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Abstract

Background: Understanding ethical and legal issues is essential for dental students to ensure responsible practice and minimize legal risks. Objective: This study evaluated the knowledge and awareness of ethical and legal principles among dental students. Methods: A cross-sectional study was conducted with 107 dental students using a structured questionnaire. Descriptive statistics and chi-square tests were employed to analyze the data. Results: Significant variations in understanding were observed, particularly regarding informed consent (p = 0.003) and malpractice liability (p = 0.001). While awareness of patient confidentiality was high, gaps existed in knowledge of medical battery and the principle of veracity. Conclusion: The findings highlight the need for improved education on ethical and legal responsibilities in dental curricula, ensuring future practitioners are equipped to provide high-quality, patient-centered care while adhering to ethical standards.

Keywords

Ethical Issues, Legal Awareness, Dental Students, Informed Consent, Malpractice Liability, Dental Education

Introduction

Dental practitioners are governed by a code of ethics and various regulations, which outline their moral responsibilities to patients, colleagues, and society.1 The Dental Council of India (DCI), the regulatory authority overseeing dentistry in India, established the Dentists (Code of Ethics) Regulations in 1976. With a significant rise in dental negligence cases over the past two decades, the DCI updated these regulations in 2014, known as the Dentists Regulations 2014. 2These revisions clarify general dentist duties, responsibilities toward patients, and collaborative obligations with other dental professionals. The DCI mandates that dentists familiarize themselves with and adhere to these guidelines.3 For dental students, an understanding of ethical and legal issues is essential to ensure professional behavior and to reduce the risk of legal infractions. Ethics underpins the dental profession, guiding practitioners in making morally sound decisions and upholding patient well-being. It encompasses principles of honorable behavior, just judgment, and respect for interpersonal relationships.4 Dental professionals, including students, must possess a strong ethical foundation to navigate the complexities of patient care and avoid potential legal pitfalls. 5A comprehensive understanding of ethical and bioethical principles is essential for making informed decisions that prioritize patient rights and needs.6 By adhering to formal guidelines and codes of ethics, dental professionals can maintain high standards of care in both clinical practice and research. Research shows that students’ awareness of ethics and law varies across educational stages; while some grasp these concepts well, others exhibit notable gaps.7 Dental practice, integrating scientific expertise with ethical and legal obligations, requires practitioners to prioritize patient care within a framework of professional integrity. Building a solid foundation in these areas is crucial for preventing legal issues and promoting high standards of care.8

AIM

This study focuses on evaluating dental students’ knowledge and awareness of ethical and legal concerns, an essential step in preparing them to be competent, responsible practitioners.

OBJECTIVE

To evaluate the understanding of core ethical principles in Dentistry among dental students

To determine the awareness of legal responsibilities

To gather feedback on the perceived adequacy of ethics and legal training.

To promote awareness of patient rights and professional obligations.

MATERIALS AND METHODS

This cross-sectional study assessed knowledge and awareness of ethical and legal issues in dentistry among dental students. Conducted over a three-month period from August to October 2024, it involved stages of data collection, analysis, and reporting. The research targeted dental students at a private dental college, with approval from the Department of Oral Medicine and Radiology and ethical clearance from the Institutional Review Board. Using simple random sampling, a sample of 107 participants was selected. A Google form questionnaire version 2.0,  consisting of 20 questions was administered, with informed consent obtained to uphold confidentiality and privacy. Participants were briefed on the questionnaire and encouraged to answer accurately. Data collected via Google Forms was transferred to Excel, with analysis performed using IBM SPSS Statistics for Windows, Version 26.0. Descriptive statistics, including frequencies and percentages, were calculated for participant responses. Comparisons across study years and gender were made using cross-tabulations, with statistical significance assessed through Pearson’s chi-square and Fisher’s exact tests. The significance level was set at p<0>

RESULTS

A total of 107 dental students participated in the study, with representation across different years of study. First-year students made up 21.5% of the participants, followed by 14% from the second year, 20.6% from the third year, and 11.2% from the fourth year. Additionally, House Surgeons, or CRRI (Compulsory Rotatory Residential Interns), comprised the largest group at 32.7% of the total participants. In terms of gender distribution, female students represented a majority at 59.8%. The survey assessed dental students' understanding and attitudes toward key ethical and legal principles in dental practice, revealing varied levels of comprehension and comfort across study years with statistically significant differences in some areas. Notably, students’ understanding of informed consent varied significantly (p = .003), indicating a need for enhanced focus on this topic in early education. Comfort with respecting patient autonomy showed a trend without statistical significance (p = .120), while the importance of ensuring justice in access to dental care was significantly affirmed by higher study years (p = .007). The exposure to discussions on professionalism was relatively uniform across years (p = .113). There was a significant variance in understanding malpractice liability (p = .001), emphasizing gaps in comprehending legal risks associated with dental care. Knowledge about HIPAA showed no significant difference (p = .137), although the principle of maintaining confidentiality was widely recognized. Awareness of the patient privacy principle protected by HIPAA was generally high, but showed no significant variation across the study years (p = .137). Responses about the legal duty of “standard of care” showed no significant difference across years (p = .143), while understanding the dentist’s role in confidentiality was consistently high across all study years (p = .688). The concept of "medical battery" as unauthorized treatment was not well understood, with no significant difference (p = .064). The principle of veracity or telling the truth to patients showed uniform recognition, lacking significance (p = .800), while the principle of beneficence ensuring patient welfare saw a minor difference without significance (p = .207). The concept of autonomy in dental ethics revealed a significant trend across years (p = .031), demonstrating improved understanding among advanced students. Regarding the lack of patient decision capacity, there was moderate understanding without significance (p = .212), and justice in fair treatment showed low significance (p = .651). Awareness of the necessity of parental consent for minors was well-recognized but not statistically significant (p = .572). Addressing unnecessary procedures by educating patients showed uniform understanding (p = .806), and recognizing negligence, particularly failure to diagnose, lacked significance across years (p = .446). Proper handling of patient dissatisfaction with treatment through empathetic listening was well understood but not statistically significant (p = .616). Reporting abuse when suspected was acknowledged but not significantly different across years (p = .606). Lastly, the importance of maintaining accurate patient records for legal protection and continuity of care was widely recognized, though without significance (p = .376).

Fig.(a)shows the different percentage of answers selected by different years of dental students for the question (Q.9) What term describes unauthorized treatment, 37.4% students have selected ethics violation whereas the correct answer is medical battery, the analysis of this pie chart indicates that a majority of students have limited knowledge regarding dental ethics and legal

       
            fig1.png
       

Fig(a)

DISCUSSION

In our study,we observed varied comprehension levels and comfort with these concepts across different study years, mirroring findings from other research. Notably, we found statistically significant differences in students' understanding of informed consent, emphasizing the necessity for early educational focus on this critical topic. This aligns with the concerns noted in previous studies, such as those by Penmetsa and Kaur, where awareness of informed consent and its significance appeared to be lacking among dental practitioners and students. Muralitharan found that Master of Dental Surgery (MDS) graduates demonstrated more knowledge of dental jurisprudence compared to Bachelor of Dental Surgery (BDS) graduates.9,10,11 While comfort with respecting patient autonomy showed a trend without statistical significance, it reflects a similar pattern seen in Nassar’s findings, where there was variability in students' respect for patients’ wishes.12 This underscores the importance of integrating discussions about autonomy and its ethical implications in dental education to ensure students develop a strong foundation in patient-centered care. Moreover, our study revealed that higher study years significantly affirmed the importance of ensuring justice in access to dental care, indicating that as students progress in their education, they increasingly appreciate the ethical obligation to promote equitable treatment. This perspective aligns with Kaur’s findings that highlighted limited awareness of ethical responsibilities among dental students, suggesting a critical need for enhanced ethical training throughout the curriculum.10 Despite some areas of strong understanding, significant gaps remained in comprehending malpractice liability. This is particularly concerning, as studies by Hasitha et al. and Kesavan et al. also indicated that awareness of medico-legal aspects was often insufficient among dental practitioners.13,14 The recognition of the need for increased training in malpractice awareness is vital, as these legal risks are inherent in dental practice. Knowledge about HIPAA showed no significant difference among the study years, though awareness of confidentiality was generally high. This aligns with our findings on patient privacy principles, which lacked significant variation across years, suggesting that while students understand the importance of maintaining confidentiality, further emphasis on the specifics of HIPAA regulations may be warranted.15 Monica Kumari's study found that while most dental students recognized the Hippocratic Oath, knowledge of the Nuremberg Code, ICMR guidelines, and Helsinki Declaration was limited.16 Overall, studies indicate that dental students, especially at Sultan Agung Islamic University, show a better understanding of ethical and legal issues, with awareness levels ranging from 76% to 100%. Conversely, dental students in Riyadh city displayed significant gaps, with 44.5% unaware of key ethical principles. The consensus across these studies stresses the urgent need for improved educational frameworks focused on ethical and legal responsibilities to cultivate knowledgeable and responsible dental professionals.17,18 Similarly, the principle of veracity, which emphasizes truth-telling, showed uniform recognition but lacked significance across study years, reflecting the need for continued emphasis on honesty in patient interactions, as also suggested in other studies. Overall, our findings indicate that while dental students have a good grasp of certain ethical and legal principles, there are notable deficiencies in their understanding of key concepts such as informed consent, malpractice, liability, and patient autonomy. This aligns with trends observed in previous research, underscoring the need for enhanced educational strategies to address these critical areas.19,20

CONCLUSION

In conclusion, our study highlights the significant disparities in dental students' knowledge and understanding of ethical and legal principles critical to their future practice. While many students demonstrated a solid grasp of foundational concepts such as informed consent and patient confidentiality, notable gaps in awareness of malpractice liability, the nuances of the medical battery, and the application of the principle of veracity were identified. These findings align with previous research indicating a widespread need for enhanced education on ethical and legal responsibilities within dental curricula. As students progress through their training, a greater emphasis on these topics can help cultivate a more robust understanding of patient autonomy and justice in care delivery. The results shows the importance of integrating comprehensive ethical training and legal education into the dental curriculum, ensuring that future practitioners are not only technically skilled but also equipped with the ethical framework necessary to navigate the complexities of dental practice. Addressing these gaps will ultimately contribute to the development of competent, conscientious dental professionals dedicated to providing high-quality, patient-centered care while upholding the highest ethical standards in their practice.

REFERENCES

  1. Undergraduate ethics teaching: revisiting the consensus statement. Mattick K, Bligh J. Med Educ. 2006;40:329–332. doi: 10.1111/j.1365-2929.2006.02407.x.
  2. Dental Council of India. Revised Dentists (Code of Ethics) Regulation. 3(4) India: Dental Council of India Notification; 2014. Dental Council of India. Revised Dentists (Code of Ethics) Regulation 2014; p. 1.
  3. Dunning JM. Principles of Dental Public Health. 4th ed. Har-vard University Press; 1986 712 p.
  4. Frâncu LL, Calin D, Paduraru D, Frâncu DL. Legal and ethical problems in dental medicine. Romanian Journal of Bioethics. 2009 Oct;7(4):157-62.
  5. Zareen, I. N., & Bhoj, M. (2019). Awareness of medicolegal aspects among dental practitioners. Drug Invention Today, 11(2):174-179.
  6. Manas, Gupta., Kirti, Shrivastava., Sunil, Kumar, Mishra., Ravish, Ahuja., Pankaj, Mishra., Shail, Kumari. (2018). 5. Importance and awareness of medico legal issues in dental practice… Alarm call. Annals of Tropical Medicine and Public Health,  doi: 10.4103/ATMPH.ATMPH_317_17
  7. The top 10 ethical challenges in dental practice in Indian scenario: dentist perspective. Kemparaj VM, Panchmal GS, Kadalur UG. Contemp Clin Dent. 2018;9:97–104. doi: 10.4103/ccd.ccd_802_17.
  8. Mallela KK, Walia R, Tm CD, Das M, Sepolia S, Sethi P. Knowledge, attitudes and practice about research ethics among dental faculty in the North India. J Int Oral Health 2015; 7(7)(Suppl. 2): 52-6.
  9. Muralidharan S, Pendyala G, Gandhage D, Sachan S. Knowledge of Dental Ethics and Jurisprudence Among Dental Practitioners in Pune: A Questionnaire Survey. Cureus. 2022 Nov 14;14(11):e31503. doi: 10.7759/cureus.31503. PMID: 36540426; PMCID: PMC9754725.
  10. Penmetsa GS, Praveen G, Ramesh MV, Radha Rani K. Awareness and practice of Revised Code of Dental Ethics and Consumer Protection Act among dental practitioners in Andhra Pradesh: A cross-sectional study. Indian J Med Ethics. March 20, 2024
  11. Kaur, Navpreet & Nagpal, Ajay & Sharma, Vivek & Gupta, Roopali & Bhalla, Manish & Jaiswal, Saumya. (2021). Knowledge Regarding Dentists (Code of Ethics) Regulation among Dental Students in Mathura: A Cross-sectional Study. Journal of Advanced Clinical and Research Insights. 8. 30-34. 10.15713/ins.jcri.325.
  12. Nassar A, Salama R. Medical Ethics Knowledge and Attitude Among Dental Students from Two Universities in The Middle East. Open Dent J, 2022; 16: e187421062208101.
  13. Hasitha Gongura et al; Knowledge and Awareness on Medico-Legal Aspects in Dentistry amongst Dental Graduates- An Original Research ,Saudi J Oral Dent Res, June, 2020; 5(6): 287-290
  14. Kesavan, R.; Mary, A. Vinita; Priyanka, M.; Reashmi, B.. Knowledge of dental ethics and jurisprudence among dental practitioners in Chennai, India: A cross-sectional questionnaire study. Journal of Orofacial Sciences 8(2):p 128-134, Jul–Dec 2016. | DOI: 10.4103/0975-8844.195915
  15. Knowledge, attitudes and practices related to healthcare ethics among medical and dental postgraduate students in South India. Janakiram C, Gardens SJ. Indian J Med Ethics. 2014;11:99–104. doi: 10.20529/IJME.2014.025.
  16. Kumari, Monika & Rajeev, Ananthalekshmy. (2022). Knowledge Of Professional Ethics In Dentistry Among Dental Students – A Cross-Sectional Study. Clinical Dentistry. 10.33882/ClinicalDent.15.30342.
  17. Erdianto, Setya, Wardhana., Grahita, Aditya. (2023). 1. Description of Ethical and Legal Dental Knowledge Level Among Students in Dentistry.   doi: 10.26714/mashijo.v2i1.5
  18. Ruba, Al-Mutlaq., Basmah, Al-Feraih., Hayat, Al-Aidroos., Hiba, Al-Neema., Rana, Al-Asmari., Rinad, Al-Balawi., Abdulrahman, Al-Saffan. (2021). 2. Knowledge of Dental Students and Dentists Towards Dental Ethics in Riyadh City: A Cross-Sectional Study.   doi: 10.52533/JOHS.2021.1105
  19. Priyanka, Goel., Pragya, Sharma., Preeti, Sharma., Shubhra, Vaish. (2020). 3. Awareness about medico legal aspects and Consumer Protection Act (CPA) among dental fraternity.   doi: 10.18231/2393-9834.2018.0030
  20. ?efik, Görkey., Tolga, Güven., Gürkan, Sert. (2012). 10. Towards a specific approach to education in dental ethics: a proposal for organising the topics of biomedical ethics for dental education. Journal of Medical Ethics,  doi: 10.1136/MEDETHICS-2011-100067

Reference

  1. Undergraduate ethics teaching: revisiting the consensus statement. Mattick K, Bligh J. Med Educ. 2006;40:329–332. doi: 10.1111/j.1365-2929.2006.02407.x.
  2. Dental Council of India. Revised Dentists (Code of Ethics) Regulation. 3(4) India: Dental Council of India Notification; 2014. Dental Council of India. Revised Dentists (Code of Ethics) Regulation 2014; p. 1.
  3. Dunning JM. Principles of Dental Public Health. 4th ed. Har-vard University Press; 1986 712 p.
  4. Frâncu LL, Calin D, Paduraru D, Frâncu DL. Legal and ethical problems in dental medicine. Romanian Journal of Bioethics. 2009 Oct;7(4):157-62.
  5. Zareen, I. N., & Bhoj, M. (2019). Awareness of medicolegal aspects among dental practitioners. Drug Invention Today, 11(2):174-179.
  6. Manas, Gupta., Kirti, Shrivastava., Sunil, Kumar, Mishra., Ravish, Ahuja., Pankaj, Mishra., Shail, Kumari. (2018). 5. Importance and awareness of medico legal issues in dental practice… Alarm call. Annals of Tropical Medicine and Public Health,  doi: 10.4103/ATMPH.ATMPH_317_17
  7. The top 10 ethical challenges in dental practice in Indian scenario: dentist perspective. Kemparaj VM, Panchmal GS, Kadalur UG. Contemp Clin Dent. 2018;9:97–104. doi: 10.4103/ccd.ccd_802_17.
  8. Mallela KK, Walia R, Tm CD, Das M, Sepolia S, Sethi P. Knowledge, attitudes and practice about research ethics among dental faculty in the North India. J Int Oral Health 2015; 7(7)(Suppl. 2): 52-6.
  9. Muralidharan S, Pendyala G, Gandhage D, Sachan S. Knowledge of Dental Ethics and Jurisprudence Among Dental Practitioners in Pune: A Questionnaire Survey. Cureus. 2022 Nov 14;14(11):e31503. doi: 10.7759/cureus.31503. PMID: 36540426; PMCID: PMC9754725.
  10. Penmetsa GS, Praveen G, Ramesh MV, Radha Rani K. Awareness and practice of Revised Code of Dental Ethics and Consumer Protection Act among dental practitioners in Andhra Pradesh: A cross-sectional study. Indian J Med Ethics. March 20, 2024
  11. Kaur, Navpreet & Nagpal, Ajay & Sharma, Vivek & Gupta, Roopali & Bhalla, Manish & Jaiswal, Saumya. (2021). Knowledge Regarding Dentists (Code of Ethics) Regulation among Dental Students in Mathura: A Cross-sectional Study. Journal of Advanced Clinical and Research Insights. 8. 30-34. 10.15713/ins.jcri.325.
  12. Nassar A, Salama R. Medical Ethics Knowledge and Attitude Among Dental Students from Two Universities in The Middle East. Open Dent J, 2022; 16: e187421062208101.
  13. Hasitha Gongura et al; Knowledge and Awareness on Medico-Legal Aspects in Dentistry amongst Dental Graduates- An Original Research ,Saudi J Oral Dent Res, June, 2020; 5(6): 287-290
  14. Kesavan, R.; Mary, A. Vinita; Priyanka, M.; Reashmi, B.. Knowledge of dental ethics and jurisprudence among dental practitioners in Chennai, India: A cross-sectional questionnaire study. Journal of Orofacial Sciences 8(2):p 128-134, Jul–Dec 2016. | DOI: 10.4103/0975-8844.195915
  15. Knowledge, attitudes and practices related to healthcare ethics among medical and dental postgraduate students in South India. Janakiram C, Gardens SJ. Indian J Med Ethics. 2014;11:99–104. doi: 10.20529/IJME.2014.025.
  16. Kumari, Monika & Rajeev, Ananthalekshmy. (2022). Knowledge Of Professional Ethics In Dentistry Among Dental Students – A Cross-Sectional Study. Clinical Dentistry. 10.33882/ClinicalDent.15.30342.
  17. Erdianto, Setya, Wardhana., Grahita, Aditya. (2023). 1. Description of Ethical and Legal Dental Knowledge Level Among Students in Dentistry.   doi: 10.26714/mashijo.v2i1.5
  18. Ruba, Al-Mutlaq., Basmah, Al-Feraih., Hayat, Al-Aidroos., Hiba, Al-Neema., Rana, Al-Asmari., Rinad, Al-Balawi., Abdulrahman, Al-Saffan. (2021). 2. Knowledge of Dental Students and Dentists Towards Dental Ethics in Riyadh City: A Cross-Sectional Study.   doi: 10.52533/JOHS.2021.1105
  19. Priyanka, Goel., Pragya, Sharma., Preeti, Sharma., Shubhra, Vaish. (2020). 3. Awareness about medico legal aspects and Consumer Protection Act (CPA) among dental fraternity.   doi: 10.18231/2393-9834.2018.0030
  20. ?efik, Görkey., Tolga, Güven., Gürkan, Sert. (2012). 10. Towards a specific approach to education in dental ethics: a proposal for organising the topics of biomedical ethics for dental education. Journal of Medical Ethics,  doi: 10.1136/MEDETHICS-2011-100067

Photo
Bhavya Bhaskaran
Corresponding author

Department Of Oral Medicine & Radiology, Thai Moogambigai Dental College & Hospital, Chennai, Tamil Nadu, India.

Photo
Ashwin Babu
Co-author

Department Of Oral Medicine & Radiology, Thai Moogambigai Dental College & Hospital, Chennai, Tamil Nadu, India.

Photo
Balaji S. B.
Co-author

Department Of Oral Medicine & Radiology, Thai Moogambigai Dental College & Hospital, Chennai, Tamil Nadu, India.

Photo
Priya Ramani
Co-author

Department Of Oral Medicine & Radiology, Thai Moogambigai Dental College & Hospital, Chennai, Tamil Nadu, India.

Photo
Manju J.
Co-author

Department Of Oral Medicine & Radiology, Thai Moogambigai Dental College & Hospital, Chennai, Tamil Nadu, India.

Photo
Gayathri P. S
Co-author

Department Of Oral Medicine & Radiology, Thai Moogambigai Dental College & Hospital, Chennai, Tamil Nadu, India.

Gayathri P. S., Priya Rmani, Bhavya Bhaskaran*, Ashwin Babu, Balaji S. B., manju J, Knowledge And Awareness About Ethical - Legal Issues in Dentistry Among Dental Students, Int. J. of Pharm. Sci., 2024, Vol 2, Issue 12, 195-200. https://doi.org/10.5281/zenodo.14262668

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