Policy on the Ethical Responsibilities in the Oral Health Care Management of Infants, Children, Adolescents, and Individuals with Special Health Care Needs
The American Academy of Pediatric Dentistry (AAPD) believes that all infants, children, adolescents, and individuals with special health care needs are entitled to oral health care that meets the treatment and ethical standards set by our specialty.
This policy was developed by the Council on Clinical Affairs and adopted in 2003. This document is a revision of the previous version, reaffirmed in 2013.
Dentists have an obligation to act in an ethical manner in the care of patients with consideration of the virtues of ethics including autonomy, beneficence, nonmaleficence, and justice. Autonomy reflects the patient’s or, if the patient is a minor, the parent’s or guardian’s right to be involved in treatment decisions. The caregiver must be informed of the problem and that treatment is recommended. Beneficence indicates the dentist has the obligation to act for the benefit of the patient in a timely manner, even when there may be conflicts with the dentist’s personal self interests. Nonmaleficence dictates that the dentist’s care does not result in harm to the patient. In situations where a dentist is not able to meet the patient’s needs, referral to a practitioner capable of providing the needed care is indicated. Justice expresses that the dentist should deal fairly with patients, colleagues, and the public.1,2
Denial of care by the provider because of age, behavior, inability to cooperate, disability, or medical status can result in unnecessary pain, discomfort, increased treatment needs and costs, unfavorable treatment experiences, and diminished oral health outcomes. If a dentist is unable to provide medically necessary care3, he or she has an ethical responsibility to refer the patient to a practitioner or facility capable of providing the care.
Oral health care practitioners may offer services for children in a variety of settings (e.g., a solo practice, a general dentistry group practice, a specialty group practice, a dental service organization, an educational institution, a public health or military clinic). Although each entity will have its own administrative policies and procedures to which practitioners must adhere, each provider also must be aware of and follow established standards and evidence-based guidelines promulgated by organizations with recognized professional expertise and stature.
Dentists are held responsible for their clinical and ethical decisions regardless of who holds the responsibility for business decisions.4 The “ultimate responsibility for compliance with state laws and regulations falls upon the practicing licensed dentist.”5 All children must receive dental care consistent with the moral, ethical, and evidence-based standards of care regardless of the care setting. The treating doctor’s clinical judgment should not be influenced by financial considerations of the business entity.
Infants, children, and adolescents, including those with special health care needs, have a right to dental care. The AAPD believes it is unethical for a dentist to ignore a disease or condition because of the patient’s age, behavior, or disabilities. Dentists have an ethical obligation to provide therapy for patients with oral disease or refer for treatment patients whose needs are beyond the skills of the practitioner.
AAPD encourages all entities and practitioners who provide oral health care services to children to follow evidence-based clinical practice guidelines developed by organizations with recognized professional expertise and stature. Under no circumstance should the business or corporate entity interfere with the clinical judgment of the treating dentist.
The AAPD advocates legislation or regulation at the federal and state levels to ensure that dentists are free to exercise individual professional clinical judgment and render appropriate treatment to their patients without undue influence or infringement by any third-party business and entity.6,7
- American Dental Association. Principles of Ethics and Code of Professional Conduct. With official advisory opinions revised to April 2012. Available at: “http://www.ada.org/194.aspx”. Accessed October 7, 2015.
- American College of Dentists. Ethics Handbook for Dentists. Introduction to Ethics, Professionalism, and Ethical Decision Making. Gaithersburg, Md.: American College of Dentists; 2012. Available at: “http://www.acd.org/ethicshandbook.htm”. Accessed October 7, 2015.
- American Academy of Pediatric Dentistry. Definition of medically necessary care. Pediatr Dent 2015;37(special issue):15.
- Academy of General Dentistry Practice Models Task Force. Investigative Report on the Corporate Practice of Dentistry, 2013. Academy of General Dentistry, Chicago, Ill. Available at: “http://www.agd.org/media/171772/corporatedentistrystudy.pdf”. Accessed October 7, 2015.
- Association of Dental Support Organizations. Toward a common goal: The role of dental support organizations in an evolving profession. July 1, 2014. Dentists for Oral Health Innovation, Waller, contributors. Available at: “http://theadso.org/resources/uploaded/media/PDFs/ ADSO%20-%20Toward%20a%20Common%20Goal. pdf”. Accessed October 7, 2015.
- American Dental Association. Regulating non-dentist owners of dental practices (Trans 2011:491). Current Policies 2013:150. Chicago, Ill.: American Dental Association; 2014. Available at: “http://www.ada.org/~/media/ADA/Member%20Center/FIles/2013%20Current%20 Policies%20Final.ashx”. Accessed October 7, 2015.
- American Dental Association. Dentist’s freedom to exercise individual clinical judgment (Trans 1997:705). Chicago, Ill.: American Dental Association; 2014. Available at: “http://www.ada.org/~/media/ADA/Member%20 Center/FIles/2013%20Current%20Policies%20Final.ashx”. Accessed October 7, 2015.