The dentist is responsible for all services provided to the "patient of record," which is a patient upon whom a dentist has taken a complete medical history, completed a clinical examination, recorded any pathologic conditions, and prepared a treatment plan.

Depending on state regulations, dental hygienists may be delegated the task of removing calculus deposits, accretions, and stains from exposed surfaces of the teeth and from the gingival sulcus. They may also perform root planing and curettage. In addition, dental hygienists may expose dental x-ray films, apply topical preventive or prophylactic agents, and perform all tasks delegable by the dentist. However, the dentist remains responsible for the care of the patient.

A discussion of professional ethics and law requires background knowledge of ethics and the definition of ethical principles. Ethics is a branch of philosophy that considers and examines the moral life. The word ethics comes from the Greek ethos and originally meant character or conduct; the word morals comes from the Latin mores, which means customs, values, or habits. These two terms are frequently used interchangeably; however, simply put, ethics are the standards of conduct an individual uses to make decisions and morality involves the judgment or evaluation of an ethical system, decision, or action based on social, cultural, or religious norms [14,15]. They both incorporate notions of approval or disapproval and in some cases are also applied to the character or virtues of the individual.

Under the deontologic umbrella, an action is deemed right or wrong according to whether it follows pre-established criteria known as imperatives. An imperative in our language is viewed as a "must do," a rule, an absolute, a black and white issue. This is an ethic based upon duty linked to absolute truths set down by specific philosophical schools of thought. If the principles dictated by these imperatives are met with dutiful compliance, one is said to be acting ethically.

A well-known deontologic ethical theory is based upon religious beliefs and is known as the theologic ethical theory. The principles of this theory promote a summum bonum, or highest good, derived from divine inspiration. A familiar principle is to do unto others as you would have them do unto you. One would be viewed as ethically sound to follow this principle within this system of beliefs.

The ADA recognizes five major ethical principles of significance to dental professionals: patient autonomy, veracity, beneficence, nonmaleficence, and justice [1].

Autonomy refers to the right of the patient to determine what will be done with his or her own person (i.e., self-governance). It also involves the patient's right to have confidentiality of his or her own medical history and records, and for the medical personnel to safeguard that right. The dentist should involve the patient in treatment decisions in a meaningful way, with due consideration being given to the patient's needs and desires [1].

Ozar, Sokol, and Patthoff present four possible models of the patient-dentist relationship [3]:

Nonmaleficence simply means that dental professionals must try to avoid doing harm to the patient. It is the duty of the dental professional to evaluate his or her own skills and recognize when further education is required or when referral to a specialist is in the best interest of the patient. A dentist must complete a patient's treatment once it has begun or make arrangements for appropriate care if for any reason the dentist cannot complete the care.

Although this course addresses dental ethics and not dental law, dental professionals should be aware of what constitutes dental malpractice. In general, dental malpractice has occurred when a dental provider, through improper treatment and/or diagnosis, causes significant injury, loss, or death to the patient. When malpractice issues arise, the consumer may report his or her complaint to a dental society, attorney, or licensing board. Although licensing boards strive to maintain high standards in the dental profession, it is not possible to conduct regular reviews of each licensed professional. Therefore, most boards rely on written complaints received from the consumer. Upon receipt of a complaint, licensing boards are usually required to open an investigation, the scope of which depends on the allegations [5].

In 2013, a dentist practicing in Connecticut (who was previously barred from practicing in every other state in New England) was sentenced to eight years in prison and ordered to pay $10 million in fines and restitution for operating a number of assembly line-style clinics that performed unnecessary dental procedures targeting poor patients and collecting more than $20 million in fraudulent claims from Medicaid [7]. The clinics hired recruiters to canvas neighborhoods and paid bonuses to those who brought in patients. In some cases, transportation was arranged for patients to the clinics, which were located in low-income neighborhoods. Most of the unnecessary procedures involved drilling into perfectly healthy teeth but included other questionable treatments. The plaintiff had relocated to Connecticut following the announcement of a program to increase Medicaid payments in an effort to induce more dentists to treat low-income patients. The dentist hid his involvement in the Connecticut clinics by using false names and false corporations and by falsifying documents.