Dentistry is a caring profession built on patient trust and high ethical standards. In private practice in India, however, these ideals can clash with real-world pressures – the temptation to market elective procedures, meet patient demands for quick cosmetic fixes, or boost profits amid stiff competition. This article examines how Indian dentists can balance ethics and business, highlighting real scenarios – from overtreatment and unrealistic patient demands to online reputation pressures and supplier kickbacks – and drawing on principles and laws to guide sound clinical decisions.
Ethical Principles and Regulatory Framework
Every treatment decision should be guided first by the patient’s welfare. Ethical duties are codified in Indian regulations as follows:
- Beneficence means recommending only care that benefits the patient
- non-maleficence means avoiding unnecessary or harmful interventions
- autonomy requires obtaining informed consent and respecting patients’ choices, and
- justice calls for fair treatment of all patients.
The DCI’s Code of Ethics (Dentists (Code of Ethics) Regulations, 1976, as revised [1] listing of “unethical practices” includes:
- “Dentist advertising whether directly, or indirectly, for the purpose of obtaining patients or promoting his own professional advantage”.
- “Allowing commission” (kickbacks) from laboratories or suppliers.
Beyond professional codes, Indian law provides patient recourse. Under the Consumer Protection Act (2019), healthcare (including dental care) is treated as a “service,” and patients can sue for deficiency of service. Ethical lapses can have consequences. For example, Karnataka’s State Dental Council investigated a case where prolonged braces treatment harmed a patient; the consumer court used those findings to order ₹2 lakh compensation and refund of fees[2]. Such rulings reinforce that ethical dentistry is not just moral but legally expected.
State dental councils echo this. In a 2025 warning, the Telangana Dental Council noted many practitioners flouting these norms – for example, engaging in direct or indirect ads and misrepresenting their services[3] – and reminded dentists of the DCI’s clear ethical guidelines under the Dentists Act and Code of Ethics.
Overtreatment for Profit
Scenario: A busy clinic, eager for higher revenue, recommends high-cost procedures – multiple root canals, crowns, or implants – even when simpler options would suffice. The dentist emphasizes all possible fixes and upsells cosmetic upgrades.
This pressure to increase fees can lead to overtreatment – providing more or more expensive procedures than clinically justified. Overtreatment violates beneficence and non-maleficence by exposing patients to unnecessary harm and cost. In esthetic dentistry, a 2025 systematic review found that aggressive marketing and patient expectations (often shaped by social media) have driven a “notable increase in overtreatment”[4]. The study warned that social media hype for perfect smiles and “idealized beauty standards” pressures dentists to perform unnecessary work, commodifying care under commercial incentives[4].
A real case illustrates the risk. A 43-year-old Bangalore patient was quoted ₹34,000 for a year-long ceramic-braces treatment. The clinic dragged the procedure to over two years, charging an extra ₹50,000, and ultimately the patient’s ten front teeth were badly damaged. A consumer forum (citing the state dental council’s findings) ordered the dentists to pay ₹2 lakh compensation and refund fees[2]. This outcome highlights how chasing profits undermined non-maleficence and trust: the patient suffered pain and harm (requiring even more costly treatment), violating the dentist’s duty to conserve welfare “to the utmost of [their] ability”[1].
Ethical balancing: To resist overtreatment, dentists must ensure clinical decisions serve the patient’s best interests, not just the practice’s bottom line. This means conducting a thorough diagnosis, considering all alternatives (including non-intervention), and explaining the risks and benefits candidly. Financial incentives (like productivity targets or clinic ownership pressures) should not override judgment. Regulatory codes exist to guide this: the DCI mandates that the welfare of the patient should be conserved to the utmost (Dentists Code of Ethics, Rule I.4).
Patient Expectations and Demands
Scenario: A patient arrives demanding a “quick fix” cosmetic procedure – e.g. snap-on veneers, full-mouth whitening, or braces for slight misalignment – influenced by social media trends or celebrity smiles. They insist on the latest trend without understanding alternatives or risks.
Patients have the right to seek specific treatments, but dentists must balance respect for patient autonomy with professional responsibility. Ethical practice requires informed consent: ensuring the patient fully understands the need (or lack thereof) for treatment, its risks, benefits, and alternatives[5]. A global review emphasizes that “patient autonomy and informed consent are central to ethical practice” and must be prioritized, especially for elective cosmetic procedures[5]. In other words, patients should never feel pressure or deception – dentists must give unbiased information so patients decide freely.
This scenario tests autonomy vs. beneficence. If a desired procedure is unnecessary or potentially harmful, the dentist should counsel against it, explaining why a conservative approach might be better. For example, recommending routine cleaning and monitoring instead of immediate veneers. Pushing unneeded work breaches non-maleficence and justice (charging for needless care). Conversely, stubbornly refusing all requests can frustrate patients, so the dentist should listen empathetically, clarify motivations, and find acceptable compromises (e.g. whitening before veneers, or minimal intervention).
In practice, dentists can manage expectations by clearly explaining the rationale for (or against) a procedure, possibly showing cases or prognosis. Obtaining written informed consent with detailed treatment plans (including cost) helps document that the patient understood the discussion. If a patient still demands an unreasonable service, the dentist may ethically decline or refer to a colleague, rather than violate standards. This protects both patient and practitioner: the patient avoids potential harm, and the dentist avoids professional misconduct.
Digital Reputation and Social Media Pressure
Scenario: Online reviews and marketing are vital in today’s marketplace. Dentists feel pressure to maintain a 5-star Google/Practo rating and a polished social media image. Some may be tempted to solicit glowing reviews (perhaps with small gifts) or to promise unrealistic outcomes in online ads.
Digital visibility is important for business, but advertising healthcare carries ethical limits. In India, unlike some countries, the DCI’s rules strictly forbid any form of advertising to attract patients. Even if social media posts feel innocuous, they can cross into “direct or indirect advertisement,” which regulators outlaw[3].
Buying or incentivizing positive reviews is equally problematic: it misleads future patients and breaches honesty. For instance, offering a discount or free dental kit in exchange for a testimonial would violate the ban on commissions and inducements.
Beyond formal ads, online reputation can influence care. A 2025 ethics review warns that commodification of care – driven by aggressive marketing – leads to unnecessary procedures[4]. If dentists chase “likes” and rave reviews, they may unconsciously cater to what looks good rather than what’s needed. Professional integrity demands transparency: if sharing results on social media, images must be genuine and outcomes accurately described. Posting false or exaggerated claims (e.g. “Guaranteed 10-shade whitening in one visit!”) undermines veracity (truthfulness) and erodes trust when the patient’s experience falls short.
On the positive side, social media can educate. Dentists can use online platforms to share preventive tips or factual information, which is ethical and beneficial. The key is content, not hype. The DCI explicitly prohibits presenting one’s clinic as more than it is – e.g. a “clinic” cannot call itself a hospital unless it truly has inpatient facilities[3]. Similarly, presenting oneself as a specialist without proper qualification is barred. In sum, online presence should reflect genuine service, and reputation management should come from quality care and patient education, not from manipulating feedback or bending ethical rules.
Conflicts of Interest and Supplier Incentives
Scenario: Dental material suppliers or equipment vendors court the practice with gifts, kickbacks, or commission-based schemes (e.g. giving part of a crown/lab fee back to the dentist). The clinic’s staff might be subtly guided to prefer certain products.
Such incentives create a conflict of interest: a dentist might subconsciously favor a procedure or material not because it best serves the patient, but because it benefits the dentist. This breaches non-maleficence (risking suboptimal care) and justice (overcharging patients to fund kickbacks). Recognizing this, the DCI’s Code of Ethics clearly forbids “allowing commission”. A dentist must not accept fees from labs or companies for referrals or product selection.
In practical terms, a dentist facing a lucrative offer to use a particular implant system must resist if it compromises clinical choice. Instead, selection should be based on quality, cost-effectiveness for the patient, and the dentist’s actual expertise. Accepting freebies (e.g. prepaid trips or equipment) for product loyalty is similarly unethical. Besides the code, Indian law may view undisclosed kickbacks as unfair trade practice.
Dental education can help: clinics should have written policies forbidding staff from colluding with suppliers in exchange for personal gain. Transparency is crucial. If a supplier asks the clinic owner for a certain volume of orders for a “discount,” the dentist should decline or pass savings to patients. Remember, the patient’s best interest – not the supplier’s profit – must dictate clinical choices. Over the long term, a reputation for integrity (honest treatment recommendations) is far more valuable than any short-term kickback benefit.
Conclusion
Maintaining clinical integrity is vital for trust and a successful practice. As dentistry evolves, so do its pressures – from booming cosmetic demand to digital marketing. However, core ethical principles remain constant: patients come first – flouting them carries risk of sanction or litigation. In fact, recent ethics analyses underline this balance: dentists need “clear ethical frameworks” and open communication to balance business with patient welfare[6]. By adhering to the DCI Code, upholding beneficence, non-maleficence, autonomy, and justice, and resisting undue pressure, practitioners not only avoid legal trouble but also build a loyal clientele. Ultimately, professionalism and ethical care create the foundation for lasting success in dentistry.
References
[1] [3] Don’t engage in unethical practices, TGDC warns dentists | Hyderabad News – Times of India
[2] dental clinic consumer forum: Bengaluru dental clinic asked to pay Rs 2 lakh compensation to patient after damaging 10 teeth – The Economic Times
[4] [5] [6] Aesthetic dentistry and ethics: a systematic review of marketing practices and overtreatment in cosmetic dental procedures | BMC Medical Ethics | Full Text
https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-025-01169-6
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