The Ethics of Well-Being — A Reimagined Professionalism

By Carlos Stringer Smith, DDS, MDiv, FACD

This column is a collaboration between AGD and the American College of Dentists.

Modern dental practice is quite literally evolving day by day. Advances in technology that include the daily integration of artificial intelligence, robotics and even virtual reality are making their way from lofty dreams to everyday realities and even articulated patient expectations. Likewise, the options for modality of practice are also expanding to include the ever-growing field of hedge funds and private equity firms acquiring, opening and operating practices. As dentists, we have an obligation to keep up not only with the newest technologies or practice opportunities, but also with the dynamic and ever-evolving definitions of the core principles that lay the foundation of our profession.

Ethical conduct toward patients and the care of patients has been prioritized throughout the history of the profession, even if healthy debate remains about the exact way in which dentistry — both as a collective and among individual providers — has upheld core principles of ethics such as autonomy, beneficence, nonmaleficence, veracity and justice. While patient care and societal trust must remain paramount, an often-overlooked aspect of ethical and professional duty is the actual well-being of dentists themselves.

The National Academy of Medicine launched the Action Collaborative on Clinician Well-Being and Resilience in 2017. Committed to reversing trends in clinician burnout, the collaborative has three goals: raise the visibility of clinician anxiety, burnout, depression, stress and suicide; improve baseline understanding of challenges to clinician well-being; and advance evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver.(1)

Self-Care Leads to More Care

The notion of self-care is nothing new. In the words of my recently deceased 106-year-old clergy grandmother: “You can’t pour from an empty vessel.” Even more colloquially, one may often hear “don’t burn the candle at both ends.” And across social media, there are clarion calls to check on your “strong friends.” All of these communicate the centrality of not merely practicing self-care as a provider, but also extending beyond self-care to cultivating and fostering environments that prioritize well-being and self-care across the oral health team. To be clear, self-care and well-being — while both important — are different, yet interrelated, domains. Self-care refers to the intentional daily actions individuals take to maintain their physical, emotional and mental health, while overall well-being encompasses the broader, sustained state of balance and fulfillment across personal and professional domains.(2) For healthcare providers, prioritizing well-being is not just a personal necessity, but a professional imperative — serving as a cornerstone for ethical, compassionate care and ensuring they can show up fully present, resilient and responsive to their patients’ diverse needs. This professional imperative, grounded in key principles of healthcare and bioethics, calls for a reimagination of how dentistry defines and understands professionalism, in particular its relationship to well-being.

Scholars across various health professions have called for a reimagination of professionalism.(3-6) “Key to that reframing is an expansion of previous definitions to allow for intervention mechanisms, systems and practices — not simply refraining from doing harm but actively interfering or taking action if wrong is being witnessed.”(6) Thus, if one thinks of professionalism as grounded in nonmaleficence, or to do no harm, that reduction of harm is not only applied to the patients served but also the team members and colleagues by which such service is carried out.

Even further, scholars have called for an expansion of beneficence beyond merely doing good, expanding the definition of doing good as specific intentionality to benefit patients, promote their welfare and remove conditions that cause harm.(7) This connects back to the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience, where optimal patient care is laid bare as clearly hinging upon the clinician-patient relationship, which in turn is only optimized if clinician well-being is centered.

Removing conditions that harm patients would include healthcare systems (and dental practices) that do not prioritize the well-being of their provider workforce. To be clear, dentists have a professional duty to care for patients, themselves and even their teams.

Within dental education, both domestically and abroad, expected competencies of dental practitioners have emphasized the professional importance of managing personal and interpersonal well-being across the dental team.(8) Furthermore, U.S. dental accreditation requires that “graduates must be competent in applying the basic principles and philosophies of practice management, models of oral health care delivery, and how to function successfully as the leader of the oral health care team.”(9) There is no successful leadership of the oral healthcare team without incorporating well-being as key to ethical foundation, patient care and, yes, practice management. While many see calls for an ethics of well-being and a reimagined notion of professionalism as merely theoretical academic pursuits, there are several practical and actionable steps many across the oral health professions can undertake.

Well-Being Strategies and Team Dynamics

Perhaps time can be made for scheduled self-reflection and decompression. Allocate time for mindfulness, journaling or brief restorative breaks during clinical hours to reduce burnout and enhance emotional regulation. Dentistry can and should normalize humane pacing and work-life harmony by reevaluating appointment templates and time expectations. Encourage regular check-ins, and normalize professional counseling or coaching for emotional resilience. Mutual well-being fuels psychological safety — when all team members feel respected, supported, and free to express concerns or vulnerabilities, collaboration thrives, and error rates drop.(10) Teams grounded in well-being show higher trust, reduced absenteeism and greater accountability — key markers for equitable care delivery.(11) Even in daily huddles, every team member — from assistants to interpreters — should be able to voice challenges or insights without fear of reprisal.

Leadership and Management Styles

Leaders who model transparent communication, emotional intelligence and humility set the tone for a culture of care for all, not tyrant control and authoritarianism. Transformational leadership, which uplifts every team member’s voice and value, especially fosters inclusion and counters othering.(12) Compassionate and equity-minded management creates space for processing trauma, acknowledging identity-based harm and ensuring that well-being isn’t merely reserved for those at the top of the hierarchy. Leadership must entail self-reflection and cultural humility.

Sexual Harassment and Safety Policies

Policies on sexual harassment are foundational to well-being — they are not just legal protections but ethical imperatives that defend team cohesion, personal dignity and trust.(13) When these policies are paired with active bystander training, reporting pathways and trauma-informed responses, they protect both historically marginalized team members and patients, who disproportionately experience such harm.(14,15)

Creating Spaces That Heal

At the end of the day, dentists are more than talented and astute tooth technicians. They are full doctors, healers and physicians of the oral cavity (really of the entire head and neck). Practices must embed well-being as a collective, structural commitment — not just the responsibility of the individual. One can do as much individual yoga as their heart desires, but, if the work environment is toxic, then personal interventions without a corporate or practice responsibility are of little effect. Ensure that policies reflect intersectional realities; what supports well-being for a queer immigrant dental assistant may differ vastly from what’s needed for a white male provider, and both deserve tailored and relevant strategies. Dentistry must recognize that well-being is not just the “soft stuff” — it’s the ethical and operational scaffolding that holds up justice, professionalism and truly humane care. By anchoring well-being as core to ethics and professionalism, clinicians can transcend outdated norms of stoicism and hierarchy to embody a practice rooted in justice, compassion and collective care. In doing so, dentistry not only safeguards the health of its patients, practitioners and team members — it may also more aptly lay claim to a moral authority as a healing profession responsive to the complex humanity it serves.

Carlos Stringer Smith, DDS, MDiv, FACD, is an associate professor and associate dean of ethics and community engagement at the Virginia Commonwealth University School of Dentistry, Richmond, Virginia. An actively practicing general dentist, he is also president of the American Society of Dental Ethics. To comment on this article, email impact@agd.org.

References

1. “Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.” National Academies of Sciences, Engineering, and Medicine, National Academies Press, 2019.

2. Kiefer, R.A. “An Integrative Review of the Concept of Well-Being.” Holistic Nursing Practice, vol. 22, no. 5, 2008, pp. 244-252.

3. Thurston, M.M., and D. Hammer. “Well-Being May Be the Missing Component of Professionalism in Pharmacy Education.” American Journal of Pharmaceutical Education, vol. 86, no. 5, 2022, p. 8808.

4. Smith C.S., S. Razack and P. Reynolds. “Advocating for Diversity, Equity, Inclusion, and Social Justice: A Reimagined Professionalism.” Medical Professionalism: Theory, Education, and Practice, edited by G. Merlo and T.D. Harter, Oxford University Press, 2024.

5. Saeed, S.G., et al. “Prioritizing Well-Being to Advance Dental Education.” Journal of the American College of Dentists, vol. 91, no. 1, 2024, pp. 25-33.

6. Smith, C.S., S.C. Stilianoudakis and C.K. Carrico. “Professionalism and Professional Identity Formation in Dental Students: Revisiting the Professional Role Orientation Inventory (PROI).” Journal of Dental Education, vol. 87, no. 5, 2023, pp. 646-653.

7. Smith, C.S., and L.E. Simon. “To Do Good and Refrain From Harm: Combating Racism as an Ethical and Professional Duty.” The Journal of the American Dental Association, vol. 156, no. 2, 2025, pp. 91-94.

8. Chan, C.C.K., E.H.W. Fok and M.G. Botelho. “An Analysis of Students’ Perceptions of Strategies to Improve Well-Being in Dentistry.” European Journal of Dental Education, vol. 29, no. 2, 2025, pp. 249-265.

9. “Accreditation Standards for Dental Education Programs.” Commission on Dental Accreditation, coda.ada.org/standards. Accessed 7 July 2025.

10. Clarke, E., et al. “Feeling Safe to Speak Up: Leaders Improving Employee Wellbeing Through Psychological Safety.” Economic and Industrial Democracy, vol. 46, no. 1, 2025, pp. 152-176.

11. Hungerford, C., and M. Cleary. “‘High Trust’ and ‘Low Trust’ Workplace Settings: Implications for Our Mental Health and Wellbeing.” Issues in Mental Health Nursing, vol. 42, no. 5, 2021, pp. 506-514.

12. Reina, C.S. Adapting Leader Behaviors to Achieve Follower Effectiveness: A Mindful Approach to Situational Leadership. Arizona State University, PhD dissertation, 2015.

13. Klein, M., and J.A. Gallus. “The Readiness Imperative for Reducing Sexual Violence in the US Armed Forces: Respect and Professionalism as the Foundation for Change.” Military Psychology, vol. 30, no. 3, 2018, pp. 264-269.

14. Raskin, S.E., et al. “Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults.” Journal of Racial and Ethnic Health Disparities, vol. 11, no. 6, 2024, pp. 3722-3735.

15. Fleming, E., et al. “American Indian/Alaska Native, Black, and Hispanic Dentists’ Experiences of Discrimination.” Journal of Public Health Dentistry, vol. 82, 2022, pp. 46-52.