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Ethics in dentistry

Article · January 2011

DOI: 10.4103/0974-7761.93409

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Original Article

Ethics in dentistry
Sabarinath B, Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College and Hospital,
Sivapathasundharam B, Chennai, India

Address for correspondence:
Dr. Balaraman Sabarinath,
Department of Oral Pathology and
Microbiology, Meenakshi Ammal
Dental College and Hospital,
Chennai, India.
E-mail: bsabarin@gmail.com
ABSTRACT
Objective: Dentists should build their reputation on their professional ability and integrity
and should abide by the regulations put forth by the Dental Council of India (DCI). The aim of
the study is to find out whether the code of ethics is followed in clinical practice by the dental
practitioners in Chennai.
Materials and Methods: A cross-sectional study was conducted in a sample of 1128 dental
clinics in Chennai and data with respect to the name boards and advertisement were collected
by means of a personalized survey.
Results: The size of the sign board exceeded in 69% of the dental clinics. The sign board
contained attractive symbols, pictures, and wordings in 68% of the dental clinics visited. 9%
of the dental practitioners used abbreviations other than academic qualifications recognized
by DCI in their clinic board. There were signboards in places other than the clinic in 22% of
the clinics surveyed. 26% of the clinics used visual or printed media for advertisements.
Conclusion: This study concludes that ethics are not strictly followed by the dental
practitioners in their clinical practice. A proper ethical committee should be formed by the
state dental councils to monitor the practitioners and dental clinics. Also, regulatory bodies
like state dental councils and DCI should think about the revision/modification of certain
codes of ethics, particularly with respect to the name boards, as these were framed almost
three decades ago.
Key words: Academic qualification, advertisements, dental clinics, ethics, sign boards

Introduction including a Joint State Council constituted in accordance with

The word “moral” is defined as relating to the principles of
right and wrong in behavior and “ethics” is defined as a system
of moral values or the principles of conduct governing an
individual or a group[1,2] and deals with the values relating to
human conduct, with respect to the rightness and wrongness of
certain actions and to the goodness and badness of the motives
and ends of such actions.[3] Ethical principles are followed in all
professions including medicine, judiciary, sports, etc.
an agreement under section 22, register, regulate, and monitor
the dental practice in the respective states.
Chennai, an important metropolitan city, houses the Tamil Nadu
State Dental Council. The Tamil Nadu Dental Council was
inaugurated in October 1952. Fourteen DCI recognized dental
colleges are functioning in Tamil Nadu. A total number of 13,286
dentists have been registered in Tamil Nadu Dental Council as on
31.01.2010, out of whom 1492 dentists hold M.D.S. qualification.[4]

Every professional body has its own code of conduct for its
members. Dental profession in India is regulated by the Dental
Council of India (DCI) and it is financed by the Ministry of
Health and Family Welfare, Government of India. DCI is a
statutory body incorporated under an act of parliament, viz.,
the Dentists Act, 1948 (XVI of 1948). While DCI mainly deals
with the dental education in India, the state dental councils,
constituted under section 21 of the Dentists Act, 1948,
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As per the WHO, the dentist:population ratio is 1:7500.[5]
Though it is apparently fulfilled in India, there is severe
maldistribution of dentists in this country.[6] The number of
dental clinics is more in urban areas and very less in rural areas.
There is a tendency for the dentists to settle in metropolitan
cities. As reported by Tandon in 2004,[7] three-fourth of the total
number of dentists was clustered in urban areas, which houses
only one-fourth of the country’s population, and Chennai is
no exception. This could be attributed to the high investment
toward the dental education and dental practice, relatively
increased paying capacity toward the dental treatment, and
increased dental awareness among the general public.

Crowding of dentists in metropolitan cities leads to unhealthy

DOI: competition and commercialization. The latter leads to violating
10.4103/0974-7761.93409 the code of conduct put forth by the state dental councils and
many of the norms are openly flouted and rules randomly bent.[8]

Journal of Education and Ethics in Dentistry

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Sabarinath and Sivapathasundharam: Ethics in dentistry

The objective of the present study is to access the amount
of violation of the code of conduct by the dental clinics with
respect to the clinic name board and advertisement, in and
around Chennai, by an on-site survey.
Materials and Methods
The study was conducted among 1128 dental clinics in and
around Chennai. A single-blinded study was conducted and
data were collected by means of a personalized survey.
The study consisted of questions regarding the size of the dental
clinic board, attractive symbols or wordings, qualifications
other than the academic ones, and advertisements of the
clinics through media or sign boards [Table 1]. The results
were tabulated in a pie chart.
Did the dental clinic advertise by any means?
5% dental clinics used visual media, 20% dental clinics used
printed media, 1% dental clinics used both as means of
advertisement, whereas 74% dental clinics did not advertise
[Figure 5].
Discussion
The privilege of being a dentist comes with a responsibility
to society and to fellow members of the profession to
conduct one’s professional activities in a highly ethical
manner. [9] It is the duty of every dentist to follow ethics
when setting up a private practice, but it is common
to see that some of the clinics do not follow them. The
Dentists regulations or Code of ethics was put forward in
the year 1976.

Results
Table 1: Criterias used in the study
What was the size of the dental clinic board? 1. Whether the size of the sign board is
69% dental clinics had their board more than 3 × 2 feet and   a. 3 × 2 feet
31% dental clinics had a size equal to 3 × 2 feet [Figure 1].   b. More than 3 × 2 feet
2. Whether the sign board contains symbols, attractive pictures or
wordings other than dentist name, registration no., and clinic
Were the clinic boards with attractive symbols/ address
pictures or wordings? Yes/No   a. Yes
68% clinic boards had attractive symbols/pictures/wordings,   b. No
while 32% clinics did not have the same [Figure 2]. 3. Whether any abbreviated words other than the academic
qualifications are present behind the dentist name
Did the dentists have abbreviations of degrees other   a. Yes
than academic qualifications? Yes/No   b. No
9% dentists had abbreviations other than the academic 4. Affixing a sign board on a Pharmacist’s shop or in places where
qualifications, whereas 91% of them did not have the the dentist does not reside or work
abbreviations [Figure 3].   a. Yes
  b. No
Were the sign boards of the dental clinic present in 5. Whether the dentist is doing advertisement through
other places?   a. Media
In 22% of the cases, the sign board was present in other places   b. News magazine
and 78% clinics did not have their sign board in other places   c. Both
[Figure 4].   d. None

3 x 2 feet More than 3 x 2 feet Yes No

31% 32%

69% 68%

3 x 2 feet More than 3 x 2 feet Yes No

345 (31%) 783 (69%) 769 (68%) 359 (32%)

Figure 1: Size of the sign board Figure 2: Sign board with attractive pictures/symbols/wordings

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Sabarinath and Sivapathasundharam: Ethics in dentistry

Yes No those in which a practice is actually carried on, or show cases, or

flickering light signs and the use of any sign showing any matter
9% other than his name and qualifications as defined under clause
(j) of section 2 of the Act”.[10]

From the present study, however, we have observed that

more than half of the dental clinics do not follow this code
of ethics. The board size ranged even more than 10 × 6 feet.
91%
The size of the dental clinic sign board was defined nearly
four to five decades ago by the DCI and the respective
state dental councils, where the general population was
less than half of the present number. There were no big
Yes No commercial establishments and multiplexes. The only way
100 (9%) 1028 (91%) of advertisement during that period was painted board and
paper posters, whereas in the present scenario of digital
Figure 3: Abbreviations other than academic qualifications
banner era, the magic size of 3 × 2 square feet, as prescribed
by these statutory bodies, may not be visible near a glamorous
Yes No
cinema banner or a cosmetic product advertisement and may
be hidden completely. It is very much essential for the service
providers to make the public aware about their existence. So,
22% this is high time that the state dental councils and the DCI
must revise the size of the sign board.

Advertisement through World Wide Web goes scot free and

78% there is nobody to monitor or censor presently. Neither the
DCI nor the state dental councils have squad to check this.
Though these statutory bodies can take action suo moto, they
seldom do it and need someone to give a written complaint
Yes No with proper proofs.
247 (22%) 881 (78%)
Advertisement of dental practice is rampant in almost all
Figure 4: Sign board of clinic in other places the metropolitan cities of India, most of which is done under
the banner of corporate setup or call themselves as a private
Visual Media Printed Media Both None limited company run or managed by the registered dental
practitioners. This practice of advertisement needs a caution
5% as it may result in “supplier induced demand.” This may also
increase the unnecessary fear and annoyance to the general
20%
public regarding their very minor oral or dental changes which
sometimes may not require any treatment at all. In addition, it
1%
may create unhealthy competition among the peers instead of
74% creating awareness to the general public.

In the present scenario where dental clinics are also housed

in multi-storeyed shopping complexes where there are
Visual Media Printed Media Both None
prominent, glaring, and large sign boards for other commercial
establishments, this code of ethics definitely needs a
69 (5%) 259 (20%) 14 (1%) 786 (74%)
complete revision. Instead of prohibiting the advertisements
Figure 5: Advertisements completely, the policy makers can revise the act with respect
to advertisements by health care professionals and regulate
The following codes are considered to be unethical practices them accordingly as in developed countries like Singapore.[11]
by a dentist:
“Styling by any dentist or a group of dentists his/their ‘Dental
“Using of sign board larger than 0.9 metre (3 feet) by 0.6 metre clinic’ or Chamber/s by the name of ‘Dental Hospital/s’”,[10]
(2 feet) and the use of such words as ‘teeth’, ‘Painless Extraction’ but we see many of the practitioners employing methods like
or the like, or notices in regard to practice on premises other than exaggerating their clinics as a hospital.

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Sabarinath and Sivapathasundharam: Ethics in dentistry
“Mentioning after the dentist’s name any other abbreviations
except those indicating dental qualifications as earned by him
during his academic career in dentistry which conform to the
definition of ‘recognised dental qualification’ as defined in
clause (j) of section 2 of the Act, or any other recognised academic
qualifications”.[10] Qualifications like M.I.D.A., M.I.C.D.,
F.C.I.P., F.A.C.D., and M.R.S.H. were the abbreviations
observed following few practitioners’ names. The use of these
unrecognized academic qualifications is to show that they are
more qualified in order to attract the patients.
Use of professional titles and degrees – The dentist shall use
only the usual titles and academic degrees such as “Doctor,”
“Dentist,” “B.D.S.,” “M.D.S.,” “Ph.D.,” in connection with the
name or signature.
“Affixing a sign board on a chemist’s shop or in places where
the dentist does not reside or work”.[10] The study revealed
few clinics were having their sign boards in other places, for
instance, at a chemist’s shop or end of a lane. It is an indirect or
rapid form of advertising and or promoting their clinics since
chemist shop is the place where the person in need of medical
attention gathers frequently.
“Advertising, whether directly or indirectly, for the purpose
of obtaining patients or promoting his own professional
advantage”.[10] A few practitioners utilized printing media
for advertisement and a few used the visual media. Internet,
pamphlets, newspapers, and magazines are some of the other
means of advertising, which have become more prevalent
nowadays. World Wide Web is also used very frequently by
many of the practitioners in India. Since there is lack of control
over the internet, the advertisements regarding the srvices
provided may not be true always and may be potentially
misleading on occasions.
Advertisement is considered as an unethical practice since
it entices patients from other dentists, convincing them to
undergo treatment, especially cosmetic procedures, that
may not be mandatory for their oral health. Not only are
these purposes harmful to other dentists and to patients,
but also they reflect poorly on the dental profession as a
whole, contrary to the requirement of the FDI International
Principles of Ethics for the Dental Profession that the dentist
“should act in a manner which will enhance the prestige and
reputation of the profession”.[13]
What does dentistry have to present in reply to the ethical
challenges that it faces? Dental professionals find themselves
facing a challenge. Many recognize that there is a need for
increased ethics education; however, they lack adequately
trained personnel to expand their teaching in this area.
To solve this ethical dilemma in dentistry, it is mandatory
to have topic of “ethics” in the syllabus of undergraduate
curriculum.[14]
Journal of Education and Ethics in Dentistry
January-June 2011 • Vol. 1 • Issue 1
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The applicability of the laws and conformity of the society
to the laws can only be possible with a strict monitoring and
penalties. In the area of dental care, dentists should conform
to the ethical rules. There is an obvious need for a committee
within the chambers of dentists that will handle contentious
situations, assess allegations received, and enforce the law by
imposing the required penalties.
Conclusion
This study concludes that ethics are not followed effectively by
the dental practitioners in their clinical practice with respect
to advertisements and name boards. The regulatory bodies like
DCI and respective state dental councils should also consider
about the revision/modification of certain code of ethics,
particularly with respect to the name board size, since it was
formed almost more than three decades back. Formation
of a proper ethical committee by the state dental councils is
warranted to monitor the practitioners and dental clinics.
Acknowledgement
The first author would like to acknowledge Dr. S. Dhanarathna, Dr. S.
Preethi and post graduate students of Department of Oral Pathology
and Microbiology, Meenakshi Ammal Dental College and Hospital,
Chennai, India.
References
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6. Sivapathasundharam B. Dental education in India. Indian J Dent Res
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How to cite this article: Sabarinath B, Sivapathasundharam B. Ethics
in dentistry. J Educ Ethics Dent 2011;1:24-7.
Source of Support: Nil, Conflict of Interest: None declared
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