American Association of Oral and Maxillofacial SurgeonsCODE OF PROFESSIONAL CONDUCTMarch 2022I.IntroductionAs do all health care professions, the oral and maxillofacial surgery specialty holds a special position oftrust within society. In recognition of their extensive scientific and clinical training, and healing mission,society grants oral and maxillofacial surgeons certain privileges, which are not available to the public atlarge. These include the right to diagnose and treat illness, perform surgery, and prescribe and administerprescription drugs within the scope of their licensure, training, education and expertise. In return, thespecialty makes a commitment to society that its members will adhere to high ethical standards of conduct.The AAOMS Code of Professional Conduct (the Code) is a compilation of those ethical obligations thathave been identified and recognized by the specialty through the American Association of Oral andMaxillofacial Surgeons (AAOMS), the largest oral and maxillofacial surgery specialty society in the UnitedStates.The Code is a product of the AAOMS House of Delegates, which consists of elected representatives of theAAOMS membership and is the official policy-making body of the AAOMS. All elements of the Code resultfrom resolutions adopted by the AAOMS House of Delegates.The Code is, in effect, a written expression of the obligations arising from the implied contract between thespecialty and society. However, since the Code is the result of an ongoing dialogue between the oral andmaxillofacial surgery specialty and the public, it is an evolving document. By its nature, the Code cannot bea complete articulation of all ethical obligations. In resolving ethical problems not explicitly covered by theCode, oral and maxillofacial surgeons should consider the ethical principles that the Code reflects, thepatient’s needs and interests, and any applicable law.AAOMS fellows and members agree to abide by the Code as a condition of membership in the Association.They recognize that continued public trust in the oral and maxillofacial surgery specialty is based on thecommitment of individual surgeons to high ethical standards of conduct.To assist AAOMS fellows and members in participating in the Code decision process, this publication alsoincludes official Guidelines for Filing a Complaint. The guidelines are designed to provide complainantswith a reasonable opportunity to seek a resolution of complaints while protecting the confidentiality andrights of fellows and members accused of violating the Code.II. Guidelines for Filing a Complaint of a Violation of the AAOMS Code of Professional ConductTo help ensure that AAOMS fellows and members honor the Code, the AAOMS maintains a process bywhich violations of the Code by AAOMS fellows and members and AAOMS component societies may bealleged and decided. The AAOMS Commission on Professional Conduct (the commission) carries out thisdecision process. To ensure that complaints receive proper consideration, the commission recommendsthat the following guidelines be followed when filing a complaint.Who may file a complaint: Any AAOMS fellow, member, candidate, resident member, state or regionaloral and maxillofacial surgery society or state dental or medical board or American Board of Oral andMaxillofacial Surgery (ABOMS) may file a complaint of unprofessional conduct or a violation of the Code;however, a current member of the commission who has a direct personal or financial interest in the matterof complaint should recuse themselves from any participation in the matter. The commission may act onits own motion, by majority vote, should a matter within its jurisdiction come to its attention from any other
source. This includes actions taken by the ABOMS, dental and medical board and criminal and civil courtjudgments.Who a complaint may be filed against: A complaint may be filed against any oral and maxillofacialsurgeon who holds any category of membership or prospective membership in the AAOMS. A complaintmay also be filed against any state or regional oral and maxillofacial surgery society that is a component ofthe AAOMS. Complainants seeking action against non-members or other organizations will be referred tothe state dental board or other appropriate body.What a complaint may allege: Complaints must allege a violation of one or more provisions of the AAOMSCode or other professional or ethical misconduct related to the practice of oral and maxillofacial surgery byan oral and maxillofacial surgeon.How to file a complaint: To ensure that the commission receives and is able to verify and evaluatecomplaints, and to ensure that confidentiality is maintained, all complaints must be: In writing. Complaints received by telephone alone will not be considered. Signed by the complainant and include an address where the commission may contact the complainant.Anonymous complaints will not be considered. Documented. At minimum, a statement or affidavit from the complainant detailing the facts andcircumstances of the alleged misconduct is required. Any supporting documentation, such as patientrecords, bills, copies of correspondence, statements of witnesses or other relevant evidence, shouldbe included. Submitted directly to the Chair of the Commission on Professional Conduct at the following address:Chair, Commission on Professional Conductc/o American Association of Oral and Maxillofacial Surgeons9700 W. Bryn Mawr Ave.Rosemont, IL 60018-5701 Clearly marked as “Confidential” on the complaint letter and the envelope in which it is sent.Who has access to complaints: Those filing complaints should understand that their identity, as well asthe nature of the allegation, would be disclosed to the respondent. Other than such disclosure, allcomplaints and proceedings are kept confidential by the commission, the AAOMS Appeals Board and theirrespective agents until a final finding of fact and action are determined, and all appeals are complete.What happens when a complaint is filed: The commission reviews all complaints within 90 working daysof receipt, or at the commission’s next scheduled meeting. Based on the evidence presented in thecomplaint and the respondent’s answer to the complaint, the commission may take one or more of thefollowing actions: Defer the complaint. The most common reason complaints are deferred is to await the outcome oflitigation in a court or action by another governmental or relevant entity over the alleged violations. Dismiss the complaint. If the commission finds a complaint groundless or unsupported bydocumentation, it may dismiss the complaint. Request additional information from the complainant. Appoint a committee to investigate the complaint.
Hold a hearing. The commission may, at its discretion, based on the nature and severity of thecomplaint, determine to hold a hearing and require both the complainant and respondent to attend suchat hearing, at their own expense.If, after investigating the complaint, the commission determines that a violation may have occurred, therespondent may request a hearing before the commission. The respondent may present additionalevidence and interview witnesses at the hearing.After the hearing the commission decides whether a violation has been shown.If the respondent is found to have violated the Code, the commission determines a sanction. Sanctionsmay include: Letter of Counsel.Probation.Censure.Suspension of AAOMS membership.Expulsion from the AAOMS.Letters of counsel and probation are actions aimed at bringing the respondent’s behavior into compliancewith accepted ethical norms. As such, these actions are kept confidential unless they occur along with apublishable sanction.Censure, suspension and expulsion are more punitive actions. As such, they are reported in AAOMSpublications. Disciplinary actions may also be reported to regulatory bodies, such as state dental andmedical boards, state oral and maxillofacial surgery societies and to the American Board of Oral andMaxillofacial Surgery. The commission will report actions, as required by law, to the National PractitionersDatabank.It should be noted, however, that decisions by the commission are binding only over oral and maxillofacialsurgeons’ relationships with and privileges within the AAOMS. Commission findings have no officialstanding outside the AAOMS, though they may be recognized or considered by other organizations at thediscretion of those organizations.The commission retains the sole discretion to impose the discipline it sees fit, in full consideration of thefacts, circumstances and any mitigating or extenuating factors it finds during the course of its investigationand adjudication processes.Respondents found to have violated the AAOMS Code may also appeal the finding to the Appeals Boardof the AAOMS Board of Trustees. The Appeals Board’s decision is final.III. Guidelines for seeking an interpretation of the CodeTo assist oral and maxillofacial surgeons in avoiding and resolving ethical conflicts, the AAOMSCommission on Professional Conduct offers interpretations of the Code to AAOMS fellows and members.Interpretations are most frequently sought in the areas of advertising and marketing, and businessarrangements, though the commission will examine any area of oral and maxillofacial surgery practicecovered by the Code of Professional Conduct.The commission encourages any oral and maxillofacial surgeon who has a question about whether agiven practice or arrangement may violate the Code to seek an interpretation. To obtain an interpretation,address inquiries to:Chair, Commission on Professional Conductc/o American Association of Oral and Maxillofacial Surgeons
9700 W. Bryn Mawr Ave.Rosemont, IL 60018-5701Requests should include enough information about the matter in question to allow the commission toreach an informed decision. Detailed information on the proposed or existing action, arrangement orpractice, and any documentation, such as advertising copy, should be forwarded for the commission toreview.The commission will review the submitted materials within 90 working days, or at its next scheduledmeeting and at that time will determine whether it wishes to issue an interpretation or official AdvisoryOpinion on the issue. At its own discretion, the commission may publish interpretations as AdvisoryOpinions in the Code.Interpretations are meant to provide guidance to fellows and members in resolving uncertain ethicalquestions. However, obtaining an interpretation does not guarantee that the matter in question may notbecome the subject of a complaint or disciplinary proceeding. As with all complaints, the commission willconsider complaints about matters on which it has issued an interpretation based on the facts andcircumstances presented in the complaint process. The fact that an interpretation was obtained may beviewed as a mitigating factor in such proceedings.IV. The AAOMS Commission on Professional ConductUnder the Constitution and Bylaws of the AAOMS, the AAOMS Commission on Professional Conductmaintains and administers the AAOMS Code of Professional Conduct (the Code). It is the commission’sresponsibility to uphold the high ethical and moral standards that have been the hallmark of the specialtyof oral and maxillofacial surgery and have distinguished the practice of the healing arts from ordinarycommerce.The commission’s authority: The commission is appointed by the AAOMS Board of Trustees andfunctions as an independent body within the Association. The commission has the sole authority to interpretthe AAOMS Code. The commission is authorized to investigate and adjudicate complaints of ethicalviolations by AAOMS fellows and members, and impose sanctions on those found to have violated theAAOMS Code.Commission functions and powers: The commission’s main duties and functions are as follows: Administering the Code. The commission is responsible for disseminating the Code to AAOMS fellowsand members, and for providing a mechanism for filing complaints, comments, and requests forinterpretations of the Code. Making decisions under the Code. The commission acts as a tribunal in determining the facts ofcomplaints made against oral and maxillofacial surgeons, and whether those facts constitute a violationof the Code. The commission may levy sanctions against violators. Issuing Advisory Opinions and interpretations. Advisory Opinions are interpretations, opinions andstatements accompanying the Code text. They are generally issued in response to specific issues orcases raised before commission, and act as a standard for interpreting the code in disciplinaryproceedings. The commission continually reviews the opinions and may modify, expand or withdrawany element at any time to meet changing conditions and considerations in the practice of oral andmaxillofacial surgery. Interpretations are opinions on the applicability of the Code in a specificcircumstance, usually at the request of an oral and maxillofacial surgeon. At the commission’sdiscretion, privately requested interpretations may be published as Advisory Opinions.
Recommending changes to the Code. The commission is responsible for continually reviewing theCode and recommending changes to reflect changing circumstances. These recommendations mustbe adopted by the AAOMS House of Delegates to become part of the Code. Educating the membership about the high ethical and moral standards that have been the hallmark ofthe specialty of oral and maxillofacial surgery and have distinguished the practice of the healing artsfrom ordinary commerce.Jurisdiction: The Code governs the commission in its consideration of complaints, and contains the ethicalstandards of the Association. The Code describes many of the matters over which the commission hasjurisdiction and the sanctions the commission may levy. However, because the Code is an evolvingdocument, the commission’s jurisdiction is not limited solely to those matters explicitly referenced in theCode. The commission may examine and recommend sanctions relating to any action by an oral andmaxillofacial surgeon that the commission determines to be an actual or potential violation of the ethicaland moral duty oral and maxillofacial surgeons owe their patients, peers and society.It should be noted, however, that the commission’s jurisdiction is limited to AAOMS fellows and membersand their relationships with and privileges within the AAOMS. Findings of ethical violations may be reportedto other organizations or agencies, in accordance with the Code. They may be recognized and consideredby outside entities only at the discretion of those entities.Occasionally, the commission is asked to determine matters outside its jurisdiction. For example, mattersthat relate primarily to quality and standards of treatment, including fees, are, generally speaking, thepurview of peer review committees and are to be resolved through the state or regional peer reviewmechanism. The commission may refer such matters to other appropriate authorities.In the event the commission determines that an allegation should be referred to another agency, thecomplainant will be advised that their complaint falls outside the jurisdiction of the Code and the commissionwill then refer the complainant to a more appropriate authority.The commission seeks to administer and enforce the Code in an objective and unbiased manner, andmakes every attempt to treat respondents and complaints with the respect and fairness due fellow oral andmaxillofacial surgeons. In keeping with these goals, commission members are expected to disclose anyconflict or potential conflict or recuse themselves in matters where a conflict of interest or even theappearance of impropriety exists.Confidentiality: Commission members shall keep confidential all information relating to their work on thecommission. Breach of confidentiality by any member of the commission shall be grounds for removal fromthe commission.V. AAOMS Code of Professional Conduct and Official Advisory OpinionsA.General principles of the AAOMS Code of Professional ConductA.1The Code of Professional Conduct (the Code) is an expression of the House of Delegates of theAmerican Association of Oral and Maxillofacial Surgeons (AAOMS). The Advisory Opinions are abasic compilation of interpretations, opinions and statements of the AAOMS Commission onProfessional Conduct. The Code and the Advisory Opinions may be expanded, withdrawn ormodified by the originating body at any time to meet changing conditions and considerations inthe practice of oral and maxillofacial surgery practice.The Code of Professional Conduct of the AAOMS is the ethical standard for fellows and membersof the Association as they seek to achieve the highest level of ethical conduct in the relations withtheir patients, their peers and the public.
In all dealings with the public and profession, oral and maxillofacial surgeons and residentmembers training in accredited oral and maxillofacial surgery programs should uphold the honorof their profession by acting in accordance with the letter and the spirit of the Code, as well as allapplicable law and regulation. Oral and maxillofacial surgeons practicing under otherprofessional designations and licenses must follow the ethical standards of the professions thatapply.In all cases, oral and maxillofacial surgeons should safeguard their patients, their profession andthe public by ensuring that care is rendered only by persons who are professionally competentand of good moral character. Fellows and members of the Association have a moral andprofessional obligation to maintain a viable relationship with all appropriate segments of thehealth care community.Advisory opinionsA.1.00 Observance: These ethical standards of professional conduct are the expressions of theAAOMS of its basic ethical principles. As a condition of membership, all fellows andmembers of the AAOMS are required to abide by the tenets of the Code.A.1.01 Respect for Law and Individual Rights: The oral and maxillofacial surgeon and the residentmember training in accredited oral and maxillofacial surgery programs should respect therule of law and the rights of the individual.A.1.02 Rights of the Public: While it is important that the rights of professional colleagues beprotected, it is equally important to protect the rights of the public. In litigation, for example,fellows or members should feel free to act as expert witnesses when they believe theiropinion would aid in the administration of justice.A.2Pledge of the Association: Each fellow and member of the Association shall be bound by thefollowing Pledge, which shall become effective upon induction to membership:Recognizing that the American Association of Oral and Maxillofacial Surgeons stands for thehighest traditions of our specialty, I hereby pledge myself, as a condition for membership, topractice oral and maxillofacial surgery with honesty and to place the welfare of my patientsabove all else; to advance constantly in professional knowledge; and to render help willingly tomy colleagues.In solemn affirmation of my dedication and upon my honor, I declare that I will abide by theCode of Professional Conduct of the American Association of Oral and Maxillofacial Surgeonsand that I will faithfully support its purposes and ideals and abide by its principles andregulations.Reproduction of the Pledge for the purpose of public display is prohibited except for copiesproduced by the American Association of Oral and Maxillofacial Surgeons or its official designees.A.3All complaints, proceedings, communications, and records concerning alleged violations of theCode shall be kept confidential by members of the Commission on Professional Conduct, membersof ad hoc investigative committees appointed by the commission, members of the AAOMS Boardof Trustees reviewing appeals of findings of violations, AAOMS staff, and others affiliated with theAAOMS, except when sanctions are publishable under the Code or when disclosure of suchinformation may be required by law.B.Patient autonomy, self-determination and confidentialityB.1The oral and maxillofacial surgeon has a duty to respect the patient’s rights to self-determinationand confidentiality.
B.2The oral and maxillofacial surgeon should inform the patient of any proposed treatment and anyreasonable alternatives, so that the patient is involved in their treatment decisions.Advisory opinionB.2.00 Oral and Maxillofacial Surgeon Responsibility and Patient Consent: The responsibility ofthe oral and maxillofacial surgeon includes preoperative diagnosis and care, the selectionand performance of the operation and postoperative surgical care. It is unethical to misleada patient as to the identity of the doctor who performs the operation. Because modern oraland maxillofacial surgery is often a team effort, oral and maxillofacial surgeons maydelegate part of the care of their patients to associated oral and maxillofacial surgeons,residents, or assistants under their direction. However, oral and maxillofacial surgeonsmust not delegate or evade their responsibility for supervising assistants, and ensuringtheir patients are cared for according to accepted practice standards. It is not improper forthe responsible oral and maxillofacial surgeon to permit an assistant to perform all or partof a given operation, provided the oral and maxillofacial surgeon is present and an activeparticipant throughout the essential part of the operation. If a resident is to operate uponand take care of the patient, under the general supervision of the attending oral andmaxillofacial surgeon who will not participate actively, the patient should be so informedand provide consent.B.3Oral and maxillofacial surgeons should protect the confidentiality of patient records. Maintenanceof patient records should provide for reasonable safeguards to protect the privacy and welfare ofpatients. At the request of a patient, another dentist or physician, the oral and maxillofacialsurgeon should provide any information beneficial to the treatment of the patient.Advisory opinionB.3.00 Furnishing Copies of Records: An oral and maxillofacial surgeon has the ethical (andoften legal) obligation to provide patient records (or copies or summaries of them),including x-rays and other imaging techniques (or copies of them) to either the patient orthe patient’s designated caregiver, at the request of the patient or the patient’ssubsequent caregiver. Oral and maxillofacial surgeons should provide such documentseither at no charge or for a nominal fee that covers the cost of reproduction and time inpresenting the records. Transfer of protected records should be done in accordance withthe law and confidentiality regulations in place at that time.C.Ensuring proper professional education, training and competenceC.1Limitation of Practice: To ensure quality of professional care, members and fellows shall first announcea limitation of their practice to oral and maxillofacial surgery and then may announce any other ADA- orABMS- recognized specialty for which they are educationally qualified, or the AAOMS Board of Trusteesmay approve a subspecialty listing within the scope of oral and maxillofacial surgery for those who candemonstrate added qualification and/or training in that area.Advisory opinionsC.1.00 Scope of practice: While an oral and maxillofacial surgeon has the right to practice to the fullextent of their license, competence and abilities governed by all applicable laws and regulations,they also maintain the obligation to act in accordance with the letter and spirit of the AAOMSCode of Professional Conduct in their scope of practice which is perpetually defined by thecurrent edition of the AAOMS Parameters of Care (ParCare). Therefore, while practicing as anoral and maxillofacial surgeon, surgery outside the oral and maxillofacial region shall beconsidered outside the scope of the profession unless such procedures are to harvest tissue forutilization in the oral and maxillofacial region.
C.1.01 An oral and maxillofacial surgeon must personally provide preoperative evaluation anddiagnosis and postoperative care according to accepted treatment parameters.C.1.02 Auxiliary Personnel: Oral and maxillofacial surgeons have an obligation to protect thehealth of their patients by not delegating to a person less qualified any service or operationwhich requires the professional competence of an oral and maxillofacial surgeon. An oraland maxillofacial surgeon has the further obligation of prescribing and supervising the workof all auxiliary personnel in the interest of rendering the best service to the patient.C.2Continuing Education: Oral and maxillofacial surgeons should continually improve themselvesand their abilities through continuing education.C.3Professional Judgment and Quality of Care: Oral and maxillofacial surgeons should treat theirpatients as they would wish to be treated in like circumstances. They should not discloseprofessional confidences unless compelled to do so by law. Their independent judgment shouldnot be compromised.Advisory OpinionsC.3.00 An oral and maxillofacial surgeon must not practice oral and maxillofacial surgery on ascheduled basis in locations other than suitably equipped and staffed facilities, such asoral and maxillofacial surgery offices (as defined in C.3.01 and C.3.02), accreditedhospitals, surgery centers, academic institutions, state or federal institutions, or in themilitary service. This provision should not prevent or discourage oral and maxillofacialsurgeons from providing unscheduled urgent or emergency care as needed in any type ofsetting.C.3.01 An oral and maxillofacial surgery office is defined as a non-mobile facility that has passedthe state general anesthesia or conscious sedation evaluation where required by state law,is represented by trained staff persons, displays the attending oral and maxillofacialsurgeon’s name, and provides 24-hour coverage by an oral and maxillofacial surgeon whois within a reasonable distance and/or response time of the facility for the administration ofemergency care.C.3.02 Facilities meeting these criteria may be a part of an associated medical or dental clinic.Each oral and maxillofacial surgery facility must meet the appropriate statutes as set forthin the state Dental Practice Acts and comply with current AAOMS office anesthesiaregulations, including the maintenance of drugs and equipment on the premises, and besubject to on-site evaluation where required.C.4Consultation: Consultation should be sought whenever the quality of care may be enhanced byconsultation.Advisory opinionsC.4.00 Advice and Counsel to Colleagues: Oral and maxillofacial surgeons, by virtue of theirtraining and professional expertise, have the obligation to advise and assist theirprofessional colleagues when their advice and counsel is sought. Their aim should be theultimate in good patient care.C.4.01 Confidentiality: Oral and maxillofacial surgeons serving as consultants should hold thedetails of their consultations in confidence between themselves and the attendingpractitioners.
C.5Itinerant Surgery: Defined as elective oral and maxillofacial surgery performed in non-accreditedsurgical facilities other than the facility or facilities owned and/or leased by the oral andmaxillofacial surgical practice employing the oral and maxillofacial surgeon.a.Fellows and members are strongly discouraged from participating in itinerant surgery.b.It is unethical if the patient is unfamiliar with the surgeon who performs theirsurgery. Therefore, if an oral and maxillofacial surgeon performs itinerant surgery, thepatient must be provided, in writing, the full name of the surgeon, their state licensenumber, their primary address or main office address, their office telephone number, andtheir after-hours number prior to their surgical appointment.c.It is unethical for the surgeon to delegate their primary patient responsibility. Therefore, ifan oral and maxillofacial surgeon performs itinerant surgery, they shall comply with thecurrent published AAOMS Parameters of Care for patient assessment and the OfficeAnesthesia Evaluation Manual for outpatient anesthesia.1)The surgeon shall perform a patient assessment including a medical history and aphysical examination prior to performing surgery.2)The surgeon shall document the patient’s physical status in their record using theAmerican Society of Anesthesiology physical status classification prior tosurgery, and3)The surgeon shall document a diagnosis justifying surgical care.d.It is unethical for the surgeon to perform surgery in an unsafe or unsuitably equippedfacility. The AAOMS Office Anesthesia Evaluation program establishes the required vitalsign monitors for the safe delivery of office based anesthesia. Therefore, if an oral andmaxillofacial surgeon performs itinerant surgery, they shall comply with the currentpublished AAOMS Office Evaluation Manual for facility and anesthesia teamrequirements for each office utilized for itinerant surgery. To further comply with requiredvital sign monitoring; each office where the surgeon operates should have its own vitalsign monitoring equipment which undergoes regularly scheduled maintenance to ensurethe equipment is properly calibrated and in working order. Required monitoring includesECG, Blood Pressure, Pulse Oximetry, and End Tidal CO2. In addition, the Oral &Maxillofacial Surgeon is required to comply with State laws pertaining to permitting andlicensing of any office facility utilizing and providing intravenous sedation and/or generalanesthesia. All facilities utilized for such patient care must therefore, comply with Stateand Federal permitting and licensing requirements. As a minimum requirement, eachsurgeon shall provide their state component an affidavit confirming their compliance withthe above standards of care incl
The commission encourages any oral and maxillofacial surgeon who has a question about whether a given practice or arrangement may violate the . Code. to seek an interpretation. To obtain an interpretation, address inquiries to: Chair, Commission on Professional Conduct . c/o American Association of Oral and Maxillofacial Surgeons