Your 15-year-old retention patient completed treatment 2 years ago with an excellent result. You remember him well—the youngest of 4 siblings whom you treated. When he returns for an adjustment of his upper retainer, you are taken aback by the severe retrograde wear of his darkened dentition since you last saw him 1 year ago. You notice severe inflammation in his nasal region. Although he tells you that he has developed an “awesome case of hay fever,” you suspect that he is engaging in illicit drug use. You close the door to your operatory, and, your direct inquiry confirms his cocaine habit. He pleads with you not to tell his father, who is your neighbor. You are now faced with an ethical dilemma. Do you respect the patient’s wishes for confidentiality? If you do so, might you be considered negligent in averting potentially serious health consequences? Alternatively, do you inform his parents of his habit so that rehabilitation can begin as soon as possible? Confidentiality is essential in the establishment of trust in a doctor-patient relationship and is an integral component of the Hippocratic oath. The oath states that “whatsoever I see or hear in the course of my profession . . . I will never divulge, holding such things to be holy secrets.” There are indeed instances when confidentiality is morally and legally violated, as in a case of suspected child abuse or a physically incompetent pilot whose uncontrolled sleep apnea places his passengers at risk. But when should confidentiality be breached in a dental setting? Many ethicists believe that confidentiality can be overridden when there is sufficient evidence to indicate that the patient would be harmed by maintaining confidentiality. Confidentiality is viewed as a “prima facie” principle: “a duty that is morally binding unless it conflicts with a more pressing moral duty.” Confidentiality can be violated if it incurs risks to other people or to society. For example, if a violent,