Professionalism: challenges for dentistry in the future.

While countries varies significantly in the financing of dental care, they are much more alike in the delivery of dentistry. Dental care is principally provided in dental offices and clinics that are independent business entities whose business leaders are most often the dentists themselves. However society expects from dentists a level of professionalism (i.e. habitually acting ethically, both in terms of competence and conduct) in contrast to the methods and motivations of the marketplace. This is why the single most important challenge of dental professional ethics continues to be giving proper priority to patients' well being and building ethically correct decision-making relationships with patients while, at the same time, trying to maintain a successful business operation. If we look into dentistry's future, the centrality of this aspect of professional ethics is not likely to change, although the ways in which dentists might violate this trust will probably multiple as funding mechanisms become increasingly complex. It is important that dentists reflect with fresh eyes on their ethical commitments. One challenge is the increased availability of oral health information to the public and the fact that so many people are uncritical of the accuracy of information in the media and on the web. A second is the increase in the amount of health care advertising in many societies. A third is the growth of aesthetic dentistry that differs from standard oral health care in important and ethically significant ways. The fourth is insurance that frequently complicates the explanation of a patient's treatment alternatives and often brings a third party into the treatment decision relationship. The ethical challenges of each of these factors will be considered and ultimately tying it to the central theme of dental professionalism.

A position paper: six lessons about managed care in dentistry.

The limitation of resources available for oral health care makes it inevitable that groups (such as third parties) would arise with a view toward conservation of these resources. Although the concept of adequate care has been generally operationally defined in dentistry, a confusion remains between adequate and best. Dentists may be under an ethical obligation to inform patients of all available treatment options (ranging from the adequate to the best) and to perform the selected treatment to the best of their ability, but they are not under an obligation to offer only the best alternative or to expect that society will make the resources available for that level of care.

Dental ethics as an intellectual discipline: taking the next step.

The development of ethics education in dental and dental hygiene schools is traced. In the early 1980s curricula were informal, often incorporated with jurisprudence or practice management courses, and there were few effective educational materials. Over the next decade formal guidelines for teaching ethics had been approved by the American Association of Dental Schools, several texts and journals featuring ethics columns had appeared and PEDNET, the Professional Ethics in Dentistry Network had been created. The next step is to develop a regular forum for publication of papers in ethics in dental care.

Conflicting values in oral health care.

It was demonstrated that a group of professionals representing diverse values with regard to oral health care can work effectively to identify pivotal issues and even reach consensus on ethical issues. Where consensus cannot be reached, it is still possible to make progress by clarifying positions. Consensus was reached on a statement regarding adequacy of care for patients whose insurance coverage is less than what the dentist considers appropriate.

Whistleblowing in dentistry: what are the ethical issues?

What should you do when you see another dental professional's substandard work? What dental professionals are most likely to encounter whistleblowing dilemmas? Generic components of whistleblowing that apply to dentistry and factors to consider when choosing to report are discussed.

The development of a professional role orientation inventory.

This paper describes the development and testing of the Professional Role Orientation Inventory, a 40-item Likert-type instrument designed to assess a dentist's perception of his or her professional role. The test includes four 10-item scales representing four attitudinal dimensions: Authority, Responsibility, Agency, and Autonomy. The study describes differences between and among groups of professionals and dental students who took the test. Responses to the various scales suggest that practitioners do have different conceptualizations of their professional role, though these conceptions vary somewhat from the various models of professionalism described in the literature.