| 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.
Keywords: Academic qualification, advertisements, dental clinics, ethics, sign boards
|How to cite this article:|
Sabarinath B, Sivapathasundharam B. Ethics in dentistry. J Educ Ethics Dent 2011;1:24-7
| Introduction|| |
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 , 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.  Ethical principles are followed in all professions including medicine, judiciary, sports, etc.
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, including a Joint State Council constituted in accordance with 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. 
As per the WHO, the dentist:population ratio is 1:7500.  Though it is apparently fulfilled in India, there is severe maldistribution of dentists in this country.  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,  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 competition and commercialization. The latter leads to violating the code of conduct put forth by the state dental councils and many of the norms are openly flouted and rules randomly bent. 
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.
| Results|| |
What was the size of the dental clinic board?
69% dental clinics had their board more than 3 × 2 feet and 31% dental clinics had a size equal to 3 × 2 feet [Figure 1].
Were the clinic boards with attractive symbols/pictures or wordings? Yes/No
68% clinic boards had attractive symbols/pictures/wordings, while 32% clinics did not have the same [Figure 2].
Did the dentists have abbreviations of degrees other than academic qualifications? Yes/No
9% dentists had abbreviations other than the academic qualifications, whereas 91% of them did not have the abbreviations [Figure 3].
Were the sign boards of the dental clinic present in other places?
In 22% of the cases, the sign board was present in other places and 78% clinics did not have their sign board in other places [Figure 4].
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.  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.
The following codes are considered to be unethical practices by a dentist:
"Using of sign board larger than 0.9 metre (3 feet) by 0.6 metre (2 feet) and the use of such words as 'teeth', 'Painless Extraction' or the like, or notices in regard to practice on premises other than 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 other than his name and qualifications as defined under clause (j) of section 2 of the Act". 
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. 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 commercial establishments and multiplexes. The only way of advertisement during that period was painted board and paper posters, whereas in the present scenario of digital banner era, the magic size of 3 × 2 square feet, as prescribed by these statutory bodies, may not be visible near a glamorous 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, 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 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 with proper proofs.
Advertisement of dental practice is rampant in almost all the metropolitan cities of India, most of which is done under the banner of corporate setup or call themselves as a private limited company run or managed by the registered dental practitioners. This practice of advertisement needs a caution as it may result in "supplier induced demand." This may also increase the unnecessary fear and annoyance to the general public regarding their very minor oral or dental changes which sometimes may not require any treatment at all. In addition, it may create unhealthy competition among the peers instead of creating awareness to the general public.
In the present scenario where dental clinics are also housed in multi-storeyed shopping complexes where there are prominent, glaring, and large sign boards for other commercial establishments, this code of ethics definitely needs a complete revision. Instead of prohibiting the advertisements completely, the policy makers can revise the act with respect to advertisements by health care professionals and regulate them accordingly as in developed countries like Singapore. 
"Styling by any dentist or a group of dentists his/their 'Dental clinic' or Chamber/s by the name of 'Dental Hospital/s'",  but we see many of the practitioners employing methods like exaggerating their clinics as a hospital.
"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".  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".  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". 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". 
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. 
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.
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Department of Oral Pathology and Microbiology, Meenakshi Ammal Dental College and Hospital, Chennai
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]