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5 — Principle: Veracity ("truthfulness")
The dentist has a
duty to communicate truthfully.
Report of the ADA Council on Ethics, Bylaws and
Judicial Affairs On Advisory Opinion 5.I.2. Credentials in General
Dentistry
Background: Advisory Opinion 5.I.2. CREDENTIALS IN GENERAL DENTISTRY
(formerly 5.I.2. FELLOWSHIPS) to the
ADA Principles of Ethics and Code of
Professional Conduct (Code), adopted
in June 1998 states:
General dentists may announce fellowships or other credentials
earned in the area of general dentistry so long as they avoid
any communications that express or imply specialization and the
announcement includes the disclaimer that the dentist is a general
dentist. The use of abbreviations to designate credentials shall
be avoided when such use would lead the reasonable person to
believe that the designation represents an academic degree, when
such is not the case.
In adopting Advisory Opinion 5.I.2, the Council made clear that
another, long-standing advisory opinion, also applies to the
announcement of credentials in general dentistry: 5.F.2. EXAMPLES
OF "FALSE AND MISLEADING." The relevant section of
Advisory Opinion 5.F.2 states:
The following examples are set
forth to provide insight into
the meaning of the term "false or misleading in a material respect." These
examples are not meant to be
all-inclusive. Rather, by restating the concept in alternative
language
and giving general examples,
it is hoped that the membership
will gain a better understanding of the term. With this
in mind,
statements shall be avoided which
would: . . . d) contain a material,
objective representation, whether
express or implied, that the advertised services are
superior in quality to those
of other dentists, if that representation is not subject
to reasonable
substantiation . . .
The purpose of this report is to provide information that will
help ADA members understand their ethical obligations under these
advisory opinions and to give guidance to the constituent and
component dental societies in interpreting and enforcing the
Code.
Return to Top Scope of Advisory Opinions: Advisory Opinion 5.F.2 sets forth
general concepts that apply across the board to professional
advertising regulated under the Code. Paragraph (d) applies to
any claim of superiority, whether the superiority relates to
education, skill, facilities or some other aspect of the dentist’s
professional qualifications or practice.
Advisory Opinion 5.I.2 applies to credentials that are earned
in the area of general dentistry, such as a fellowship or mastership.
It also applies to certificates earned upon completion of general
practice residency and advanced general dentistry programs, accredited
by the Commission on Dental Accreditation. Advisory Opinion 5.I.2
does not apply to the announcement of specialization (such as
orthodontist or prosthodontist) or to announcement of credentials
in non-specialty interest areas (such as cosmetic dentistry or
the treatment of TMJ). These credentials are covered elsewhere
in the Code (see Section 5.H. ANNOUNCEMENT OF SPECIALIZATION
AND LIMITATION OF PRACTICE; Section 5.H.2. SPECIALIST ANNOUNCEMENT
OF CREDENTIALS IN NON-SPECIALTY INTEREST AREAS; and Section 5.I.1.
GENERAL PRACTITIONER ANNOUNCEMENT OF CREDENTIALS).
Return to Top Ethical Issues Involved in Advertising Credentials in
General Dentistry: Advertising of credentials raises a number of ethical
issues. Such advertising may lead patients to believe that the
dentist is a specialist when such is not the case. Patients may
confuse the credentials, especially when they are abbreviated,
with academic degrees. Announcement of credentials may also give
patients the impression that the dentist who possesses the credential
has superior qualifications to the dentist who does not. Advisory
Opinion 5.I.2 addresses the first two issues. Advisory Opinion
5.F.2 addresses the third. The advisory opinions must be read
together to understand the ethical issues involved in advertising
of credentials in general dentistry.
Return to Top "False or Misleading" Standard: The touchstone of all
advertising under the Code is whether the advertisement is false
or misleading in any material respect. This standard was incorporated
into the Code in 1984 and has provided the basis for ethical
regulation of advertising under the Code ever since. It is important
to keep in mind that what is false or misleading must be judged
from the patient’s perspective. In analyzing professional
advertising, dentists are liable to confuse their own knowledge
about dentistry with that of the average patient. The
relevant inquiry for purposes of an advertising analysis is how
the reasonable
patient is likely to interpret a particular
claim. The claim
may be express or implied. The message that the dentist intends
to convey is not the issue. The key consideration is the message
the patient is likely to receive.
The average patient’s knowledge of what the credentials
after a dentist’s name mean is extremely limited. Beyond "D.D.S." and "D.M.D." the
average patient is usually at a loss to sort out the initials
and designations granted by a growing number of credentialing
organizations. As a result, dentists are challenged to be clear
and complete in their communications, so the public understands
exactly what a given credential does—and does not—represent.
The following sections provide guidance to dentists on how to
announce credentials in general dentistry without misleading
patients. The three ethical aspects of this type of advertising
are discussed in turn.
Return to Top Claims of Specialization: The ADA Code provides that dentists
who announce specialization "must have met in each approved
specialty for which they announce the existing educational requirements
and standards set forth by the American Dental Association" (Section
5.H. ANNOUNCEMENT OF SPECIALIZATION AND LIMITATION OF PRACTICE).
General dentists must avoid communications that express or imply
specialization (Section 5.I. GENERAL PRACTITIONER ANNOUNCEMENT
OF CREDENTIALS). The best and easiest way for a general dentist
to avoid the implication that he or she is a specialist is to
disclose that the dentist is a general dentist.
Advisory Opinion 5.I.2 states, "General dentists may announce
fellowships and other credentials earned in the area of general
dentistry so long as they avoid any communications that express
or imply specialization and the announcement includes a disclaimer
that the dentist is a general dentist." For example, "John
Jones, D.D.S., general dentist, diplomate, Institute of General
Dentistry." The disclaimer must be clear and visible in
the context of the ad as a whole. Generally, this means that
the disclaimer must be in the same font size, style and color
as the announcement of the credential.
Return to Top Use of Abbreviation: The use of abbreviations to announce non-academic
credentials can be misleading if it leads the patient to confuse
the credential with an academic degree. Advisory Opinion 5.I.2
states, "The use of abbreviations to designate credentials
shall be avoided when such use would lead the reasonable person
to believe that the designation represents an academic degree,
when such is not the case."
Return to Top Implied Claims of Superiority: When a patient sees "fellow," "master" or
other professional designation after a dentist’s name,
the patient is likely to interpret this to mean that the dentist
has professional qualifications that are superior to those of
dentists who do not possess the credential. Hence, the Council
believes that the announcement of such credentials represents
an implied claim of superiority that is subject to "reasonable
substantiation" under Advisory Opinion 5.F.2. EXAMPLES OF "FALSE
OR MISLEADING," part (d), unless the implication is dispelled
through the use of a disclaimer.
One possible way to dispel the implied
claim of superiority would be with the use of appropriate
language such as the following:
John R. Jones, D.D.S.
General Dentist
Fellow, Institute of General Dentistry*
*an award based on continuing education credits
Alternatively, another acceptable option would be to use a disclaimer
such as that required by law in the State of Alabama: "no
representation is made that the quality of the dental services
to be performed is greater than the quality of dental services
performed by other dentists." Such disclaimers must be clear
and visible compared to the announcement of the credential. Whether
a particular disclaimer is clear and visible will be judged in
the context of the advertisement as a whole, but at a minimum,
the Council will require the disclaimer to be in the same font,
size, style and color as the credential.
A dentist who makes an implied claim of superiority must have
a reasonable basis for the claim and be ready to support it with
objective evidence. It is impossible to itemize the specific
evidence that would satisfy the "reasonable basis" requirement
in a particular case; this would depend on the specific credential
and the context in which it appeared. However, among the factors
the constituents or components should consider in reviewing member
advertising are: Is the credential earned or honorary? If the
credential is earned, what are the training, education and testing
requirements for the credential? What relevance do they have
to the clinical practice of dentistry? How do they compare to
any state-mandated continuing education requirements that apply
to other licensed dentists? What standards are used to evaluate
the educational programs or providers? What standards are used
to evaluate any testing required to gain the credential?
Return to Top Enforcement of the Code: Members of the American Dental Association
voluntarily agree to conform their professional conduct to the
ADA Principles of Ethics and Code of Professional Conduct. Dentists
who violate the Code may be subject to discipline, ranging from
censure to expulsion from membership. Under the Association’s
tripartite structure, responsibility for enforcing the Code is
delegated, in the first instance, to the constituent and component
dental societies. The ADA Council on Ethics, Bylaws and Judicial
Affairs serves as the appellate body to hear member appeals from
adverse decisions of the constituent and component societies.
In this capacity, the Council serves as the ultimate authority
for interpreting the Code as it applies to the facts and circumstances
of a particular case. The Council will continue to exercise this
authority in cases involving alleged violations of the Code’s
advertising sections. The Council’s appellate decisions,
which are reported annually, will provide additional guidance
on the meaning of these sections. The constituent and component
societies are reminded that, before a member may be disciplined,
he or she is entitled to a hearing conducted in accordance with
Chapter XII, section 20 of the ADA Bylaws.
Advisory Opinion adopted in 1998;
Report adopted in 1999
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