Dental ethics in the age of artificial intelligence: Global perspectives and the Saudi experience

Global perspectives and the Saudi experience in publishing the first AI ethical document for healthcare

Abstract

Artificial intelligence (AI) is rapidly transforming dentistry through applications in radiographic interpretation, caries detection, orthodontic planning, and digital smile design. Yet, these advances raise profound ethical questions regarding patient privacy, algorithmic bias, accountability, and transparency. This article examines the ethical foundations of Dental AI, drawing on global frameworks and emerging debates, while highlighting the pioneering Saudi experience in publishing the first national-level AI ethics charter for healthcare. The Saudi framework, issued in 2022 by the Saudi Data and Artificial Intelligence Authority (SDAIA) and the Ministry of Health, integrates international best practices with Islamic bioethical values, emphasizing patient-centricity, privacy, transparency, equity, accountability, and sustainability. Case studies demonstrate the real-world consequences of ethical lapses, from radiographic misinterpretation to orthodontic bias and data-sharing concerns. Particular attention is given to federated learning as a privacy-preserving solution that enables collaboration without compromising data security. Finally, future directions are discussed, including the integration of ethics into dental curricula and the need for international consensus through bodies such as the FDI World Dental Federation. By embedding ethics at the core, Dental AI can remain a tool in service of humanity, not the reverse.

Introduction

Artificial intelligence (AI) is transforming dentistry with unprecedented speed and depth. From diagnostic imaging and caries detection to orthodontic planning, implantology, and digital smile design, AI has begun to redefine the relationship between technology, clinician, and patient. Studies have shown that AI can reach or even exceed expert-level performance in radiographic interpretation, pathology detection, and predictive analytics for oral diseases. Despite this promise, profound ethical questions emerge: How can patient data be protected? How can we prevent algorithmic bias that could disadvantage vulnerable populations? Who bears responsibility when AI fails? These are not peripheral questions—they are central to the legitimacy and long-term adoption of AI in dentistry.

This article examines the broad ethical landscape of AI in dental practice, drawing on global guidelines and bioethical debates, and then focuses on the pioneering Saudi experience in publishing the first national-level ethical framework for AI in healthcare. This initiative represents a historic milestone for the region and provides valuable lessons for global dentistry, including implications for the diverse dental communities across the United States.

Moreover, AI’s integration into dentistry is not limited to diagnostics. Robotics for oral surgery, AI-powered scheduling systems, smart dental chairs, and patient engagement chatbots are redefining dental care delivery. With these advances, ethical issues become intertwined with practical realities—making the discussion of Dental AI ethics not merely theoretical, but a pressing matter for clinicians, policymakers, and technologists alike.

Core ethical challenges in dental AI

The integration of AI into dental practice raises several key ethical challenges that must be addressed:

• Patient privacy and data security – Reliance on imaging and records raises concerns around consent, secondary use, and vulnerability to cyberattacks. For instance, dental radiographs stored in cloud servers may be vulnerable to unauthorized access if robust encryption protocols are not followed. Ethical dental AI must therefore incorporate state-of-the-art cybersecurity solutions while ensuring compliance with local and international regulations such as GDPR and HIPAA.
• Algorithmic bias and fairness – Datasets may underrepresent certain populations, creating disparities in diagnostic accuracy. This challenge is universal, affecting diverse populations whether in the Middle East, North America, or other regions globally.
• Transparency and explainability – The ‘black box’ nature of AI requires explainable AI (XAI) for trust and adoption across all healthcare systems.
• Accountability and liability – Clarity is needed in defining responsibility when AI outputs cause harm, regardless of jurisdiction.
• Human oversight and autonomy – The dentist must remain the final decision-maker in all clinical contexts.
• Professional integrity – Preventing over-reliance on AI and preserving clinical reasoning skills remains essential for maintaining professional standards globally.

Global ethical frameworks for AI in healthcare

International organizations have addressed these issues through guidelines:

• WHO (2021) emphasized accountability, inclusiveness, and sustainability.
• European Commission (2019) proposed ‘Trustworthy AI.’
• ADA and various dental AI associations have begun adapting general AI principles into dentistry.

Yet, most frameworks remain broad and not specific to dental practice, highlighting the need for more specialized guidance.

The Saudi experience: A pioneering ethical charter

Saudi Arabia, aligned with Vision 2030, has positioned itself as a global leader in AI governance. In 2022, the Saudi Data and Artificial Intelligence Authority (SDAIA), in collaboration with the Ministry of Health, published the ‘AI Ethics in Healthcare Charter’—the first national framework of its kind in the Middle East. The Charter integrates international best practices with Islamic bioethical principles such as justice, beneficence, and respect for human dignity.

The process of drafting the Charter involved multi-stakeholder collaboration—including ethicists, engineers, clinicians, legal scholars, and policymakers. Workshops and consultations ensured that the framework was both technically rigorous and socially legitimate. Importantly, dentistry was identified as a priority field given its rapid digitization and the unique sensitivity of dental data, such as facial images and 3D intraoral scans.

Key principles of the Saudi framework

1. Patient-centricity – Prioritizing safety and dignity in all AI applications.
2. Privacy and security – Ensuring robust data protection within national jurisdiction while enabling beneficial uses.
3. Transparency – Requiring explainable and auditable AI systems that practitioners can understand and trust.
4. Equity – Ensuring fair access across urban and rural regions, addressing disparities in healthcare delivery.
5. Accountability– Clarifying roles and responsibilities of developers, clinicians, and regulators.
6. Sustainability – Aligning AI adoption with long-term healthcare goals and resource allocation.

Historical and cultural context of dental ethics in AI

Ethics in medicine and dentistry has a long history rooted in cultural, religious, and professional codes. From the Hippocratic Oath to Islamic medical ethics pioneered by Ibn Sina and Al-Razi, the central principles of beneficence, non-maleficence, autonomy, and justice remain relevant. In modern dentistry, these principles intersect with new technological paradigms: algorithms, machine learning models, and robotic systems. Saudi Arabia’s approach is distinctive in that it explicitly connects its AI ethics framework to Islamic values, positioning the Kingdom at the crossroads of tradition and innovation while offering universal principles applicable across cultures.

Federated learning: An ethical enabler

One of the most promising approaches to address privacy and fairness challenges in Dental AI is Federated Learning. Instead of centralizing sensitive dental data, federated learning allows multiple clinics or hospitals to train a shared AI model locally. The model parameters are then aggregated centrally without transferring raw patient data. This method, first proposed by Konečný et al. (2016), enables cross-institutional collaboration while safeguarding privacy.

In the Saudi context, federated learning aligns perfectly with the AI Ethics Charter. It allows hospitals from Riyadh to Jeddah, and from Dammam to NEOM, to contribute to the development of robust AI tools without compromising confidentiality. Such a system not only protects privacy but also ensures representation of diverse patient populations, thereby reducing algorithmic bias.

Additionally, federated learning supports continual model improvement while respecting local regulations. For example, dental schools across Saudi Arabia could collectively train AI systems for caries detection, benefiting from data diversity without compromising privacy. This collaborative approach also aligns with global trends towards distributed, privacy-preserving AI and offers a model that other countries and regions can adapt to their own contexts.

Case studies in dental AI ethics

Several real-world scenarios highlight the importance of ethical principles in practice:

• Radiographic misinterpretation: An AI model misclassified a periapical lesion, leading to unnecessary endodontic treatment. The case raised questions about liability between the dentist and software developer, demonstrating the need for clear accountability frameworks.
• Bias in orthodontic predictions: A machine learning model trained primarily on European patients underperformed when used on Saudi adolescents, underlining the need for diverse datasets that represent global populations.
• Data sharing concerns: A multinational dental imaging project faced resistance from patients who feared their facial scans could be misused beyond healthcare. Federated learning was introduced as a solution, demonstrating practical applications of privacy-preserving technologies.

Implications for dental AI worldwide

The Saudi ethical framework, combined with federated learning, offers a replicable model for the global community:

• It serves as a blueprint for other nations seeking culturally grounded AI ethics frameworks that respect local values while maintaining universal ethical principles.
• It encourages dental associations worldwide to issue Dental AI-specific ethical guidelines adapted to their regulatory and cultural contexts.
• It strengthens international collaborations in AI development without violating privacy regulations, enabling global knowledge sharing while protecting patient data.

The Saudi experience demonstrates that comprehensive ethical frameworks can be developed that honor cultural and religious traditions while embracing technological innovation. This model has particular relevance for diverse societies worldwide, including the multicultural communities served by dental professionals globally.

Future directions

Looking ahead, Dental AI ethics will increasingly require dynamic governance structures. Rapid innovations such as generative AI, 3D printing with AI-based design, and integration of genomic data pose new ethical dilemmas. Saudi Arabia’s framework offers a strong foundation, but continuous updates will be essential as technology evolves.

Professional dental associations should develop AI ethics curricula for dental education, ensuring that future dentists are not only competent in using AI tools but also conscious of their ethical implications. International collaboration, perhaps through the FDI World Dental Federation, could lead to a global consensus on Dental AI ethics, harmonizing diverse cultural and regulatory perspectives while building on pioneering efforts like the Saudi framework.

The integration of ethics education into dental curricula worldwide will be essential for preparing the next generation of practitioners. This education should include both theoretical foundations and practical case studies, drawing on experiences from various cultural and regulatory contexts.

Conclusion

Ethics in Dental AI is not an afterthought—it is the foundation of trust between patients, clinicians, and technology. Saudi Arabia’s pioneering step in publishing the first AI ethics framework in healthcare demonstrates that cultural values and modern bioethics can converge successfully. By embracing privacy-preserving technologies such as federated learning, the Kingdom sets a global precedent for ethical AI in dentistry.

The Saudi experience offers valuable lessons for the international dental community, demonstrating that comprehensive ethical frameworks can be developed that honor local values while establishing universal principles. As dental professionals worldwide grapple with similar challenges, the Saudi model provides a roadmap for integrating ethics into AI implementation.

As dentistry enters an era where AI systems may detect caries, design smiles, and even guide surgeries, the guiding question remains: Will AI remain a servant of humanity, or will humanity become its servant? Saudi Arabia’s experience suggests that ethics can ensure the former, providing a model that the global dental community can adapt and build upon.

The path forward requires continued international collaboration, sharing of best practices, and commitment to placing patient welfare and professional integrity at the center of all AI development and implementation efforts.

References

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4. World Health Organization. Ethics and governance of artificial intelligence for health: WHO guidance. Geneva: WHO; 2021.
5. European Commission. Ethics Guidelines for Trustworthy AI. Brussels; 2019.
6. Saudi Data and Artificial Intelligence Authority (SDAIA). Charter of AI Ethics in Healthcare. Riyadh; 2022.
7. Konečný J, McMahan HB, Ramage D, Richtárik P. Federated optimization: Distributed optimization beyond the datacenter. arXiv preprint arXiv:1511.03575. 2016.
8. American Dental Association. AI in Dentistry: Current and Future Applications. ADA White Paper; 2023.

About the author

Dr. Ameed Khalid Abdul-Hamid is an Iraqi–British dental surgeon and academic researcher, internationally recognized for his contributions to artificial intelligence in dentistry and healthcare. He holds advanced qualifications from the University of Baghdad and the University of London, and is a Fellow of the Royal College of Surgeons (UK). Dr. Abdul-Hamid serves as Chairman of the Arab Organisation for Artificial Intelligence in Healthcare and Chairman of the Saudi-British Medical Forum (London). His research focuses on AI-enabled diagnostics, digital health systems, and the ethical, responsible integration of artificial intelligence in clinical care. In 2025, his work in dental artificial intelligence was published in the British Dental Journal, and he is a recipient of the Alan Turing Award in Dental Artificial Intelligence.