Understanding Boundary Violations and Sexual Abuse
The College of Dental Hygienists of Ontario’s (CDHO) mandate is to regulate the practice of dental hygiene in the interest of the overall health and safety of the public of Ontario. Part of this responsibility, as mandated by the Regulated Health Professions Act, 1991 (RHPA), is that the College has a program in place to develop and implement measures for preventing and dealing with sexual abuse of clients. This program is taken very seriously by the College and the Patient Relations Committee who is charged with ensuring its functionality.
What is sexual abuse?
Under the RHPA, the definition of sexual abuse is not as simple as it sounds. When one thinks of sexual abuse, immediately the notion of forced or undesired sexual behaviour may come to mind. However, this definition takes on a broader meaning and can include any of the following conduct with respect to a client:
- Having sex of any form with a client
- Touching a client in a sexual way
- Making comments of a sexual nature to a client or in the presence of a client
- Behaving in a sexual way towards a client
Sexual nature does not include touching, behaviour, or remarks of a clinical nature appropriate to the services being provided.
What constitutes a boundary violation?
Clients trust their dental hygienist because of their knowledge and skills and the dental hygienist–client relationship is based on the principles of trust, respect, intimacy and power. It is generally recognized that a power imbalance exists between any health professional and a client. The dental hygienist is responsible for maintaining the professional boundaries in the relationship at all times.
Something like sexual misconduct or a romantic relationship between a dental hygienist and a client seem like obvious boundary crossings. But numerous other actions may cross the ethical line. For instance, if your dental hygienist shares secrets with you, tries to involve you in a business deal, or asks to see you outside the clinic setting, roles can become blurred. When that happens, the dental hygienist is stepping out of their professional role, and isn’t acting in your best interests.
Sometimes, clients themselves cross the line, by treating the dental hygienist more like a friend, for example, or by trying to instigate an intimate relationship. Yet it’s the responsibility of the dental hygienist to keep the boundaries in place. The person who’s in a position of authority and who has professional obligations, is always the one who has to maintain ethics and clarify the roles and goals in the relationship.
What should you do if you feel uncomfortable or feel that a boundary has been crossed during your dental hygiene visit?
If you ever feel uneasy or uncomfortable about what happened at your dental hygiene visit, or believe that your care is being compromised as a result, raise these concerns with your dental hygienist, their employer, or the College.
If you think that you have been sexually abused by a dental hygienist, please contact the Manager of Investigations and Hearings:
Manager, Investigations and Hearing
416 961-6234 or 1 800 268-2346 ext. 240