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Ethical decision-making in dental hygiene

March 1, 2019
Have you ever encountered a situation in the dental workplace that made you feel uncomfortable about what you were asked to do? Jessica Raymond-Allbritten, BASDH, CRDH, provides a helpful set of steps dental hygienists can use to evaluate dilemmas, along with the ADHA’s core values, and explains how to use them as a guide in making the best ethical decisions.
Have you ever encountered a workplace situation that made you feel uncomfortable about what you were asked to do? Understanding ethics and ethical decision-making can help guide you.

Jessica Raymond-Allbritten, BASDH, CRDH

As dental professionals, we face ethical dilemmas daily. These may have to do with treatment planning, patient care, or infection control. We should use evidence-based research to guide us, but sometimes that is not the case.

When we graduate from dental hygiene school, our minds are filled with the education that we need to be ethical, successful, and provide the best care we can. As we grow in our profession, who we work for and where we work can adapt and pollute what we know to be ethical. Sometimes, hygienists may not realize that what they are doing is not right, or maybe they realize it isn’t right but they comply in an effort to avoid uncomfortable confrontations. Understanding ethics and ethical decision-making can help guide dental hygienists in making the best decisions.

The process

When faced with an ethical dilemma, using the following steps can aid hygienists in coming to an appropriate conclusion:1,2

1. Identify the problem and individuals involved.

2. Gather facts about the problem and the individuals. Don’t be afraid to ask questions.

3. List alternative solutions or outcomes, and discuss the pros and cons.

4. Compare the anticipated action with acceptable professional standards.

5. Select a course of action and act on it.

6. Evaluate the action’s outcome.

It also can be helpful to speak with peers and a mentor for guidance. Taking an online continuing education course on ethics can also be insightful.

Core values

The following core values established by the American Dental Hygienists’ Association should be considered in every ethical dilemma:1,2

• Autonomy: the patient has the right to make a choice or decision (informed consent)

• Confidentiality: right to patient privacy

• Societal trust: protect the trust between the dental hygienist, patient, other professionals, and the public

• Nonmaleficence: protect patients and do no harm

• Beneficence: benefit the patient, doing good for a benefit

• Justice and fairness: fair treatment, no discrimination

• Veracity: the duty to tell the truth when information is disclosed to the patient about treatment

• Virtue: a character trait; honesty, compassion, care, wisdom, and being truthful

Ethical dilemma example

A new patient, a 32-year-old female, presents with 4 mm to 5 mm probing depths located on posterior teeth, no radiographic bone loss or recession present clinically, generalized radiographic interproximal calculus, generalized bleeding upon probing, and moderate plaque. The patient also reports thyroid disease and diabetes on her medical history.

The dentist recommends D4342 (SRP). The hygienist knows this isn’t the correct diagnosis and that it should be coded as D4346. The hygienist is now in an ethical dilemma. The decision-making steps are the following:

Identify the problem. The hygienist believes the patient doesn’t qualify for SRP based on the CDT definition of D4342, which is used when there is periodontitis and bone loss present. The hygienist knows that the patient should be coded as D4346, due to generalized moderate gingival inflammation with no bone loss or recession. The hygienist is torn between completing D4342 versus D4346.

Gather the facts. The hygienist reviews the patient’s periodontal and radiographic assessment as well as the CDT code definitions. The hygienist could ask further questions regarding dental and medical history to aid in decision-making process.

List alternatives. Discuss doctor diagnosis versus hygiene diagnosis with the dentist. Complete D4346 and discuss with the doctor after the fact. Complete D4342 as directed by the dentist in hopes that this scenario doesn’t present itself again.

Compare the anticipated action with acceptable professional standards. The hygienist should not only compare the definitions of the codes but also state laws and current research. Talking with a peer or mentor can also be helpful.

Select course of action. The hygienist chooses to discuss with the dentist the doctor diagnosis versus the hygiene diagnosis prior to completing treatment based on several core values involved: beneficence, nonmaleficence, veracity, and virtue.

Evaluate the action. The hygienist should reflect on the core values that helped her in the decision-making process and know that she did the right thing by standing up for herself and the patient no matter what the outcome was. Based on the outcome, she may be faced with another ethical dilemma that may lead to going through this process again.

It is every hygienist’s responsibility to put the patient first and to ensure that each patient receives optimal, evidence-based care. When faced with a dilemma, it is important to go through the decision-making steps in order to decide on the best course of action. All hygienists take an oath of ethics and values upon graduation. Each hygienist is responsible for understanding and using the code of ethics and values set forth by the Association. Remember, you’re not only standing up for your ethics and morals but also for your patients.


1. Carr M. Ethical decision making in dental hygiene. Dimens Dent Hyg. 2017;15(5):37-40. Published May 1, 2017. Accessed January 13, 2019.

2. Wilkins EM. Clinical Practice of the Dental Hygienist. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.

Jessica Raymond-Allbritten, BASDH, CRDH, practices dental hygiene with Ryan Lepore, DMD, at Lepore Comprehensive Dentistry in Dunedin, Florida. Jessica was a member of the 2015 Colgate Oral Health Advisory Board. She is also a contributing author for the Colgate Oral Health Advisor web page. You may contact her at [email protected].