Patient Relations Program

• Dental hygienists should use clear and direct communications with clients, should use correct terminology for body parts, and should use an interpreter whenever necessary.
• Dental hygienists should limit physical contact with clients to actions that are nurturing and helpful and acceptable to the client and, when touching is required for the provision of dental hygiene care, dental hygienists should obtain the client’s permission before touching.
• Dental hygienists must accept that the definition of professional misconduct of a sexual nature includes actions or comments that a reasonable person would know are unwanted or would create discomfort. Dental hygienists should seek opportunities to learn about multi-cultural attitudes and behaviours that are appropriate, so that professional misconduct of a sexual nature does not occur as a result of ignorance.
• Dental hygienists must not exhibit behaviour, gestures, expressions or comments that are seductive or sexually demeaning to a client.
• Dental hygienists should be sensitive to the discomfort a client may feel from their words or behaviour, and should change such words or behaviour.
• Dental hygienists should never place any items or materials on a client’s body.
• Dental hygienists should never comment on or criticize a client’s sexual orientation.
• Dental hygienists should never initiate or participate in conversations or jokes with clients regarding sexual problems, preferences or fantasies.
• Dental hygienists should ensure that all conversations carried on in the presence of clients, or where the conversation may be overheard by clients, are not offensive to clients in any way whatsoever.

This section has been developed as a guide for dental hygienists who are registrants of the British Columbia College of Oral Health Professionals  (BCCOHP) and to meet requirements of the Health Professions Act as defined in Section 16(2). It has been approved by the Quality Assurance Committee of the College and by the Board. Professional misconduct of a sexual nature is a serious matter and could result in the sexual abuse and/or sexual harassment of a client. These are offenses under both the civil and criminal law. The dental hygienist could be charged and the client could be entitled to collect damages as determined by an administrative tribunal, judge or judge and jury. The dental hygienist would have to pay these damages to the client. A complaint of professional misconduct of a sexual nature against a dental hygienist may also result in disciplinary action by the College.

The College upholds and promotes the public’s interest and informs registrants, as per the spirit and intention of the Health Professions Act, that clients have the right to receive dental hygiene care in a healthy, safe and respectful practice environment.

Professional misconduct of a sexual nature is a blatant and abusive misuse of power that violates the human dignity of clients seeking dental hygiene care for themselves and their relatives. It is characterized as a violation of the relationship of trust and confidence that exists between clients and health care professionals. Such professional misconduct by any registrants, providing any type of dental hygiene care, in any practice settings, will not be tolerated by the College.

The dental hygienist/patient relationship is a professional relationship defined by the Dental Hygienists Regulation and bylaws, which includes the BCCOHP Code of Ethics and Practice Standards. All dental hygienists are empowered and bound by these laws and have a corresponding duty and obligation to uphold these laws at all times as a condition of their registration with the College. The law always presumes that where there is a benefit bestowed on a person, such as the privilege of practicing dental hygiene, there always exists a corresponding obligation to society in the exercising of that benefit.

The dental hygienist/patient professional relationship begins when a dental hygienist first interacts with a client in the workplace and continues with every subsequent interaction, within or outside of the workplace, until the client and/or dental hygienist ends the professional relationship.

By mutual consent, some professional relationships develop into personal friendships or relationships, where the boundaries of professional and personal relations blur. It is not inappropriate for a personal relationship to develop between patients and dental hygienists. However, evidence of a personal relationship is inappropriate in the workplace, even if welcomed by the recipient. Signs of personal affection could be misinterpreted by others who do not know of the personal relationship and could be uncomfortable to those who overhear personal comments or observe personal behaviours. Common sense and respect for others should guide the dental hygienist’s behaviour. The practice setting is to be respected at all times. Only the highest standard of professional behaviour should occur in a practice setting.

If a dental hygienist feels that their professional judgment is affected by a personal relationship, the dental hygienist should cease providing care to that client and should refer them to another dental hygienist or health care professional.

Currently dental hygienists may provide dental hygiene care to spouses and partners with whom they have a romantic or sexual relationship. While there are no specific provisions that prevent treatment of spouses, registrants must provide dental hygiene care in accordance with the BCCOHP Code of Ethics and Practice Standards. Registrants are encouraged to consider the impact of the relationship with the patient on their ability to obtain full, free, and informed consent and appropriately plan dental hygiene care before proceeding with treatment for any patient, particularly family members including spouses. If the registrant feels that their professional judgement and ability to provide safe and ethical dental hygiene care is affected by the personal relationship with the patient, the dental hygienist should refer them to another dental hygiene professional.

The dental hygiene profession attracts supportive, caring individuals; some practice settings require dental hygienists to be physically near their patients, and some procedures cause stress or discomfort to patients. With these points in mind, dental hygienists need to be careful that words and actions that are intended to be caring, supportive and calming are clearly communicated, so as not be misinterpreted in a sexual manner. Also, some clients feel particularly vulnerable in a dental hygiene practice setting.

Professional judgment should be used to assess the patient’s comfort level to determine whether an additional person needs to be present during patient care. If in doubt, a witness to the provision of care is advised.

When a dental hygienist assesses a patient, she/he seeks information required for understanding social, cultural, personal and environmental factors. If language is a barrier, the client could be asked to bring an interpreter to the appointment to ensure that the client understands and consents to the process, nature, and extent of dental hygiene care that has been recommended. A signed statement could be requested from the interpreter, stating that all aspects of the recommended care were fully explained to the patient and that the patient fully understood the nature and extent of the care.

As stated in the BCCOHP Code of Ethics, a registered dental hygienist has a professional obligation to report to the College any illegal or unethical professional decisions or practices by dental hygienists or others. This includes any of their own actions or comments that are, or could reasonably be perceived as being, professional misconduct of a sexual nature.

A dental hygienist also has a professional and legal responsibility to make a written complaint to the appropriate licensing authority about any reasonable beliefs that professional misconduct of a sexual nature by a dental professional has occurred. Prior to a report being submitted, the registrant must obtain the client’s consent and the client should be advised to obtain legal advice about the consequences of making a written report. All reports are treated confidentially but not anonymously. The licensing authority receiving the report will follow their formalized process of investigation. Resulting actions will vary depending on the regulatory authority and the nature of the complaint. Further information about the complaint process is available from the specific licensing authority.

The British Columbia College of Oral Health Professionals will act on all written complaints of professional misconduct of a sexual nature in a fair, timely and confidential manner according to the complaint process approved by the Board.

The situation may occur when a client shows unwanted attention or attempts to initiate an unwanted personal relationship with a dental hygienist. The unwanted attention could be intentional, unintentional, related to medication the client might be taking, an undisclosed emotional condition, or the client could be mentally challenged. In all situations, the dental hygienist should try to immediately curtail the attention and should document any suggestive or unusual behaviour or comments made by the client as well as their own response or action.

When the dental hygienist first perceives clear and open unwanted attention, the dental hygienist should immediately call a third person into the practice setting and review the rules of conduct with the client and ask the client for their cooperation in front of the witness. This can be done in a friendly and positive manner but in a way that makes it clear to the client that the dental hygienist is serious. It is not advisable to refrain from acting on a first occurrence because the client could perceive that the attention is wanted or the client could reverse the incident and accuse the dental hygienist of inappropriate behaviour. Clear and precise communication is best and a clear definition of roles will help the client see that inappropriate behaviour is unacceptable. If language is a barrier to communication, the dental hygienist should end the appointment and reschedule the appointment at a time when the client can provide an interpreter.

If the client persists, the dental hygienist should withdraw from the professional relationship and refer the client to another dental hygienist or health care professional for dental hygiene care. If the client continues to persist, the dental hygienist should notify a higher authority, and could contact the BCCOHP for advice and action options or to seek legal advice.

Appendix A

Definitions

To clarify the information in this section, some definitions have been provided:

Client is interchangeable with the term ‘patient’ and may be applied to groups.

Workplace is defined as the dental hygienists practice setting. This may include, but is not limited to dental offices, health and education institutions and facilities, and research laboratories.

Dental hygiene care is defined as the assessment, dental hygiene diagnosis, planning, implementation and evaluation of health promotion, preventive and therapeutic interventions in a variety of practice settings, as outlined in the BCCOHP Scope of Practice Statement and Practice Standards.

Professional sexual misconduct is defined as intentional or unintentional actions or comments of a sexual nature, or sexual innuendo, perceived by the client and made by a dental hygienist in the course of their professional work that a reasonable person would know are unwanted or would create discomfort. Professional misconduct of a sexual nature has a negative effect on the client and could lead to the client experiencing a variety of conditions including nervous shock, loss of memory, regressive behaviour, loss of sleep, and the loss of the ability to work. Any or all of these conditions, if proven by the client, could lead to a claim for damages or a criminal conviction of the dental hygienist.

Professional sexual misconduct by a registrant includes, but is not limited to:

1. sexual intercourse or other forms of physical sexual relations between the registrant and the client;
2. touching of a sexual nature of the client by the registrant; or
3. behaviour or remarks of a sexual nature by the registrant towards the client.

Appendix B

Examples

Examples of behaviors towards clients that constitute professional misconduct of a sexual nature include but are not limited to:

• sexually demeaning gestures or expressions;
• leering and staring, particularly at intimate areas;
• sexually suggestive remarks, innuendos and jokes, and giggling or laughter that cause awkwardness or embarrassment;
• lewd or suggestive comments, inquiries or jokes about any person’s sexual habits, appearance or sexual attractiveness;
• verbal threats which have sexual overtones;
• sexual flirtations, advances or propositions; 
• implied or expressed promise of reward, or threat of reprisal, for complying with a sexually oriented request;
• inappropriate physical contact, such as touching, patting, pinching or punching;
• persistent unwanted contact such as standing close or brushing up against a client unnecessarily;
• procedural techniques that may involve touching in an intimate area (such as placing items on the client’s bib, or reaching across the client’s bib to obtain an item);
• hugging, kissing or touching without the client’s permission;
• displaying sexually offensive or derogatory material.