare of the patient will be safeguarded or advanced by having recourse to those who have special skills, knowledge and experience. A consultant will hold the details of a consultation in confidence and will not undertake treat ment without the consent of the attend ing practitioner. A D V ISO R Y O P IN IO N
N one.
Section 8. Unjust Criticism and Expert Testimony.— The dentist has the obliga
tion of not referring disparagingly to the services of another dentist in the presence of a patient. A lack of knowledge of con ditions under which the services were afforded may lead to unjust criticism and to a lessening of the patient’s confidence in the dental profession. I f there is indis putable evidence of faulty treatment, the welfare of the patient demands that cor rective treatment be instituted at once and in such a way as to avoid reflection on the previous dentist or on the dental profession. T h e dentist also has the obli gation of cooperating with appropriate public officials on request by providing expert testimony. A D V ISO R Y O P IN IO N
In a m a lp ra ctice suit b o th parties have a right to present e x p ert testim ony th rou g h witnesses. A dentist a c tin g as a witness sh ould n ot be d iscip lin ed m erely fo r presen tin g his p rofes sional op in ion .
Section 9. Rebates and Split Fees.— The dentist may not accept or tender “ re bates” or “ split fees.” A D V ISO R Y O P IN IO N S
1. A fee arran gem en t betw een dentists w h ich is n ot d isclosed to the p atien t constitutes fee-splittin g an d is un eth ical. 2. W h ere a v eteran receiv es dental care at the expense o f the fed era l gov ern m en t, the fa ilu re to disclose to the veteran a V .A . ap p ro v e d fee arran gem en t betw een the general p ra ctition er an d a sp ecialist does n ot c o n stitute fee-splittin g. 3. A fee arran g em en t betw een a dentist an d an anesthesiologist w h ic h is fu lly disclosed to the p atien t is n o t un eth ica l. (T h is op in ion is based u p o n the equ iva len t section o f the 1950 Principles. U n d e r the Principles as re v ised in 1955, it w o u ld seem that each p ra c titioner sh ou ld su bm it a b ill fo r his services d irectly to the p atien t to a v oid un eth ica l p ra c tice. ) 4. A dentist w h o p urch ases a deceased dentist’ s p ra ctic e a n d agrees to p a y to the w id o w o r the estate a p ercen ta g e o f the fees c o lle cte d fr o m p atien ts o f r e co r d o f the d e ceased dentist fo r a lim ited p e rio d o f tim e is
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n o t in v io la tio n o f S ection 9 o f the Principles of Ethics. T h is type o f arrangem ent m ay, h ow ever, b e in v io la tio n o f som e o f th e state den tal p r a c tic e acts. 5. A d en tist w h o purchases a p ra ctice fro m a retirin g dentist m ay p ro p erly agree to p ay to the latter a p e rcen ta g e o f the fees receiv ed fro m the re tir in g dentist’ s patients o f r e co r d fo r a lim ite d p e rio d o f tim e. A g a in , this type o f arran g em en t m ay b e in v io la tio n o f som e state d en ta l p ra ctice acts. 6. A dentist w h o agrees to p a y to an oth er dentist a p e rce n ta g e o f his fees as part o f an a greem en t c o v e rin g the sharing o f o ffice fa cili ties is n ot in v io la tio n o f the p roh ib ition s w ith in S e ctio n 9 o f the Principles of Ethics against split fees a n d rebates. A g a in , this arran ge m en t m ay b e in v io la tio n o f som e state dental p ra ctice acts. 7. D en tists in partn ership m a y use any reason able fo r m u la fo r d eterm in in g h o w p a rt nership p rofits m ay b e d iv id e d a m o n g p a rt ners. I n partn ersh ip p ra ctice the distribu tion o f p artn ersh ip rev en u e is outsid e the scop e a n d a p p lic a tio n o f the ethical p ro h ib itio n against “ sp lit fees” so lo n g as there is a reason able re la tio n o f service p e rfo rm e d to the a m ou n t draw n by e a ch partner.
Section 10. Secret Agents and Exclusive Methods.— T h e dentist has an obligation not to prescribe, dispense or promote the use of drugs or other agents whose com plete formulae are not available to the dental profession. H e also has the obli gation not to prescribe or dispense, ex cept for limited investigative purposes, any therapeutic agent, the value of which is not supported by scientific evidence. The dentist has the further obligation of not holding out as exclusive, any agent, method or technic. A D V IS O R Y O P IN IO N S
1. W h e r e a dentist induces a n ew spaper to p u b lish an article d escribin g the dentist’ s tra in in g a n d ex p e rie n ce w ith a n e w te ch n ic n ot yet used b y o th er practition ers in the c o m m unity, th a t c o n d u c t is un ethical. (T h is w o u ld also b e in v io la tio n o f S ection 12, e n titled “ A d v e r tisin g .” ) 2. T h e use o f hyp notism b y dentists does n o t o f itself co n flict w ith the Principles o f
Ethics.
Section 11. Patents and Copyrights.— Th e dentist has the obligation of making the fruits of his discoveries and labors available to all when they are useful in safeguarding or promoting the health of the public. Patents and copyrights may be secured by a dentist provided that they and the remuneration derived from them are not used to restrict research, prac tice or the benefits of the patented or copyrighted material. A D V IS O R Y O P IN IO N
T h e m ere o b ta in in g o f a p aten t su ch as o n a d en tal ch a ir by a dentist is n o t un eth ical.
Section 12. Advertising.— Advertising re flects adversely on the dentist who em ploys it and lowers the public esteem of the dental profession. The dentist has the obligation of advancing his reputation for fidelity, judgment and skill solely through his professional services to his patients and to society. The use of adver tising in any form to solicit patients is inconsistent with this obligation. A D V IS O R Y O P IN IO N S
1. A dentist w h o arranges fo r a p a id new s p a p e r advertisem ent o f his “ D e n ta l C lin ic ” is en g a ged in u n eth ica l con d u ct. 2. A dentist in a specialist p ra ctice w h o in clu d es on his referral slips a m ap o r d ia gram o f his office lo ca tio n is m erely p ro v id in g h e lp fu l in fo rm a tion to the p atien ts o f referrin g dentists an d is n ot en g a ged in u n eth ica l c o n d u ct. 3. A dentist w h o ind uces, o r agrees to, the p u b lica tio n o f an article in a lo c a l new spaper praising him fo r h a vin g a research fin d in g p u b lished in a p rofession a l jo u r n a l is en g a ged in u n e th ica l co n d u ct. 4. A dentist w h o actin g in his o w n b eh a lf in d u ces the p u b lica tio n o f a n ew spa per article d escribin g his activities as a lea d er o f the loca l society ’s C h ild re n ’ s D en ta l H e a lth D a y a c tivity is e n g a ged in u n eth ica l c o n d u c t. 5. A dentist w h o places a n o tic e in a lo c a l n ew spa per that he is lea v in g tow n to take a p ostg rad u a te course in dentistry is en g a g e d in u n eth ica l con d u ct.
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6. I t is n o t u n e th ica l f o r a lo c a l dental society to p u rch ase in stitu tion al a d vertisin g to c ou n te ra ct the a d vertisin g o f u n eth ica l d en tists. S u ch a p ra ctice , h o w e v e r, m a y n o t b e in g o o d taste. 7. A d ign ified p a id an n o u n ce m e n t o f the availa bility o f a b u d g e t p a y m en t d en ta l care p lan is n o t u n eth ica l, i f the p lan a n d the an n ou n cem en t are a p p ro v e d b y the lo c a l dental society. 8. A dentist w h o perm its his na m e to b e used in a d en tal h ea lth e d u ca tio n p a m p h le t to b e distribu ted to the p u b lic at la rg e by a c om m e rcia l firm is e n g a g e d in u n eth ica l c o n d u ct. 9 . A dentist w h o issues a new s release link in g him self to n e w ad van ces in dentistry is en g a ged in u n e th ica l c o n d u c t. N ew s releases co n ce rn in g achievem ents o f dentistry sh ou ld c o m e fr o m d en tal societies o r oth er a p p ro p ria te p rofession a l sources. 10. A dentist w h o an n ou n ces the e m p lo y m ent o f a d en tal hygienist to all dentists an d p hysicians o f the c o m m u n ity is en g a g e d in u n eth ica l co n d u ct. 11. A dentist w h o ind icates o n a p ro m in e n t sign outside an un fin ish ed b u ild in g th at he in tends to re lo ca te his p ra ctic e there is en ga ged in u n eth ica l c o n d u c t. 12. T h e d escrip tion o f a sch o o l dentist’ s w ork in a new s article is n o t necessarily the equ iva len t o f advertisin g, b u t it is advisable th at su ch articles b e c le a re d b y the lo c a l so ciety in a d v a n ce o f p u b lica tio n . 13. A dentist is n o t p ro h ib ite d b y ethics fr o m en g a gin g in an activity such as that o f a r a d io “ sports-caster,” b u t h e sh ou ld n o t give u n d u e em phasis to his id e n tity as a p ra ctic in g dentist. I t is advisable, also, fo r a dentist to con su lt w ith his lo c a l so cie ty b e fo re u n d ertak in g su ch an activity. 14. A dentist w h o distributes h is p ro fe s sion al cards to a ll persons elig ible f o r dental care u n d er a g ro u p h ea lth care p la n , in c lu d in g m an y persons n o t his p atien ts o f r e c o r d , is en g a ged in u n eth ica l c o n d u c t ev en th ou g h he is the o n ly dentist w h o has ag reed to ren d er services to the g rou p . 15. I t is u n eth ica l fo r a specialist to dis t r ib u t e reprints o f his p u blish ed articles to a large segm ent o f g e n e ra l p ra ctition ers. T h is p ra ctice appears to b e an ob v iou s e ffo rt to solicit referrals b y in d ic a tin g su periority in the isp ecia l field. ' 16. I t is u n eth ica l fo r an e n d o d o n tist to fu rn ish so -ca lle d p atien t e d u ca tio n p am ph lets to general p ra ctition ers fo r d istribu tion to p a
tients w h ere the p a m p h lets, in effe ct, stress u n d u ly the su p eriority o f the p roced u res used b y end od ontists. It is the J u d icia l C o u n c il’s o p in io n that p u b lic a tio n o f su ch so-ca lled p a tient ed u ca tion m aterial has th e e ffe ct o f so lic itin g p atien ts in v io la tio n o f S e ctio n 12 o f the Principles. 17. A dentist w h o gives lectu res o r d em on strations b e fo re lay g rou p s o n a p articu la r te ch n ic (su ch as h y p n osis) w h ic h he em ploys in his p ra ctice is in v io la tio n o f S ection 12 o f the Principles o f Ethics. S u ch c o n d u c t is m erely a fo rm o f a d v ertisin g w h ic h im ports su periority ov er the d en tist’ s colleagues. 18. A dentist w h o arranges fo r the p u b lic a tion o f a n ew spa per a rticle o n his use o f h y p nosis in his d en tal p r a c tic e is in v io la tion o f S e ction 12 o f the Principles of Ethics w h ich p roh ibits a d vertisin g b y dentists. 19. T h e p u b lic a tio n o f a list o f dentists w h o h ave a greed to p a rticip a te in a g rou p d ental care p lan a p p ro v e d b y the state dental society to those w h o are elig ib le fo r care un der the p lan w o u ld n o t result in a v io la tion o f S ection 12 o f the Principles o f Ethics g ov ern in g advertising. 20. A dentist w h o in clu d es on his an n o u n cem en t cards la n g u a g e w h ic h im plies that his use o f a d en tal h y g ien ist m akes h im a su perior p ra ctition er is in v io la tio n o f Sections 12 an d 13 o f the Principles of Ethics.
Section 13. Cards, Letterheads and A n nouncements.— A dentist may properly utilize professional cards, announcement cards, recall notices to patients of record and letterheads when the style and text are consistent with the dignity of the pro fession and with the custom of other den tists in the community. Announcement cards may be sent when there is a change in location or an altera tion in the character of practice, but only to other dentists, to members of other health professions and to patients of record.
A D V IS O R Y O P IN IO N S
1. A dentist w h o invites his patients o f re co rd , oth er dentists a n d physicians to an “ o p e n hou se” in c o n n e c t io n w ith the estab
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lishm ent o f a n ew o ffice is n ot e n g a ged in u n eth ica l con d u ct. 2. A dentist w h o im prints fla m boya n t p ic tures a n d descrip tive m aterial o n his office stationery is e n g a ged in u n eth ica l co n d u ct. 3. A specialist w h o entertains general p ra c titioners fr o m w h o m he expects referrals is n o t en g a g e d in un eth ical co n d u ct. 4. It is u n eth ica l fo r a dentist to send an n ou n cem en t cards to the p u b lic-a t-la rg e . 5. It is n o t u n eth ica l fo r a dentist w h o has retu rn ed fr o m m ilitary service to send an n ou n cem en ts to his fo rm e r patients. 6. W h e r e a dentist purchases o r takes ov e r the p ra ctic e o f an oth er dentist w h o is retiring, it is n o t u n eth ica l to send an nou ncem en ts to the retirin g dentist’s p atien ts o f r e co rd . 7. A dentist w h o has p u rch ased a p ra ctice fr o m a retirin g dentist m ay p ro p e rly n o tify all p atien ts o f r e co r d o f the retirin g dentist o f the ch a n g e. B ut it w o u ld b e u n eth ica l fo r the new dentist to send reca ll cards at a later d ate to those w h o d id n o t definitely in d ica te th at they w ish ed to b e a cce p te d in to the n ew dentist’ s p ra ctice. T h a t p art o f S ection 13 o f the Principles p erm ittin g an n ou n cem en ts w h ere there is a ch a n g e in the ch a ra cte r o f p ra ctice w o u ld n ot p erm it a dentist to an n ou n ce to his patien ts o f r e c o r d o r o th e r dentists an d p h ysician s that he is qu alified to p e rfo rm oral reh a b ilita tion o r that he is using a n ew te ch n ic in his p ra ctice . N eith er o f these constitutes a ch a n g e in the ch aracter o f p ra ctice w ith in the m ea n in g o f S e ctio n 13 o f the Principles. 8.
o f Ethics
9. I t is the J u d icia l C o u n cil’ s o p in io n that the use o f p ictu res an d sym bols o n professional stationery sh ou ld b e d iscou rag ed. T h e use o f a sm all p ictu re o n a dentist’ s letterh ea d sym b o liz in g a ch ild re n ’ s p ra ctice , h ow ever, is not un eth ica l i f co m m u n ity custom p erm its such usage. 10. I t is un eth ical fo r a dentist to send an n ou n cem en ts to the p rofession -at-large in his c om m u n ity that he has the facilities an d is com p e te n t to adm in ister a p articu la r type o f an esth etic. S u ch an an n ou n cem en t, m oreov er, sh ou ld n ot b e sent even o n a lim ited basis since the use o f a n ew te ch n ic is n o t a ch an ge in the ch aracter o f p ra ctice w ith in the m ean in g o f that part o f S ection 13 w h ich perm its an n ou n cem en ts o n a lim ited basis w h ere there is a ch a n g e in the ch aracter o f p ra ctic e (fo r ex am p le, fr o m general p ra ctice to a sp e c ia lty ). B roa d scale an nou ncem en ts, fu rth erm ore, are im p r o p e r an d un eth ica l becau se they op e n ly solicit patients an d referrals, in this case o n the basis o f a claim o f superiority.
11. A dentist m ay insert a p a id a n n ou n ce m e n t o f his dental p ra ctice in a lo ca l new s p a p e r o n a restricted basis o n ly w h ere such m e th o d o f co m m u n ica tin g in form a tion is d e e m e d in th e best interests o f the p u b lic an d the p rofession as d eterm in ed b y the a p p ro p ria te co m p o n e n t dental society.
Section 14. Office Door Lettering and Signs.— A dentist may properly utilize office door lettering and signs provided that their style and text are consistent with the dignity of the profession and with the custom of other dentists in the community. A D V ISO R Y O P IN IO N S
1. A lth o u g h com m u n ity cu stom m ainly d e term ines th e p ro p e r use b y dentists o f office d o o r letterin g an d signs, n o dentist m ay p ro p e r ly use an office sign w h ic h is clearly u n d ig n ifie d an d ou t o f k eep in g w ith p rofes sion al en d eavor. 2. A sm all sign on the fa ce o f a b u ild in g id e n tify in g it as the “ .................................................. D e n ta l B u ild in g ” is n ot u n eth ica l unless c o m m u n ity cu stom proh ibits su ch designations. 3. I t is the o p in io n o f the J u d icia l C o u n cil th at a c o m p o n e n t society m ay d eterm in e c o m m u n ity cu sto m to p roh ib it dentists fr o m using flo o d lig h ts to d ra w a tten tion to their nam e p lates o n th e outside o f th eir p riv a te p ra ctice fa cilities. C o m p o n e n t societies sh ou ld be aw are, fu rth erm ore, that the state d en tal p ra c tice acts o rd in a rily establish regulations on the use o f o ffice d o o r letterin g an d signs.
Section 15. Use of Professional Titles and Degrees.— A dentist may use the titles or degrees, Doctor, Dentist, D .D .S ., or D .M .D ., in connection with his name on cards, letterheads, office door signs and announcements. A dentist who has been certified by a specialty board for one of the specialties approved by the Am er ican Dental Association may use the title “ diplomate” in connection with his spe cialty on his cards, letterheads and an nouncements if such usage is consistent with the custom of dentists of the com munity. A dentist may not use his title or degree in connection with the promo
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tion of any drug, agent, instrument or appliance. Th e use of eponyms in connection with drugs, agents, instruments or appliances is generally to be discouraged. A D V ISO R Y O P IN IO N S
1. T h e Principles of Ethics p erm it dentists to use the titles “ d o c t o r ” or “ dentist” o r the degrees “ D .D .S .” o r “ D .M .D .” in c o n n e ctio n w ith their nam es o n cards, letterheads, o ffice d o o r letterin g o r signs. T h e use o f o th e r titles, su ch as “ dental su rg eon ” o r “ su rgeon d en tist,” is un eth ical. 2. A dentist m ay p e rm it his na m e to be used to id e n tify a d en tal instrum ent so lo n g as his d egree o r title is n o t a d d e d to that id en tifi ca tio n . 3. A dentist w h o perm its his na m e w ith title o r d e g re e to b e used in circu la rs an d o th er m aterial advertising a p ro d u c t, such as a d e n ture cleanser, is p ro m o tin g a dental p r o d u c t in v io la tio n o f the Principles of Ethics. 4. A p ra ctic in g dentist w h o identifies h im self b y title o r d e g re e in m aterial p ro m o tin g the p ro d u cts o f a d en ta l su pp ly hou se o w n e d o r m a n a ged by that dentist is en g a g e d in u n eth ica l co n d u ct. 5. A dentist w h o m erely d em on strates a new p ie ce o f dental eq u ip m e n t w ith in a c o m m ercia l e x h ibit at a profession a l m eetin g is n o t e n g a ged in u n eth ica l c o n d u c t. 6. T h e use o f the title “ D ip lo m a te o f . . .” on o ffice d o o r letterin g o r signs is n o t p e r m itted. 7. T h e lim itations o n the use o f titles an d degrees in c o n n e ctio n w ith a dentist’ s na m e o n cards, letterheads, an n ou n cem en ts an d signs sh ou ld be strictly observed . A dentist sh ou ld n o t spell o u t his d egree, “ D o c t o r o f D e n ta l Surgery” or “ D o c to r o f D e n ta l M e d ic in e ,” w ith his na m e o n office d o o r lettering. S e ctio n 15 o f the Principles perm its the use o f the abbreviation s o f these degrees. 8. A dentist w h o distributes to a sub stantial segm ent o f the p rofession -at-larg e re prints o f his articles la u d in g a p a rticu la r tra de na m e d en tifrice is p ro m o tin g a d en tal p r o d u c t in v io la tio n o f S e ctio n 15 o f the Principles of
Ethics. 9. A dentist w h o p articip a tes in a d en tal m otio n p ictu re film sp on sored b y a c o m m e r cia l film co m p a n y in w h ic h he has a fin an cial interest w ill b e in v io la tio n o f S ection 15 o f the Principles of Ethics if h e is id en tified by nam e an d title o r d egree.
10. P erm itting a co m m e rcia l p u b lic a tio n to re p rin t an article origin a lly p u b lish ed in an officia l dental society p u b lic a tio n sh ou ld be d iscou rag ed b y con stitu en t an d c o m p on en t societies. In effect this p ra ctice m ig h t p u t th e author o f su ch a rep rin ted article in the p osition of le n d in g his na m e w ith title o r d eg ree to the p ro m o tio n o f a dental p ro d u c t in v io la tion o f S e ction 15 o f the Principles. 11. A dentist w h o au th orizes o r perm its a co m m ercia l firm in th e d en ta l field to dis tribute reprints o f his scien tific articles to a substantial n u m b er o f dentists on a n ation al basis m ay, in effect, b e p ro m o tin g a dental p ro d u c t in v iola tion o f S ection 15 o f the
Principles. 12. A lth o u g h the H ou se o f D elegates has re co m m en d ed that p ostg ra d u a te courses for dentists sh ou ld be c o n d u c te d u n d er th e aus p ices o f r ecog n ized ed u ca tio n a l institutions, hospitals an d dental societies (Trans. 19 51: 1 8 0 ), that p o lic y has n ot b e e n in co rp o ra te d in the Principles o f Ethics. I t is the J u d icia l C o u n c il’s o p in io n th erefore, that S ection 15 o f the Principles does n o t p roh ib it a dentist from p a rticip a tin g in a scien tific o r professional p resentation u n d er the sponsorsh ip o f a c o m m ercial c on cern , unless that dentist’ s p a rticip a tion does, in effe ct, p ro m o te the p r o d u c t or p ro d u cts o f the sp on sorin g co m m e rcia l c o n cern. 13. T h e p u b lica tio n o f a dentist’ s nam e w ith title o r d egree as o n e o f the au th ors o f a p a m p h let advertisin g business form s fo r sale to dentists is, in effe ct, th e use o f that d en tist’ s p rofession a l p restige to p ro m o te a c o m m ercial en d ea v or in v io la tio n o f S ection 15 of the Principles. 14. A dentist e m p loy ed fu ll-tim e as re search d irector o f a d en tal su p p ly firm m ay n o t sign his na m e w ith title o r d eg ree to letters o r circulars p ro m o tin g th e p ro d u c ts o f his em ployer. S u ch c o n d u c t is, in the o p in io n of the J u d icia l C o u n cil, in v io la tion o f S ection 15 o f the Principles. 15. A dentist w h o perm its a d en tal supply h ouse to use a tap e r e co r d in g o f the dentist’ s lectu re on p ra ctice ad m in istra tion b e fo r e other dentists is in v io la tio n o f S ection 15 o f the Principles of Ethics. T h is c o n d u c t w o u ld re sult in the use o f a dentist’ s p rofession a l id en ti fication in the p ro m o tio n o f a d en tal p rod u ct. 16. A dentist m a y eth ica lly c o m b in e the p ra ctice o f dentistry w ith th e p ra ctice o f o p tom etry . T h e J u d icia l C o u n c il believes, h ow ever, that the c o n d u c t o f a successful d en tal p ra ctice requires fu ll co n ce n tra tio n an d at
REPORTS O F C O U N C IL S A N D BUREAUS
ten tion an d advises against c o m b in in g a p ra c tice o f o p to m e try w ith dentistry. 17. T h e a cce p ta n ce by a dentist o f a p osi tion as ad v isory consu ltant to a co m m e rcia l c o rp o r a tio n is n o t p e r se a v io la tio n o f the Principles of Ethics. A dentist a c c e p tin g such a p osition m ust, in the o p in io n o f the J u dicial C o u n cil, b e constan tly alert so that his p ro fe s sional id en tifica tion is n o t used in the p ro m otio n o f a co m m e rcia l p r o d u c t o r endeavor. 18. I t is the m a jo rity o p in io n o f the J u d i cia l C o u n cil that a dentist m ay e th ically invest fu nds in an insurance c o m p a n y p ro v id in g d e n tal insurance, su bject, h o w e ve r, to the fo llo w in g lim ita tio n : It m ust be a b o n a fid e dental care p lan n o t lim ited to the investing dentists. T h e use o f the dentist’ s n am e in an y w ay to p ro m o te the p lan w o u ld b e un eth ical. 19. I t is the C o u n c il’ s o p in io n th at a dentist m ay eth ically display in his office pam ph lets o f a d en tal insurance c o m p a n y w h e n the plan is a b o n a fid e p lan an d n o t lim ited to investing dentists. I f the co m p a n y is n o th in g m o re than a g rou p o f dentists b a n d in g to ge th e r to solicit patients, it sh ould be d iscou rag ed . I f all d en tists m ay p a rticip a te, it is desirable an d ethical.
Section 16. Use of the Terms “ Clinic” and “Group Practice.”— Unless the use of the term “ clinic” has long been estab lished by the custom of dentists in a com munity as applicable to a dental practice, it is strongly recommended that the term “ clinic” be limited to designate public or quasi-public institutions established on a not-for-profit basis for the purpose of providing dental health care. The use of the term “group practice,” in accordance with the following definition, is recommended as applicable to a dental practice and as an alternative to the term “ clinic” when its use is consistent with existing statutes and the custom of the dentists in the community: Group practice is that type of dental practice in which ethical, licensed dentists, sometimes in association with members of other health professions, agree formally between themselves on certain central arrangements designed to advance the economical and efficient conduct of a dental practice in order to render an improved health service to the patient.
.V O L U M E 66, J A N U A R Y 1963 • 145/131
A D V ISO R Y O P IN IO N S
1. I t is the J u d icia l C o u n c il’ s o p in io n that a c o m p o n e n t o r constitu ent society m ay in clu d e in its c o d e o f ethics a p ro h ib itio n against the use o f “ g r o u p ” or “ g rou p p ra ctic e ” ' to id e n tify associates in a d en tal p ra ctice. T h e Principles p erm it the use o f “ g r o u p ” o r “ g rou p p ra ctic e ” on ly if su ch d esignations are n ot in co n flict w ith com m u n ity custom . 2. T h e J u d icia l C o u n c il reaffirm s its p rev i ous op in ion s that the use o f the term “ c lin ic ” to designate a p riv ate p ra ctic e fa cility should be d isco u r a g e d ; S ection 16 o f the Principles p erm its constitu ent o r c o m p o n e n t societies to p ro h ib it the use o f the term “ c lin ic ” to id en tify a p riv ate p ra ctice.
Section 17. Contract Practice.— A den tist may enter into an agreement with individuals and organizations to provide dental health care provided that the agreement does not permit or compel practices which are in violation of these Principles of Ethics. A D V ISO R Y O P IN IO N S
1. T h e p ra ctice o f dentistry u n d er con tra ct w ith, o r as an em ploy ee o f, a coop era tiv e h ealth p lan is n ot o f itself un eth ica l. T h e co o p e ra tiv e ’ s efforts to p ro m o te its dental benefits to the p u b lic, h ow ever, m ay in v olv e p a rticip a tin g dentists in u n eth ica l con d u ct. 2. T h e in clu sion o f a clause in a con tra ct betw een partners in a dental p ra ctice w h ich fo rb id s any partner w h o w ith d ra w s fr o m the d en tal partn ership fr o m lo c a tin g a new p r a c tice near the partn ersh ip ’ s lo c a tio n is n ot o f itself un ethical. 3. I t is the J u d icia l C o u n c il’ s o p in io n that the d efin ition o f “ fre e d o m o f c h o ic e ” in c o n n e ctio n w ith the d entist-patien t relation ship is p ro p e rly a m atter fo r a p o lic y statem ent by a constitu ent o r co m p o n e n t society ’s g ov ern in g b o d y . B ecause there m ay b e variation s in the d efin ition o f “ fre e d o m o f c h o ic e ” betw een an d a m o n g societies, h ow ever, it is p refera ble n o t to in clu d e the d efin ition o f this term w ith in a c o d e o f ethics. 4. U nless the p ra ctices an d p roced u res o f a dental care p lan requ ire a dentist p a rtici p a tin g in that p lan to v iola te the Principles of Ethics, p a rticip a tion in such a plan sh ou ld not be p ro h ib ite d by a c o m p o n e n t society as a v io la tio n o f p rofession a l ethics.
146/132 • THE J O U R N A L O F THE A M E R IC A N DENTAL A S S O C IA T IO N
Section 18. Announcement of Limitation of Practice.— Only a dentist who limits his practice exclusively to one of the spe cial areas approved by the American Dental Association for limited practice may include a statement of his limitation in announcements, cards, letterheads and directory listings (consistent with the cus toms of dentists of the comm unity), pro vided at the time of the announcement, he has met the existing educational re quirements and standards* set by the American Dental Association for m em bers wishing to announce limitation of practice or possesses a state license permit ting announcement in an area approved by the American Dental Association. In accord with established ethical rul ing that dentists should not claim or imply superiority, use of the phrases “ Spe cialist i n ........................ ” or “ Specialist on ......................” in announcements, cards, letterheads or directory listings should be discouraged. The use of the phrase “ Practice limited t o ......................” is pref erable.
*The follow ing are included within the standards of the American Dental Association fo r determining the educational experience and other appropriate require ments fo r announcing a lim ited practice: 1. The indicated area of dentistry must be one fo r which^ there is a certifying board approved by the American Dental Association. 2. The dentist's practice must be lim ited exclusively to the indicated area of dentistry. 3. The dentist must b e -a diplom ate of a certifying board approved by the American Dental Association for the indicated area of dentistry; or he must be a member of, or be e lig ib le fo r membership in, a specialty society officially related to a certifying board approved by the American Dental Association fo r the indicated area of dentistry; or he must have a state license in the indi cated area of dentistry if he practices within a state which licenses dentists who engage in specialty practice.
A D V ISO R Y O P IN IO N S
1. A dentist w h o indicates o n his cards and stationery that he specializes in “ oral m e d i cin e” o r any oth er field n o t re co g n ize d as a sp ecia lty by the A m e rica n D e n ta l A ssociation is en g a ged in un eth ical con d u ct. 2. D ire cto ry an nou ncem en ts an d o th er an n ou ncem ents o f a lim itation o f p ra ctice must co n fo r m to com m u n ity custom . 3. I t is the o p in io n o f the J u d icia l C o u n cil that a dentist m ay n o t p ro p e rly an n ou n ce that
he lim its his pra ctice to tw o sp ecia l fields o f dentistry. O n ly one special field m ay be an n ou n ced . 4. W h eth er a specialist in oral surgery m ay p rop erly em ploy a dental hygienist is not govern ed by the Principles o f Ethics. 5. It is the o p in io n o f th e J u d icia l C o u n cil that a constituent o r c o m p o n e n t society m ay d eterm in e com m un ity cu stom to requ ire that a dentist w h o announces him self as a specialist m ust lim it his p ra ctice to that specialty if such lim itation o f p ra ctice is requ ired fo r b oa rd certification in that specialty. [A ll o f the advisory op in ion s un der S ection 18 w ere h a n d ed d o w n b e fo re the 1960 revision o f the section. It is b e liev ed that all o f these op in ion s are still pertinent.]
Section 19. Directories.— A dentist may permit the listing of his name in a direc tory provided that all dentists in similar circumstances have access to a similar listing and provided that such listing is consistent in style and text, with the cus tom of the dentists in the community. A D V ISO R Y O P IN IO N S
1. Listings in teleph one d irectories should b e in g o o d taste an d co n fo r m to com m u n ity c u sto m ; d irectory listings m ust also c o n fo rm to those sections o f the Principles of Ethics c o n ce rn e d w ith an nou ncem en ts in general, sp ecialty an nou ncem en ts an d proh ibition s against advertising. 2. A n unusual m eth od o f listing a dental p ra ctice in a teleph one d irectory is n o t p e r m itted by the Principles of Ethics. 3. C o m m u n ity custom w ill determ in e w h eth er dentists m ay b e listed in directories publish ed by fraternal organizations or sim ilar groups. 4. I f com m u n ity custom perm its, specialists m ay be listed un der separate headings in tele p h o n e directories as lo n g as they are n o t also listed un der the general dentistry h eadin g. 5. U nless com m u n ity cu stom perm its, d en tists sh ou ld n o t list their nam es in the classi fied teleph on e directories fo r localities outside their residen ce or p ra ctice location s. 6. I f com m u n ity cu stom perm its, a dentist m ay in d icate in his telep h on e d irectory listing that h e is a m em ber o f the A m erica n D en tal A ssociation. 7. I t is n ot un eth ical fo r a dentist to use the d escrip tion “ ch ild ren ’s dentistry” rather than “ p e d o d o n tia ” in a te le p h o n e directory listing as lo n g as com m u n ity cu stom perm its that usage.
REPORTS O F C O U N C IL S A N D BUREAUS . . . V O LU M E 66, J A N U A R Y 1963 • 147/133
Section 20. Health Education of the Public.— A dentist may properly partici pate in a program of health education of the public involving such media as the press, radio, television and lecture, pro vided that such programs are in keeping with the dignity of the profession and the custom of the dental profession of the community. A D V IS O R Y O P IN IO N S
1. It is n o t u n eth ica l fo r a dentist to m ail h ealth e d u ca tio n p am ph lets to his patients o f record . 2. B efore a dentist initiates the p u b lica tio n o f a d en ta l h ea lth c o lu m n in a new spaper, it is ad visable fo r h im to seek the a p p rov a l o f his lo c a l a n d state dental societies. 3. A d entist has the righ t to speak ou t against the p o licie s espoused b y org an ized dentistry, in c lu d in g the righ t to m ake p u b lic p ron ou n cem e n ts against flu orid a tion . I t is u n eth ica l, h o w e v e r, fo r a dentist to represent his view s as those o f the d en tal society o r as those o f th e m a jo r ity o f dentists o f the c o m m u n ity w h e re in fa c t his view s are o p p o se d to the society ’ s o r to the m a jo rity o f dentists in the com m u n ity . 4. T h e d e scrip tio n o f a sch ool dentist’ s w ork in a new s article is n o t necessarily the equ iva len t o f an advertisem ent. I t is ad visable that su ch articles b e cle a re d in ad v an ce by the lo c a l society. 5. A dentist w h o prepares a health e d u ca tion c o lu m n fo r a n ew spa per syndicate is n ot req u ired to o b ta in the a p p ro v a l o f every c o m p o n e n t socie ty in w h ose ju risd ictio n the c o l um n is p u blish ed . It is the o p in io n o f the C o u n cil that the “ G u id in g R u le s fo r P articip ation o n R a d io an d T e le v is io n ,” p u b lish ed in the Ju ne, 1957 issue o f the J A D A , m ig h t also be a p p lica b le to the p resen tation o f d en tal h ealth ed u ca tio n m aterial in su ch m e d ia as new spapers an d m agazines. It is the o p in io n o f the J u d icia l C o u n cil, fu rth erm ore, that the c o n te x t o f dental health e d u ca tion co lu m n s sh ou ld b e the m ost im p orta n t c o n sid e r a tio n ; this assumes, o f course, that the b y lin e o r oth er id e n tifica tio n o f the au th or is d ign ified . 6. A dentist w h o prep ares an d publishes d en tal h ea lth e d u ca tio n m aterial fo r sale to o th er dentists m a y n ot im p rin t his n am e w ith p rofession a l id e n tifica tio n an d address o n su ch m aterial. T h is p ra ctic e co u ld also b e con stru ed as a d vertisin g in v io la tio n o f S ection 12 o f the
Principles.
Section 21. Judicial Procedure.— Prob lems involving questions of ethics should be solved at the local level within the broad boundaries established in these Principles of Ethics and within the inter pretation of the code of ethics of the component society. If a satisfactory de cision cannot be reached, the question should be referred, on appeal, to the con stituent society, the Judicial Council of the American Dental Association and the House of Delegates of the American Dental Association, as provided in Chap ter X I of the Bylaws of the American Dental Association. A D V IS O R Y O P IN IO N S
1. G rie v a n ce p roced u res are n ot w ith in the ju risd ictio n o f the J u d icia l C o u n cil. 2. T h e e lig ibility o f a dentist to rem ain a m em b er o f the A m erica n D e n ta l A ssociation after le a v in g dental p ra ctice to enter a c o m m e rcia l en d e a v or is n o t w ith in the ju risd iction o f the J u d ic ia l C ou n cil, 3. T h e tim e lim it fo r reta in in g in a ctive patien t re co rd s is n ot a m atter fo r the J u d icia l C o u n c il’s con cern . 4. M e th o d s used b y dentists to c o lle ct ov er d u e bills d o n o t fa ll w ith in the c on cern o f the J u d icia l C o u n cil. 5. T h e establishm ent o f a system fo r c o l le ctin g o v e r-d u e accou n ts b y a lo c a l dental society is n ot w ith in the co n c e r n o f the J u d icia l C o u n cil. 6. W h e re the o p in io n o f the J u d icia l C o u n cil o n a qu estion raised b y an in d iv id u a l d en tist w ill a ffe ct the w h ole d en ta l com m u n ity , a c o p y o f that o p in io n w ill b e sent to the sec retary o r presiden t o f the con stitu en t o r c o m p o n e n t society, as the case m a y be (B o a rd o f T ru stees d ire ction to J u d icia l C o u n c il). 7. W h e th e r a dentist sh ou ld take x-rays b e fo re in itiatin g a series o f treatm ents is a m atter o f p rofession al ju d g m e n t an d n ot ethics. 8. W h e th er a dentist m ay p ro p e rly enter in to a lease arrangem ent in w h ic h p a rt o f his m o n th ly office rental w ill b e eq u a l to a p e r cen ta g e o f the gross in c o m e d eriv e d fr o m his p ra ctic e is n o t g ov ern ed b y th e Principles of Ethics. P u b lic p o lic y ( state d en ta l an d m ed ica l p ra ctice a cts) m ay, h ow ever, a ffe c t su ch lease arrangem ents w h ere dentists o r p hysicians are tenants.
Principles of Ethics with official advisory opinions
J U D IC IA L C O U N C IL
T h e Association’s Principles of Ethics, although presented in the form of general guides, clearly suggests the conduct which a dentist is expected to follow in carrying out his professional activities whether they be related to his patients or to fellow practitioners. It should be kept in mind that the Principles are aimed primarily at upholding and strengthening dentistry as a full-fledged member of the learned professions. T h e dentist constantly should remind himself that the ethics of dental practice, the basic system for self-regulation of the dental profession, grow out of the obligations inherent in the practice of a profession. The dentist should reflect constantly upon the professional characteristics of his occupation. They are: 1.
T h e provision of a service (usually personal) which is essential to the health
and well-being of society. 2. T h e necessity of intensive education and training to qualify as competent to provide the essential service. 3. The need for continuing education and training to maintain and improve pro fessional knowledge and skills. 4. The need for j’ oining with professional colleagues in organized efforts to share new knowledge and new developments of professional practice. 5. Dedication to service rather than to gain or profit from service. Following are the Principles of Ethics, as revised November 1962, integrated with the advisory opinions of the Judicial Council handed down between October 1951 and June 1962.
REPORTS O F C O U N C IL S A N D BUREAUS . . . V O LU M E 66, J A N U A R Y 1963 • 139/125
Section 1. Education Beyond the Usual Level.— T h e right of a dentist to profes sional status rests in the knowledge, skill and experience with which he serves his patients and society. Every dentist has the obligation of keeping his knowledge and skill freshened by continuing educa tion through all of his professional life. A D V IS O R Y O P IN IO N
T h e a w a rd in g o f certificates to dentists w h o co m p le te p ostg ra d u a te courses does n o t b rin g the c o m p o n e n t society o r the recip ien t dentists in co n flict w ith the Principles o f Ethics. D e n tists sh ou ld b e en co u ra g e d to con tin u e their p rofession a l ed u ca tion .
Section 2. Service to the Public.— The dentist has a right to win for himself those things which give him and his family the ability to take their proper place in the community which he serves, but there is no alternative for the pro fessional man in that he must place first his service to the public. The dentist’ s primary duty of serving the public is discharged by giving the highest type of service of which he is capable and by avoiding any conduct which leads to a lowering of esteem of the profession of which he is a member. A D V IS O R Y O P IN IO N S
1. Im p r in tin g o f a dentist’ s nam e o n favors d istribu ted to p atien ts m ig h t ten d to low er p u b lic esteem fo r the p rofession an d sh ould be d iscou rag ed. 2. I t is u n eth ica l fo r a dentist to display his fees o n a fo r m in his w a itin g r o o m . T h is p ra ctice is u n d ig n ifie d an d w ill lo w e r p u b lic esteem fo r the profession. 3. T h e use o f profession a l letterheads in c o n n e ctio n w ith a dentist’s efforts to p ro m o te a com m ercia l end eav or, such as the sale o f oil leases, is u n d ig n ified an d m igh t ten d to low er p u b lic esteem fo r the p rofession. 4. A lo c a l so cie ty ’s an n ou n cem en t in the p u b lic press o f the availability o f a b u d g et p aym en t d en tal care p lan sh ou ld be dignified. It w o u ld be u n dig n ified fo r the a n n ou n ce
m en t to list the nam es o f the dentists p a rtici p a tin g in th e plan. 5. It is u n eth ica l fo r a dentist to in form his p atien ts o n reca ll cards o r otherw ise that he w ill ren d er certain services free o f ch arge. T h is p ra ctic e m ay w ell lead to a low erin g o f p u b lic esteem . In ad d ition , the o ffe r o f any typ e o f free service is a m isrepresentation if the cost o f such service is re co v e re d in d irectly by a d d in g that cost to fees ch arg ed fo r other services. 6. I t w o u ld b e u n eth ica l fo r a dentist to sell to his p atien ts at a p rofit articles such as tooth brush es. S ection 2 o f the Principles of Ethicss en titled “ S ervice to the P u b lic,” g o v erns this situation b y its general p roh ib ition against c o n d u c t that m ay lea d to the low erin g o f th e d en ta l profession ’ s esteem. 7. A dentist w h o perm its his professional id en tifica tion to b e a p rom in en t p art o f an ad vertisem en t in co n n e ctio n w ith a n o n p rofes sion al co m m e rcia l en d ea v or is in v iola tion o f S ection 2 o f the Principles of Ethics. S u ch c o n d u c t w o u ld certain ly ten d to low er the dental p ro fe ssio n ’ s esteem . 8. It is the o p in io n o f the J u d icia l C o u n cil that a dentist w h o allow s use o f his o ffice or his p e rso n as part o f a television advertisem ent is a c tin g co n tra ry to the spirit o f this section, if n o t in d irect v io la tion o f it.
Section 3. Government of a Profession. — Every profession receives from society the right to regulate itself, to determine and judge its own members. Such regula tion is achieved largely through the in fluence of the professional societies, and every dentist has the dual obligation of making himself a part of a professional society and of observing its rules of ethics. A D V IS O R Y O P IN IO N
N one.
Section 4. Leadership.— The dentist has the obligation of providing freely of his skills, knowledge and experience to so ciety in those fields in which his qualifica tions entitle him to speak with profes sional competence. T h e dentist should be a leader in his community, especially in all efforts leading to the improvement of the dental health of the public.
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A D V ISO R Y O P IN IO N
N on e.
Section 5. Emergency Service.— T h e dentist has an obligation when consulted in an emergency by the patient of an other dentist to attend to the conditions leading to the emergency and to refer the patient to his regular dentist who should be informed of the conditions found and treated. A D V ISO R Y O P IN IO N
N on e.
Section 6. Use of Auxiliary Personnel.— The dentist has an obligation to protect the health of his patient by not delegat ing to a person less qualified any service or operation which requires the profes sional competence of a dentist. The den tist has a further obligation of prescrib ing and supervising the work of all auxiliary personnel in the interests of rendering the best service to the patient. A D V ISO R Y O P IN IO N
I t is u n eth ica l fo r a dentist to d elega te to a lay person the fu n c tio n o f taking im pressions o f the m o u th in cid e n t to the co n stru ctio n o f ath letic m o u th guards.
Section 7. Consultation.— The dentist has the obligation of seeking consultation whenever the welfare of the patient will be safeguarded or advanced by having recourse to those who have special skills, knowledge and experience. A consultant will hold the details of a consultation in confidence and will not undertake treat ment without the consent of the attend ing practitioner. A D V ISO R Y O P IN IO N
N one.
Section 8. Unjust Criticism and Expert Testimony.— The dentist has the obliga
tion of not referring disparagingly to the services of another dentist in the presence of a patient. A lack of knowledge of con ditions under which the services were afforded may lead to unjust criticism and to a lessening of the patient’s confidence in the dental profession. I f there is indis putable evidence of faulty treatment, the welfare of the patient demands that cor rective treatment be instituted at once and in such a way as to avoid reflection on the previous dentist or on the dental profession. T h e dentist also has the obli gation of cooperating with appropriate public officials on request by providing expert testimony. A D V ISO R Y O P IN IO N
In a m a lp ra ctice suit b o th parties have a right to present e x p ert testim ony th rou g h witnesses. A dentist a c tin g as a witness sh ould n ot be d iscip lin ed m erely fo r presen tin g his p rofes sional op in ion .
Section 9. Rebates and Split Fees.— The dentist may not accept or tender “ re bates” or “ split fees.” A D V ISO R Y O P IN IO N S
1. A fee arran gem en t betw een dentists w h ich is n ot d isclosed to the p atien t constitutes fee-splittin g an d is un eth ical. 2. W h ere a v eteran receiv es dental care at the expense o f the fed era l gov ern m en t, the fa ilu re to disclose to the veteran a V .A . ap p ro v e d fee arran gem en t betw een the general p ra ctition er an d a sp ecialist does n ot c o n stitute fee-splittin g. 3. A fee arran g em en t betw een a dentist an d an anesthesiologist w h ic h is fu lly disclosed to the p atien t is n o t un eth ica l. (T h is op in ion is based u p o n the equ iva len t section o f the 1950 Principles. U n d e r the Principles as re v ised in 1955, it w o u ld seem that each p ra c titioner sh ou ld su bm it a b ill fo r his services d irectly to the p atien t to a v oid un eth ica l p ra c tice. ) 4. A dentist w h o p urch ases a deceased dentist’ s p ra ctic e a n d agrees to p a y to the w id o w o r the estate a p ercen ta g e o f the fees c o lle cte d fr o m p atien ts o f r e co r d o f the d e ceased dentist fo r a lim ited p e rio d o f tim e is
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n o t in v io la tio n o f S ection 9 o f the Principles of Ethics. T h is type o f arrangem ent m ay, h ow ever, b e in v io la tio n o f som e o f th e state den tal p r a c tic e acts. 5. A d en tist w h o purchases a p ra ctice fro m a retirin g dentist m ay p ro p erly agree to p ay to the latter a p e rcen ta g e o f the fees receiv ed fro m the re tir in g dentist’ s patients o f r e co r d fo r a lim ite d p e rio d o f tim e. A g a in , this type o f arran g em en t m ay b e in v io la tio n o f som e state d en ta l p ra ctice acts. 6. A dentist w h o agrees to p a y to an oth er dentist a p e rce n ta g e o f his fees as part o f an a greem en t c o v e rin g the sharing o f o ffice fa cili ties is n ot in v io la tio n o f the p roh ib ition s w ith in S e ctio n 9 o f the Principles of Ethics against split fees a n d rebates. A g a in , this arran ge m en t m ay b e in v io la tio n o f som e state dental p ra ctice acts. 7. D en tists in partn ership m a y use any reason able fo r m u la fo r d eterm in in g h o w p a rt nership p rofits m ay b e d iv id e d a m o n g p a rt ners. I n partn ersh ip p ra ctice the distribu tion o f p artn ersh ip rev en u e is outsid e the scop e a n d a p p lic a tio n o f the ethical p ro h ib itio n against “ sp lit fees” so lo n g as there is a reason able re la tio n o f service p e rfo rm e d to the a m ou n t draw n by e a ch partner.
Section 10. Secret Agents and Exclusive Methods.— T h e dentist has an obligation not to prescribe, dispense or promote the use of drugs or other agents whose com plete formulae are not available to the dental profession. H e also has the obli gation not to prescribe or dispense, ex cept for limited investigative purposes, any therapeutic agent, the value of which is not supported by scientific evidence. The dentist has the further obligation of not holding out as exclusive, any agent, method or technic. A D V IS O R Y O P IN IO N S
1. W h e r e a dentist induces a n ew spaper to p u b lish an article d escribin g the dentist’ s tra in in g a n d ex p e rie n ce w ith a n e w te ch n ic n ot yet used b y o th er practition ers in the c o m m unity, th a t c o n d u c t is un ethical. (T h is w o u ld also b e in v io la tio n o f S ection 12, e n titled “ A d v e r tisin g .” ) 2. T h e use o f hyp notism b y dentists does n o t o f itself co n flict w ith the Principles o f
Ethics.
Section 11. Patents and Copyrights.— Th e dentist has the obligation of making the fruits of his discoveries and labors available to all when they are useful in safeguarding or promoting the health of the public. Patents and copyrights may be secured by a dentist provided that they and the remuneration derived from them are not used to restrict research, prac tice or the benefits of the patented or copyrighted material. A D V IS O R Y O P IN IO N
T h e m ere o b ta in in g o f a p aten t su ch as o n a d en tal ch a ir by a dentist is n o t un eth ical.
Section 12. Advertising.— Advertising re flects adversely on the dentist who em ploys it and lowers the public esteem of the dental profession. The dentist has the obligation of advancing his reputation for fidelity, judgment and skill solely through his professional services to his patients and to society. The use of adver tising in any form to solicit patients is inconsistent with this obligation. A D V IS O R Y O P IN IO N S
1. A dentist w h o arranges fo r a p a id new s p a p e r advertisem ent o f his “ D e n ta l C lin ic ” is en g a ged in u n eth ica l con d u ct. 2. A dentist in a specialist p ra ctice w h o in clu d es on his referral slips a m ap o r d ia gram o f his office lo ca tio n is m erely p ro v id in g h e lp fu l in fo rm a tion to the p atien ts o f referrin g dentists an d is n ot en g a ged in u n eth ica l c o n d u ct. 3. A dentist w h o ind uces, o r agrees to, the p u b lica tio n o f an article in a lo c a l new spaper praising him fo r h a vin g a research fin d in g p u b lished in a p rofession a l jo u r n a l is en g a ged in u n e th ica l co n d u ct. 4. A dentist w h o actin g in his o w n b eh a lf in d u ces the p u b lica tio n o f a n ew spa per article d escribin g his activities as a lea d er o f the loca l society ’s C h ild re n ’ s D en ta l H e a lth D a y a c tivity is e n g a ged in u n eth ica l c o n d u c t. 5. A dentist w h o places a n o tic e in a lo c a l n ew spa per that he is lea v in g tow n to take a p ostg rad u a te course in dentistry is en g a g e d in u n eth ica l con d u ct.
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6. I t is n o t u n e th ica l f o r a lo c a l dental society to p u rch ase in stitu tion al a d vertisin g to c ou n te ra ct the a d vertisin g o f u n eth ica l d en tists. S u ch a p ra ctice , h o w e v e r, m a y n o t b e in g o o d taste. 7. A d ign ified p a id an n o u n ce m e n t o f the availa bility o f a b u d g e t p a y m en t d en ta l care p lan is n o t u n eth ica l, i f the p lan a n d the an n ou n cem en t are a p p ro v e d b y the lo c a l dental society. 8. A dentist w h o perm its his na m e to b e used in a d en tal h ea lth e d u ca tio n p a m p h le t to b e distribu ted to the p u b lic at la rg e by a c om m e rcia l firm is e n g a g e d in u n eth ica l c o n d u ct. 9 . A dentist w h o issues a new s release link in g him self to n e w ad van ces in dentistry is en g a ged in u n e th ica l c o n d u c t. N ew s releases co n ce rn in g achievem ents o f dentistry sh ou ld c o m e fr o m d en tal societies o r oth er a p p ro p ria te p rofession a l sources. 10. A dentist w h o an n ou n ces the e m p lo y m ent o f a d en tal hygienist to all dentists an d p hysicians o f the c o m m u n ity is en g a g e d in u n eth ica l co n d u ct. 11. A dentist w h o ind icates o n a p ro m in e n t sign outside an un fin ish ed b u ild in g th at he in tends to re lo ca te his p ra ctic e there is en ga ged in u n eth ica l c o n d u c t. 12. T h e d escrip tion o f a sch o o l dentist’ s w ork in a new s article is n o t necessarily the equ iva len t o f advertisin g, b u t it is advisable th at su ch articles b e c le a re d b y the lo c a l so ciety in a d v a n ce o f p u b lica tio n . 13. A dentist is n o t p ro h ib ite d b y ethics fr o m en g a gin g in an activity such as that o f a r a d io “ sports-caster,” b u t h e sh ou ld n o t give u n d u e em phasis to his id e n tity as a p ra ctic in g dentist. I t is advisable, also, fo r a dentist to con su lt w ith his lo c a l so cie ty b e fo re u n d ertak in g su ch an activity. 14. A dentist w h o distributes h is p ro fe s sion al cards to a ll persons elig ible f o r dental care u n d er a g ro u p h ea lth care p la n , in c lu d in g m an y persons n o t his p atien ts o f r e c o r d , is en g a ged in u n eth ica l c o n d u c t ev en th ou g h he is the o n ly dentist w h o has ag reed to ren d er services to the g rou p . 15. I t is u n eth ica l fo r a specialist to dis t r ib u t e reprints o f his p u blish ed articles to a large segm ent o f g e n e ra l p ra ctition ers. T h is p ra ctice appears to b e an ob v iou s e ffo rt to solicit referrals b y in d ic a tin g su periority in the isp ecia l field. ' 16. I t is u n eth ica l fo r an e n d o d o n tist to fu rn ish so -ca lle d p atien t e d u ca tio n p am ph lets to general p ra ctition ers fo r d istribu tion to p a
tients w h ere the p a m p h lets, in effe ct, stress u n d u ly the su p eriority o f the p roced u res used b y end od ontists. It is the J u d icia l C o u n c il’s o p in io n that p u b lic a tio n o f su ch so-ca lled p a tient ed u ca tion m aterial has th e e ffe ct o f so lic itin g p atien ts in v io la tio n o f S e ctio n 12 o f the Principles. 17. A dentist w h o gives lectu res o r d em on strations b e fo re lay g rou p s o n a p articu la r te ch n ic (su ch as h y p n osis) w h ic h he em ploys in his p ra ctice is in v io la tio n o f S ection 12 o f the Principles o f Ethics. S u ch c o n d u c t is m erely a fo rm o f a d v ertisin g w h ic h im ports su periority ov er the d en tist’ s colleagues. 18. A dentist w h o arranges fo r the p u b lic a tion o f a n ew spa per a rticle o n his use o f h y p nosis in his d en tal p r a c tic e is in v io la tion o f S e ction 12 o f the Principles of Ethics w h ich p roh ibits a d vertisin g b y dentists. 19. T h e p u b lic a tio n o f a list o f dentists w h o h ave a greed to p a rticip a te in a g rou p d ental care p lan a p p ro v e d b y the state dental society to those w h o are elig ib le fo r care un der the p lan w o u ld n o t result in a v io la tion o f S ection 12 o f the Principles o f Ethics g ov ern in g advertising. 20. A dentist w h o in clu d es on his an n o u n cem en t cards la n g u a g e w h ic h im plies that his use o f a d en tal h y g ien ist m akes h im a su perior p ra ctition er is in v io la tio n o f Sections 12 an d 13 o f the Principles of Ethics.
Section 13. Cards, Letterheads and A n nouncements.— A dentist may properly utilize professional cards, announcement cards, recall notices to patients of record and letterheads when the style and text are consistent with the dignity of the pro fession and with the custom of other den tists in the community. Announcement cards may be sent when there is a change in location or an altera tion in the character of practice, but only to other dentists, to members of other health professions and to patients of record.
A D V IS O R Y O P IN IO N S
1. A dentist w h o invites his patients o f re co rd , oth er dentists a n d physicians to an “ o p e n hou se” in c o n n e c t io n w ith the estab
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lishm ent o f a n ew o ffice is n ot e n g a ged in u n eth ica l con d u ct. 2. A dentist w h o im prints fla m boya n t p ic tures a n d descrip tive m aterial o n his office stationery is e n g a ged in u n eth ica l co n d u ct. 3. A specialist w h o entertains general p ra c titioners fr o m w h o m he expects referrals is n o t en g a g e d in un eth ical co n d u ct. 4. It is u n eth ica l fo r a dentist to send an n ou n cem en t cards to the p u b lic-a t-la rg e . 5. It is n o t u n eth ica l fo r a dentist w h o has retu rn ed fr o m m ilitary service to send an n ou n cem en ts to his fo rm e r patients. 6. W h e r e a dentist purchases o r takes ov e r the p ra ctic e o f an oth er dentist w h o is retiring, it is n o t u n eth ica l to send an nou ncem en ts to the retirin g dentist’s p atien ts o f r e co rd . 7. A dentist w h o has p u rch ased a p ra ctice fr o m a retirin g dentist m ay p ro p e rly n o tify all p atien ts o f r e co r d o f the retirin g dentist o f the ch a n g e. B ut it w o u ld b e u n eth ica l fo r the new dentist to send reca ll cards at a later d ate to those w h o d id n o t definitely in d ica te th at they w ish ed to b e a cce p te d in to the n ew dentist’ s p ra ctice. T h a t p art o f S ection 13 o f the Principles p erm ittin g an n ou n cem en ts w h ere there is a ch a n g e in the ch a ra cte r o f p ra ctice w o u ld n ot p erm it a dentist to an n ou n ce to his patien ts o f r e c o r d o r o th e r dentists an d p h ysician s that he is qu alified to p e rfo rm oral reh a b ilita tion o r that he is using a n ew te ch n ic in his p ra ctice . N eith er o f these constitutes a ch a n g e in the ch aracter o f p ra ctice w ith in the m ea n in g o f S e ctio n 13 o f the Principles. 8.
o f Ethics
9. I t is the J u d icia l C o u n cil’ s o p in io n that the use o f p ictu res an d sym bols o n professional stationery sh ou ld b e d iscou rag ed. T h e use o f a sm all p ictu re o n a dentist’ s letterh ea d sym b o liz in g a ch ild re n ’ s p ra ctice , h ow ever, is not un eth ica l i f co m m u n ity custom p erm its such usage. 10. I t is un eth ical fo r a dentist to send an n ou n cem en ts to the p rofession -at-large in his c om m u n ity that he has the facilities an d is com p e te n t to adm in ister a p articu la r type o f an esth etic. S u ch an an n ou n cem en t, m oreov er, sh ou ld n ot b e sent even o n a lim ited basis since the use o f a n ew te ch n ic is n o t a ch an ge in the ch aracter o f p ra ctice w ith in the m ean in g o f that part o f S ection 13 w h ich perm its an n ou n cem en ts o n a lim ited basis w h ere there is a ch a n g e in the ch aracter o f p ra ctic e (fo r ex am p le, fr o m general p ra ctice to a sp e c ia lty ). B roa d scale an nou ncem en ts, fu rth erm ore, are im p r o p e r an d un eth ica l becau se they op e n ly solicit patients an d referrals, in this case o n the basis o f a claim o f superiority.
11. A dentist m ay insert a p a id a n n ou n ce m e n t o f his dental p ra ctice in a lo ca l new s p a p e r o n a restricted basis o n ly w h ere such m e th o d o f co m m u n ica tin g in form a tion is d e e m e d in th e best interests o f the p u b lic an d the p rofession as d eterm in ed b y the a p p ro p ria te co m p o n e n t dental society.
Section 14. Office Door Lettering and Signs.— A dentist may properly utilize office door lettering and signs provided that their style and text are consistent with the dignity of the profession and with the custom of other dentists in the community. A D V ISO R Y O P IN IO N S
1. A lth o u g h com m u n ity cu stom m ainly d e term ines th e p ro p e r use b y dentists o f office d o o r letterin g an d signs, n o dentist m ay p ro p e r ly use an office sign w h ic h is clearly u n d ig n ifie d an d ou t o f k eep in g w ith p rofes sion al en d eavor. 2. A sm all sign on the fa ce o f a b u ild in g id e n tify in g it as the “ .................................................. D e n ta l B u ild in g ” is n ot u n eth ica l unless c o m m u n ity cu stom proh ibits su ch designations. 3. I t is the o p in io n o f the J u d icia l C o u n cil th at a c o m p o n e n t society m ay d eterm in e c o m m u n ity cu sto m to p roh ib it dentists fr o m using flo o d lig h ts to d ra w a tten tion to their nam e p lates o n th e outside o f th eir p riv a te p ra ctice fa cilities. C o m p o n e n t societies sh ou ld be aw are, fu rth erm ore, that the state d en tal p ra c tice acts o rd in a rily establish regulations on the use o f o ffice d o o r letterin g an d signs.
Section 15. Use of Professional Titles and Degrees.— A dentist may use the titles or degrees, Doctor, Dentist, D .D .S ., or D .M .D ., in connection with his name on cards, letterheads, office door signs and announcements. A dentist who has been certified by a specialty board for one of the specialties approved by the Am er ican Dental Association may use the title “ diplomate” in connection with his spe cialty on his cards, letterheads and an nouncements if such usage is consistent with the custom of dentists of the com munity. A dentist may not use his title or degree in connection with the promo
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tion of any drug, agent, instrument or appliance. Th e use of eponyms in connection with drugs, agents, instruments or appliances is generally to be discouraged. A D V ISO R Y O P IN IO N S
1. T h e Principles of Ethics p erm it dentists to use the titles “ d o c t o r ” or “ dentist” o r the degrees “ D .D .S .” o r “ D .M .D .” in c o n n e ctio n w ith their nam es o n cards, letterheads, o ffice d o o r letterin g o r signs. T h e use o f o th e r titles, su ch as “ dental su rg eon ” o r “ su rgeon d en tist,” is un eth ical. 2. A dentist m ay p e rm it his na m e to be used to id e n tify a d en tal instrum ent so lo n g as his d egree o r title is n o t a d d e d to that id en tifi ca tio n . 3. A dentist w h o perm its his na m e w ith title o r d e g re e to b e used in circu la rs an d o th er m aterial advertising a p ro d u c t, such as a d e n ture cleanser, is p ro m o tin g a dental p r o d u c t in v io la tio n o f the Principles of Ethics. 4. A p ra ctic in g dentist w h o identifies h im self b y title o r d e g re e in m aterial p ro m o tin g the p ro d u cts o f a d en ta l su pp ly hou se o w n e d o r m a n a ged by that dentist is en g a g e d in u n eth ica l co n d u ct. 5. A dentist w h o m erely d em on strates a new p ie ce o f dental eq u ip m e n t w ith in a c o m m ercia l e x h ibit at a profession a l m eetin g is n o t e n g a ged in u n eth ica l c o n d u c t. 6. T h e use o f the title “ D ip lo m a te o f . . .” on o ffice d o o r letterin g o r signs is n o t p e r m itted. 7. T h e lim itations o n the use o f titles an d degrees in c o n n e ctio n w ith a dentist’ s na m e o n cards, letterheads, an n ou n cem en ts an d signs sh ou ld be strictly observed . A dentist sh ou ld n o t spell o u t his d egree, “ D o c t o r o f D e n ta l Surgery” or “ D o c to r o f D e n ta l M e d ic in e ,” w ith his na m e o n office d o o r lettering. S e ctio n 15 o f the Principles perm its the use o f the abbreviation s o f these degrees. 8. A dentist w h o distributes to a sub stantial segm ent o f the p rofession -at-larg e re prints o f his articles la u d in g a p a rticu la r tra de na m e d en tifrice is p ro m o tin g a d en tal p r o d u c t in v io la tio n o f S e ctio n 15 o f the Principles of
Ethics. 9. A dentist w h o p articip a tes in a d en tal m otio n p ictu re film sp on sored b y a c o m m e r cia l film co m p a n y in w h ic h he has a fin an cial interest w ill b e in v io la tio n o f S ection 15 o f the Principles of Ethics if h e is id en tified by nam e an d title o r d egree.
10. P erm itting a co m m e rcia l p u b lic a tio n to re p rin t an article origin a lly p u b lish ed in an officia l dental society p u b lic a tio n sh ou ld be d iscou rag ed b y con stitu en t an d c o m p on en t societies. In effect this p ra ctice m ig h t p u t th e author o f su ch a rep rin ted article in the p osition of le n d in g his na m e w ith title o r d eg ree to the p ro m o tio n o f a dental p ro d u c t in v io la tion o f S e ction 15 o f the Principles. 11. A dentist w h o au th orizes o r perm its a co m m ercia l firm in th e d en ta l field to dis tribute reprints o f his scien tific articles to a substantial n u m b er o f dentists on a n ation al basis m ay, in effect, b e p ro m o tin g a dental p ro d u c t in v iola tion o f S ection 15 o f the
Principles. 12. A lth o u g h the H ou se o f D elegates has re co m m en d ed that p ostg ra d u a te courses for dentists sh ou ld be c o n d u c te d u n d er th e aus p ices o f r ecog n ized ed u ca tio n a l institutions, hospitals an d dental societies (Trans. 19 51: 1 8 0 ), that p o lic y has n ot b e e n in co rp o ra te d in the Principles o f Ethics. I t is the J u d icia l C o u n c il’s o p in io n th erefore, that S ection 15 o f the Principles does n o t p roh ib it a dentist from p a rticip a tin g in a scien tific o r professional p resentation u n d er the sponsorsh ip o f a c o m m ercial c on cern , unless that dentist’ s p a rticip a tion does, in effe ct, p ro m o te the p r o d u c t or p ro d u cts o f the sp on sorin g co m m e rcia l c o n cern. 13. T h e p u b lica tio n o f a dentist’ s nam e w ith title o r d egree as o n e o f the au th ors o f a p a m p h let advertisin g business form s fo r sale to dentists is, in effe ct, th e use o f that d en tist’ s p rofession a l p restige to p ro m o te a c o m m ercial en d ea v or in v io la tio n o f S ection 15 of the Principles. 14. A dentist e m p loy ed fu ll-tim e as re search d irector o f a d en tal su p p ly firm m ay n o t sign his na m e w ith title o r d eg ree to letters o r circulars p ro m o tin g th e p ro d u c ts o f his em ployer. S u ch c o n d u c t is, in the o p in io n of the J u d icia l C o u n cil, in v io la tion o f S ection 15 o f the Principles. 15. A dentist w h o perm its a d en tal supply h ouse to use a tap e r e co r d in g o f the dentist’ s lectu re on p ra ctice ad m in istra tion b e fo r e other dentists is in v io la tio n o f S ection 15 o f the Principles of Ethics. T h is c o n d u c t w o u ld re sult in the use o f a dentist’ s p rofession a l id en ti fication in the p ro m o tio n o f a d en tal p rod u ct. 16. A dentist m a y eth ica lly c o m b in e the p ra ctice o f dentistry w ith th e p ra ctice o f o p tom etry . T h e J u d icia l C o u n c il believes, h ow ever, that the c o n d u c t o f a successful d en tal p ra ctice requires fu ll co n ce n tra tio n an d at
REPORTS O F C O U N C IL S A N D BUREAUS
ten tion an d advises against c o m b in in g a p ra c tice o f o p to m e try w ith dentistry. 17. T h e a cce p ta n ce by a dentist o f a p osi tion as ad v isory consu ltant to a co m m e rcia l c o rp o r a tio n is n o t p e r se a v io la tio n o f the Principles of Ethics. A dentist a c c e p tin g such a p osition m ust, in the o p in io n o f the J u dicial C o u n cil, b e constan tly alert so that his p ro fe s sional id en tifica tion is n o t used in the p ro m otio n o f a co m m e rcia l p r o d u c t o r endeavor. 18. I t is the m a jo rity o p in io n o f the J u d i cia l C o u n cil that a dentist m ay e th ically invest fu nds in an insurance c o m p a n y p ro v id in g d e n tal insurance, su bject, h o w e ve r, to the fo llo w in g lim ita tio n : It m ust be a b o n a fid e dental care p lan n o t lim ited to the investing dentists. T h e use o f the dentist’ s n am e in an y w ay to p ro m o te the p lan w o u ld b e un eth ical. 19. I t is the C o u n c il’ s o p in io n th at a dentist m ay eth ically display in his office pam ph lets o f a d en tal insurance c o m p a n y w h e n the plan is a b o n a fid e p lan an d n o t lim ited to investing dentists. I f the co m p a n y is n o th in g m o re than a g rou p o f dentists b a n d in g to ge th e r to solicit patients, it sh ould be d iscou rag ed . I f all d en tists m ay p a rticip a te, it is desirable an d ethical.
Section 16. Use of the Terms “ Clinic” and “Group Practice.”— Unless the use of the term “ clinic” has long been estab lished by the custom of dentists in a com munity as applicable to a dental practice, it is strongly recommended that the term “ clinic” be limited to designate public or quasi-public institutions established on a not-for-profit basis for the purpose of providing dental health care. The use of the term “group practice,” in accordance with the following definition, is recommended as applicable to a dental practice and as an alternative to the term “ clinic” when its use is consistent with existing statutes and the custom of the dentists in the community: Group practice is that type of dental practice in which ethical, licensed dentists, sometimes in association with members of other health professions, agree formally between themselves on certain central arrangements designed to advance the economical and efficient conduct of a dental practice in order to render an improved health service to the patient.
.V O L U M E 66, J A N U A R Y 1963 • 145/131
A D V ISO R Y O P IN IO N S
1. I t is the J u d icia l C o u n c il’ s o p in io n that a c o m p o n e n t o r constitu ent society m ay in clu d e in its c o d e o f ethics a p ro h ib itio n against the use o f “ g r o u p ” or “ g rou p p ra ctic e ” ' to id e n tify associates in a d en tal p ra ctice. T h e Principles p erm it the use o f “ g r o u p ” o r “ g rou p p ra ctic e ” on ly if su ch d esignations are n ot in co n flict w ith com m u n ity custom . 2. T h e J u d icia l C o u n c il reaffirm s its p rev i ous op in ion s that the use o f the term “ c lin ic ” to designate a p riv ate p ra ctic e fa cility should be d isco u r a g e d ; S ection 16 o f the Principles p erm its constitu ent o r c o m p o n e n t societies to p ro h ib it the use o f the term “ c lin ic ” to id en tify a p riv ate p ra ctice.
Section 17. Contract Practice.— A den tist may enter into an agreement with individuals and organizations to provide dental health care provided that the agreement does not permit or compel practices which are in violation of these Principles of Ethics. A D V ISO R Y O P IN IO N S
1. T h e p ra ctice o f dentistry u n d er con tra ct w ith, o r as an em ploy ee o f, a coop era tiv e h ealth p lan is n ot o f itself un eth ica l. T h e co o p e ra tiv e ’ s efforts to p ro m o te its dental benefits to the p u b lic, h ow ever, m ay in v olv e p a rticip a tin g dentists in u n eth ica l con d u ct. 2. T h e in clu sion o f a clause in a con tra ct betw een partners in a dental p ra ctice w h ich fo rb id s any partner w h o w ith d ra w s fr o m the d en tal partn ership fr o m lo c a tin g a new p r a c tice near the partn ersh ip ’ s lo c a tio n is n ot o f itself un ethical. 3. I t is the J u d icia l C o u n c il’ s o p in io n that the d efin ition o f “ fre e d o m o f c h o ic e ” in c o n n e ctio n w ith the d entist-patien t relation ship is p ro p e rly a m atter fo r a p o lic y statem ent by a constitu ent o r co m p o n e n t society ’s g ov ern in g b o d y . B ecause there m ay b e variation s in the d efin ition o f “ fre e d o m o f c h o ic e ” betw een an d a m o n g societies, h ow ever, it is p refera ble n o t to in clu d e the d efin ition o f this term w ith in a c o d e o f ethics. 4. U nless the p ra ctices an d p roced u res o f a dental care p lan requ ire a dentist p a rtici p a tin g in that p lan to v iola te the Principles of Ethics, p a rticip a tion in such a plan sh ou ld not be p ro h ib ite d by a c o m p o n e n t society as a v io la tio n o f p rofession a l ethics.
146/132 • THE J O U R N A L O F THE A M E R IC A N DENTAL A S S O C IA T IO N
Section 18. Announcement of Limitation of Practice.— Only a dentist who limits his practice exclusively to one of the spe cial areas approved by the American Dental Association for limited practice may include a statement of his limitation in announcements, cards, letterheads and directory listings (consistent with the cus toms of dentists of the comm unity), pro vided at the time of the announcement, he has met the existing educational re quirements and standards* set by the American Dental Association for m em bers wishing to announce limitation of practice or possesses a state license permit ting announcement in an area approved by the American Dental Association. In accord with established ethical rul ing that dentists should not claim or imply superiority, use of the phrases “ Spe cialist i n ........................ ” or “ Specialist on ......................” in announcements, cards, letterheads or directory listings should be discouraged. The use of the phrase “ Practice limited t o ......................” is pref erable.
*The follow ing are included within the standards of the American Dental Association fo r determining the educational experience and other appropriate require ments fo r announcing a lim ited practice: 1. The indicated area of dentistry must be one fo r which^ there is a certifying board approved by the American Dental Association. 2. The dentist's practice must be lim ited exclusively to the indicated area of dentistry. 3. The dentist must b e -a diplom ate of a certifying board approved by the American Dental Association for the indicated area of dentistry; or he must be a member of, or be e lig ib le fo r membership in, a specialty society officially related to a certifying board approved by the American Dental Association fo r the indicated area of dentistry; or he must have a state license in the indi cated area of dentistry if he practices within a state which licenses dentists who engage in specialty practice.
A D V ISO R Y O P IN IO N S
1. A dentist w h o indicates o n his cards and stationery that he specializes in “ oral m e d i cin e” o r any oth er field n o t re co g n ize d as a sp ecia lty by the A m e rica n D e n ta l A ssociation is en g a ged in un eth ical con d u ct. 2. D ire cto ry an nou ncem en ts an d o th er an n ou ncem ents o f a lim itation o f p ra ctice must co n fo r m to com m u n ity custom . 3. I t is the o p in io n o f the J u d icia l C o u n cil that a dentist m ay n o t p ro p e rly an n ou n ce that
he lim its his pra ctice to tw o sp ecia l fields o f dentistry. O n ly one special field m ay be an n ou n ced . 4. W h eth er a specialist in oral surgery m ay p rop erly em ploy a dental hygienist is not govern ed by the Principles o f Ethics. 5. It is the o p in io n o f th e J u d icia l C o u n cil that a constituent o r c o m p o n e n t society m ay d eterm in e com m un ity cu stom to requ ire that a dentist w h o announces him self as a specialist m ust lim it his p ra ctice to that specialty if such lim itation o f p ra ctice is requ ired fo r b oa rd certification in that specialty. [A ll o f the advisory op in ion s un der S ection 18 w ere h a n d ed d o w n b e fo re the 1960 revision o f the section. It is b e liev ed that all o f these op in ion s are still pertinent.]
Section 19. Directories.— A dentist may permit the listing of his name in a direc tory provided that all dentists in similar circumstances have access to a similar listing and provided that such listing is consistent in style and text, with the cus tom of the dentists in the community. A D V ISO R Y O P IN IO N S
1. Listings in teleph one d irectories should b e in g o o d taste an d co n fo r m to com m u n ity c u sto m ; d irectory listings m ust also c o n fo rm to those sections o f the Principles of Ethics c o n ce rn e d w ith an nou ncem en ts in general, sp ecialty an nou ncem en ts an d proh ibition s against advertising. 2. A n unusual m eth od o f listing a dental p ra ctice in a teleph one d irectory is n o t p e r m itted by the Principles of Ethics. 3. C o m m u n ity custom w ill determ in e w h eth er dentists m ay b e listed in directories publish ed by fraternal organizations or sim ilar groups. 4. I f com m u n ity custom perm its, specialists m ay be listed un der separate headings in tele p h o n e directories as lo n g as they are n o t also listed un der the general dentistry h eadin g. 5. U nless com m u n ity cu stom perm its, d en tists sh ou ld n o t list their nam es in the classi fied teleph on e directories fo r localities outside their residen ce or p ra ctice location s. 6. I f com m u n ity cu stom perm its, a dentist m ay in d icate in his telep h on e d irectory listing that h e is a m em ber o f the A m erica n D en tal A ssociation. 7. I t is n ot un eth ical fo r a dentist to use the d escrip tion “ ch ild ren ’s dentistry” rather than “ p e d o d o n tia ” in a te le p h o n e directory listing as lo n g as com m u n ity cu stom perm its that usage.
REPORTS O F C O U N C IL S A N D BUREAUS . . . V O LU M E 66, J A N U A R Y 1963 • 147/133
Section 20. Health Education of the Public.— A dentist may properly partici pate in a program of health education of the public involving such media as the press, radio, television and lecture, pro vided that such programs are in keeping with the dignity of the profession and the custom of the dental profession of the community. A D V IS O R Y O P IN IO N S
1. It is n o t u n eth ica l fo r a dentist to m ail h ealth e d u ca tio n p am ph lets to his patients o f record . 2. B efore a dentist initiates the p u b lica tio n o f a d en ta l h ea lth c o lu m n in a new spaper, it is ad visable fo r h im to seek the a p p rov a l o f his lo c a l a n d state dental societies. 3. A d entist has the righ t to speak ou t against the p o licie s espoused b y org an ized dentistry, in c lu d in g the righ t to m ake p u b lic p ron ou n cem e n ts against flu orid a tion . I t is u n eth ica l, h o w e v e r, fo r a dentist to represent his view s as those o f the d en tal society o r as those o f th e m a jo r ity o f dentists o f the c o m m u n ity w h e re in fa c t his view s are o p p o se d to the society ’ s o r to the m a jo rity o f dentists in the com m u n ity . 4. T h e d e scrip tio n o f a sch ool dentist’ s w ork in a new s article is n o t necessarily the equ iva len t o f an advertisem ent. I t is ad visable that su ch articles b e cle a re d in ad v an ce by the lo c a l society. 5. A dentist w h o prepares a health e d u ca tion c o lu m n fo r a n ew spa per syndicate is n ot req u ired to o b ta in the a p p ro v a l o f every c o m p o n e n t socie ty in w h ose ju risd ictio n the c o l um n is p u blish ed . It is the o p in io n o f the C o u n cil that the “ G u id in g R u le s fo r P articip ation o n R a d io an d T e le v is io n ,” p u b lish ed in the Ju ne, 1957 issue o f the J A D A , m ig h t also be a p p lica b le to the p resen tation o f d en tal h ealth ed u ca tio n m aterial in su ch m e d ia as new spapers an d m agazines. It is the o p in io n o f the J u d icia l C o u n cil, fu rth erm ore, that the c o n te x t o f dental health e d u ca tion co lu m n s sh ou ld b e the m ost im p orta n t c o n sid e r a tio n ; this assumes, o f course, that the b y lin e o r oth er id e n tifica tio n o f the au th or is d ign ified . 6. A dentist w h o prep ares an d publishes d en tal h ea lth e d u ca tio n m aterial fo r sale to o th er dentists m a y n ot im p rin t his n am e w ith p rofession a l id e n tifica tio n an d address o n su ch m aterial. T h is p ra ctic e co u ld also b e con stru ed as a d vertisin g in v io la tio n o f S ection 12 o f the
Principles.
Section 21. Judicial Procedure.— Prob lems involving questions of ethics should be solved at the local level within the broad boundaries established in these Principles of Ethics and within the inter pretation of the code of ethics of the component society. If a satisfactory de cision cannot be reached, the question should be referred, on appeal, to the con stituent society, the Judicial Council of the American Dental Association and the House of Delegates of the American Dental Association, as provided in Chap ter X I of the Bylaws of the American Dental Association. A D V IS O R Y O P IN IO N S
1. G rie v a n ce p roced u res are n ot w ith in the ju risd ictio n o f the J u d icia l C o u n cil. 2. T h e e lig ibility o f a dentist to rem ain a m em b er o f the A m erica n D e n ta l A ssociation after le a v in g dental p ra ctice to enter a c o m m e rcia l en d e a v or is n o t w ith in the ju risd iction o f the J u d ic ia l C ou n cil, 3. T h e tim e lim it fo r reta in in g in a ctive patien t re co rd s is n ot a m atter fo r the J u d icia l C o u n c il’s con cern . 4. M e th o d s used b y dentists to c o lle ct ov er d u e bills d o n o t fa ll w ith in the c on cern o f the J u d icia l C o u n cil. 5. T h e establishm ent o f a system fo r c o l le ctin g o v e r-d u e accou n ts b y a lo c a l dental society is n ot w ith in the co n c e r n o f the J u d icia l C o u n cil. 6. W h e re the o p in io n o f the J u d icia l C o u n cil o n a qu estion raised b y an in d iv id u a l d en tist w ill a ffe ct the w h ole d en ta l com m u n ity , a c o p y o f that o p in io n w ill b e sent to the sec retary o r presiden t o f the con stitu en t o r c o m p o n e n t society, as the case m a y be (B o a rd o f T ru stees d ire ction to J u d icia l C o u n c il). 7. W h e th e r a dentist sh ou ld take x-rays b e fo re in itiatin g a series o f treatm ents is a m atter o f p rofession al ju d g m e n t an d n ot ethics. 8. W h e th er a dentist m ay p ro p e rly enter in to a lease arrangem ent in w h ic h p a rt o f his m o n th ly office rental w ill b e eq u a l to a p e r cen ta g e o f the gross in c o m e d eriv e d fr o m his p ra ctic e is n o t g ov ern ed b y th e Principles of Ethics. P u b lic p o lic y ( state d en ta l an d m ed ica l p ra ctice a cts) m ay, h ow ever, a ffe c t su ch lease arrangem ents w h ere dentists o r p hysicians are tenants.