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Year : 2015  |  Volume : 6  |  Issue : 4  |  Page : 159-160

The necessity of accountability and ethics in Dental Service Organizations

University of Conneccut School of Dental Medicine, Conneccut, USA

Date of Web Publication27-Nov-2015

Correspondence Address:
Joseph Everett
University of Connecticut School of Dental Medicine, Connecticut
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2155-8213.170644

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Dental Service Organizations (DSOs) are an up-and-coming platform for dental treatment, and are quickly becoming a lucrative business. In light of this, a closer look must be taken at the ethical foundation of these organizations to ensure that the pursuit of profit does not outweigh the best interests of the patient.

Keywords: Ethic, dental service

How to cite this article:
Everett J. The necessity of accountability and ethics in Dental Service Organizations. Dent Hypotheses 2015;6:159-60

How to cite this URL:
Everett J. The necessity of accountability and ethics in Dental Service Organizations. Dent Hypotheses [serial online] 2015 [cited 2023 Apr 2];6:159-60. Available from:

  Introduction Top

When imagining a dental practice, what picture comes to your mind? Do you visualize a Norman Rockwell painting showing a kindly gentleman dressed in a white coat standing over a dental chair treating a young smiling patient or do you see a shopping mall with a sign of a DSO? DSOs are the reincarnation during the last decade of a dental delivery system called chain-store dentistry. [1] While chain-store dentistry failed, DSOs are a success.

Regardless of the size and shape, all successful corporations have at least one thing in common; they are businesses with a fiduciary responsibility to earn a profit. The motive of profit is ingrained in American capitalism, and for companies such as Walmart and Apple making as big a profit as possible is an admirable goal. However, for those companies delivering oral health care, profit might be a problem. How can a profit be justified when a person's oral health is at stake? To make the question specific, consider a real situation of a patient in pain from a deep periodontal abscess arriving at a dental clinic. The patient in question arrives with no funds to pay for the treatment. Does the patient receive treatment or are they sent away? While the laws in most states require the dentist treat the patient, it is the American Dental Association's (ADA)'s code of professional conduct that should guide the decision. [2]

But DSOs, the multisite, multi-operatory corporations sprouting in the United States' shopping malls, are often owned by those who are not covered by the ADA code of conduct. In some states, corporate dental offices must be owned by licensed dentists while in others, the laws are less defined. If a dentist is the last checkpoint in the decision-making process regarding the care of patients, then the ADA code of conduct should apply. However, if the dental practice is owned by a corporation headed by nondentists, the ADA code may not be applied. This distinction should be carefully considered by a dental graduate, when considering employment.

DSOs are changing landscape of dental practice models. According to Joel Diringer in his 2013 ADA report on the trends in dentistry, corporate dentistry is on the rise due to a combination of factors that include: Economic pressures on recent graduates related to loan repayment, the rise of Medicaid patients, and the emergence of mid-level providers. [3] All these factors contribute to a surge of interest in joining a DSO. A recent article reported that new dental school graduates are three times more likely to seek employment in a large group practice than a decade ago. [4] Additionally, DSOs often provide care to patients who cannot afford care at traditional solo practices. Dental students need to understand the necessity for profit. Whether the graduate enters a solo practice, a group practice, or a DSO, all dental practices must make a profit to stay in business. One part of the ADA code of conduct states that dentists should do no harm, and at graduation, dental students at the University of Connecticut School of Dental Medicine and other dental schools recite the Hippocratic Oath. [5] However, when a recent graduate accepts employment at a DSO, other considerations may enter the treatment decision process. In a 2012 investigative report on possible production pressures put on dentists, the Center for Public Integrity found that some of the largest DSOs were offering bonuses for higher revenue and scored dentists based on production. [6] This finding suggests that DSOs need to be subject to the same ethical accountability as dentists. This way, no undue pressures are put on providers, and the integrity of the dental profession can be maintained.

As a dental student who may seek employment in a DSO, I visualize two problems. First, the Association of Dental Support Organizations (ADSO) should edit its assigned Code of Ethics stating unequivocally that the organization abides by the ADA code of conduct. [7] Second, the dental schools should include DSOs in practice management curriculum. Recently, Dr. Richard Valachovic, Executive Director of the American Dental Education Association (ADEA), wrote about DSOs. In his article, he balances the pros and cons of DSOs concluding with the following observation: "Perhaps it's time we put aside our preconceived notions about DSOs and make a conscious effort to prepare our student for the full range of practice options that await them" [Valachovic]. Being a dental student I would welcome a very general discussion of the different types of practice models, and in particular, information on how a dentist can perform ethical dentistry and still make a profit. This discussion would benefit the dental student, the dental profession, and would, most importantly, be in the best interest of the patient.

  References Top

Rossomando EF, Moura M. The delivery of oral health care in America: The economic impact of chain-store dentistry on private practice. Dent Econ 2007;97:42-3.  Back to cited text no. 1
ADA Principles of Ethics and Code of Professional Conduct Available from: [Last accessed on 2015 Jul 25].  Back to cited text no. 2
Diringer J, Phipps P, Carsel B. Clinical Trends Affecting the Future of Dentistry: Assessing the Shifting Landscape. American Dental Association; 2013.  Back to cited text no. 3
Valachovic R. From Bungalow to Big Box? ADA News; 2014. p. 4-6.  Back to cited text no. 4
Tyson P. The Hippocratic Oath Today. PBS. 2001. Available from: [Last accessed on 2015 Aug 1].  Back to cited text no. 5
Pierce O. Are High-Volume Dental Chains Exploiting Kids on Medicaid? ProPublica 2012.  Back to cited text no. 6
ADSO Code of Ethics. Available from: [Last accessed on 2015 Aug 1].  Back to cited text no. 7


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