The Comprehensive Dental Topics Guide for Dental Schools

The American Dental Association Principles of Ethics and Code of Professional Conduct rests on five principles. Medicine usually teaches four; dentistry adds veracity, truthfulness, which matters in a profession where patients often can't judge the work themselves and where treatment decisions involve money.

When Principles Collide

Most interview dilemmas set two principles against each other. A patient who wants a healthy tooth extracted pits autonomy against nonmaleficence. A colleague's poor work pits veracity (honesty with the patient) against loyalty, which the code doesn't list as a principle at all. Naming the conflict precisely is half the answer.

In Canada, the Canadian Dental Association's Principles of Ethics (adopted 2015) group dental ethics under two headings:

Who Actually Regulates Dentists

The CDA is a national association. Enforceable rules come from each province's regulator, for example the Royal College of Dental Surgeons of Ontario (RCDSO) or the Ordre des dentistes du Québec. Regulators license dentists, set standards of practice, and investigate complaints. If you're interviewing in Canada, refer to "the provincial regulator" when an answer calls for escalation.

The ADA Code requires dentists to "inform the patient of the proposed treatment, and any reasonable alternatives, in a manner that allows the patient to become involved in treatment decisions." Consent is a conversation, not a signature.

What Valid Consent Requires

• Disclosure: diagnosis, the recommended treatment, reasonable alternatives (including no treatment), and the material risks and costs of each
• Understanding: in plain language, checked by asking the patient to explain it back
• Capacity: the patient can understand and weigh the information
• Voluntariness: no pressure, including financial pressure from the practice

Minors and Capacity

Rules on when young people can consent on their own vary by province and state. Many Canadian jurisdictions focus on whether the young person can understand the treatment rather than a fixed age. In an interview, say you would follow local law and your regulator's guidance, involve parents where appropriate, and respect a capable young person's voice.

Dentists "are obliged to safeguard the confidentiality of patient records" (ADA Code 1.B). Two details often surprise applicants:

• Patients must be given copies of their records "whether or not the patient's account is paid in full" (1.B.1). Records can't be held hostage for payment.
• Sensitive information, "such as HIV seropositivity," needs written permission before it is forwarded to another provider (1.B.2).

Confidentiality has limits: suspected child abuse must be reported, and some situations involving risk of serious harm allow or require disclosure. A strong answer names both the duty and its limits.

Unlike physician and hospital care, dental care was never part of Canada's universal medicare system. Most Canadians pay through employer insurance or out of pocket, with public programs for specific groups.

The Canadian Dental Care Plan (CDCP)

• Announced December 11, 2023, with about $13 billion over five years and $4.4 billion ongoing
• Eligibility: no access to dental insurance, adjusted family net income under $90,000, Canadian tax resident, and last year's tax return filed
• Co-pays: none under $70,000; 40% for $70,000–79,999; 60% for $80,000–89,999
• Rollout: seniors first (care from May 2024), then children under 18 and Disability Tax Credit holders (June 2024), then adults 18–64 (coverage from June 1, 2025)
• As of April 2026, Health Canada reported about 6.5 million people covered and more than 4 million who had received care, with near-universal participation by dental providers

Early on, many dentists were reluctant to participate because of paperwork, fee schedules and contract terms. In July 2024 the government let providers treat CDCP patients claim by claim without formally signing up. The CDA has supported the plan's goal of improving access while urging less administrative burden and attention to prevention and workforce.

Other Public Programs

The federal Non-Insured Health Benefits (NIHB) program covers dental care for registered First Nations and recognized Inuit, without deductibles or co-pays, though some services need approval in advance. Provinces also run programs for groups such as children in low-income families and people on social assistance; details vary by province.

In the US, most dental care is paid through private dental insurance or out of pocket. Traditional Medicare generally doesn't cover routine dental care. For adults, dental coverage under Medicaid is an optional benefit that each state decides on.

• As of December 2025, CareQuest Institute counted 38 states plus DC offering extensive or enhanced adult Medicaid dental benefits, six with limited benefits, and five with emergency-only coverage
• Optional benefits "are often the first to be cut when budgets shrink"; federal Medicaid funding changes passed in 2025 take effect mostly from 2027
• Several states added annual caps on adult dental benefits in 2025–26, while others expanded coverage

The ADA Code calls dentists "the leaders of the oral healthcare team." Leading well means knowing what each member does:

The Dental Therapy Debate

Dental therapists are authorised in at least some settings in more than a dozen US states, including Alaska, Minnesota, Washington and Michigan (which licensed its first in January 2026). US national accreditation standards were adopted in 2015. In Canada, the University of Saskatchewan launched the country's only dental therapy degree in 2023, with priority for Indigenous applicants.

Dentists traditionally owned their own practices. Increasingly, many work for dental service organizations (DSOs) or large groups that handle the business side. In the US, DSO affiliation rose from about 7% of dentists in 2015 to about 16% in 2024, and to about 27% among dentists within ten years of graduating (ADA Health Policy Institute).

Adjusting fluoride in public water to a level that helps prevent tooth decay. The ADA says community water fluoridation reduces decay by more than 25%. The current US Public Health Service recommendation, set in 2015, is 0.7 mg/L.

Recent Developments

• Calgary stopped fluoridating in 2011, voted to reintroduce it after a 2021 plebiscite (62% in favour), and reintroduced it on June 30, 2025
• Utah (effective May 2025) and Florida (effective July 2025) became the first US states to ban community water fluoridation
• In April 2025 the US health secretary said he would ask the CDC to stop recommending fluoridation, and the EPA announced a review
• In 2024 a US federal court found an "unreasonable risk" at 0.7 mg/L under toxic-substances law; the EPA appealed. Reviews were still under way in 2026
• The ADA has backed an independent National Academies review and urged a "deliberative approach"

Because dental care is mostly privately funded, income, insurance and geography largely decide who gets care. The result is large gaps.

• Indigenous communities: in the US, the Indian Health Service reports that 54% of American Indian and Alaska Native children aged 1–5 have had decay, and AI/AN schoolchildren are almost four times as likely to have untreated decay. In Canada, NIHB covers registered First Nations and recognized Inuit, but distance and provider shortages remain barriers
• Rural areas: fewer dentists and longer travel
• Low-income adults and seniors: coverage often ends with employment
• People with disabilities: may need specialised settings or sedation

What Schools Are Doing

The University of Saskatchewan reserves 6 of 36 dental seats for Indigenous applicants, and Manitoba has an Indigenous admission category. Expect questions about how you'd serve communities different from your own.

Dentists are significant prescribers. CDC data show general dentists wrote more than 10% of all US outpatient antibiotic prescriptions in 2020–2022, with no decline from 2018 to 2022.

• The ADA's 2019 guideline limits antibiotics for most toothaches (pulpal and periapical pain), where treating the source is what works
• The ADA's 2024 acute-pain guideline makes NSAIDs, alone or with acetaminophen, first-line; opioids only when first-line therapy isn't enough, never "just in case," at the lowest dose for the shortest time (which "rarely exceeds 3 days")

Research has linked oral disease, particularly periodontal (gum) disease, to conditions such as cardiovascular disease and diabetes. Precision matters here: an American Heart Association scientific statement published in late 2025 found associations between periodontal disease and atherosclerotic cardiovascular disease are supported, but causality has not been established.

Dental amalgam ("silver fillings") contains mercury. In November 2025, parties to the Minamata Convention on Mercury agreed to phase out the manufacture, import and export of dental amalgam by 2034, while keeping an exception where a dentist considers it necessary for a patient.

Separately, the ADA Code says removing sound amalgam from a non-allergic patient "for the alleged purpose of removing toxic substances from the body," solely on the dentist's recommendation, is unethical.

SDF is a liquid painted onto cavities to stop them progressing. It's fast, inexpensive and needs no drilling or injections, which makes it valuable for young children, people with disabilities and settings with limited access to care. The trade-off: it permanently stains decayed areas black.

SDF was cleared in the US for tooth sensitivity, and its use to arrest decay is off-label, supported by pediatric dentistry guidelines.

ADA Code 5.B.6: "A dentist who recommends or performs unnecessary dental services or procedures is engaged in unethical conduct." It applies regardless of practice type or contract.

• Watch-and-wait is often a legitimate option for early or stable problems
• Cosmetic treatment isn't unethical, but recommending it must not exploit the patient's trust
• Selling products to patients requires disclosing any financial incentive (5.D.2)

The ADA Code treats several common requests as unethical: falsifying treatment dates or procedure codes to get coverage, raising fees because a patient is insured, and waiving a co-payment without telling the insurer (which overstates the fee).

Practising while impaired by alcohol or drugs is unethical under the ADA Code. Dentists should urge impaired colleagues to seek treatment, and those with first-hand knowledge have "an ethical responsibility to report such evidence" to the appropriate professional assistance committee.

For poor work by others, dentists must report "gross or continual faulty treatment," while giving patients information about their oral health "without disparaging comment about prior services."

• If patients are at immediate risk, act first: stop the situation and involve a supervisor
• Otherwise, gather facts and speak to the colleague privately
• Use formal channels (assistance programs, the regulator), not gossip

Dentists must "become familiar with the signs of abuse and neglect and … report suspected cases to the proper authorities." Many injuries from child abuse involve the head, face and mouth, which puts dentists in a position to notice.

• For children, reporting suspected abuse is a legal duty across Canada and the US
• For competent adults, the ADA Code says to respect the patient's wishes where reporting isn't legally required
• Document objectively and report to the proper authority, not just to a parent or partner

Dentists "shall not refuse to accept patients" because of "race, creed, color, gender, sexual orientation, gender identity, national origin or disability." Decisions about patients with HIV, hepatitis B or C "should be made on the same basis as they are made with other patients."

• Standard precautions protect patients and staff regardless of diagnosis
• If staff are afraid, respond with education and support, not by turning patients away
• Once treatment has started, a dentist can't abandon a patient without adequate notice and a chance to find another dentist (ADA 2.F)
• Dentists must arrange emergency care for their patients of record (4.B)

The ADA Code says no dentist shall advertise "in any form of communication, including via social media, in a manner that is false or misleading in any material respect." Before-and-after photos, specialist claims and testimonials are common grey areas.

• Patient photos need consent and must not be misleading
• Claiming to be a specialist without the qualification is prohibited
• In Canada, provincial regulators set advertising rules

AI software that flags possible cavities and other findings on X-rays has received US FDA clearance and is being adopted in practices. Teledentistry, used for triage, follow-ups and remote communities, is governed by ADA policy that care delivered this way must be consistent with in-person standards.

Knowing these topics is the foundation. What earns marks is how you reason with them: naming the principles at stake, considering everyone affected, and reaching a clear, kind decision.