Introduction:
The medical profession holds a special position of trust within society. As a consequence, society affords the profession certain privileges that are not available to members of the public-at-large. In return, the profession makes a commitment to society that its members will adhere to high ethical standards of conduct.[1],[2] The recent growth of ethical literature has been significant in this profession but it is far behind the medical profession in the term of ethical analysis of dental problems.[2] Ethical standards in modern society are in a time of rapid flux and show the contraction. Consumers are better informed and demand more and better services including those related to health care. Ethics consultants in hospitals are now commonplace, and most of the larger hospitals have ethics committees that offer a formal review of problems with ethical overtones.[3] One of the most important reasons for the growth in concerns over ethics is rooted in the tremendous technological advances that, with great cost, offer prolonged or improved life quality. With high-tech enhancements come questions about who gets the care, who pays for it, and how those decisions are made. Especially important are concerns over genetic engineering, reproduction, and termination of care.[4],[5]

What is meant by Ethics?[6]
Ethics are the moral principles or virtues that govern the character and conduct of an individual or a group.
Ethics, as a branch of both philosophy and theology, is the systematic study of what is right and good with respect to character and conduct.
The terms ethical and moral have been used synonymously and used to mean only that the issue, question, reflection, or judgment to which they apply concerns what ought or ought not be done, or what is a matter of someone's obligation.

Why ethics are important?[6]
Ethics affect virtually every decision made in a dental office, encompassing activities of both judging and choosing. Ethics affect relationships with patients, the public, office staff, and other professionals. As a dentist, you have to make numerous decisions. Some decisions are straightforward and easy; others can be very difficult. Ethics are inextricably linked with these decisions and with the day-to-day activities of your office. When ethics are ignored, you risk making unethical or less ethical decisions. Unethical decisions can lead to unethical conduct.

What is a “professional”?[6]
A professional is a member of a profession. Four qualities have been attributed to those who practice a profession:
1.    A professional has respect for human beings;
2.    A professional is competent;
3.    A professional has integrity;
4.    A professional's primary concern is service, not prestige or profit.
These qualities are consistently reflected in the decisions and actions of a professional. To act professionally is to act as a true professional-to comply with the duties and obligations expected of a learned professional.

What is "professionalism"?[6]
Professionalism extends ethics to include the conduct, aims, and qualities that characterize a professional or a profession. Professionalism relates to the behaviour expected of one in a learned profession. Professionalism embodies positive habits of conduct, judgment, and perception on the part of both individual professionals and professional organizations. Professionals and professional organizations give priority to the well-being and self determination of the patients they serve.
Professionalism has been viewed as that quality of conduct and character that accompanies the use of superior knowledge, skill, and judgment, to the benefit of another, prior to any consideration of self-interest.

What are codes of ethics?[6]
A code of ethics marks the moral boundaries within which professional services may be ethically provided.

Principles of Ethics:[1]
Like many other professions, the field of dentistry has the right and obligation to regulate itself-to determine and judge its own members. The ability to have such regulations is achieved largely through the influence of professional societies, such as the American Dental Association (ADA). Though the ADA is not a governing body and is not a legal guardian or enforcer, its established Code of Ethics is generally accepted as the "law" for those who are members of the Association. Although the code is presented in the form of general guidelines and holds no legal ramifications for infractions, the Code of Ethics clearly evokes ideals that most dentists would agree should be followed when carrying out professional activities, whether they are related to patients or to fellow practitioners.

1-Patient Autonomy ("self-governance" ):[1] The dentist has a duty to respect the patient's rights to self-determination and confidentiality.
This principle expresses the concept that professionals have a duty to treat the patient according to the patient's desires, within the bounds of accepted treatment, and to protect the patient's confi dentiality. Under this principle, the dentist's primary obligations include involving patients in treatment decisions in a meaningful way, with due consideration being given to the patient's needs, desires and abilities, and safeguarding the patient's privacy.

2-Nonmaleficence ("do no harm"):[1] The dentist has a duty to refrain from harming the patient.
This principle expresses the concept that professionals have a duty to protect the patient from harm. Under this principle, the dentist's primary obligations include keeping knowledge and skills current, knowing one's own limitations and when to refer to a specialist or other professional, and knowing when and under what circumstances delegation of patient care to auxiliaries is appropriate.

3-Beneficence ("do good"):[1] The dentist has a duty to promote the patient's welfare.
This principle expresses the concept that professionals have a duty to act for the benefit of others. Under this principle, the dentist's primary obligation is service to the patient and the public-at-large. The most important aspect of this obligation is the competent and timely delivery of dental care within the bounds of clinical circumstances presented by the patient, with due consideration being given to the needs, desires and values of the patient. The same ethical considerations apply whether the dentist engages in fee-for-service, managed care or some other practice arrangement. Dentists may choose to enter into contracts governing the provision of care to a group of patients; however, contract obligations do not excuse dentists from their ethical duty to put the patient's welfare first.

4-Justice ("fairness"):[1] The dentist has a duty to treat people fairly.
This principle expresses the concept that professionals have a duty to be fair in their dealings with patients, colleagues and society. Under this principle, the dentist's primary obligations include dealing with people justly and delivering dental care without prejudice. In its broadest sense, this principle expresses the concept that the dental profession should actively seek allies throughout society on specific activities that will help improve access to care for all.

5-Veracity ("truthfulness"):[1] The dentist has a duty to communicate truthfully.
This principle expresses the concept that professionals have a duty to be honest and trustworthy in their dealings with people. Under this principle, the dentist's primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity.

Ethical Decision Making:[7]
Doctors Ozar and Sokol present four steps to making ethical decisions relating to dental situations.
The first step, identifying the alternatives, involves determining the most appropriate course of action, identifying resulting circumstances of the procedure, and relaying the most important features of each treatment to the patient.
The second step, determining what is professionally at stake, relates to the professional opinion of the dentist. The dentist must specifically consider the normative action taken in similar treatment situations and apply those considerations to the decision making process.
The third step, determining what else is ethically at stake, takes a more broad view of what is ethically at stake for the patient in each treatment alternative.
In step four, determining what ought to be done, or ranking the alternatives, the decision is made applying various values, virtues, rules, rights, and professional norms. No matter what the outcome, the principles of ethics come into play during every decision made regarding dental treatment.

One of the most effective methods for decision making in the dental treatment process is the ACD Test. It is comprised of three steps: Assess, Communicate, Decide. Each step is deeply rooted in ethical guidelines set forth by the ADA.[1]
The first step, Assess, asks such questions as: is it true, is it fair, is it accurate, and is what I am doing legal?
The second step, communicate, questions whether the dentist is making an informed decision by asking such questions as: have you listened, have you informed the patient, have you explained the outcomes, and have you presented alternatives?
The third step, decide, focuses on the dentist and his or her ability to perform the treatment by asking such questions as: Is now the best time, is it within your ability, is it in the best interest of your patient, and is it what you would want for yourself?
The answers to these questions should lead to the best and most ethical decision for the patient's treatment and should be utilized when faced with an ethical dilemma.

The Dental Literature
Ghostwriting, Conflicts of Interest, and the Impact Factor
Ghostwriting is the paid recruitment of a prominent researcher to lend his or her name to a paper actually written wholly or partially by a commercial entity, typically a drug company.
The practice allows unscrupulous researchers to gain additional publications for their resumes, while the articles present the company's products in the best light possible. The potential losers are the patients, whose health depends on accurate information reaching their healthcare providers.[8]
Another ethical issue that arises in scientific publishing is conflict of interest. This is obvious in the case of ghostwriting, but it occurs outside of that practice as well. Each of us has attended continuing education presentations at which the sponsoring organization, or the speakers themselves, declare whether or not a possible conflict of interest exists. Speakers often receive financial or other support from commercial companies; it is reasonable that these relationships be disclosed to the audience so that attendees can raise their "bias antennas."[8]
The third issue involves the ethics of the journals themselves - attempts to manipulate the references used by an author to boost the "impact factor" of the journal. The impact factor is a measure of a journal's importance based on how many other scientific papers cite articles from that journal. Impact factors for thousands of journals are determined annually by Thomson Scientific. The editor asked the author to cite more studies that had appeared in the journal, a transparent attempt to manipulate the journal's ranking. Journals may also publish
"best of" features - annual recounting of their "most memorable papers," resulting in more citations referring back to the journal itself.[8]

Suggestions:[9]
Articles written by "ghostwriters" but carrying the name of the person hiring the ghost writer,
"Infomercials" written by commercial groups to promote a product, concept, technique, device, or equipment for a company, acknowledging an author identifiable to readers who lends credibility to the article,
Articles supporting a commercially available product written by authors paid by the owners of the company involved,
Product advertisements that immediately follow articles promoting the product,
Articles in "peer-reviewed" journals that have been stimulated by, paid for, and edited by companies manufacturing the products supported in the articles.[5]

Commercialism-What is ethical And What Is Questionable[9]
When commercialism in any form is intended to deceive, misstate, and/or exaggerate, or it is directed primarily toward increased profit, it would probably be classified by most people as unethical.
When commercialism is intended to educate, and it is truthful and unbiased, it is often not only good but also necessary to provide professional information about new concepts to an otherwise unknowing lay public.

Conclusion:
It is intended to heighten ethical and professional responsibility, promote ethical conduct in dentistry, advance dialogue on ethical issues, and stimulate further reflection on common ethical problems in dental practice. Dentist should familiarize themselves with prevailing law, regulations and standards that effect their decisions.

References
1.    American Dental Association, Council in Ethics, Bylaws and Judicial Affairs. Principles of Ethics and Code of Professional Conduct. Chicago: American Dental Association. Revised April 2012.
2.    Maryam Jessri and Seyyed Ahmad Fatemitabar, Implication of Ethical Principles in Chair-Side Dentistry, Iran J Allergy Asthma Immunol February 2007; 6 (Suppl. 5): 53-59.
3.    Anonymous. Ethics committees double since '83 survey. Hospitals 1985;59:60-66.
4.    Odom JG. Recognizing and resolving ethical dilemmas in dentistry. Med Law 1985;4:543-549.
5.    Beauchamp TL, Walters L, eds. Contemporary Issues in Bioethics. 3rd ed. Belmont, Calif: Wadsworth; 1982:655.
6.    Ethics Handbook For Dentists-An Introduction to Ethics, Professionalism, and Ethical Decision Making, American College of Dentists 839J Quince Orchard Boulevard Gaithersburg, Maryland, 2012.
7.    Ozar, David T. and Sokol, David J. Dental Ethics at Chairside: Professional Principles and Practical Applications. 2nd Ed. Washington, DC: Georgetown University Press, 2002.
8.    Steven M. Adair, Ethics in Publishing: Ghostwriting, Conflicts of Interest, and the Impact Factor, Pediatric Dentistry - 28:4; 2006.
9.    Gordon J. Christensen, Ethics In The Dental Profession-2006; 18, 4, 2006; 171.