What do dental codes of ethics and conduct suggest about attitudes to raising concerns and self-regulation?

Background The ability of the dental profession to self-regulate and address poor performance or impairment is crucial if practitioners are to demonstrate a public commitment to patient safety. Failure of the profession to actively engage in this activity is likely to call into question trustworthiness and ability to place the interests of patients and the public first.Aim To investigate attitudes towards self-regulation and the raising of concerns as expressed through the ethical codes of different dental professional and regulatory organisations.Method A qualitative review of professional codes of ethics written and published by dental associations and regulatory bodies using thematic analysis to discern common attitudes and perspectives on self-regulation.Results Four main themes were identified; (1) explicit expression of the need to report; (2) warning against frivolous reporting; (3) acceptance of reporting being difficult and; (4) threshold requiring a professional to report. From these themes, common and differing attitudes were then explored.Conclusions This review shows that often codes of ethics and practice do discuss an obligation to self-regulate and raise concerns but that this is accompanied by an anxiety surrounding unsubstantiated or malicious reporting. This gives the collective guidance a defensive tone and message that may be unhelpful in promoting a culture of openness and candour.