Abstract
Background
In dentistry, moral judgment skills are a fundamental competency that helps dentists make the best decisions when faced with challenging clinical problems and ethical dilemmas. The aim was toexamine the moral sensitivity levels of fourth- and fifth-grade dentistry students and orthodontic clinicians.
Methods
The study included fourth-grade (n = 116) and fifth-grade dentistry students (n = 106) as well as orthodontic clinicians, including residents and specialists (n = 117). Data were collected using a sociodemographic form and the self-administered Moral Sensitivity Questionnaire (MSQ) including six sub-dimensions: autonomy, holistic approach, conflict, orientation, providing benefit, and application. Participants were asked to rate the questionnaire on a 7-point Likert-type scale. Cronbach’s alpha coefficient was used in reliability analysis. Continuous variables were presented as mean and standard deviation, and categorical variables were summarized as frequency and percentage. Intergroup differences were assessed by one-way ANOVA. Pairwise comparisons were further identified with Tukey’s post-hoc test. Two-way ANOVA was performed to assess the combined effects of group and demographic variables on the total scale score.
Results
The overall reliability of the MSQ scale was 0.84. The total moral sensitivity scores for fourth-grade, fifth-grade students, and orthodontic clinicians were 92.7 ± 15.7, 92.4 ± 17.8, and 93.8 ± 14.4, respectively, revealing no statistically significant difference. Fifth-grade students scored significantly lower than orthodontic clinicians on the Holistic Approach and Conflict sub-dimensions but scored significantly higher on the Orientation sub-dimension compared to orthodontic clinicians.
Conclusions
Undergraduate dentistry students and orthodontic clinicians exhibited moderate levels of moral sensitivity. Fifth-grade students were found to have higher moral sensitivity thanorthodontic clinicians on the holistic approach and conflict sub-dimensions, while orthodontic clinicians were found to be more sensitive on the orientation sub-dimension. These differences suggest that integrating case-based ethics training into the dental curriculum, regardless of academic year, can help students better identify ethical issues and develop strategies to address them effectively.
Keywords: Moral sensitivity questionnaire, Dentistry students, Dentistry education, Orthodontist, Ethical sensitivity
Introduction
Healthcare professionals aim to reveal right and wrong during their professional activities; however, they may face ethical dilemmas such as informed consent, responsibility for decision-making, equal distribution of resources, doing good, and avoiding harm. It is crucial to possess moral and ethical sensitivity to maintain the profession’s reputation, establish trust with patients, and preserve a positive patient-physician relationship [1, 2]. Although the terms ethical sensitivity and moral sensitivity are sometimes used interchangeably in the literature, a conceptual distinction may be drawn between them. Ethical sensitivity is generally associated with knowledge of ethical theories and principles, whereas moral sensitivity relates to individuals’ awareness of ethical issues and their responsiveness within interpersonal relationships [3].
Ethical decision-making extends beyond merely following professional rules or procedures and requires sensitivity to the patient’s vulnerable situation. In addition to knowing what should be done, clinicians must understand how and why to act in specific situations, emphasizing the role of personal qualities in the decision-making process. In this regard, moral sensitivity can be described as the ability to recognize the presence of an ethical problem, interpret the situation from multiple perspectives, and determine which actions are ethically appropriate [4]. Higher levels of moral sensitivity among healthcare professionals have been associated with lower levels of moral distress and have been reported to contribute to improvements in the quality of patient care [5].
Ethics education has been recognized as an important factor in fostering moral sensitivity, as it helps students recognize ethical dilemmas and reflect on the consequences of clinical decisions [6, 7]. In this context, the discussion of medical ethical issues is internationally recognized as an integral part of medical education and has become a fundamental element of medical curricula.Eckles et al. [8] presented a comprehensive review of the literature on ethics education for medical students and declared that teaching medical ethics can be a way to prepare virtuous physicians and to provide physicians with the skills to resolve ethical dilemmas.
A recent study highlighted the lack of basic ethical knowledge among dental students, where students reported feeling helpless in dealing with ethical issues and experiencing psychological pressure. In conclusion, the authors emphasized that ethical-theoretical foundations should be taught before starting patient treatment [9]. In the literature, the need for ethical reasoning and ethical analysis methodologies in the dental education of students has been emphasized, and the importance of patient autonomy and informed consent in the relationship between dentist and patient has been stated [10]. The American Dental Education Association (ADEA) has also stated that dentistry graduates must be competent in ethical and legal standards [11].Consistent with this emphasis, the ethics module has been integrated into the dental curriculum in Germany [12].
Monitoring the moral sensitivity of health providers is important both for service quality and ethical practice [2]. To assess this construct, the Moral Sensitivity Questionnaire (MSQ), developed by Kim Lützén in 1994, was originally designed to evaluate moral sensitivity in nurses [13]. The questionnaire was subsequently translated and adapted into the Turkish language [13, 14] and was shown to be valid and reliable in assessing the moral sensitivity of Turkish nursing students [2]. The MSQ has also been applied to measure the moral sensitivity of dental students at different academic levels, consistently demonstrating high reliability [1]. However, the existing literature provides limited insight into orthodontists’ moral sensitivity, particularly in dentistry, where the patient–physician relationship often extends over many years.
Considering that education plays an important role in developing students into responsible, empathetic, and respectful citizens, it seems appropriate to evaluate moral competencies, especially in the healthcare field, where human interaction is important and ethical decisions are required. A similar situation should be taken into consideration when assessing competencies and meeting developmental needs in the dental curriculum [15]. Based on the aforementioned information, it is beneficial to assess students’ attitudes on ethical issues to enlighten the need for curricular development initiatives in dental education. To our knowledge, there are no resources available to assess the moral sensitivities of undergraduate dental students and individuals pursuing or completed residency training. Therefore, this study aimed to compare the moral sensitivity levels of fourth- and fifth-grade dentistry students andorthodontic clinicians, including residents and specialists, using the MSQ, taking into account some demographic factors. It was hypothesized that increased clinical experience would positively impact total moral sensitivity scores.
Materials and methods
This descriptive and cross-sectional study was conducted with the approval of the Gazi University Ethics Committee (E-1095136). Informed consent to participate was obtained from all participants prior to data collection. Participation was entirely voluntary; all participants were informed about the purpose and scope of the research and were free to withdraw at any time without any consequences. All data were collected anonymously or fully anonymized during the survey process, ensuring that no conclusions could be drawn about identifiable individuals. Undergraduate participants were recruited from the same faculty, while orthodontic clinicians included postgraduate students undergoing specialization training at different universities and orthodontic specialists working in private clinics and universities.
The research was conducted between January and June 2025 with a total number of 339 participants. All were asked to fill out a sociodemographic form and the “Moral Sensitivity Questionnaire (MSQ)”.The demographic form included items on age, parental education level, the presence of a healthcare professional in the family, reasons for choosing the profession, experience of encountering ethical problems, and prior ethics education. For the questions related to reasons for choosing the profession and experience with ethical problems, participants were allowed to select more than one response option. The response options provided to the participants are presented in Table 1.
Table 1.
Distribution of the demographic features
| Demographic features | Variables | GROUPS | Total (n: 339) |
||||||
|---|---|---|---|---|---|---|---|---|---|
| 4th Grade (n: 116) |
5th Grade (n: 106) |
Orthodontic clinicians (n: 117) |
|||||||
| n | (%) | n | (%) | n | (%) | n | (%) | ||
| Gender | Male | 41 | (35.3) | 43 | (40.6) | 27 | (23.1) | 111 | (32.7) |
| Female | 75 | (64.7) | 63 | (59.4) | 90 | (76.9) | 228 | (67.3) | |
| Mothers’ education | Elementary School | 25 | (21.6) | 27 | (25.5) | 18 | (15.4) | 70 | (20.6) |
| Middle School-High School | 52 | (44.8) | 40 | (37.7) | 25 | (21.4) | 117 | (34.5) | |
| University | 39 | (33.6) | 39 | (36.8) | 74 | (63.2) | 152 | (44.8) | |
| Fathers’ education | Elementary School | 15 | (12.9) | 12 | (11.3) | 16 | (13.7) | 43 | (12.7) |
| Middle School-High School | 39 | (33.6) | 36 | (34.0) | 27 | (23.1) | 102 | (30.1) | |
| University | 62 | (53.4) | 58 | (54.7) | 74 | (63.2) | 194 | (57.2) | |
| Presence of health worker in the family | Yes | 34 | (29.3) | 32 | (30.2) | 65 | (55.6) | 131 | (38.6) |
| No | 82 | (70.7) | 74 | (69.8) | 52 | (44.4) | 208 | (61.4) | |
| Reason for choosing dentistry profession | Humanitarian reasons | 30 | (25.9) | 36 | (34.0) | 38 | (32.5) | 104 | (30.7) |
| Social prestige | 48 | (41.4) | 43 | (40.6) | 67 | (57.3) | 158 | (46.6) | |
| Economic reasons | 52 | (44.8) | 51 | (48.1) | 63 | (53.8) | 166 | (49.0) | |
| Scientific interest | 13 | (11.2) | 18 | (17.0) | 39 | (33.3) | 70 | (20.6) | |
| Other | 16 | (13.8) | 14 | (13.2) | 11 | (9.4) | 41 | (12.1) | |
| Ethical issues experienced with patients | Treatment-related | 6 | (5.2) | 21 | (19.8) | 22 | (18.8) | 49 | (14.5) |
| Professional behavior-related | 5 | (4.3) | 12 | (11.3) | 25 | (21.4) | 42 | (12.4) | |
| Patient-related | 53 | (45.7) | 68 | (64.2) | 67 | (57.3) | 188 | (55.5) | |
| Financial-related | 8 | (6.9) | 18 | (17.0) | 38 | (32.5) | 64 | (18.9) | |
| I did not experience any problems | 49 | (42.2) | 24 | (22.6) | 37 | (31.6) | 110 | (32.4) | |
| Taking any courses on ethics | Yes | 101 | (100.0) | 95 | (81.2) | 196 | (58.7) | ||
| No | 116 | (100.0) | 22 | (18.8) | 138 | (41.3) | |||
n (%): number (percentage)
The MSQ, previously adapted into Turkish and shown to be valid and reliable [14], was used in this study.Permission to use the Turkish version was obtained through personal communication with the researchers who had previously applied the scale in a similar context [14, 16].
The MSQ consists of 30 items rated on a 7-point Likert scale as follows: 1 = strongly agree; 2 = agree; 3 = somewhat agree; 4 = neither agree nor disagree; 5 = somewhat disagree; 6 = disagree; and 7 = strongly disagree. The questionnaire comprises six sub-dimensions. These sub-dimensions are defined as follows: (1) Autonomy (seven items 10, 12, 15, 16, 21, 24, 27; minimum score 7, maximum score 49 points), indicating respect for the patient’s choices; (2) Holistic approach (five items 1, 6, 18, 29, and 30; minimum score 5, maximum score 35 points), referring to preventing harm to the patient and protecting their integrity; (3) Conflict (three items 9, 11, and 14; minimum score 3, maximum score 21 points), meaning the encountered internal ethical conflicts; (4) Orientation (four items 7, 13, 19, and 22; minimum score 4, maximum score 28 points), showing the healthcare professional’s concern for how actions affect the relationship with the patient; (5) Providing benefit (four items 2, 5, 8, and 25; minimum score 4, maximum score 28 points), presenting acts that are motivated by doing what is believed to be best for the patient; (6) Application (four items 4, 17, 20, 28; minimum score 4, maximum score 28 points), contemplating the ethical dimension while choosing an action or practice. Three items (3, 23, and 26) were not included in any sub-dimension. The lowest score could be achieved as 30, and the highest score could be 210. In accordance with the original scoring system, lower total scores indicated higher levels of moral sensitivity.
Statistical analysis
All statistical analyses were performed using IBM SPSS Statistics, version 25.0 (IBM Corp., Armonk, NY, USA). Continuous variables were presented as mean and standard deviation, whereas categorical variables were summarized as frequency and percentage. Differences in sub-dimension and total scale scores among the three groups (fourth-grade students, fifth-grade students, and orthodontic clinicians) were examined using one-way analysis of variance (one-way ANOVA). When significant group differences were identified, Tukey’s post-hoc test was performed to determine pairwise comparisons.
To evaluate the combined effects of group and demographic variables on the total scale score, two-way analysis of variance (two-way ANOVA) was conducted. In these models, group was used as the first factor, while gender, mother’s education level, father’s education level, and the presence of a health professional in the family were included as second factors. For each model, both main effects (Factor 1 and Factor 2) and interaction effects (Factor 1 × Factor 2) were assessed.
Reliability analysis was performed by Cronbach’s alpha coefficient. A significance level of p < 0.05 was considered statistically significant for all analyses.
Results
The internal consistency of the overall scale was found to be high, with a Cronbach’s alpha coefficient of 0.84. A total of 339 volunteers (228 female, 111 male) participated in this study. In terms of school year, participants constituted 116 fourth-grade students, 106 fifth-grade students, and 117 orthodontic clinicians, including residents and specialists. The overall mean age of all participants was 26.67 (SD = 7.34; range 21 to 57) years. Detailed demographic data is shown in Table 1.
Assessment of the demographic characteristics of the participants
It was found that the majority of the parents had completed university education (mothers, 44.8%; fathers, 57.2%). Participants revealed that 38.6% had a health worker in the family, but the majority (61.4%) did not have a health worker in the family. When asked about their reasons for choosing the dentistry profession, the majority of participants (49.0%) cited economic reasons, followed by social prestige (46.6%).
The most frequent issue for experiencing ethical problems was patient-related problems (55.5%). Other less frequent issues were financial-related (18.9%), treatment-related (14.5%), and professional behavior-related (12.4%) problems. The percentage of participants that didn’t experience any ethical problems was 32.4%. The majority of the participants (58.6%) stated that they had taken a course on ethics, while 41.3% stated that they had not taken any courses.
Assessment of the total and sub-dimension scores among groups
Results of the one-way ANOVA test for the total and sub-dimension scores are presented in Table 2. The total moral sensitivity scores for fourth- and fifth-grade students and orthodontic clinicians were 92.7 ± 15.7, 92.4 ± 17.8, and 93.8 ± 14.4, respectively, and there was no statistically significant difference among them (p > 0.05).
Table 2.
Comparisons of total and sub-dimension scores among groups
| Sub-dimensions | Groups | P-value | |||||
|---|---|---|---|---|---|---|---|
| 4th Grade | 5th Grade | Orthodontic clinicians | |||||
| Autonomy | 20.8 | (5.1) | 20.6 | (5.8) | 20.7 | (5.0) | 0.939 |
| Providing | 11.3 | (3.8) | 12.3 | (3.9) | 11.3 | (3.8) | 0.109 |
| Holistic | 13.8 | (3.5) A, B | 12.9 | (3.4) A | 14.0 | (3.3) B | 0.038* |
| Conflict | 13.6 | (3.6) A.B | 12.9 | (3.5) A | 14.4 | (2.8) B | 0.004* |
| Application | 13.0 | (3.4) | 12.9 | (3.4) | 12.3 | (3.6) | 0.304 |
| Orientation | 8.2 | (3.1) A.B | 9.0 | (3.4) A | 7.9 | (3.1) B | 0.033* |
| Unclassified | 12.0 | (2.9) A | 11.9 | (3.5) A | 13.2 | (2.6) B | 0.001* |
| Total | 92.7 | (15.7) | 92.4 | (17.8) | 93.8 | (14.4) | 0.791 |
One-way ANOVA, * p < 0.05
Different capital letters (A, B) in the same row indicated statistically significancy among different groups (p < 0.05). Groups sharing at least one common letter (e.g., AB with A or B) are not significantly different from each other (p> 0.05).
Significant differences were observed among the groups at the subdimension level. There is a statistically significant difference between at least two groups according to the Holistic approach (p = 0.038), Conflict (p = 0.004), and Orientation (p = 0.033) scores. Fifth-grade students scored significantly lower than orthodontic clinicians for the holistic approach and conflict subdimension, whereas they scored significantly higher on the orientation subdimension compared to orthodontic clinicians .
No significant differences were found among the groups regarding autonomy, providing benefit, and application subdimensions (p > 0.05).
Assessment of the effects of group and demographic variables on the total scale score
Table 3 presented the two-way ANOVA results, showing that the Group factor (fourth- and fifth-grade students and orthodontic clinicians) had no significant effect on the total scale score (p > 0.05). However, a significant interaction was found between the variable “Presence of health worker in the family” and the variable “Group” (p = 0.018), indicating that the effect of this variable differs across the groups. The significant interaction suggested that the effect of the variable “Presence of health workers in the family” varies across the groups. Specifically, in the fifth-grade student group, the total mean score of those who reported the presence of a health worker in the family was significantly higher than that of those who did not. In contrast, in the fourth-grade group, the mean total score of students who had a health worker in the family was significantly lower than that of the fifth-grade group.
Table 3.
Effects of group and demographic variables on the total scale score
| Variables (Factor 2) |
Category | Groups (Factor 1) | Factor 1 | Factor 2 | Interaction (Factor 1 x Factor 2) |
|||||
|---|---|---|---|---|---|---|---|---|---|---|
| 4th Grade | 5th Grade | Orthodontic clinicians | ||||||||
| Gender | Female | 93,3 | (14,9) | 96,3 | (18,9) a | 94,0 | (14,6) | 0,655 | 0,031 | 0,103 |
| Male | 91,6 | (17,3) | 86,5 | (14,4) b | 93,2 | (13,6) | ||||
| Mother education | Elementary School | 89,1 | (18,2) | 91,8 | (12,8) | 96,9 | (17,7) | 0,347 | 0,897 | 0,303 |
| Middle School-High School | 93,0 | (13,5) | 91,3 | (18,8) | 97,1 | (14,5) | ||||
| University | 94,6 | (16,8) | 93,8 | (19,8) | 91,9 | (13,2) | ||||
| Father education | Elementary School | 82,2 | (12,0) a | 90,3 | (16,9) | 85,7 | (13,0) a | 0,589 | 0,002 | 0,619 |
| Middle School-High School | 95,5 | (13,6) b | 95,3 | (16,6) | 98,9 | (15,7) b | ||||
| University | 93,5 | (16,9) b | 91,3 | (18,7) | 93,7 | (13,4) b | ||||
| Presence of health worker in the family | No | 94,1 | (15,2) | 89,8 | (15,1) a | 92,6 | (15,1) | 0,540 | 0,302 | 0,018 |
| Yes | 89,3 | (16,7) A | 98,3 | (22,0) Bb | 94,7 | (13,8) | ||||
| Taking any courses on ethics | No | 92,7 | (15,7) | 92,6 | (13,8) | 0,771 | 0,706 | |||
| Yes | 92,4 | (17,8) | 94,1 | (14,5) | ||||||
Two-way ANOVA, * p < 0.05
Different capital lowercase letters (a and b) indicate statistically different categories in the same column
Different capital letters (A and B) indicate statistically different groups in the same row
Additionally, gender was found to have a significant main effect on the total score (p = 0.031). Overall, female participants had higher total scores than male participants. In particular, within the fifth-grade students, females were found to have a significantly higher mean total score compared with males. Similarly, the father’s education level was found to have a significant main effect on the total score (p = 0.002). The mean total scores of participants whose fathers had an elementary-level education were significantly lower than those whose fathers had middle/high school or university-level education. This difference was consistently observed in both the fourth-grade students and the orthodontic clinicians group. According to the ANOVA results regarding the mother’s education level, neither the main effects nor the interaction effects were found to be significant (p > 0.05).
Discussion
Moral sensitivity, defined as the ability to recognize ethical issues and consider relevant moral norms and principles, plays a crucial role in guiding dentists when faced with complex clinical challenges and ethical dilemmas [17].Therefore, the current study aimed to assess the moral sensitivity levels of fourth- and fifth-grade dentistry students and orthodontic clinicians with a survey based on volunteering. It can be considered that the evaluated participants’ moral sensitivity levels were at a moderate level. It was hypothesized that clinical experience would positively affect total moral sensitivity scores, but the hypothesis was rejected because no significant difference was found between the groups.
The MSQ has been widely used in healthcare research to evaluate moral sensitivity, reflecting individuals’ capacity to recognize and interpret ethical issues in clinical practice [1, 4, 18]. The inclusion of participants at different stages of professional development provided an opportunity to explore whether increasing clinical experience is associated with differences in moral sensitivity. Dental students represent individuals in the early stages of professional training, whereas orthodontic clinicians have greater clinical exposure and experience in managing patient-related ethical situations.
Consistent with our findings, a recent study found that the moral skills of dental students across academic years were at a moderate level. This result was attributed to individual and systemic challenges such as prioritizing personal interests, lack of constructive feedback, and unsupportive behavior from clinical instructors [6]. Similarly, various results suggested that the moral skills of general dentists were at a moderate level [19, 20]. Our study found that 4th-grade students did not take an ethics course, while all 5th-grade students and 81% of orthodontic clinicians did.Ethics education is considered an important component in the development of moral sensitivity, as it encourages students to identify ethical dilemmas and evaluate the implications of clinical decisions [6, 7]. In light of this, the absence of a significant difference in total scores in the present study may suggest potential limitations or gaps in the structure and implementation of ethics education within the current curriculum.It has been suggested that it is important for students to develop ethical and moral sensitivities before they begin their clinical experience [21]. Research suggests that traditional lecture-based ethics education may be insufficient to develop moral sensitivity, whereas interactive approaches such as role-play and case studies have been shown to enhance students’ ethical awareness and moral sensitivity [22].Similarly, Perkins et al. [23] stated that real patient cases are the most effective tools for teaching ethics, as well as views shared by dental educators that enhance students’ engagement and clinical relevance. In this context, future studies focusing on moral and ethical decision-making negotiations in real case scenarios may be beneficial to the literature.
An earlier study examined dental students' moral sensitivity from 1st to 5th grade, and found a significant difference regarding the autonomy and application sub-dimensions [1]. In a study examining the ethical and moral sensitivities of medical faculty students according to their class years, the level of moral sensitivity decreased as the grade increased [16]. Considering the sub-dimensions of the questionnaire used in this study, the results indicated that the autonomy sub-dimension scores, which reflect respect for patient principles and preferences, were moderate in all groups. This demonstrated all participants’ sensitivity to this issue. However, a high level of agreement may appear to contradict the contemporary ethical emphasis on shared decision-making, particularly following legal developments such as the Montgomery v Lanarkshire Health Board decision in the UK [24]. Nevertheless, as emphasized by Lützén et al. [13], the scores obtained from the MSQ reflect participants’ attitudes toward or responses to moral issues rather than indicating “correct” or “incorrect” answers. Accordingly, this dimension should not be interpreted as an endorsement of paternalistic practices; instead, it reflects clinicians’ awareness of their moral responsibilities and the inherent complexity of decision-making between professional judgment and patient preferences [13]. Therefore, it is recommended that these findings be interpreted within the conceptual framework and validated scoring structure of the MSQ rather than as a direct reflection of contemporary normative ethical standards [25]. Comparisons among the groups regarding the holistic approach sub-dimension showed that fifth-grade students demonstrated significantly greater sensitivity than orthodontic clinicians. Again, fifth-grade dentistry students exhibited significantly higher sensitivity to conflict sub-dimension compared to orthodontic clinicians. These results may be related to the content of the ethics course the fifth-grade students took before graduation. Again, fifth-grade dental students are largely focused on meeting patient quotas and graduation requirements [26]. Therefore, the present finding may also be attributable to students' increased sense of responsibility. On the other hand, orthodontic clinicians who are more experienced than undergraduates can act on what they have learned from negative experiences and focus on their own interests when faced with moral issues [6]. The decreasing moral sensitivity of orthodontic clinicians may also result from individual anxieties arising from increasing clinical duties. On the orientation sub-dimension, current scores showed a significant difference between fifth-year students and orthodontic clinicians, indicating that they are more sensitive about their relationship with their patients. Orthodontists treat the same patient for extended periods, which may increase their likelihood of encountering ethical issues [27]. Therefore, this may suggest that students expressed a positive attitude and a greater sense of responsibility. Again, compared to undergraduate students, orthodontic clinicians may prioritize communication with patients because they do not have time constraints or grade concerns. Mosavi et al. [6] found that students reported prioritizing efficiency over adherence to professional standards when faced with unsupportive behavior from their clinical instructors. Consequently, they emphasized the need for supportive improvements in curricula to foster an ethical mindset in dental students.
Factors affecting the moral sensitivity levels of the nursing students were reported to be gender, income status, and receiving ethics and critical thinking education out of school [28]. Literature also showed potential determinants of decision-making as years of experience, specialization, prior ethical education, and socioeconomic factors [29, 30]. In our study, the important determinants on the total scores were identified as gender, with female participants demonstrating higher scores, particularly for the fifth-grade students, in consistent with a previous study [16]. However, studies conducted with physicians did not reveal any significant gender differences [18, 29]. Additionally, in the current study, fathers’ education level showed an impact on moral sensitivity. The total mean scores of those whose fathers had primary school education were found to be significantly lower in all groups. It has been reported that the family plays a crucial role in the formation of an individual’s moral sensitivities and the internalization of these values [31]. This can be further evaluated by examining the family structures and ties in future studies. In the fifth-grade student group, the total mean score of those who reported having a health worker in the family was significantly higher than that of those who did not. In contrast, in the fourth-grade group, students with a health worker in the family exhibited significantly lower mean total scores compared with the fifth-grade group. This pattern demonstrated that the variable produced a group-dependent interaction effect with a change in direction across the groups. This difference observed across education levels may be related to the increased individualization of fifth-year students as a result of their greater clinical experience. In contrast, because fourth-year students are at the early stages of their clinical training, their reasoning skills may be more strongly influenced by their relationships with instructors, family members, and peers.
Dentistry students care for patients from their early undergraduate years through graduation, and as they gain experience, they take on more responsibility. Postgraduate dental students pursue their education in the specialized fields of dentistry, representing a transitional stage between student life and academic practice. The elective nature of orthodontic procedures and the wide range of possible treatment options often give rise to ethical dilemmas for orthodontists [27]. When asked about ethical issues, the majority of current participants (55.5%) indicated that they had experienced patient-related issues. Similarly, the most common ethical dilemmas encountered by participants were found to be patient-related problems in a previous study [32].
Previous research has reported that most students are motivated by a strong sense of idealism at the beginning of their medical education [33]. In this study, the primary motivation for students choosing the dental profession was economic reasons (49.0%), followed by social prestige (46.6%). This difference may be partially explained by generational shifts in values and expectations, as newer generations increasingly prioritize economic stability and societal recognition when making career choices [34].
The current study has several limitations. First, its cross-sectional design does not allow for the assessment of changes across academic years. Second, the generalizability of the findings is restricted due to the inclusion of dentistry students from a single institution. In addition, the diversity of patient profiles encountered by dental students, as well as the nature of their relationships with clinical instructors, may have influenced the results. Moreover, variables such as students’ communication skills, critical thinking attitudes, empathy levels, and ethical decision-making abilities in the presented case scenarios were not evaluated. Therefore, further studies incorporating these factors are warranted.The orthodontic clinicians group included both residents and specialists from different universities and clinical settings. This heterogeneity may be considered a strength of the study, as it increases the sample's representativeness and potentially enhances the generalizability of findings for this group. However, the possible impact of differences in clinical experience and professional practice settings (e.g., academia, public hospitals, or private practice) on outcomes was not analyzed separately and should be addressed in future research. In this study, the validated original scoring methodology of the MSQ was applied. Future research may benefit from reassessing the structural validity of the autonomy sub-dimension, particularly in light of evolving shared decision-making models in clinician–patient collaboration.
Conclusion
A moderate level of moral sensitivity was found for the undergraduate dental students and orthodontic clinicians. Fifth-grade students were found to be significantly more sensitive than orthodontic clinicians in the holistic approach and conflict sub-dimensions, while orthodontic clinicians were found to be more sensitive in the orientation sub-dimension.
The current study provided insights into the need to update moral and ethical education curricula to better shape students’ moral behavior. Assessments that include clinical scenarios are needed to assess the ethical challenges that dental students will face in the future.Furthermore, continuous ethics education and professional development programs may also be important for orthodontic clinicians to maintain and update their knowledge of ethical principles in clinical practice.
Acknowledgements
Not applicable.
Abbreviations
- MSQ
Moral Sensitivity Questionnaire
- ADEA
The American Dental Education Association
Authors’ contributions
TS performed data collection, interpreted the results, and drafted the manuscript. BC performed statistical analysis. BBT participated in the study conception, supervised the whole project, helped in data analysis, revised the manuscript critically for important intellectual content. TT participated in the study conception, supervised the whole project, helped in data analysis, revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.
Funding
Not applicable.
Data availability
The data used and/or analyzed during the current study are available from the corresponding author on reasonable request (mailto: tevhidesokmen@gazi.edu.tr).
Declarations
Ethics approval and consent to participate
This descriptive cross-sectional study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethical Committee of Gazi University (Approval No. E-1095136). Informed consent to participate was obtained from all participants prior to data collection; participation was entirely voluntary, and all participants were informed about the purpose and scope of the research. All data were collected anonymously or fully anonymized during the survey process, ensuring that no conclusions could be drawn about identifiable individuals.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data used and/or analyzed during the current study are available from the corresponding author on reasonable request (mailto: tevhidesokmen@gazi.edu.tr).