Dental hygienists in Ontario often work in diverse professional settings — from traditional dental offices to spas, clinics, and independent dental hygiene practices. With this flexibility comes the responsibility to avoid conflicts of interest, maintain professional independence, and structure compliant business arrangements.
This article explains some key legal and regulatory requirements and principles under the Regulated Health Professions Act, 1991 (RHPA), the Dental Hygiene Act, 1991 (DHA), the policies of the College of Dental Hygienists of Ontario (CDHO), and related regulations, which govern business and employment arrangements for dental hygienists.
1. Working with Non-Dental Hygienists
The CDHO Registrants’ Handbook recognizes that hygienists may be employed by non-health professionals, such as in spas or wellness clinics.
While this is permitted, dental hygienists must ensure the following:
- Their professional judgment remains independent;
- The employer’s business practices do not compromise patient care or ethical standards; and
- They can end associations based on another professional’s misconduct, incompetence, or incapacity.
2. Avoiding Conflicts of Interest
General Prohibition
Under Ontario law, dental hygienists cannot enter into an agreement or arrangement that influences or appears to influence their ability to exercise independent professional judgment (O. Reg. 218/94).
This includes any arrangement that could:
- Compromise a hygienist’s objectivity;
- Pressure them to make specific recommendations; or
- Benefit another party at the client’s expense.
Acting in a Conflict of Interest
Providing dental hygiene services while in a conflict of interest is considered professional misconduct under the DHA and RHPA.
3. No Referral Benefits or Kickbacks
The DHA regulations state that dental hygienists cannot:
- Accept a benefit (e.g., rebate, gift, or credit) related to referring a client; or
- Offer a benefit in exchange for receiving a client referral.
These restrictions ensure that all referrals are based on client needs, rather than personal financial incentives.
Consequently, dental hygienists in arrangements with other health professionals should ensure that all compensation and fee terms avoid these kinds of activities.
4. Use of Premises and Equipment
Dental hygienists are prohibited from using premises, materials, or equipment provided by someone who gains an inappropriate benefit from the arrangement.
However, this does not prohibit legitimate rental or lease agreements, so long as the dental hygienist pays reasonable consideration and maintains full control over professional decisions.
Dental hygienists should consider having a lawyer review their lease or license agreements to ensure they avoid conflict of interest scenarios.
5. Fee Splitting and Revenue Sharing
Dental hygienists must not share fees or income with others except in the following permitted circumstances:
- With another dental hygienist;
- With a member of another regulated health profession under the RHPA; or
- Through a written agreement that clearly states the hygienist retains responsibility and control over all aspects of their practice (including but not limited to billing and recordkeeping).
Even when an employer issues invoices or collects payments, the hygienist remains responsible for truthful and accurate billing.
The CDHO recommends that dental hygienists:
- Review billing procedures regularly;
- Conducting periodic spot checks for accuracy; and
- Including the right to review billing practices in your employment or associate agreement, particularly when working for an unregulated business owner.
Having a lawyer draft or review these clauses can prevent future compliance issues.
6. Managing Conflicts of Interest: The DORM Principle
The CDHO encourages hygienists to manage potential conflicts through the DORM principle — Disclosure, Options, Reassurance, and Modification.
D – Disclosure
Always disclose any potential benefit, personal interest, or relationship that could influence your recommendations. Failure to disclose is often a breach of professional obligations.
O – Options
Provide clients with alternative options (e.g., other suppliers or providers). This empowers clients to make informed decisions and reduces pressure.
R – Reassurance
Reassure clients that declining your recommendation will not affect their treatment or professional relationship with you.
M – Modification
When possible, modify the situation to remove or reduce the conflict. For example, if a family business provides dental products, you might offer those products at cost or no profit to eliminate personal gain.
7. Practical Recommendations for Compliance
Documenting Referrals
When referring clients to other practitioners, include written documentation outlining the reason for referral and any relevant context.
Disclosing Recommendation Relationships
Hygienists are not in a conflict of interest when recommending a treatment or product that could benefit someone with whom they have a non-arm’s-length relationship, if they do the following:
- Disclose the nature of the benefit;
- Disclose the nature of the relationship; and
- Advise the client that services will not be affected if the client declines the recommendation.
Disclosing Referral Relationships
Similarly, hygienists may refer clients to someone with whom they have a non-arm’s-length relationship, if they do the following:
- Disclose the relationship to the client; and
- Reassure the client that services will not be affected if they decline the referral.
The CDHO advises that clients should always feel free to choose another provider without feeling pressured or obligated.
8. Key Takeaways for Dental Hygienists
- Independence is essential. Always maintain control over your clinical decisions, billing, and records.
- Transparency prevents misconduct. Disclose all relationships or benefits that could influence your professional judgment. However, some relationships and arrangements must be completely avoided.
- Written agreements could protect you. Clearly define ownership, responsibility, and oversight rights in your contracts.
- Monitor practice compliance. Ensure any referral, rental, or fee-sharing arrangement is compliant with applicable laws, regulations, and CDHO policies.
- Seek legal guidance early. Before entering into any business or employment arrangement, consult a lawyer familiar with health professional and corporate law in Ontario.
In today’s evolving health and wellness industry, dental hygienists are taking on new business roles and collaborative professional opportunities. With these opportunities come increased regulatory responsibilities.
By understanding the conflict-of-interest rules, permitted arrangements, and DORM-based safeguards, dental hygienists can protect their professional integrity — and their practice.
Thank you to Ephraim Barrera for his contribution to this article. The contents of this article are not to be construed as legal advice. Contact Emerge Law’s lawyers for legal assistance.