NBDHE Professional Ethics and Law 2 — Questions and Answers

Question 1: Which ethical principle requires the dental hygienist to tell the truth and provide accurate information to patients?

Veracity (Correct answer)
Beneficence
Justice
Autonomy

Correct answer: Veracity

Veracity is the ethical principle of truthfulness — dental hygienists have a duty to provide accurate, complete, and honest information to patients regarding diagnosis, prognosis, and treatment options.

The ethical principles guiding dental hygiene practice include: (1) Autonomy — patient's right to self-determination; (2) Beneficence — doing good/acting in the patient's best interest; (3) Nonmaleficence — do no harm; (4) Justice — fair and equitable treatment; (5) Veracity — truthfulness and honesty in all communication; (6) Fidelity — keeping promises and commitments to patients. Veracity requires dental hygienists to accurately document findings, honestly report periodontal status and disease progression, disclose mistakes, and provide unbiased information about treatment options — even when the truth may be uncomfortable for the patient or clinician. Deception or withholding material information violates veracity.

Question 2: Informed consent in dental hygiene practice requires all of the following EXCEPT:

The patient must be guaranteed a specific treatment outcome (Correct answer)
Explanation of the proposed treatment and its purpose
Discussion of potential risks and benefits
Disclosure of reasonable alternatives

Correct answer: The patient must be guaranteed a specific treatment outcome

Informed consent requires disclosure of diagnosis, proposed treatment, risks/benefits, alternatives, and consequences of no treatment — but cannot guarantee specific outcomes, as individual variation exists.

Valid informed consent requires: (1) Disclosure — proposed treatment, diagnosis, expected outcomes, material risks and benefits, alternatives, consequences of no treatment; (2) Understanding — patient comprehends information (may require interpreter, plain language, visual aids); (3) Voluntariness — decision free from coercion; (4) Competency — patient has decision-making capacity. Guaranteeing specific treatment outcomes (e.g., 'this will completely cure your gum disease') is unethical and constitutes express warranty — creating legal liability. Treatment contracts and consent forms should never include outcome guarantees. For minors, consent is obtained from a parent/guardian; mature minors may consent in some states. Implied consent applies only for emergency treatment of an unconscious patient.

Question 3: The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule requires dental practices to:

Provide patients with a Notice of Privacy Practices and protect individually identifiable health information from unauthorized disclosure (Correct answer)
Store all patient records in paper format only
Disclose patient information to any healthcare provider who requests it
Require patient consent before any clinical treatment

Correct answer: Provide patients with a Notice of Privacy Practices and protect individually identifiable health information from unauthorized disclosure

HIPAA requires covered entities (including dental practices) to provide patients a Notice of Privacy Practices and to implement safeguards protecting Protected Health Information (PHI) from unauthorized use or disclosure.

The HIPAA Privacy Rule (45 CFR Parts 160 and 164) applies to covered entities (healthcare providers, health plans, clearinghouses) and their business associates. Key requirements: (1) Provide patients with a Notice of Privacy Practices (NPP) at first visit and upon request; (2) Protect PHI — any individually identifiable health information (paper, electronic, oral); (3) Minimum necessary rule — share only the PHI needed for the purpose; (4) Patient rights — access to their own records, amendment requests, accounting of disclosures, restriction requests. PHI may be disclosed without authorization for: treatment, payment, healthcare operations, and specific public health/law enforcement purposes. The Security Rule covers electronic PHI (ePHI) specifically.

Question 4: A dental hygienist who performs a procedure that they are not legally authorized to perform in their state may be charged with:

Practicing dentistry without a license (unauthorized practice of dentistry) (Correct answer)
Only civil negligence
Battery only if the patient was injured
No violation if the dentist asked them to perform it

Correct answer: Practicing dentistry without a license (unauthorized practice of dentistry)

Performing procedures beyond the dental hygienist's legal scope of practice — regardless of dentist authorization — constitutes unauthorized practice of dentistry, which is a criminal offense in all states.

Dental practice acts in each state define the scope of practice for dental hygienists. Performing procedures not included in the DH scope of practice — even if instructed by a supervising dentist — constitutes unauthorized practice of dentistry (UPD), which is typically a criminal misdemeanor or felony charge. The supervising dentist may also face disciplinary action for directing the illegal activity. Neither verbal nor written authorization from a dentist can expand a DH's scope beyond what the state practice act permits. Scope of practice varies by state — some permit direct supervision, general supervision, or independent practice for certain procedures. DHs must maintain current knowledge of their state's practice act.

Question 5: Which action represents proper documentation in the event of a patient refusing recommended treatment?

Document the refusal in the patient's chart, including the risks and alternatives explained, and have the patient sign a refusal of care form (Correct answer)
Simply note 'patient refused' without additional detail
Do not document the refusal to protect the patient's privacy
Dismiss the patient from care for non-compliance

Correct answer: Document the refusal in the patient's chart, including the risks and alternatives explained, and have the patient sign a refusal of care form

Informed refusal must be fully documented: what was recommended, what risks were explained, what alternatives were offered, the patient's decision, and ideally a signed informed refusal form to protect both patient and provider.

Just as informed consent is required before treatment, informed refusal (the patient's right to decline recommended care) requires thorough documentation: (1) What treatment was recommended and the clinical rationale; (2) The risks of refusing the recommended treatment; (3) Alternative treatments or modifications discussed; (4) The patient's verbal expression of their decision; (5) Patient's signature on an Informed Refusal of Care form; (6) Clinician signature and date. This documentation protects against malpractice claims alleging the patient was not informed. Dismissing a patient for refusing a specific procedure without offering alternatives may violate professional obligations and state law. ADHA's Code of Ethics supports patient autonomy in treatment decisions.

Question 6: The concept of 'standard of care' in dental hygiene malpractice cases is defined as:

The level of care a reasonably prudent dental hygienist with similar training and experience would provide under the same or similar circumstances (Correct answer)
The highest possible level of care available anywhere
The care provided by the most experienced specialist
The minimum care described in the state dental practice act only

Correct answer: The level of care a reasonably prudent dental hygienist with similar training and experience would provide under the same or similar circumstances

Standard of care is the objective legal standard — what a reasonably prudent dental hygienist with comparable training would do in the same circumstances — not the best care possible or minimum statutory requirements.

In dental malpractice litigation, four elements must be proven: (1) Duty — a professional relationship existed; (2) Breach of duty — the standard of care was not met; (3) Causation — the breach caused harm; (4) Damages — actual harm/injury occurred. The standard of care is established through expert testimony from dental hygiene professionals, clinical guidelines, textbooks, and professional organization standards (ADHA). It is a community standard — national in scope in most jurisdictions (not local). Dental hygienists can be held to the standard even when following dentist instructions if the instructions require a deviation from accepted practice. Risk management strategies include proper documentation, continuing education, and practice within defined competencies.

NBDHE Professional Ethics and Law 2

Which ethical principle requires the dental hygienist to tell the truth and provide accurate information to patients?

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