- **Ethics in Dentistry:**

- Concerns: moral principles, values, conduct standards.

- Addresses ethical issues in healthcare delivery, research, and new techniques.

- **Learning Objectives:**
- Importance of ethics.
- Dentistry-business relationship.
- Prof./Professionalism distinctions.
- Ethics in patient relations, duties, and finances.
- Ethical decision-making, dilemma evaluation, and application in practice.

- **Key Points:**
- Principles crucial in day-to-day clinical practice.
- Emphasizes strong health communication.
- Patient trust, comprehensive care, bioethics, legal adherence.

- **Communication Impact:**
- Treat each patient individually.
- Emotional investment for better understanding and decisions.

- **Professional Practice:**
- Trust-based patient relationships.
- Integration of scientific, technical, and ethical components.
- Bioethics knowledge and legal rules are essential.

- **Communication in Practice:**
- Vital for professional development and patient interaction.
- Enables effective treatment, early diagnosis, and user needs identification.

- **Quality of Care:**
- Substandard care without patient knowledge or consideration of wishes is unethical.

- **Advertising:**
- Concerns about unprofessional marketing; ADA Code emphasizes truthfulness.

- **Oversupply of Dentists:**
- Oversupply may affect quality of care, leading to potential overtreatment.

- **Patient Autonomy:**
- Ethical challenges include prioritizing patient interests and ensuring informed consent.

- **Conflicts and Resolution:**

- Conflicts initiated by dentists or patients, involving issues like non-compliance or requests contrary
to standards.

- **Justice:**
- Ethical concerns about treatment obligations, discontinuing treatment due to payment issues, and
providing free services.
- **Intraprofessional Relationships:**
- Challenges in covering colleagues' practices without criticism, and concerns about referral
practices.

- **Financial Transactions:**
- Issues include falsifying billing, responsibility for failed treatment, and ethical problems with
dental benefit plans.

- **Ethic Principles Applicable to Communication:**

1. Patient autonomy
2. Nonmaleficence
3. Beneficence
4. Justice (Patients, Colleagues, Society)
5. Veracity

- **Patient Autonomy:**
- Patient's right to make treatment decisions.
- Dentist provides treatment options, successes, and challenges for informed decision-making.

- **Nonmaleficence:**
- Dentist must avoid unnecessary harm.
- Commitment to complete treatment; immediate disclosure of potential exposure to infectious
materials.

- **Beneficence:**
- Dentist prioritizes patient welfare.
- Areas include community service, reporting findings promoting public health, and addressing
symptoms of domestic violence and child abuse.

- **Justice:**
- Dentists must be fair in dealings with patients, colleagues, and society.
- Practicing justice involves serving patients without discrimination, providing professional
testimony, and respecting prior treatment.

- **Veracity:**
- Focuses on truthful communication without deception.
- Unethical practices include marking up charges based on insurance, recommending unnecessary
treatment, and soliciting patients with partial truths.

- **Ethical Dilemma:**
- Autonomy vs. Non-Maleficence.
- Balancing patient autonomy with the obligation to avoid harm.

- **Recognition of Dignity:**
- Respecting individuals' right to make personal choices.
- Emphasizes a physician's duty to act in "Good Faith."

- **Acting in the Best Interests:**

- Prioritizing patients and society even when conflicting with personal self-interest.
- **Promotion of Justice:**
- Treating all individuals and groups fairly.
- Promoting justice in society.

- **Values of Truthfulness:**
- Truthfulness as the foundation for trust in personal and professional relationships.

- **Shared Decision Making (SDM):**

- Ethically justified for better health decisions.
- Enhances informed consent, bridges disparities, and impacts healthcare quality, cost, and safety.

- **SDM Definition:**
- Collaborative process involving patients and providers, considering clinical evidence and patient
preferences.
- Uses decision aids to facilitate unbiased conversations.

- **Four Steps to Ethical Decisions in Dental Situations:**

- Identify alternatives, assess professional and ethical stakes, and decide based on values, virtues,
rules, and norms.

- **ACD Test for Decision Making:**

- Effective, ADA-guided method for ethical dental decisions.

- **Patient-Dentist Relationship Responsibilities:**

- Includes truthfulness, mutual respect, and considering patient values from the start.

- **Ethical Decision Making:**

- Involves complex decisions, and various models exist to guide dental professionals.

- **Ethic Principles:**
- Dentists face challenges in making ethical judgments, utilizing models to navigate complexities.

- **Professionalism:**
- Positive habits of conduct, judgment, and perception.
- Prioritizing superior knowledge, skill, and judgment for others' benefit before self-interest.

- **What Defines a "Professional"?**

- Respects human beings, is competent, has integrity, and prioritizes service over prestige or profit.

- **Dentistry Definition (ADA):**

- Involves the evaluation, diagnosis, prevention, and treatment of oral conditions within a dentist's
education, training, and ethical boundaries.

- **Professional Obligations in Dentistry:**

- Dentists are obligated to respect privacy, maintain confidentiality, keep promises, be truthful, and
consider patient values.
- **Categories of Professional Obligations:**
- Commitment to the wellbeing of clients and fostering ideal relationships based on mutual respect.

- **Values, Competence, and Relationships:**

- Professions must work towards securing specific values for clients, and professionals must acquire
and maintain expertise.
- Consideration of patient wellbeing as a priority, but not absolute.
- Ideal relationships between dentists and coprofessionals, and obligations to the larger community.

- **Integrity and Education:**

- Components of conduct communicating personal values and choices, both in actions and how they
are chosen and presented to others.

- **Legal vs. Ethical Rights:**

- Legal rights grounded in written law, ethical rights grounded on principles and values.
- Fundamental ethical principles for dentists include protecting patient life and health, respecting
autonomy, and fair and unbiased treatment.

- **Ethical Dilemmas in Dentistry (A):**

1. Autonomy
2. Medical error
3. Refusal of treatment
4. Confidentiality
5. Patient/dentist relationships

- **Ethical Dilemmas (B-C):**

- Dental fees and insurance, dentist and colleagues issues.

- **Autonomy:**
- Dentists must educate patients fully for informed decision-making.
- Ensuring patient awareness and understanding of treatment risks is crucial.

- **Medical Error:**
- Dentists should remain truthful and disclose errors immediately.
- Distinctions between telling the truth, informing about errors, and distinguishing between "bad
outcomes" and "bad work."

- **Refusal of Treatment (Patient):**

- Patients can refuse treatment; dentists should respect autonomy.
- Considerations for mental disorders and financial conflicts of interest.

- **Refusal of Treatment (Dentist):**

- Dentists may refuse treatment for various reasons, including lack of insurance or ethical dilemmas.
- Considerations for alternative treatments and ethical obligations regarding substance abuse and
infectious diseases.

- **Confidentiality:**
- Dentist-patient relationship based on patient information confidentiality.
 - Privacy rights yield to public health laws under certain circumstances.

- **Patient/Dentist Relationships:**
- Trust is fundamental; skilled dentists ease fears, rendering dental experiences pleasant and
painless.
- Professionalism involves separating personal and professional relationships.

- **Relationships based on Openness and Trust:**

- High standards of personal conduct include being courteous, respectful, compassionate, and
honest.
- Encouraging informed decision-making, respecting patient choices, and avoiding exploitation in
the practitioner-patient relationship.

- **Effective Communication:**
- Practitioners should listen to patients, encourage them to share, inform about care, discuss
options, and ensure understanding. Address language and cultural needs through interpreters.

- **Ethical Dilemmas in Dentistry:**

- **Dental Fees and Insurance:**
- Balancing financial viability and ethical responsibility in dental care is challenging. Dentists should
consider meeting the needs of potential patients.

- **Dentist and Colleagues Issues:**

- **Fee-Splitting:**
- Forbidden due to the risk of unnecessary referrals for financial gain.
- **Advertising Campaigns:**
- Advertising is accepted but should serve public interest along with professional gain.
- **Reporting Unsafe or Unethical Practices:**
- Reporting incompetence or misconduct among colleagues is a professional duty.

- **Relationships with Other Health Professionals:**

- Non-discrimination and respect are crucial in relationships with colleagues. Grounds for refusing
or terminating relationships include a lack of confidence or serious conflicts.

- **Removing a Patient from Practice:**

- Provide written notice with reasons and alternative providers.
- Time termination appropriately and communicate to prevent reestablishment of the physician-
patient relationship.

- **Confidentiality in Dentistry:**
- Protecting patient information is essential for the dentist-patient relationship.
- Laws and ethics highlight the duty to maintain patient confidentiality.

- **Use of Images:**
- Intraoral cameras and digital photography simplify records, but confidentiality principles apply.

- **Consent for Image Treatment:**

 - Patients' explicit consent is crucial for any use of images beyond patient care.

- **Reception Areas:**
- Extend confidentiality principles to reception areas to ensure patient privacy.

- **Principles of Patient Confidentiality:**

- **Duty of Confidentiality:**
- Patients expect and deserve confidentiality.
- All dental team members must protect patient confidentiality, as detailed in employment
contracts.

- **Releasing Information:**
- Information release should align with patient consent, prevent accidents, and consider the public
interest when necessary.

**Essentials of Patient Confidentiality in Dentistry**

1. **Privacy Assurance:**
- Ensure private discussions in reception and treatment areas.
- [Visual guide](https://www.youtube.com/watch?v=_svMCtQQsfo).

2. **Posthumous Respect:**
- Uphold confidentiality even after a patient's passing.
- Share information with clear patient consent, emphasizing minimal disclosure.

3. **Consensual Information Sharing:**

- Educate patients on potential information sharing circumstances.
- Obtain explicit consent, clarifying details and recipients.

4. **Accidental Disclosure Prevention:**

- Safeguard patient data in storage and conversations.
- [Learn from a case study](https://www.dentalprotection.org/uk/publications-resources/case-
studies/case-studies-display/exercising-caution-with-communications).

5. **Public Interest Decisions:**

- Share information without consent in public interest situations.
- Seek consent or advice before disclosure, minimizing shared information.

6. **Specific Disclosures:**
- Clarify processes for sharing information with solicitors, police, and social services.
- Balance confidentiality with legal and public interest considerations.

7. **Professional Commitments:**
- Prioritize patient confidentiality.
- Disclose information with consent or in compelling public interest scenarios.
- Approach diverse third-party requests for patient information cautiously.
**Informed Consent in Dentistry: A Brief Overview**

1. **Patient Right:**
- Informed consent is crucial, involving voluntary, conscious agreement after detailed information.

2. **Components:**
- Patients must understand treatment details, benefits, risks, and alternatives for voluntary
decision-making.

3. **Capacity:**
- Adults are presumed capable, while parents decide for minors; some adults may lack capacity.

4. **Communication:**
- Advance information is vital; Spain requires a 24-hour notice for non-urgent procedures.

5. **Verbal/Written Consent:**
- Verbal is standard; written is obligatory for risk-involved procedures with documentation.

6. **Ongoing Process:**
- Consent involves continuous dialogue, potentially with the dental team, ensuring ongoing
understanding.

7. **Consent by Representation:**
- Competence is essential; parents decide for children, and legal guardians for those without
decision-making capacity.

Understanding informed consent is vital for ethical dental practice, prioritizing patient
empowerment.

1. **Communication and Language:**

- Effective communication is crucial for informed consent.
- Language alignment or interpreters are vital to avoid misunderstandings.

2. **Emergency Treatment Exception:**

- Life-threatening emergencies allow treatment without prior consent.
- Dental offices should not misuse emergencies to bypass legal processes.

3. **Right to Refuse Treatment:**

- Competent patients can legally and morally refuse any treatment.
- Their decisions, even if detrimental, are within their rights.

4. **Good Practice:**
- Provide clear information before seeking consent.
- Obtain consent for examinations, treatments, teaching, or research.
- Advise on potential additional costs.
- In cases of impaired consent capacity, involve legal authorities and document appropriately.

**Nonverbal Communication Overview:**

- Communication without spoken words, including body language, facial expressions, gestures,
posture, tone of voice, and eye contact.
- Crucial in healthcare for smooth interaction, reflecting sincerity, attentiveness, and trustworthiness.

**Roles of Nonverbal Communication:**

- Reflects genuine feelings, impacting trust, clarity, and rapport.
- Sensitivity to others' cues and self-awareness are essential for effective communication.

**Faking Nonverbal Communication:**

- Manipulating nonverbal cues is unlikely to succeed unless feelings align.
- Authentic, unforced signals are more convincing than deliberate actions.

**Factors Affecting Nonverbal Communication:**

- Listening attentively, considering body language, tone, eye contact, and facial expressions.
- Dentist's appearance and physical contact influence communication.

**Patient Experience at the Dentist:**

- Positive nonverbal communication crucial for making patients feel comfortable.
- Contributes to happy patients and higher satisfaction.

**Cultural Nuances in Nonverbal Communication:**

- Conventional gestures may have conflicting meanings across cultures.
- A nod signifies agreement in the Western world but disagreement in the Indian sub-continent.

**Messages of Movement - Kinesics:**

- Facial cues in kinesics reveal feelings, interest levels, and emotional involvement.
- Eyes serve as key communicators, indicating interest, persuasiveness, and regulating interactions.

**Gestures, Posture, and Paralinguistics:**

- Body language communicates identity and feelings.
- Paralanguage, including pitch and volume, contributes to effective communication.

**Proxemics - Space and Distance:**

- Physical proximity signals desire or disinterest in communication.
- Space use indicates dominance or submissiveness in relationships.

**Artifact Communication and Appearance:**

- Clothing, jewelry, and appearance influence first impressions and judgments.

**Olfactics, Color, and First Impressions:**

- Smell influences preferences.
- Colors impact emotions and behaviors.
- Positive first impressions involve charisma, smiles, handshakes, and eye contact.

**Impacts of Media and Technology on Nonverbal Messages:**

- Emoticons are used online to compensate for the absence of nonverbal cues.
**Tips for Effective Nonverbal Communication:**
- Maintain a balanced posture, avoiding stiffness or slouching.
- Control gesticulation to appear deliberate and avoid distraction.
- Adopt positive mannerisms while staying true to your character.

**Additional Strategies for Nonverbal Competence:**

1. **Attentiveness to Nonverbal Cues:** Be mindful of nonverbal messages.
2. **Seek Clarification:** When uncertain about a cue, ask for clarification.
3. **Recognize Inconsistent Messages:** Inconsistent cues convey meaning.
4. **Align Closeness and Behavior:** Match nonverbal behavior with desired closeness.
5. **Self-Monitoring:** Be aware of your nonverbal behavior.
6. **Acknowledge Variability:** Recognize differences in encoding and decoding abilities.

**Conflict Resolution in Dental Practices:**

- **Introduction:**
- Conflicts are inevitable in professional environments.
- Preparation is essential to manage conflicts effectively.

- **Tips for Managing Conflict:**

- **Patients:**
- Prioritize courteous conduct, respect privacy, and encourage informed decisions.
- **Physicians/Colleagues:**
- Foster mutual respect, effective teamwork, and clear communication.
- **Coordinating Care:**
- Ensure timely information exchange and clarify responsibilities.

- **Causes of Conflict:**
- **Misunderstanding:** Emphasizes clear communication and restating instructions.
- **Lack of Communication:** Advocates for written procedures and job descriptions.
- **Controversy:** Addresses issues related to job roles and responsibilities.

- **Resolution Techniques:**
- Actively listen, describe both perspectives, and focus on solutions.

- **Assertiveness in Conflict Resolution:**

- Assertiveness styles (Passive, Aggressive, Passive-Aggressive, Assertive) explained.
- Assertiveness is a learnable skill with tips for improvement.

- **Common Conflict Areas in Dental Offices:**

- Addressing misunderstanding through clear communication.
- Promoting communication through written procedures and comprehensive job descriptions.
- Resolving controversies by encouraging empathy and planning.

- **Conclusion:**
- Effective conflict resolution is vital for a healthy work environment.
- Assertiveness, active listening, and communication skills are key to resolving conflicts.