The debate over dental practice advertising resurfaces each time professional bodies tighten their enforcement of Article 20 of the code of medical ethics. Yet the discussion usually turns on impressions rather than on the text itself: what exactly does it prohibit? Why was the prohibition introduced in the first place? And how does it square with the reality of a private practice carrying overheads, salaries and investment? This article revisits the Algerian legal framework as written, then the economic and ethical foundations underpinning bans on medical advertising internationally, the line between advertising and health information, and finally the underlying question: is a dental practice a care facility or a profit-making business?
1 What the texts actually prohibit
1.1 The wording of Article 20 and its scope
The central legal reference in Algeria is Executive Decree No. 92-276 of 6 July 1992 establishing the code of medical ethics, a text that applies expressly to physicians, dentists and pharmacists alike. Its Article 20 is drafted in terms that leave little room for broad interpretation[1]:
"Medicine and dentistry must not be practised as a commercial activity. All direct or indirect advertising methods are prohibited to any physician or dentist."
Article 20 of Executive Decree No. 92-276 of 6 July 1992 (unofficial translation from the French original)
The article contains two distinct limbs that are frequently conflated. The first is a matter of principle: medical practice is not, in its legal nature, a commercial activity, meaning that profit logic cannot serve as the acknowledged driver of a therapeutic decision. The second is operational: advertising methods are prohibited, whether direct or indirect. The word "indirect" carries the broadest reach, since it covers everything that is not an explicit advertisement yet performs the same function — sponsored content, collaboration with influencers, before-and-after results published to persuade, or the display of prices and discounts.
1.2 What the text still permits
Contrary to what is often said, the code does not prohibit identifying the practice at all; it restricts that identification to a closed list of details. Article 77 sets out the particulars permitted on prescription pads, business cards and professional directories; Article 78 sets out those that may appear on the practice plate, together with its dimensions; and Article 4 opens an exception for announcing the opening of a first practice through the press, after notifying the regional ordinal section and submitting the wording of the announcement in advance[1].
| Item | Legal status | Basis |
|---|---|---|
| Surname, first name, address, telephone, consultation days and hours | Permitted | Articles 77 and 78 |
| Recognised titles, positions and qualifications; names of associates | Permitted | Articles 77 and 78 |
| Plate not exceeding 25 × 30 cm, at the practice entrance, building entrance or letterbox | Permitted | Article 78 |
| Single press announcement on opening, after notifying the ordinal section | Permitted, conditionally | Article 4 |
| Promotional offers, discounts, displayed prices, treatment "packages" | Prohibited | Articles 20 and 24 |
| Sponsored content or collaboration with influencers | Prohibited (indirect advertising) | Article 20 |
| Diverting colleagues' patients; undercutting fees to compete | Prohibited | Articles 62 and 65 |
| Using an elected mandate or administrative post to grow one's patient base | Prohibited | Articles 22 and 89 |
1.3 The supporting articles that tend to be overlooked
Article 20 does not operate in isolation: it sits within a framework prohibiting anything that turns care into a commercial transaction. Article 24 prohibits any act designed to procure an unjustified material advantage for a patient, as well as any rebate in cash or in kind; Article 65 prohibits the debasement of fees through discounts or flat rates for competitive purposes; Article 62 prohibits diverting, or attempting to divert, another practitioner's patients; and Article 19 requires the practitioner to refrain, even outside professional practice, from any act liable to bring the profession into disrepute. The debate over a social media page is therefore inseparable from the rest of the code: published offers and discounts run into Article 24 before they are even assessed under Article 20.
Key point
The prohibition does not target making the practice known, but promoting it. That distinction is the heart of the matter, and it is embodied in the exhaustive list of permitted details in Articles 77 and 78.
2 The rationale behind the ban
2.1 Information asymmetry: the economic foundation
The prohibition on medical advertising was not adopted arbitrarily, nor for "conservative" reasons as is sometimes claimed. Its theoretical basis has been documented since 1963, when the economist Kenneth Arrow showed, in a foundational article in the American Economic Review, that the market for medical care differs structurally from ordinary commercial markets because of uncertainty and information asymmetry between practitioner and patient[3]. Unlike the buyer of a standard good, the patient can neither assess their own need precisely nor judge with any certainty the quality of the service received; they must trust a professional who decides both the diagnosis and the treatment that is then billed.
In such a market, advertising competition does not perform the function attributed to it. In a commercial market, advertising is supposed to convey information helping the consumer choose; here, the recipient lacks the means to evaluate that information, which makes advertising an instrument of persuasion rather than of information. It is this structural imbalance that historically justifies a professional code of ethics distinct from commercial rules, including the advertising ban and the obligation of means rather than of result.
2.2 Dental care as a credence good
Contemporary dental literature restates the same idea under the label of the credence good. In an article published in 2025 in the British Dental Journal, Raj Rattan notes that the patient is structurally unable to judge for themselves whether the proposed treatment was genuinely necessary, or even whether it was well executed[4]. This inability is not a health-literacy gap that education could close: it is a property of the service itself. Even after treatment, the patient remains unable to know whether the crown was indicated or whether a simpler restoration would have sufficed.
It is in this context that Rattan introduces the notion of ethical fading: under commercial pressure and profitability targets, a practitioner may gradually lose sight of the ethical dimension of their decisions without ever feeling they are acting in bad faith. The prohibition thus functions as a preventive rule addressed to the profession as a whole, not as an accusation levelled at individuals.
2.3 Professional dignity and price competition
The third rationale is less often cited but economically decisive: once advertising becomes possible in a market where the consumer cannot assess quality, competition shifts towards what they can actually compare — price and the appearance of the result. That competition pushes in two opposite and equally damaging directions: compressing the real cost of the work (lower-grade materials, less chair time per patient, shortened sterilisation protocols), or increasing the number of procedures proposed to restore the margin. This is precisely what Articles 24 and 65 seek to prevent by expressly prohibiting rebates and the debasement of fees for competitive purposes.
Flawed argument
Claiming that "advertising drives quality" transposes to the care market a logic that holds for a good the buyer can evaluate. In a credence good, what advertising competes on is not clinical quality — which the patient cannot compare — but image and price.
3 From the practice plate to digital platforms
3.1 A 1992 text facing the reality of 2026
Article 20 was drafted when the available advertising channels were limited: the printed press, plates, professional directories. Today a single page on a platform can reach tens of thousands of people a day, at near-zero cost and with precise geographic targeting. That shift does not alter the principle of the prohibition, but it complicates its application and explains much of the current tension within the profession: the text is clear in principle and imprecise in how it characterises new digital formats, in the absence of a recent implementing text defining what constitutes an "advertising page".
3.2 What studies document about dental content online
The issue is not confined to Algeria. A reference article published in 2019 in the Dental Press Journal of Orthodontics documents that dentists' social media posts frequently contain ethical breaches, contribute to the commodification of care, and at times conflict with consumer protection law itself, particularly where clinical images of patients are used for self-promotion[11]. An analysis published in 2022 in the Angle Orthodontist, examining Instagram posts concerning marketed orthodontic products, found that a substantial share of that content lacks scientific accuracy or presents results selectively[12].
The difficulty facing Algerian professional bodies is therefore no local peculiarity: digital platforms have raised an old question with new tools, and different legal systems have addressed it with varying degrees of severity.
3.3 The current Algerian context
In September 2026, a notice attributed to the National Council for Ethics in Dental Practice circulated among professional circles, calling on all practices to withdraw their advertising pages before 30 September 2026, expressly on the basis of Article 20[13]. The announcement produced a clear split within the profession: between those who see it as a necessary correction of real excesses and those who consider it disproportionate, penalising every practitioner for the conduct of a minority, and raising legitimate questions about the definition of an "advertising page" and about consistency of enforcement.
Methodological point
The first practical problem is the imprecision of the definition, not the principle of the prohibition. As long as no implementing text distinguishes an "advertising page" from an "informational page", practitioners remain exposed to variable assessment, and adhering to the letter of Articles 77 and 78 remains the safest reference.
4 Advertising or health information
4.1 Three tests for distinguishing the two
The first test is purpose: does the content aim to improve the patient's understanding of their situation and options, or to bring them to book an appointment at a particular practice? The second is the evidential basis: does the content rest on verifiable data, or on selected results and testimonials? The third is comparison: any content that positions the practice favourably against colleagues, explicitly or by implication, leaves the register of information for that of promotion, and additionally runs into Article 62 on diverting patients.
The code adds a scientific constraint independent of the advertising question: Article 30 prohibits disclosing to a non-medical audience a diagnostic or therapeutic procedure that is insufficiently validated, and Article 31 prohibits offering patients a remedy or procedure that is illusory or insufficiently tested, with any form of quackery separately prohibited[1]. In other words, strictly educational content with no promotional intent may still be non-compliant if it presents a recent technique as settled fact.
4.2 Worked examples
| Type of post | Likely characterisation | Reason |
|---|---|---|
| Explaining the causes of childhood caries and how to prevent it | Health information | Educational purpose, no link to the practice's offering |
| "Implant for … DA, this month only" | Commercial advertising | Price and time-limited offer (Articles 20 and 24) |
| Before-and-after photograph with an invitation to book | Indirect advertising | Persuasion through the result; promotional use of a clinical image |
| Announcing a change of opening hours or telephone number | Administrative information | Falls within the particulars listed in Article 77 |
| Video explaining a sterilisation protocol, addressed to colleagues | Professional communication | Professional audience, technical rather than promotional content |
| Sponsored content targeting residents of a given district | Direct advertising | Purchasing reach in order to capture patients |
| Publishing a satisfied patient's testimonial | Indirect advertising | Third-party testimonials persuade rather than inform verifiably |
4.3 The question of the patient's image
A wholly separate issue arises here: professional secrecy. Article 37 of the code extends secrecy to everything the practitioner has seen, heard, understood or been told in the course of their practice, and Article 40 requires that, when using patient records for scientific publication, the practitioner ensure the patient cannot be identified[1]. Publishing a clinical image on a public platform therefore raises a twofold problem: an advertising one where the purpose is promotional, and a confidentiality one whatever the purpose, including where the patient has given verbal agreement.
A practice publishes genuinely educational content, but closes every post with "contact us to book" and photographs of results. The page shifts from information to promotion without the practitioner noticing.
Keep educational content and administrative information strictly separate: scientific content with no call to action and no patient images, and contact details grouped in a fixed section limited to the particulars of Article 77.
5 Care facility or profit-making business
5.1 A structural duality, not a choice
This is the question underlying every debate about advertising. Clinically and ethically, the answer is settled: the practice is a healthcare facility, and what is performed there is a medical act, with the professional liability, medical confidentiality and obligation of means that follow. Economically, a private practice does function as a service business: fixed costs for premises, salaries, equipment and consumables; cash flow to manage; profitability tied directly to chair occupancy and to the quality of its organisation.
The common methodological error is to set these two dimensions against each other and demand a choice between them. In reality they coexist within the same structure but at two distinct levels: the level of clinical decision-making, where commercial considerations have no place, and the level of management, where financial and organisational rigour is not merely legitimate but necessary to the practice's survival.
5.2 What the text prohibits and what it does not
Article 20 repays careful reading: nowhere does it prohibit running a practice with financial rigour, monitoring cash flow, costing a procedure, or organising the schedule to reduce idle time. What it prohibits comes down to two things: that the medical act be practised "as a commercial activity", meaning that the treatment decision is built on a sales logic, and that commercial promotion tools be used to capture patients.
Key point
"No commerce in medicine" does not mean "no management in the practice". It is the distinction between the clinical decision line and the managerial decision line that makes compliance with the text compatible with the practice's financial balance.
5.3 The working rule: separate the two decision lines
This duality translates into a simple operating rule: the treatment plan is built on clinical criteria documented in the file, and payment terms, instalments, follow-up and retention are then handled separately, afterwards. As soon as the two decisions blend — for instance when treatment options are presented to a patient in an order dictated by profitability rather than indication — the drift described in the literature begins, usually without any malicious intent.
This duality has already been examined in detail in a separate article on this blog devoted to the identity of the dental practice, between medical practice and service business. What the current advertising debate adds is that the boundary between the two logics is no longer merely a matter of personal conviction: it has become publicly visible on the platforms, and therefore a subject for regulation.
6 What the research literature shows
6.1 A review of 47 studies
Holden, Adam and Thomson published a scoping review in the British Dental Journal in 2020 covering 47 studies on the relationship between professional and commercial obligations in dentistry[6]. It identifies three recurring themes among practitioners surveyed worldwide: the commitment of the majority to placing the patient's clinical interest above all other considerations; the reality of daily practice — overheads, time pressure, profitability — which makes that commitment harder in practice than in theory; and situations of open conflict between a commercial objective imposed by a structure and the practitioner's clinical judgment.
The authors' conclusion is unambiguous: unchecked commercial interests pose a direct threat to professional values. At the same time, they note a shortage of tested, practical solutions for managing that tension day to day — an important observation in the current Algerian debate, since the literature confirms that the concern is legitimate without supplying a formula that would spare each professional body the task of defining the limits itself.
6.2 The "McDonaldisation" of dental care
In a qualitative study conducted in Australia and published in 2021, the same authors apply McDonaldisation theory to the phenomenon of practices organised as chains or groups[7]. Such structures tend to optimise four dimensions: efficiency, predictability, calculability through numerical profitability targets, and control of the practitioner by the structure. The practitioners interviewed acknowledge real benefits — access to employment, shared equipment, potentially more affordable care — while warning of the risk of standardising a care relationship that is inherently individual.
That context is Anglophone, and the Algerian sector remains overwhelmingly made up of independent practices. But the warning signs to watch for are the same: the appearance of numerical production targets per chair or per practitioner, and appointment pacing that compresses clinical time. It is worth noting that the Algerian code anticipates this debate by decades: Article 86 expressly prohibits physicians and dentists from accepting remuneration based on productivity norms or hourly output that would limit or surrender their professional independence[1].
7 Comparative law: from ban to regulation
7.1 The 2017 Court of Justice of the European Union ruling
On 4 May 2017 the Court of Justice of the European Union ruled in the Vanderborght case, criminal proceedings brought against a Belgian dentist over a sign, a website and advertisements in local newspapers[8]. The Court held that a general and absolute prohibition on all advertising relating to oral and dental care is contrary to EU law, in particular the e-commerce directive and the freedom to provide services. The judgment did not, however, rule out supervision: the Court expressly accepted that protecting public health and the dignity of the dental profession can justify controlling the form and content of advertising messages. The difference between an "absolute ban" and "strict regulation" is thus a substantive legal distinction, not a matter of form.
7.2 The 2020 French reform
France moved in the same direction with Decree No. 2020-1658 of 22 December 2020, amending the dentists' code of ethics[9]. The wording prohibiting all direct or indirect advertising methods was removed from Article R.4127-215, leaving only the principle that the profession must not be practised as a commercial activity. In its place, Article R.4127-215-1 recognises the practitioner's freedom to communicate to the public, by any means including a website, information capable of contributing to the patient's free choice of practitioner — competences, professional background, conditions of practice — provided that this communication is fair and honest, does not rely on third-party testimonials, does not rest on comparisons with other practitioners or establishments, and does not encourage unnecessary recourse to preventive or curative procedures[10].
7.3 What Algeria can take from this
The comparison does not mean the European solution is transferable as it stands: the Algerian framework rests on an explicit text in force, Article 20, which no professional opinion can neutralise. But comparative experience brings out three concrete points. First, the question posed internationally is no longer "advertising or not" but "what criteria for professional communication". Second, the criteria adopted by systems that have liberalised such communication — fairness, no third-party testimonials, no comparison, no encouragement of unnecessary treatment — map closely onto the philosophy of the Algerian code. Third, updating the implementing texts remains the only legal instrument capable of closing the gap between a 1992 text and 2026 practice, and that legislative route cannot be substituted by any short-term measure.
A balanced reading
The international trend is towards freer information coupled with tighter supervision, not towards abandoning the principle that medicine is not a trade. That principle still appears verbatim in the French text after the 2020 reform, exactly as it does in the Algerian one.
8 What a practitioner can do in practice
8.1 Audit the practice's communication against the text
The legally safest approach does not start from "is my page advertising?" but from the reverse question: "what do Articles 77 and 78 expressly permit?". Anything outside that list — prices, offers, patient images, testimonials, sponsored content, comparisons — sits in a risk zone. Strictly educational content aimed at the public remains acceptable in spirit, provided it does not become an indirect promotional shop window and respects the limits of Articles 30 and 31 on insufficiently validated data.
8.2 Build a reputation with levers no text prohibits
The most frequent objection to the ban is that a newly qualified practitioner loses any means of becoming known. It is partly well founded, but it overlooks the fact that the levers that matter most to a practice's growth are not advertising ones. Reducing missed appointments through an organised reminder system, cutting waiting time, explaining the treatment plan and its cost clearly before starting, and following up after the procedure all directly determine the patient return rate and word-of-mouth recommendation — the channel that remains, for a credence good, both the most effective and the most compliant with the text.
8.3 The link to the other pillars of practice management
This question is not separate from the other management tools covered individually on this blog. A clear vision for the practice is what sets in advance the line that will not be crossed whatever the profitability; written operating standards — of the kind "no treatment is proposed without a clinical indication documented in the file" — are what turn that line from an intention into a rule applicable even under the pressure of the moment; a quality approach is what makes it possible to verify periodically that the rule is still being followed; and the five pillars of performance are a reminder that the financial dimension is only one of five, and that none should be strengthened at the expense of the clinical one.
Management pitfall
Simply deleting the page without examining what it actually did. If it handled appointment booking or patient reminders, removing it without a replacement shifts the problem from legal compliance to daily organisation.
Practical Summary
- 1
Start from the exhaustive list of permitted details in Articles 77 and 78, rather than trying to define what counts as "advertising".
- 2
Remove anything containing a price, an offer or a discount, which breaches Articles 20 and 24 alike.
- 3
Do not publish clinical images of patients on public platforms, for two separate reasons: advertising and professional secrecy.
- 4
Avoid patient testimonials and comparisons with colleagues, which are prohibited even in systems that have liberalised professional communication.
- 5
Separate the clinical decision line from the managerial decision line explicitly and in writing.
- 6
Respect the limits of Articles 30 and 31 in educational content: no insufficiently validated technique presented to a non-medical audience.
- 7
Replace the page's organisational function (bookings, reminders) with an internal solution before removing it, not after.
Frequently Asked Questions
Does Algerian law prohibit a practice from having a social media page?→
Article 20 of Executive Decree 92-276 makes no mention of social media, since it dates from 1992. What it explicitly prohibits is practising medicine and dentistry “as a commercial activity” and resorting to “all direct or indirect advertising methods”. The issue therefore concerns the nature of the content rather than the platform: a page publishing offers, prices, promotions or before-and-after results in order to attract patients falls within the ban, whereas administrative information or health education content without promotional character does not. In the absence of a recent implementing text defining digital advertising precisely, the assessment rests with the disciplinary bodies.
Which details are legally permitted on the practice plate and on business cards?→
Articles 77 and 78 of Decree 92-276 set out an exhaustive list: surname, first name, address, telephone number, consultation days and hours, floor, the names of associated colleagues where the practitioner works in partnership, and recognised titles, positions and qualifications. Article 78 further caps the plate at 25 × 30 cm and restricts its placement to the entrance of the practice, the letterbox and the entrance of the building.
May a practitioner announce the opening of a new practice?→
Yes, within a defined framework. Article 4 of Decree 92-276 allows a practitioner setting up for the first time to inform the public of the opening of the practice through the press, provided the competent regional ordinal section has been notified beforehand and the text of the announcement submitted to it, in compliance with the regulations in force. This is a one-off, time-limited exception rather than an authorisation for ongoing promotion.
What is the practical difference between advertising and health information?→
The test is not the medium but the purpose and the wording. Content explaining a condition or a preventive measure, without linking it to the practice's offering, without a call to book and without highlighting prices or results, remains health information. Conversely, content comparing the practice with colleagues, publishing patient testimonials, displaying a price or a discount, or using before-and-after photographs to persuade, is promotional. Articles 30 and 31 of the decree add a separate constraint: insufficiently validated diagnostic or therapeutic procedures must not be presented to a non-medical audience, and any form of quackery is prohibited.
Is an absolute advertising ban a universal rule?→
No. On 4 May 2017, in the Vanderborght case, the Court of Justice of the European Union held that a general and absolute prohibition on all advertising relating to oral and dental care is incompatible with EU law, while accepting that protecting public health and the dignity of the dental profession can justify supervising the form and content of such messages. In France, Decree 2020-1658 removed the explicit prohibition on advertising and replaced it with a regulated freedom of professional communication, subject to requirements of fairness, no comparison with colleagues and no reliance on third-party testimonials. The international trend is therefore towards regulation rather than absolute prohibition, with the principle that medicine is not a trade remaining intact.
If a practice needs to be profitable, is advertising not an economic necessity?→
A practice does need financial balance, and that point raises no legal controversy: no text prohibits running a practice with financial rigour. What the texts prohibit is allowing commercial logic to reach the treatment decision itself, and using commercial promotion tools to capture patients. Legitimate growth runs through clinical quality, scheduling organisation, clarity of the information given to the patient and the reduction of missed appointments — levers whose effect is documented and which conflict with no provision.
References
- People's Democratic Republic of Algeria. Executive Decree No. 92-276 of 6 July 1992 on the Code of Medical Ethics (Articles 4, 19, 20, 22, 24, 30, 31, 37, 40, 62, 65, 77, 78, 86, 89).Regulation
- People's Democratic Republic of Algeria. Law No. 18-11 of 2 July 2018 on Health.Regulation
- Arrow, K. J. (1963). Uncertainty and the Welfare Economics of Medical Care. American Economic Review, 53(5), 941–973.Foundational classic
- Rattan, R. (2025). Ethics on the edge: commodification, credence and care in general dental practice. British Dental Journal, 239, 409.Study
- Holden, A. C. L. (2018). Consumer-driven and commercialised practice in dentistry: an ethical and professional problem? Medicine, Health Care and Philosophy, 21, 583–589.Study
- Holden, A. C. L., Adam, L., & Thomson, W. M. (2020). The relationship between professional and commercial obligations in dentistry: a scoping review. British Dental Journal, 228, 117–122.Review
- Holden, A. C. L., Adam, L., & Thomson, W. M. (2021). Rationalisation and 'McDonaldisation' in dental care: private dentists' experiences working in corporate dentistry. British Dental Journal.Qualitative study
- Court of Justice of the European Union. Judgment of 4 May 2017, Criminal proceedings against Luc Vanderborght, Case C-339/15.Case law
- France. Decree No. 2020-1658 of 22 December 2020 amending the code of ethics for dentists and relating to their professional communication.Comparative law
- France. Public Health Code, Articles R.4127-215 and R.4127-215-1.Comparative law
- Simplício, A. H. M. (2019). Social media and Dentistry: ethical and legal aspects. Dental Press Journal of Orthodontics, 24(6), 80–89.Reference article
- Alkadhimi, A., Al-Moghrabi, D., & Fleming, P. S. (2022). The nature and accuracy of Instagram posts concerning marketed orthodontic products. Angle Orthodontist, 92(2), 247–254.Study
- National Council for Ethics in Dental Practice (Algeria). Notice concerning the withdrawal of practices' advertising pages, deadline 30 September 2026, based on Article 20 of the code of ethics.Professional notice
