QAn assistant who works for me one day a week and for another four days a week asked me what kind of cement I used to recement nonretentive permanent crowns. At first, I thought she was trying to gather information to improve her assisting skills. During the conversation, however, it became clear that she was providing emergency care for patients of her other employer, who was out of the office recovering from surgery. The assistant was recementing permanent crowns, placing sedative fillings and reshaping sharp edges on broken teeth with a high-speed handpiece. Because the other dentist is not an ADA member, does she need to abide by the American Dental Association Principles of Ethics and Code of Professional Conduct? Also, what are my obligations as an ADA member?AAs stated in the Introduction to the American Dental Association Principles of Ethics and Code of Professional Conduct (ADA Code), the “dental profession holds a special position of trust within society.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar The Introduction states further that “[i]n return, the profession makes a commitment to society that its members will adhere to high ethical standards of conduct.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar This statement is clear that every dentist (a member of the profession), whether or not he or she is a member of the ADA, has an obligation to aspire and adhere to the highest ethical standards. And those ethical standards require the dentist to make choices that benefit the patient first and foremost. Although the ADA Code cannot be enforced with regard to a nonmember dentist, its principles should, nonetheless, serve as a guide to ethical practice.Section 4B, Emergency Service, states that as a matter of justice, “[d]entists shall be obliged to make reasonable arrangements for the emergency care of their patients of record.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar The question here is whether it is reasonable for a dental assistant, who is untrained in this area and unable to recognize pathology, to be tasked with recementing a permanent crown that may have come out because of decay or fracture of the underlying tooth. If decay or fracture had been present, the clinician would have had to address specific issues, such as whether the pulp had been compromised. What additional treatments may have been necessary that would preclude recementing the crown? Expecting a dental assistant to make these decisions, given her lack of training in making such assessments, is not a reasonable arrangement for emergency care. We should interpret “reasonable arrangements” as making arrangements with another dentist to be available to care for patients on an emergency basis. For practitioners who are concerned that other dentists might “steal” their patients, Section 2.B, Consultation and Referral, obligates the dentist who has provided emergency services for another dentist's patient to return that patient to the original dentist “unless the patient expressly reveals a different preference.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle ScholarAlso applicable to the dilemma you present is Section 1, Principle of Patient Autonomy (“self governance”), which carries with it the duty to “treat the patient according to the patient's desires, within the bounds of accepted treatment. …”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In the scenario you present, the other dentist has delegated responsibilities to a dental assistant, who is neither trained nor licensed to perform the tasks assigned. In carrying out these emergency procedures, the assistant is working outside the “bounds of accepted treatment” because the procedures are outside of her scope of practice. This is both unethical and illegal.Another section that applies to this dilemma is Section 2, Principle of Nonmaleficence (“do no harm”). “The dentist has a duty to refrain from harming the patient.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In this case, the dentist, by delegating responsibilities to a person who is not trained or licensed to perform these responsibilities, is risking potentially great harm to the patient. In particular, Section 2.C, Use of Auxiliary Personnel, requires that dentists “be obliged to protect the health of their patients by only assigning to qualified auxiliaries those duties which can be legally delegated.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar Therefore, it is imperative that the dentist be made aware of what is permissible under the law in her state.Finally, Section 5, Principle of Veracity (“truthfulness”), obligates the dentist to be honest in his or her dealings with patients. This section states that “the dentist's primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception. …”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In the situation you describe, it would be dishonest to have patients believe that the assistant is qualified to perform emergency procedures when she has had no training to do so and is acting outside the scope of her qualifications.The dentist you describe may be violating the ethical principles found in the ADA Code, but she also may be violating state law that addresses delegation of duties to a dental auxiliary.In this situation, patients are at risk of experiencing harm. Your responsibility is to take action to protect these patients. According to Section 4.C, Justifiable Criticism, dentists are “obliged to report to the appropriate reviewing agency as determined by the local component or constituent society instances of gross or continual faulty treatment by other dentists.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar This obligation, however, typically pertains to the reporting of ADA member-dentists, according to Section IV, “Interpretation and Application of Principles of Ethics and Code of Professional Conduct.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In this case, the treatment described may be an inappropriate delegation of responsibility to an auxilliary.Before taking action, however, you need to consider that the dentist may be unaware of her obligation to have made arrangements with another dentist to provide emergency care in her absence; the practitioner also may be unaware of the duties that can be delegated legally and ethically to a dental assistant. It also is possible that the assistant misinterpreted the instructions given to her and made a unilateral decision to provide treatment for patients rather than refer them to another dentist.Although confrontation is never easy, it is important for you to contact the dentist and explain that it has come to your attention that the assistant is violating her scope of practice. If the dentist is unaware of what is transpiring in her office, she can take immediate corrective steps. If, however, the dentist is uninformed about her duties and obligations, you should review them with her, carefully and nonjudgmentally. You can offer to provide emergency coverage and reassure the dentist that you will not solicit these patients for your practice, as is your obligation under Section 2.B.1. If the dentist refuses to provide appropriate emergency coverage for her patients, you should consider reporting—and may even be obligated to report—the activities to your state licensing entity and your local component or constituent dental society.During our working years, we may be faced with a need to be away from our practices for an extended period for various reasons, such as an illness, an accident or the need to care for an elderly parent or a sick child. While you are feeling well and your life is on an even keel, consider which colleagues you can reach out to and with whom you can establish your emergency safety net. In this case, an ounce of prevention would have been worth a pound of cure.▪ QAn assistant who works for me one day a week and for another four days a week asked me what kind of cement I used to recement nonretentive permanent crowns. At first, I thought she was trying to gather information to improve her assisting skills. During the conversation, however, it became clear that she was providing emergency care for patients of her other employer, who was out of the office recovering from surgery. The assistant was recementing permanent crowns, placing sedative fillings and reshaping sharp edges on broken teeth with a high-speed handpiece. Because the other dentist is not an ADA member, does she need to abide by the American Dental Association Principles of Ethics and Code of Professional Conduct? Also, what are my obligations as an ADA member? An assistant who works for me one day a week and for another four days a week asked me what kind of cement I used to recement nonretentive permanent crowns. At first, I thought she was trying to gather information to improve her assisting skills. During the conversation, however, it became clear that she was providing emergency care for patients of her other employer, who was out of the office recovering from surgery. The assistant was recementing permanent crowns, placing sedative fillings and reshaping sharp edges on broken teeth with a high-speed handpiece. Because the other dentist is not an ADA member, does she need to abide by the American Dental Association Principles of Ethics and Code of Professional Conduct? Also, what are my obligations as an ADA member? AAs stated in the Introduction to the American Dental Association Principles of Ethics and Code of Professional Conduct (ADA Code), the “dental profession holds a special position of trust within society.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar The Introduction states further that “[i]n return, the profession makes a commitment to society that its members will adhere to high ethical standards of conduct.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar This statement is clear that every dentist (a member of the profession), whether or not he or she is a member of the ADA, has an obligation to aspire and adhere to the highest ethical standards. And those ethical standards require the dentist to make choices that benefit the patient first and foremost. Although the ADA Code cannot be enforced with regard to a nonmember dentist, its principles should, nonetheless, serve as a guide to ethical practice.Section 4B, Emergency Service, states that as a matter of justice, “[d]entists shall be obliged to make reasonable arrangements for the emergency care of their patients of record.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar The question here is whether it is reasonable for a dental assistant, who is untrained in this area and unable to recognize pathology, to be tasked with recementing a permanent crown that may have come out because of decay or fracture of the underlying tooth. If decay or fracture had been present, the clinician would have had to address specific issues, such as whether the pulp had been compromised. What additional treatments may have been necessary that would preclude recementing the crown? Expecting a dental assistant to make these decisions, given her lack of training in making such assessments, is not a reasonable arrangement for emergency care. We should interpret “reasonable arrangements” as making arrangements with another dentist to be available to care for patients on an emergency basis. For practitioners who are concerned that other dentists might “steal” their patients, Section 2.B, Consultation and Referral, obligates the dentist who has provided emergency services for another dentist's patient to return that patient to the original dentist “unless the patient expressly reveals a different preference.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle ScholarAlso applicable to the dilemma you present is Section 1, Principle of Patient Autonomy (“self governance”), which carries with it the duty to “treat the patient according to the patient's desires, within the bounds of accepted treatment. …”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In the scenario you present, the other dentist has delegated responsibilities to a dental assistant, who is neither trained nor licensed to perform the tasks assigned. In carrying out these emergency procedures, the assistant is working outside the “bounds of accepted treatment” because the procedures are outside of her scope of practice. This is both unethical and illegal.Another section that applies to this dilemma is Section 2, Principle of Nonmaleficence (“do no harm”). “The dentist has a duty to refrain from harming the patient.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In this case, the dentist, by delegating responsibilities to a person who is not trained or licensed to perform these responsibilities, is risking potentially great harm to the patient. In particular, Section 2.C, Use of Auxiliary Personnel, requires that dentists “be obliged to protect the health of their patients by only assigning to qualified auxiliaries those duties which can be legally delegated.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar Therefore, it is imperative that the dentist be made aware of what is permissible under the law in her state.Finally, Section 5, Principle of Veracity (“truthfulness”), obligates the dentist to be honest in his or her dealings with patients. This section states that “the dentist's primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception. …”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In the situation you describe, it would be dishonest to have patients believe that the assistant is qualified to perform emergency procedures when she has had no training to do so and is acting outside the scope of her qualifications.The dentist you describe may be violating the ethical principles found in the ADA Code, but she also may be violating state law that addresses delegation of duties to a dental auxiliary.In this situation, patients are at risk of experiencing harm. Your responsibility is to take action to protect these patients. According to Section 4.C, Justifiable Criticism, dentists are “obliged to report to the appropriate reviewing agency as determined by the local component or constituent society instances of gross or continual faulty treatment by other dentists.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar This obligation, however, typically pertains to the reporting of ADA member-dentists, according to Section IV, “Interpretation and Application of Principles of Ethics and Code of Professional Conduct.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In this case, the treatment described may be an inappropriate delegation of responsibility to an auxilliary.Before taking action, however, you need to consider that the dentist may be unaware of her obligation to have made arrangements with another dentist to provide emergency care in her absence; the practitioner also may be unaware of the duties that can be delegated legally and ethically to a dental assistant. It also is possible that the assistant misinterpreted the instructions given to her and made a unilateral decision to provide treatment for patients rather than refer them to another dentist.Although confrontation is never easy, it is important for you to contact the dentist and explain that it has come to your attention that the assistant is violating her scope of practice. If the dentist is unaware of what is transpiring in her office, she can take immediate corrective steps. If, however, the dentist is uninformed about her duties and obligations, you should review them with her, carefully and nonjudgmentally. You can offer to provide emergency coverage and reassure the dentist that you will not solicit these patients for your practice, as is your obligation under Section 2.B.1. If the dentist refuses to provide appropriate emergency coverage for her patients, you should consider reporting—and may even be obligated to report—the activities to your state licensing entity and your local component or constituent dental society.During our working years, we may be faced with a need to be away from our practices for an extended period for various reasons, such as an illness, an accident or the need to care for an elderly parent or a sick child. While you are feeling well and your life is on an even keel, consider which colleagues you can reach out to and with whom you can establish your emergency safety net. In this case, an ounce of prevention would have been worth a pound of cure.▪ As stated in the Introduction to the American Dental Association Principles of Ethics and Code of Professional Conduct (ADA Code), the “dental profession holds a special position of trust within society.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar The Introduction states further that “[i]n return, the profession makes a commitment to society that its members will adhere to high ethical standards of conduct.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar This statement is clear that every dentist (a member of the profession), whether or not he or she is a member of the ADA, has an obligation to aspire and adhere to the highest ethical standards. And those ethical standards require the dentist to make choices that benefit the patient first and foremost. Although the ADA Code cannot be enforced with regard to a nonmember dentist, its principles should, nonetheless, serve as a guide to ethical practice. Section 4B, Emergency Service, states that as a matter of justice, “[d]entists shall be obliged to make reasonable arrangements for the emergency care of their patients of record.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar The question here is whether it is reasonable for a dental assistant, who is untrained in this area and unable to recognize pathology, to be tasked with recementing a permanent crown that may have come out because of decay or fracture of the underlying tooth. If decay or fracture had been present, the clinician would have had to address specific issues, such as whether the pulp had been compromised. What additional treatments may have been necessary that would preclude recementing the crown? Expecting a dental assistant to make these decisions, given her lack of training in making such assessments, is not a reasonable arrangement for emergency care. We should interpret “reasonable arrangements” as making arrangements with another dentist to be available to care for patients on an emergency basis. For practitioners who are concerned that other dentists might “steal” their patients, Section 2.B, Consultation and Referral, obligates the dentist who has provided emergency services for another dentist's patient to return that patient to the original dentist “unless the patient expressly reveals a different preference.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar Also applicable to the dilemma you present is Section 1, Principle of Patient Autonomy (“self governance”), which carries with it the duty to “treat the patient according to the patient's desires, within the bounds of accepted treatment. …”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In the scenario you present, the other dentist has delegated responsibilities to a dental assistant, who is neither trained nor licensed to perform the tasks assigned. In carrying out these emergency procedures, the assistant is working outside the “bounds of accepted treatment” because the procedures are outside of her scope of practice. This is both unethical and illegal. Another section that applies to this dilemma is Section 2, Principle of Nonmaleficence (“do no harm”). “The dentist has a duty to refrain from harming the patient.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In this case, the dentist, by delegating responsibilities to a person who is not trained or licensed to perform these responsibilities, is risking potentially great harm to the patient. In particular, Section 2.C, Use of Auxiliary Personnel, requires that dentists “be obliged to protect the health of their patients by only assigning to qualified auxiliaries those duties which can be legally delegated.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar Therefore, it is imperative that the dentist be made aware of what is permissible under the law in her state. Finally, Section 5, Principle of Veracity (“truthfulness”), obligates the dentist to be honest in his or her dealings with patients. This section states that “the dentist's primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception. …”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In the situation you describe, it would be dishonest to have patients believe that the assistant is qualified to perform emergency procedures when she has had no training to do so and is acting outside the scope of her qualifications. The dentist you describe may be violating the ethical principles found in the ADA Code, but she also may be violating state law that addresses delegation of duties to a dental auxiliary. In this situation, patients are at risk of experiencing harm. Your responsibility is to take action to protect these patients. According to Section 4.C, Justifiable Criticism, dentists are “obliged to report to the appropriate reviewing agency as determined by the local component or constituent society instances of gross or continual faulty treatment by other dentists.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar This obligation, however, typically pertains to the reporting of ADA member-dentists, according to Section IV, “Interpretation and Application of Principles of Ethics and Code of Professional Conduct.”1American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to April 2012.www.ada.org/sections/about/pdfs/code_of_ethics_2012.pdfGoogle Scholar In this case, the treatment described may be an inappropriate delegation of responsibility to an auxilliary. Before taking action, however, you need to consider that the dentist may be unaware of her obligation to have made arrangements with another dentist to provide emergency care in her absence; the practitioner also may be unaware of the duties that can be delegated legally and ethically to a dental assistant. It also is possible that the assistant misinterpreted the instructions given to her and made a unilateral decision to provide treatment for patients rather than refer them to another dentist. Although confrontation is never easy, it is important for you to contact the dentist and explain that it has come to your attention that the assistant is violating her scope of practice. If the dentist is unaware of what is transpiring in her office, she can take immediate corrective steps. If, however, the dentist is uninformed about her duties and obligations, you should review them with her, carefully and nonjudgmentally. You can offer to provide emergency coverage and reassure the dentist that you will not solicit these patients for your practice, as is your obligation under Section 2.B.1. If the dentist refuses to provide appropriate emergency coverage for her patients, you should consider reporting—and may even be obligated to report—the activities to your state licensing entity and your local component or constituent dental society. During our working years, we may be faced with a need to be away from our practices for an extended period for various reasons, such as an illness, an accident or the need to care for an elderly parent or a sick child. While you are feeling well and your life is on an even keel, consider which colleagues you can reach out to and with whom you can establish your emergency safety net. In this case, an ounce of prevention would have been worth a pound of cure.▪