Foundations of Professionalism sets out the core principles and duties of professionalism for Ontario dentists. This document provides the foundation for all Standards of Practice, Guidelines, and Practice Advisories.
The document also includes these Frequently Asked Questions to help you interpret and apply these principles and duties in practice.
What is Foundations of Professionalism?
Foundations of Professionalism sets out the core principles and duties of professionalism for Ontario dentists. This document provides the foundation for all Standards of Practice, Guidelines, and Practice Advisories.
Standards of Practice, Guidelines, and Practice Advisories expand on these duties by detailing legal, ethical, and professional obligations in specific areas (e.g., recordkeeping, professional boundaries, virtual care).
Dentists are expected to comply with all College documents, including Foundations of Professionalism.
Foundations of Professionalism was developed as part of the Access to Care Strategic Project. Improving access to oral health care is a priority for the RCDSO and it is a strategic project under the 2023-25 Strategic Plan.
Professionalism can help increase access to oral health care by fostering a culturally safe, inclusive, equitable, and accessible environment that is free from discrimination. Improving access to oral health care has a direct connection to the RCDSO’s mandate and supports patients’ overall health and wellbeing.
Another key objective for creating the new document was to update and modernize the RCDSO’s Code of Ethics. Foundations of Professionalism replaced the Code of Ethics and more accurately and comprehensively reflects the current environment.
This document affirms the ethical commitments and duties that dentists make and uphold throughout their careers. It is meant to support dentists in navigating the ethical complexities that arise in practice.
Dentists can use the document to help them make clinical and professional practice decisions that embody the core principles and duties of professionalism. These sometimes-difficult decisions are ultimately at the dentist’s discretion.
It will be used by the RCDSO, together with Standards of Practice, Guidelines, and Advisories and related resources that inform dentists’ conduct, when evaluating dentists’ practice and conduct.
Foundations of Professionalism will be a basis for College teaching with respect to ethics and professionalism.
No. As dental students are not registrants of the RCDSO, College documents cannot apply to them in the same sense that they apply to licensed Ontario dentists. However, Foundations of Professionalism will be used by Ontario faculties of dentistry to help learners understand what professionalism means, as dentists’ commitment to professionalism begins with entry into dental school.
No. Foundations of Professionalism does not require dentists to participate in specific initiatives or programs. The document states that dentists can demonstrate their commitment to justice by promoting health and preventing oral disease by understanding and taking reasonable steps to address the determinants of health (e.g., by participating in initiatives to reduce health inequities that are driven by the determinants of health).
Professional regulation refers to an approach or system that ensures members of health professions meet standards of competency and conduct, usually involving registering, licensing, and monitoring members to ensure that they meet these standards. Professional regulation is based on the premise that regulated professionals (i.e., dentists) can be trusted to regulate themselves in the public interest.
The RCDSO is the regulatory body for the profession of dentistry in Ontario. The RCDSO has a mandate to protect and serve the public interest. See the RCDSO’s website for more information about what we do.
Requirements for professional regulation are set out in law and by the RCDSO. Dentists must comply with all legal, professional, and ethical obligations, including those that relate to professional regulation (e.g., licensure, investigations). If dentists do not comply with these obligations, it could pose a risk of harm to patients, the public, and the reputation of the profession and the RCDSO.
Examples of how dentists can participate in professional regulation include, but are not limited to:
- Collectively serving on RCDSO Council and Committees and supporting RCDSO processes (e.g., assessments, inspections);
- Remaining current with RCDSO communications and requirements and complying with the requirements;
- Reviewing and providing feedback on RCDSO consultations (e.g., proposed by-law amendments, new or revised College documents (e.g., Standards of Practice); and
- Cooperating with RCDSO processes, as necessary or relevant.
Dentists’ obligations regarding dental records can be found in the following:
- RCDSO’s Guidelines on Dental Recordkeeping and Electronic Records Management, and Practice Advisory on Release and Transfer of Patient Records.
- RCDSO’s Frequently Asked Questions – Dental Recordkeeping.
- Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A.
- Section 2, paragraphs 29-30 of Professional Misconduct, O. Reg. 853/93, enacted under the Dentistry Act, 1991, S.O. 1991, c. 24.
No. Foundations of Professionalism states that dentists are to respect patient autonomy by providing patient-centered care that upholds the standards of practice of the profession. This does not mean that patients can dictate treatment because dentists will have to use their professional judgement to determine which treatment options will meet the standards of practice of the profession.
See the RCDSO’s Practice advice: Constructive conversations with patients article for more information.
Dentists and their teams can take steps to help ensure the office environment is welcoming and safe for all patients. Examples include, but are not limited to:[1]
- Create a calm atmosphere (e.g., display images of nature, play soothing music).
- Before every appointment, remind patients to bring in objects (or people who will support them) that give them a sense of security or stress relief, such as stress balls, etc.
- At the beginning of every appointment, remind the patient that they have control to stop the procedure for any reason by raising their hand for example or using another established signal.
- During the appointment, avoid surprises and provide cues for the steps of the procedure that create different sensations (e.g., changing the angle of the chair or using an instrument that creates a different sound or vibration).
- Make forms, signage, waiting areas, washrooms, and office policies, practices, and procedures inclusive.
- Create anti-discrimination policies, practices, and procedures, inclusive communication and data collection practices, and ongoing cultural competency training.
[1] Adapted from CareQuest Institute for Oral Health and Rainbow Health Ontario.
Examples include, but are not limited to:
- School-based dental education
- Counselling patients on the connection between oral health and overall health
- Community dental screening, fluoride treatments, and oral health education
- Doing outreach with underserved patient populations
- Practising in mobile dental clinics
- Participating in public health programs
- Participating in campaigns to promote oral health
- Advocating for policy changes (e.g., public programs)
Foundations of Professionalism states that dentists can demonstrate nonmaleficence by being truthful and providing accurate information about themselves (e.g., education, qualifications, competence) and/or their practice. There are a number of resources that describe dentists’ requirements with respect to this.
The College has two Practice Advisories on Professional Advertising and Practice Names that are guided by the O. Reg. 853/93. (Professional Misconduct) under the Dentistry Act, 1991. All dentists are expected to ensure that their professional advertising complies with the requirements contained in the Practice Advisories and regulations. The relevant resources are as follows:
Foundations of Professionalism states that dentists demonstrate nonmaleficence by addressing harm. Financial is one of the types of harm that patients can experience, which can be described as the negative monetary impact or damage that people experience as a result of financial misconduct.
Financial misconduct refers to fraudulent actions which result in a monetary loss, waste or violation of ethical, regulatory or legal standards. Affected parties may be patients and/or those responsible for making payments towards the patient’s treatment (including dental insurance companies).
Examples of financial misconduct include, but are not limited to:
- Overbilling;
- Billing inappropriate codes;
- Billing for treatment not provided/performed;
- Billing for a date other than the date of service;
- Billing codes to circumvent dental insurance plan limitations; and
- Failure to collect co-payments.
Examples include, but are not limited to:
- Take the Implicit Association Test
- Do Unconscious Bias Training
- Consider experiences from the point of view of the person (e.g., consuming media about the group, directly interacting with people from that group); pause and reflect on your potential biases before interacting with people of certain groups to reduce reflexive reactions (e.g., think about positive examples of that group, such as celebrities or friends); evaluate people based on their personal characteristics rather than those affiliated with their group (e.g., connect over shared interests or backgrounds).[1]
- Practice conscious, positive formal and informal role modeling; take active-bystander training to learn how to address or interrupt microaggressions and other harmful incidents; and undergo training aimed at eliminating negative patient descriptions and stigmatizing words in chart notes and direct patient communications.[2]
- Learn about health disparities; have positive and frequent intergroup contact with different historically marginalized groups.[3]
[1] Adapted from American Academy of Family Physicians.
[2] Adapted from: Sabin, J.A. (2022). Tackling Implicit Bias in Health Care. N Engl J Med, 387: 105-107.
[3] Adapted from: Smith Haghighi, A., (2023). Biases in healthcare: An overview. Medical News Today.
Dentists can respect patient autonomy by supporting and empowering patients. This can include, but is not limited to:
- Actively listening to patients’ needs, values, beliefs, goals, and concerns
- Using clear, inclusive, and non-technical language
- Taking time to explain information thoroughly
- Encouraging questions and fostering open dialogue where concerns can be safely shared
- Informing patients that they can pause or request breaks during treatment
- Demonstrating empathy, especially when patients share experiences of discrimination
- Learning about and respecting cultural practices, boundaries, and preferences
- Communicating respectfully
- Using interpreters when needed to overcome language barriers
- Modifying office policies and procedures, where feasible, to reflect and respond to cultural and individual needs
- Recognizing and using existing supports, such as community supports
- Understanding economic circumstances and offering flexible options, when possible
- Acknowledging systemic barriers and discrimination faced by patients
- Ensuring care is inclusive, equitable, and responsive to diverse identities.
Supporting and empowering other members of the oral health care team could include, but is not limited to:
- Communicating respectfully
- Encouraging questions and fostering open dialogue where concerns can be safely shared
- Respecting and valuing their contributions
- Supporting continuing education and professional development
- Acknowledging and celebrating achievements.
Examples include, but are not limited to:
- Learning about the historical and ongoing impacts of colonialism
- Recognizing the relevance of intergenerational trauma to the lives and health outcomes of Indigenous Peoples
- Recognizing and respecting the diversity among Indigenous Peoples
- Learning about cultural practices and traditions that are essential to the health and well-being of Indigenous peoples (e.g., including the role of Elders and Knowledge Keepers play), and respecting and responding to them
- Learning about and seeking to implement the Truth and Reconciliation Commission of Canada's Calls to Action
- Engaging in ongoing cultural safety and humility, and trauma and violence-informed care training
- Incorporating culturally safe and trauma and violence-informed approaches to care into their practices
- Supporting Indigenous-led health initiatives and self-determination.
Some resources for further learning include:
Some examples include, but are not limited to:
- Promoting good oral health hygiene, regular oral health visits, and health literacy
- Promoting and applying preventive treatments such as dental sealants and fluoride
- Encouraging healthy diets low in sugar
- Supporting and participating in smoking cessation
- Advocating for policies that address socioeconomic disparities.
Some examples include, but are not limited to:
- Offering financial accommodations (e.g., payment plans)
- Participating in publicly funded oral health programs (e.g., CDCP)
- Volunteering
- Doing outreach
- Participating in or supporting innovative care models (e.g., mobile or community clinics)
- Pursuing relevant education or training (e.g., cultural safety, trauma and violence-informed care).
The Foundations of Professionalism Glossary defines determinants of health. Some examples can be found on the Government of Canada’s Social determinants of health and health inequalities webpage.
Determinants of health can:
- Influence access to care, treatment adherence, and perceptions of oral health
- Influence how individuals engage with health care services (negative perceptions of health care professionals or health care system can create mistrust, avoidance).
Prejudice, stigma and discrimination related to social identities can impact treatment engagement (e.g., deters individuals from seeking treatment, hinders access) and outcomes (e.g., disparities, poor oral health, reduced quality of life).
When issues arise within the oral health care team, how a dentist addresses them in front of patients can impact patient trust, team morale, and the overall professionalism in the practice. Dentist can consider addressing issues by:
- Staying calm and composed – avoid showing frustration or assigning blame in front of the patient
- Using neutral language
- Presenting a unified front – resolve issues privately
- Reassuring the patient that their care is the top priority
- Addressing the issue privately afterward – debrief with the team in a respectful, non-confrontational way, and focus on solutions
- Modeling respectful communication.
Dental associations also have resources on professionalism, including:
The following resources are available:
