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Romanian Journal of Bioethics, Vol. 7, No. 4, October – December 2009 
 
 
 
 
 
LEGAL AND ETHICAL PROBLEMS IN 
DENTAL MEDICINE 
 
Laurian Lucian Frâncu ∗ 
Dorelia Lucia Călin** 
Dumitru Păduraru*** 
Doina-Lucia Frâncu**** 
 
Abstract 
In this paper the authors present some particularities of the dental ethical standards. There are 
described and analyzed the general ethical principles specific to dental practitioners in their 
relationships with patients. We insist on the profile and competences of the new European dentist 
under current conditions. The change of mentality and attitude of the dentists must begin with the 
modification of the dental educational curriculum. We define more accurately the dentist’s 
autonomy, their responsibilities regarding the competence and the confidentiality. Informed 
consent of the patient, one of the problems faced by private dental medicine, is the clearest 
expression of individual autonomy. Dental ethics is closely related to law; in some situations the 
law and ethics are in conflict, and the dentist needs to reconsider and solve these problems. The 
authors analyze the prospects for dental ethics focusing on flexibility and adapt it to political 
conditions, economic and social existence at a time. Since dental practice involves many ethical 
issues, physicians must be kept informed on the progress of dental ethics principles as related to 
other aspects of their profession. 
 
Keywords: dental ethics, dentist’s autonomy, dental education. 
 
 
∗ Lecturer, Universiy of Medicine and Pharmacy “Gr. T. Popa” of Iaşi, Romania, laurianfrancu@yahoo.com 
** Asist. Prof.,Universiy of Medicine and Pharmacy “Gr. T. Popa” of Iaşi, Romania, dorelia@yahoo.com 
*** Assoc. Prof., University of Medicine and Pharmacy “Gr. T. Popa” Iaşi, Romania, 
mitus.paduraru@gmail.com 
**** Univ. Prof., Universiy of Medicine and Pharmacy “Gr. T. Popa” of Iaşi, Romania, dlfrincu@yahoo.com 
Dental practitioners worldwide are 
part of a profession with very high 
ethical standards, because they need to 
deal with situations that require a 
behavior and judgment based on ethics, 
an intrinsic component of dental practice. 
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Conceptual boundaries 
Dental ethics includes the study of 
morality that requires both a careful and 
systematic reflection and the analysis of 
the moral and behavioral decisions. 
Dental ethics is, first of all, a matter of 
knowledge, while morality is a matter of 
"implementation", with a strong 
connection between them, because ethics 
generates the rational criteria that allow 
dentists to decide or behave in a certain 
way. 
Dental ethics is an area of confluence 
of various moral and philosophical 
concepts with legality and with their help 
we can solve the conflicts of values in 
order to draw up principles that are 
accepted by most dentists. 
Dental ethics is a very wide and 
complex field of study, with many 
branches and subdivisions, which has 
developed its own specialized 
vocabulary, mainly structured on 
problems that are generated by the dental 
practice. 
Dental ethics generated the 
publication of ethical codes that vary 
from one country to another [2, 8, 13, 
15], even if they have common features, 
such as: dentist’ obligations to place the 
patient’s interests above his own, not to 
discriminate patients based on race, 
religion or other human rights, to protect 
patient confidentiality, etc. 
In most countries the dentistry 
associations are responsible for the 
development and application of the 
standards of ethics [1, 2], which have a 
general character, that makes impossible 
to the dentist to solve any situation that 
he/she may encounter while practicing 
his/her job. The dental codes of ethics 
tried an international standardization 
materialized in guidelines for universities 
or authorities when they give dentists 
permission to practice or to offer private 
services. The principles contained in 
these codes reflect consensus about how 
the dentist must act. 
In 1997, The International Dental 
Federation [7] adopted The International 
Principles of Ethics for the Profession of 
Dentist Everywhere, which must be 
considered as guidance by any dentist. 
These principles are not above the local 
and national traditions, laws or 
circumstances. According to these 
principles, the dentist must practice 
following the art and dental science, but 
also the principles of humanity. 
Dental ethics was strongly influenced 
by the recognition of the human rights, 
that represent the foundation for the 
dental ethics. 
Some ethical principles are based on 
documents officially accepted all over 
the world, especially on The Universal 
Declaration of the Human Rights [17] 
that proclaims the primacy of the human 
being over the social and collective 
interests. 
The right to life and health represents 
the core of the other human rights, 
because the patients’ rights derive from 
the human rights [11], that comprise the 
non-discrimination, freedom of opinion 
and expression, the equal access to public 
services and the ones of health care, 
principles that are important to dental 
ethics. 
The ethical grounds of the dental 
medicine consist of three principles [12]: 
the principles of the patient’s benefit and 
autonomy, but also the principle of social 
right. Their acceptance provides a 
genuine revival of the value of 
professionalism including ethics and 
social responsibility reflected in health 
care and access to healthcare services for 
all members of society [3, 5, 12]. In 
addition to these principles, dental ethics 
recognizes a series of values targeted 
specifically on oral healthcare such as 
compassion, competence, autonomy or 
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self-determination. 
 
Compassion in dental practice 
Compassion is essential in dentistry. 
The dentist must identify the symptoms 
presented by the patient, their causes and 
to express understanding and concern for 
their medical problems and to help the 
patient by offering the therapeutic 
options. 
It has been noticed that the patients’ 
response to treatment is better if the 
doctor shows sympathy to their 
problems, if the doctor’s approach is 
personal, and not neutral, like of a simple 
medical record. 
Compassion is based on respect for 
the patient’s dignity and value, but it can 
go further by understanding and 
responding to the patient’s vulnerability 
when the patient is suffering from, dental 
pains particularly. If the patients feel the 
dentist’s compassion, they will 
understand that the doctor acts in their 
best interest and will approve all the 
doctor’s decisions and comply with the 
prescribed treatment that has a major 
contribution to the process of healing. 
 
Competence in dental practice 
In dental practice, like in all medical 
specialties, "competence ... in the context 
of life sciences development, remains the 
first duty and form of honesty of the 
doctor for the patient" [11]. 
To limit the existing requirements of 
the profession, the General Assembly of 
the European Association for Education 
in Dental Medicine (A.D.E.E.) from 
Cardiff, adopted in September 2004, the 
profile and competencies of the new 
European dentist [9]. 
Due to the rapid progress of the 
medical knowledge, dentists have to 
study continuously in order to maintain 
their competence at high standards. It is 
not ethical for the population in general 
and on behalf of globalization to consider 
that all dentists are trained the same, that 
they have the same competence levels 
and that they can practice dentistry in the 
same way. 
The professional competence 
represents the intrinsic value of the 
dentist and it is specified in The Code of 
Medical Deontology [16]. Besides, the 
dentist must have the ability/skill to 
integrate in the national and international 
health system [6]. 
The doctor’s lack of competence 
reflects on the patients and it generates 
serious consequences for their oral 
health, but it can also affect their psychic, 
includingthe social insertion. 
By contrast, the liberal dental practice 
of the present provides a contract-based 
doctor-patient relationship and it 
increases the doctor’s responsibility for 
the final results, leading often to the 
practice of a defensive medicine 
(although dental practitioners have the 
necessary knowledge according to the 
current data on dentistry), due to fear of 
risks and legal liability. 
In these situations, the dental ethics 
can offer solutions of prophylaxis. 
Unlike other practitioners in the 
medical field, the dentists have total 
freedom over prescriptions and medical 
acts that they consider necessary, within 
the limits of their competence, and they 
are responsible for these. 
The dentist must be aware that the 
duties of his professional competence 
extend over his whole staff, too. 
Although the collaboration between the 
dentist and the dental technician is based 
on a service contract, they must co work 
when selecting the best prothetic 
solutions according to the patient’s 
option and interest. 
 
 
 
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Autonomy in dental practice 
Autonomy or self determination of the 
dentist is imposed by the specific of its 
profession. Traditionally, the dentists 
always had a high degree of clinical 
autonomy regarding the place and the 
way they practice their profession. The 
large number of private dental practices 
and their establishment requirements are 
easier allow the dentists to decide freely 
the standards of their professional 
education, but also the way in which it 
must be practiced, and give them the 
freedom to choose the techniques and 
materials they feel safe with and over 
which they have competence. However, 
dentist’s autonomy does not mean that 
he/she can judge the patient’s values, that 
he/she decides the therapeutic conduct 
and imposes it. 
The patients’ autonomy was accepted 
by dentists all over the world and it refers 
to the fact that people have control over 
their own lives and they are able to make 
their own decisions, without anybody 
interfering. As a consequence, the patient 
should choose the treating physician and 
decide the course of treatment, based on 
clear information provided by dentists, 
the latter having the obligation to respect 
the patient's decision. 
Agreement / patient consent is the 
voluntary acceptance of dental treatment 
by understanding the nature, purpose, 
and consequences thereof. Thus, the 
dentist should explain the patient the 
reasons for recommending a specific 
treatment, the risks and benefits 
involved, but also alternative treatments. 
Patient's informed consent is based on 
two ethical principles: first, the patient’s 
right to think independently of others 
opinion and to make decisions and, the 
second, the doctor’s obligation to act in 
the best interest of the patient, i.e. to 
respect the individual autonomy [10, 11]. 
The desire of patients to be informed 
and involved in treatment decisions is 
becoming increasingly common in dental 
practice, generating thus a series of 
ethical obligations for doctors, compared 
to the past. 
A special case is the care of children 
who may suffer psychological problems 
caused by odontological diseases. In such 
cases the final decision should be made 
by the family, after being well-informed 
and possibly advised by other specialists. 
Confidentiality is essential in order 
to obtain the patient’s trust and it is a 
vital part of the codes of ethics all along 
the history, starting with the Hippocratic 
Oath. This ancient oath was amended by 
The Declaration from Geneva [18], 
which stipulates that the doctor will 
respect the secrets confided to him, even 
if the patient died. 
The doctor - patient relationship is 
based on trust, so the dentists will not 
disclose to other people information 
about the patients without their 
permission and they must be aware of the 
fact that these duties extend to their staff, 
too. The patient must be protected 
against any possible discrimination 
caused by the disclosure of personal 
information. A privilege of the dentist is 
to ask the patient confidential questions, 
but, at the same time, the doctor has the 
obligation to keep this information 
confidential. 
 
Dental ethics and law 
Dental ethics is closely related to law 
[4, 14]. In many countries there are laws 
that specify the way in which the dentist 
must deal with ethical problems 
occurring in the practice of the 
profession. 
Usually, the dental ethics and legal 
requirements are similar, but legislation 
must not be mistaken for ethics. While 
the laws are very specific, accurate, and 
different from one country to another, by 
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providing minimum standards of 
conduct, ethics is less specific, less 
accurate, without geographical borders 
and it follows the highest standards of the 
profession. 
Dental practitioners must be familiar 
with the legal aspects of the profession 
they practice, particularly because it may 
sometimes happen that the law and ethics 
conflict. In these cases, dentists must 
judge whether to obey the laws or 
principles of ethics, placing first the 
interest and wellbeing of the patient. 
After joining the European Union, 
our country has made amendments to the 
law, in compliance with the new 
requirements and it joined the dental 
education curriculum that allows 
Romanian dentists to practice in other 
EU countries. For this purpose, the 
acquirement of the certificate of 
respectability and morality issued by The 
Dentists’ College is compulsory to the 
dentist. 
 
Dental practitioners’ rights. 
In parallel with a series of obligations 
and responsibilities, dental practitioners 
have specific rights. Dental ethics would 
not be complete unless it raises the issue 
of how dentists should be treated by 
patients, society or colleagues. It would 
be very difficult to maintain ethical and 
professional standards when dentists 
rights would be jeopardized, and for this 
reason, one of the fundamental roles of 
the dental association is to defend their 
rights. In Romania, The Dentists’ 
College and dental associations are 
responsible for the update, development 
and application of ethical principles, 
under the political, economic and social 
circumstances at the time being, but also 
for the promotion of their members’ 
rights. 
 
The perspectives of dental ethics 
The future of dental ethics depends 
on the future of dentistry, the progress of 
science, so it is difficult to predict it. In 
principle, dental ethics should be flexible 
and open to change. Since dental practice 
involves many ethical challenges, 
physicians should be kept informed on 
the progress of the principles of dental 
ethics, which is in close relation with the 
technical aspects of this profession. 
 
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