California RDH Law & Ethics Exam Area 3B: Professional Role

Area 3B (Obligations within Professional Role) makes up 10% of the 2025 outline (the exam has 60 questions, 50 scored, in 90 minutes). This subarea tests the duties you owe to the profession and the public beyond any single patient encounter. It covers managing conflicts of interest, keeping personal values out of clinical judgment, the absolute line against practicing while impaired, and the difficult duty of addressing a colleague's misconduct. Mastering this area requires you to connect the ethical principles from the hygiene codes of ethics to the strict disciplinary statutes enforced by the Dental Hygiene Board of California (DHBC).

At a glance

What the exam expects you to know

T25 — Managing conflicts of interest

A conflict of interest occurs when a secondary interest, such as financial gain or a personal relationship, could influence your professional judgment. The ethical standard is straightforward: you must avoid conflicts of interest and declare them when they occur. ^{3 4} Avoidance is your primary strategy. When a conflict cannot be avoided, declaring it allows the patient to make an informed decision, which honors the core value of individual autonomy. ⁴

However, disclosure does not make illegal conduct lawful. California law strictly prohibits certain financial conflicts regardless of transparency. Accepting or receiving any commission, or rebating fees for professional services, radiographs, or articles supplied to patients, is unprofessional conduct. ⁸ Furthermore, if a financial incentive leads you to recommend unnecessary care, you cross into clearly excessive treatment. Providing clearly excessive treatment, as determined by the customary practice and standards of the dental hygiene profession, is not only unprofessional conduct but also a misdemeanor punishable by a fine of $100 to $600, imprisonment of 60 to 180 days, or both. ⁸

T26 — Professionalism and personal values

You are entitled to your personal beliefs, but professional objectivity must govern your clinical practice. The ADHA Code of Ethics relies on the principle of universality, which dictates that if one individual judges an action to be right or wrong in a given situation, other people considering the same action in the same situation would make the same judgment, and complementarity, which requires considering the values and perspectives of others before acting. ⁴ You must serve all clients without discrimination and avoid any action that may even be interpreted as discriminatory. ⁴

If a clash of values makes it impossible for you to provide the standard of care, you cannot simply refuse to treat the patient on the spot. California law defines patient abandonment as unprofessional conduct unless three conditions are met: you must provide written notice that treatment is to be discontinued, the patient must have ample opportunity to secure another licensed hygienist, and the health of the patient must not be jeopardized during the transition. ⁸

Maintaining objectivity also requires honest documentation. Altering a patient's record with the intent to deceive is unprofessional conduct. ⁸ The record must reflect the care actually provided and the clinical conditions observed, serving as an objective measure of your practice.

T27 — Practicing while impaired

Practicing while impaired conflicts with non-maleficence (ADHA) and is unprofessional conduct under §1952(b). The core value of non-maleficence obligates you to provide services in a manner that protects clients and minimizes harm. ^{4 6}

California law enforces this through strict disciplinary measures. The DHBC can discipline a licensee for incompetence, gross negligence, or repeated acts of negligence. ⁹ Substance abuse directly threatens your license. By regulation, conduct involving narcotics or dangerous drugs used in a dangerous manner, and any DUI conviction, are substantially related (16 CCR §1135(c)(8)–(9)). Using alcohol or drugs to an extent that impairs safe practice is unprofessional conduct under BPC §1952(b). ^{5 6} A conviction is proven conclusively by the court record, and a plea of nolo contendere (no contest) counts as a conviction. ¹⁰

To encourage rehabilitation over hidden impairment, California established the DHBC diversion program. This is a voluntary alternative to traditional discipline for licensees impaired by dangerous drugs or alcohol. ⁷ A licensee not under investigation may self-refer confidentially. If an investigation is based primarily on self-administration of a controlled substance, dangerous drugs or alcohol under Section 1951, or on illegal possession, prescription or nonviolent procurement of a controlled substance or dangerous drugs for self-administration that does not involve actual, direct harm to the public, the board must close it once the licensee is accepted into and successfully completes the diversion program. However, the board may still investigate and discipline for other unprofessional conduct. ⁷ Upon successful rehabilitation, participation records are purged. However, there is a strict exception: if you withdraw or are terminated from the program at a time when the evaluation committee determines you present a threat to public health and safety, the board may use your confidential treatment records in disciplinary or criminal proceedings. ⁷

T28 — Collaborating with other professionals

Dental hygiene is inherently collaborative. The ethical codes require you to maintain honest, candid relationships with other providers and to refer patients when their needs exceed your scope of practice. ^{3 4}

California law structures this collaboration rigidly. An RDH is expressly prohibited from diagnosing, comprehensive treatment planning, and prescribing medication. ¹¹ Diagnosis always belongs to a dentist; your screening findings must be referred for one. This remains true even in modern public health settings. Under current law, an RDH in a public health setting may determine which radiographs to take based on a dentist's protocols, and may place an interim therapeutic restoration (ITR) using telehealth. ¹² However, the ITR may only be placed after the supervising dentist has provided the diagnosis, treatment plan, and instruction. ¹² Telehealth changes the communication method, but it does not expand your scope of practice to include diagnosis. ¹³

When collaborating, patient privacy must be maintained. Under California's Confidentiality of Medical Information Act (CMIA), you may disclose medical information to other health care providers for the purpose of diagnosing or treating the patient without a separate written authorization. ¹⁴ Disclosing that same information to an uninvolved coworker or outside the treatment context requires the patient's valid authorization. ¹⁴

T29 — Addressing unethical or incompetent colleagues

Responding when a colleague is impaired, incompetent, or acting unlawfully is one of the hardest professional situations. The ADHA and CDHA codes call on you to document and report substandard care or illegal activity to the responsible authorities. ^{3 4} Separately, §1950.5(w) makes it unprofessional conduct to aid or abet another hygienist's negligent or incompetent practice. ⁸

The law protects those who fulfill this duty. It is unprofessional conduct for an employer to discharge an employee primarily for attempting to comply with the law, or for anyone to use threats or harassment against a licensee for providing evidence in a disciplinary action. ⁸ Furthermore, the Board must provide legal representation, in a defamation action, for anyone who reports to it or to a diversion evaluation committee about a licensee's participation in the diversion program. ⁷

Common traps

• The disclosure-cures-everything trap: It is tempting to think that declaring a conflict of interest makes any arrangement acceptable. While disclosure manages lawful conflicts, accepting commissions or fee rebates for products supplied to patients is always unprofessional conduct, regardless of transparency. ⁸
• The "DUI is a personal matter" trap: Candidates often assume off-duty conduct does not affect the license. A DUI conviction is explicitly listed by regulation as substantially related to hygiene practice, and a nolo contendere plea counts as a conviction that can trigger discipline. ^{5 10}
• The diversion immunity trap: Assuming the diversion program is a guaranteed shield against discipline. If you quit or are terminated from the program while deemed a threat to public safety, your confidential treatment records lose their protection and can be used against you in disciplinary proceedings. ⁷
• The same-day refusal trap: Believing you can immediately refuse to treat a patient due to a personal values clash. Ending a professional relationship requires written notice, ample opportunity for the patient to find another provider, and no jeopardy to their health; otherwise, it is disciplinable abandonment. ⁸
• The telehealth scope expansion trap: Assuming that working via telehealth in a public health setting allows you to diagnose cavities for ITR placement. Telehealth facilitates communication, but diagnosis remains strictly excluded from hygiene practice; the dentist must diagnose and instruct before you place the ITR. ^{12 11}

Check yourself

Answer the original practice item, then take the free 15-question practice test to see every area.

How to study this area

Allocate your study time to match this area's 10% weight in the 2025 outline (the exam has 60 questions, 50 scored, in 90 minutes). Your focus should be on the intersection of ethical principles and California's disciplinary statutes. The bulletin's recommended-reading list links to cdha.org and adha.org, the hygienists' associations, though the printed names read 'California Dental Association' and 'American Dental Association.' Its outline uses hygiene-code terms such as universality, complementarity and non-maleficence, so the ADHA and CDHA codes are the natural references. The list is optional and not an endorsement.

When drilling this area, focus on the following patterns:

1. The conflict formula: Memorize the sequence of avoid, then declare. Pair this with the absolute bans in the Dental Hygiene Practice Act: no commissions, no rebates, and no excessive treatment.
2. The diversion mechanics: Understand that the diversion program is voluntary and confidential, but know the exact exception that allows the board to use treatment records if a participant withdraws while posing a public threat.
3. The reporting duty: The ADHA and CDHA codes call on you to document and report substandard care or illegal activity to the responsible authorities. Separately, §1950.5(w) makes it unprofessional conduct to aid or abet another hygienist's negligent or incompetent practice.

Questions candidates ask

Do I need to memorize the ADA code of ethics for this exam?

No. The bulletin's recommended-reading list links to cdha.org and adha.org, the hygienists' associations, though the printed names read 'California Dental Association' and 'American Dental Association.' Its outline uses hygiene-code terms such as universality, complementarity and non-maleficence, so the ADHA and CDHA codes are the natural references. The list is optional and not an endorsement. ^{1 3 4}

What happens if I plead "no contest" to a DUI?

Under California law, a plea of nolo contendere (no contest) counts as a conviction. Because a DUI is defined by regulation as substantially related to your qualifications and duties as a hygienist, the board can use the court record of that plea as conclusive evidence to initiate disciplinary action. ^{10 5}

Can I share patient records with a specialist without written authorization?

Yes, provided the disclosure is strictly for treatment purposes. The Confidentiality of Medical Information Act (CMIA) permits health care providers to share medical information with other providers for the diagnosis or treatment of the patient without requiring a separate written authorization. ¹⁴

Does the diversion program protect me from being investigated?

It can, under specific conditions. If an investigation is based primarily on self-administration of a controlled substance, dangerous drugs or alcohol under Section 1951, or on illegal possession, prescription or nonviolent procurement of a controlled substance or dangerous drugs for self-administration that does not involve actual, direct harm to the public, the board must close it once the licensee is accepted into and successfully completes the diversion program. However, the board may still investigate and discipline for other unprofessional conduct. ⁷

Footnotes

1. PSI Services LLC / DHBC, Registered Dental Hygienist (RDH) Laws and Ethics Written Examination — Candidate Information Bulletin, January 2026 edition — RDH exam logistics and blueprint. PSI Services LLC / DHBC, *Registered Dental Hygienist ↩ ↩² ↩³ ↩⁴

2. 16 CCR § 1121 — Dental Hygiene Written Examinations. Reprinted in DHBC 2025 Laws and Regulations, p. 112 — The exam itself. 16 CCR § 1121 ↩

3. California Dental Hygienists' Association, Code of Ethics, within the CDHA Policy Manual (amended June 2022); on the PSI bulletin's recommended preparation list via cdha.org — CDHA Code of Ethics. California Dental Hygienists' Association, Code of Ethics, within the CDHA Policy Manual ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

4. American Dental Hygienists' Association, Code of Ethics (revised October 2024); on the PSI bulletin's recommended preparation list via adha.org — ADHA Code of Ethics. American Dental Hygienists' Association, Code of Ethics ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰

5. 16 CCR §§ 1135–1137 — Substantial Relationship and Rehabilitation Criteria. Reprinted in DHBC 2025 Laws and Regulations, pp. 114–115 — Discipline criteria. 16 CCR §§ 1135–1137 ↩ ↩² ↩³ ↩⁴

6. Dental Hygiene Board of California, 2025 Dental Hygiene Board of California Laws and Regulations, revised January 2025 — The first publication on the CIB's list of recommended preparation references (recommended, not the corpus the exam is written from). Dental Hygiene Board of California, 2025 Dental Hygiene Board of California Laws and Regulations, revised January 2025 ↩ ↩² ↩³

7. Cal. Bus. & Prof. Code §§ 1966–1966.6 — Diversion Program. (and following sections; reprinted in the DHBC 2025 Laws and Regulations book) — Impairment rehabilitation and the DHBC diversion program (§§ 1966–1966.6). Cal. Bus. & Prof. Code §§ 1966–1966.6 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

8. Cal. Bus. & Prof. Code § 1950.5 — Unprofessional Conduct Defined — Unprofessional conduct defined, subds. (a)–(z). Cal. Bus. & Prof. Code § 1950.5 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹

9. Cal. Bus. & Prof. Code § 1949 — Consequences of Unprofessional Conduct and the Like — Discipline for unprofessional conduct, incompetence, gross negligence, repeated negligent acts, or license issued by mistake. Cal. Bus. & Prof. Code § 1949 ↩

10. Cal. Bus. & Prof. Code § 1950 — Consequences of Conviction of a Substantially Related Crime — Discipline upon conviction of a substantially related crime. Cal. Bus. & Prof. Code § 1950 ↩ ↩² ↩³

11. Cal. Bus. & Prof. Code § 1908 — Practices Included in and Excluded from Dental Hygiene — The practice of dental hygiene (assessment, care-plan development/implementation, education, counseling, screenings) and the excluded acts. Cal. Bus. & Prof. Code § 1908 ↩ ↩²

12. Cal. Bus. & Prof. Code § 1910.5 — Additional Authorized Duties — Additional duties. Cal. Bus. & Prof. Code § 1910.5 ↩ ↩² ↩³

13. Cal. Bus. & Prof. Code § 2290.5 — Telehealth — Telehealth definitions. Cal. Bus. & Prof. Code § 2290.5 ↩

14. Cal. Civ. Code § 56.10 et seq. — Confidentiality of Medical Information Act — Confidentiality of Medical Information Act. Cal. Civ. Code § 56.10 et seq ↩ ↩² ↩³