How to recognize sexual abuse and boundary violations

Sexual abuse is defined differently for dentists than in criminal law. Under the law that governs dentists, the Regulated Health Professions Act, sexual abuse of a patient happens when a dentist:

  • has physical sexual relations with a patient
  • touches a patient in a sexual manner (for example, stroking a patient’s hip or thigh)
  • behaves in a sexual manner toward a patient (for example, touching a patient’s hand in a manner that suggests a sexual interest in the patient, or staring at a patient’s breasts)
  • makes remarks of a sexual nature to a patient (for example, making sexualized jokes).

Patient sexual abuse is different from sexual assault. In the criminal system, sexual assault is a sexual act without consent. Under the RHPA, a patient cannot consent to have a sexual relationship with a dentist. Whenever there is sexual behaviour, contact, or remarks by a dentist to a patient, it is always sexual abuse. The dentist is responsible for maintaining an appropriate professional relationship with a patient.

Sexual abuse is not always obvious. Sexual abuse includes inappropriate comments, gestures, or behaviour such as:

  • saying something sexually suggestive or seductive
  • asking personal questions, such as asking about personal intimate relationships, sexual orientation, and sexual preferences
  • making sexualized comments about appearance or clothing, sexual jokes, or sending sexual jokes by email
  • displaying inappropriate materials in the office or on a computer, such as sexualized photographs or videos, or cartoons of a sexual nature
  • touching or asking for touching of a sexual manner, such as kissing, hugging, or any other sexual touching like stroking a hand or face.

Sexual abuse always includes the following behaviour:

  • touching a patient’s buttocks, breasts, or genitals
  • sexual intercourse with a patient.

Sexual abuse does not include touching, behaviour, or comments that are clinical and appropriate to the care provided.

Boundary violations

Before we can define boundary violations, we need to describe a boundary.

A boundary sets the limit of a dentist’s professional relationship with a patient. There are sexual boundaries and non-sexual boundaries in a dentist-patient relationship.

A boundary violation occurs when the nature of the dentist-patient relationship moves from professional to personal. Boundary violations can be sexual and non-sexual. 

Examples of likely sexual boundary violations include situations with a dentist:

  • making unwanted contact with a patient on social media
  • asking a patient out on a date
  • making inappropriate personal disclosures to a patient
  • socializing with a patient to pursue any kind of relationship other than a professional one
  • responding to any sexual advance made by a patient.

Boundary violations can be the first step toward increased familiarity with a patient and may lead to sexual abuse. Dentists must always establish and maintain appropriate boundaries with patients.

Examples of inappropriate conduct by dentists that are boundary violations and sexual abuse include the following. 

Example 1

A dentist places tools on the bib on a patient’s chest, and brushes against a patient’s breasts when picking up or placing the instruments. The dentist comments that the patient is a “good instrument tray”.

Example 2

A dentist sends a rude and sexual joke or rhyme by Facebook Messenger to their staff, some of whom are the dentist’s patients. The dentist adds a comment that the joke reminds them of their staff.