Professional Ethics, Patient Records, and Confidentiality
Ethical duties
The hygienist owes the patient fiduciary duties: competence, informed consent, honesty, and avoidance of exploitation. Missouri Board rules treat unprofessional conduct as discipline, even when the conduct is not a clinical error. Conflicts of interest, false billing, and abusive behavior can all qualify.
Records
Keep accurate, legible, contemporaneous records: chief complaint, medical history, assessment, treatment, anesthesia, radiographs, referrals, and patient instructions. Record only what was done and observed; do not chart a diagnosis reserved to the dentist. Retain records for the period required by Board rule and other applicable law. Patients generally have a right to access their records; follow the authorization and fee rules. Never alter a record after a patient requests it or after a complaint arises-make corrections by dated addendum.
Confidentiality
Do not disclose patient information without a valid authorization or a legal exception (for example, required public-health reporting, subpoena, or treatment coordination). HIPAA's minimum-necessary rule applies, and Missouri law adds its own protections. Office conversations, social media, and unencrypted email are common leak points.
Worked example
A patient asks for a copy of her chart. The front desk says "office policy is to send records only to another dentist." That policy is too narrow: the patient's authorized request should be honored under the applicable law, with reasonable copying fees and proper identity verification. Refusing without a legal basis can support a complaint.
Traps
Do not discuss patients in public or on social media, even without names if identifiable. Do not destroy records early. Do not backdate or "clean up" a note; an addendum is the defensible correction.