Ethics: When romance blossoms between a dental hygienist and a patient

ByDiana Macri, RDH, BSDH, MSEd, AADH

The fireman was one of those men who easily makes women swoon—broad shoulders, powerful chest, beautiful smile, and a kind heart. Our meeting was straight out of the cheesiest romance novel. I was flustered and idiotic; he a model of stoic perfection. Truthfully, I recall very little of that first meeting, even though the events that followed are clear in my mind to this day.

The subject of romance is rarely discussed in dentistry or dental hygiene. I suppose the reason why is rooted in shame or embarrassment, as if men and women are not attracted to each other, as if attraction and love exist only outside the confines of the workplace. Dental and dental hygiene “leaders” are quick to denounce those who become romantically involved with their patients, citing that a lack of reasoning and proper conduct is sure to ensue should the relationship sour.

Ethical considerations

As health-care providers, dental hygienists, of course, have ethical obligations to those entrusted to their care. Autonomy, veracity, beneficence, non-maleficence, confidentiality, trust, and justice make up the core values of the ADHA Code of Ethics. They serve as a strong foundation from which we, as individuals, build our professional ethical identity. Morality and ethics are closely related, but not identical to, jurisprudence. Jurisprudence is the science and philosophy of law and is the minimum that we, as a society, expect from its citizens.

In dental hygiene jurisprudence, what dental hygienists are legally required to do, is found in the state’s dental hygiene practice act. Each state in the United States has a dental hygiene practice act, available online, which outlines the duties and responsibilities of dental hygienists.

Additionally, each state has a dental board that is responsible for addressing allegations of misconduct and for enforcing the laws written by the state’s legislature. Their job, essentially, is to protect the safety and welfare of citizens. In New York state, for example, the dental board is comprised of 17 licensed members—13 dentists, three dental hygienists, one dental assistant, and one public member—each of whom is appointed by the board of regents.(1) If a complaint is received from a citizen, it is their job to review all of the circumstances and render a judgment which may include disciplinary and/or legal action.

Is romance unprofessional?

Engaging in a romantic relationship with a patient is seen by some as unprofessional conduct. While it is well accepted across the country that sexual misconduct and sexual abuse are violations of the law, definitions of what constitutes sexual misconduct and sexual abuse are subjective.(2) Certain organizations, thankfully, provide clear guidelines for their members. Dentists in California, for example, are warned not to date their patients, “A dental professional who has a sexual relationship with a patient is in violation of the Dental Practice Act.”(3)

In ethical circles, this is not a new topic for consideration and has been the subject of many surveys and essays in medicine. Ethics scholars such as Dr. Richard Martinez believe that it is not so clear cut: "Relationships are complicated. Every ethical dilemma has to be evaluated and considered on a case-by-case basis."(4)

In dentistry and dental hygiene, such honest discussions are harder to find and appear more as editorials or responses to editorials. In response to an article written in the September/October 1999 issue of General Dentistry, Ralph DeFelice writes: “My wife of 25 years was and is a patient of mine. I hope she is not inclined to sue me … should I get divorced or transfer her to another dentist now that I know how unethical I have been?”

In the “Ethical Moment” section of the September 2005 issue of the Journal of the American Dental Association, Dr. George acknowledges personally knowing many dentists who’ve enjoyed successful marriages with patients but encourages knowledgeable decision making: “Dentists should balance the fact that there may be much more at risk than stands to be gained by entering into a dating or romantic relationship with a patient.”(5)

Caring for the fireman

I was unaware of all this when I met the fireman. Being a mentally well-balanced individual, I never considered the effects a breakup would have on my ability to care for his oral health needs. This was primarily due to the logistics of the dental office I was working in. There were five other dental hygienists who could have taken over care should I have felt that I could no longer provide it.

Our romance proceeded much the same as all romances do and lasted, off and on, for a couple of years. During this time, I continued providing care to him and his children, even when we separated and decided we were better off as friends.

Ethics and morality is a huge topic which deserves more reflection than what’s been offered here. Developing an ethical identity, a way of living which each of us can be proud of, takes time and cannot come to fruition without some failures.

This was my experience and I share it in the hopes that it may generate honest, respectful discussion and not as an attempt to encourage dating between dental hygienists and patients! What I do encourage is for those who find themselves in this situation to become aware of the possible repercussions so that they may make a decision that they are comfortable with.

Some may say I acted foolishly, possibly unethically. I say that, when love knocked on my door, I answered. And I've never regretted it.

Diana Macri, RDH, BSDH, MSEd, AADH, is an assistant professor at Hostos Community College in New York City. She can be contacted at [email protected]

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