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Progress Notes

Dr. Stan Cobb

Dr. Stan Cobb,
associate professor of
restorative sciences

Photo by Steven Doll

All you need to know about current ethics issues in dentistry

In these Q-and-A sessions, we take a closer look at some pressing topics within the dental profession and just what they mean to Texas A&M Health Science Center Baylor College of Dentistry. From TAMHSC-BCD initiatives to hot-button questions, we consult the college’s own subject matter experts to get their input.

This issue includes the perspectives of Dr. Stan Cobb, associate professor of restorative sciences, on how hands-on, direct experience coupled with classroom discussion strengthens the ethics curriculum at TAMHSC-BCD. He also delves into profession-wide concerns for dentists, which begs the question: Is it possible to instill ethics after a certain age?

Who better than to share the answers with us than this longtime faculty member who also coincidentally contributed the article, “Teaching Ethics and Change,” to the August issue of the Texas Dental Journal? 

BDRO: Dr. Cobb, just how do you teach students to make ethical choices for when they will eventually practice dentistry? 

Cobb: I think you teach ethics the same way you teach any other subject. The difference is that in most subjects students are expected to come to the program with some basic tools, which are measured by the curriculum they had in college, their GPA in those subjects and their dental admission test cores. We don't have that in ethics. Even if we did there is a problem — just because a person does have a strong moral compass doesn't mean one will act on that knowledge.

For instance, whether I am speaking to a group of doctors or students, I can ask the following line of questions:

  • How many of you have ever received a ticket for speeding?
  • OK, how many of you took a defensive driving course to pay your debt to society for this crime? (Most people grin and raise their hands to both questions.)
  • How many of you have received a ticket since your education on the dangers of speeding? (Again, lots of hands go up.)
  • How many of you still speed but just haven't gotten a ticket? (The same thing; knowledge doesn't make you good.)

Fortunately, here at Baylor that begins with ethics in academic integrity. If students can begin to see that the things they are learning in gross anatomy, for instance, will play out in the way they will manage an infection or carry out a surgical procedure in a living human being, then the knowledge has great importance. It is not just something crammed into your head for a test; you need to know this not just for today but for the rest of your practice life. It starts with the basic sciences. Don't cheat; this is important to your future, your happiness and your patients’ well-being.

BDRO: You mention in your Texas Dental Journal article that ethics classes reveal the ideals and also the consequences of failure. Just how does TAMHSC-BCD’s ample clinical experience during the D3 and D4 years provide the opportunity for students to recognize these ideals and address potential failures? 

Cobb: Clinically, the ideals are not arbitrary; they are laid out by the American Dental Association, the Texas Dental Association and the laws of the state. They are fixed. Early in the D3 year, patient management works like this: The students see patients with faculty, and in those earliest experiences the ethics and standards of care of the faculty are being passed on as the student and faculty members work together. In the third year, it is done in formal ethics courses, the various disciplines and comprehensive care groups. The D4 year has practice management courses, an ethics and law course, as well as D4 general dentistry groups where faculty members monitor students.

Failure to meet standards of care, say in a procedure, often are self-reported by students. In cases like this, the patient is told a restoration is not quite what it should be and is going to be redone. The patients usually are very understanding; this is a school, after all, and the students have an opportunity to correct the problem, which makes patients feel good about the treatment they are receiving and the students feel better about themselves. None of us, faculty or students, likes falling short in any area but we all have and will. How we handle our shortcomings separates the ethical and unethical.

The whole transformation process from a layperson to a doctor is difficult because American culture, as diverse as it is, works from "moral relativism" and the codes, principles and laws that we as doctors are judged by are not relative at all. No patient wants a dentist that is relatively honest, relatively competent or relatively fair — we expect our dentist to be honest, competent and fair — period.

BDRO: What are some big picture concerns in dentistry that are impacting dentists right now in our own neck of the woods, across the metroplex? 

Cobb: Corporate, commercial practices where cash over care rules the day. This includes fraudulent claims to Medicaid, Medicare, insurance, and above all, violations in standards of care. These are the biggies shared with me from our recent alumni and can be found in the records at the Texas State Board of Dental Examiners.

BDRO: What difference do ethics courses make at this age?  

Cobb: Ethics, which is the study of the general nature of morals and how those are applied in specific situations, makes a difference at any age. It's fatalistic to think otherwise. It makes the same difference that waxing teeth does in hand-eye coordination in the first year in that it makes us sensitive to things we have not thought about previously. Issues that we had not thought about as ethical concerns are recognized. Those are sensitivity issues; they help us rid ourselves of defective reasoning. Those may be related to beneficence, justice and veracity, to name a few. They help us gain clarity to the expectations of the profession and patients. And they help give us courage to do what’s right and the wherewithal to persevere in trying times.