Abstract The ethical implications of sharing clinical cases on social media have become increasingly important in dentistry. This study aimed to explore the perceptions of clinical-year dental students (defined as those in Years 3 to 5 who are actively engaged in clinical patient care) regarding ethical considerations in this context. A cross-sectional survey was conducted among clinical-year dental students at a private dental school in Northern Malaysia, using a validated online questionnaire comprising 14 closed-ended items across two domains and two open-ended questions. Quantitative data were analysed using one-way ANOVA and independent t tests, while qualitative responses underwent content analysis. A total of 173 students participated (response rate: 80.5%), with a mean age of 23.0 years (±1.08); most respondents were female and of Chinese ethnicity. Participants demonstrated generally positive perceptions across both domains. Female students scored significantly higher than males in Domain 1 (P = 0.027). Qualitative findings revealed that students prioritised patient privacy and confidentiality when sharing clinical cases online, yet also recognised the potential benefits of social media for professional networking and knowledge exchange. Overall, undergraduate clinical-year dental students expressed positive perceptions of the ethical considerations involved in sharing clinical cases on social media. Given the growing role of digital platforms in healthcare, there is an urgent need to strengthen awareness and guidelines to ensure that ethical principles and patient-centred care remain central to clinical case sharing practices.

Keywords: Clinical cases, Confidentiality, Dental ethics, Dental students, Social media

Citation:  Tan, W.W., Hashim, H., and Lin, G.S.S. 2026. Exploring the ethical dimensions: Clinical-year dental students' perceptions of sharing clinical cases on social media at a private dental school in northern Malaysia. Natural and Life Sciences Communications. 25(2): e2026041.

Graphical Abstract:

INTRODUCTION

Social media platforms have become ubiquitous worldwide, including in Malaysia, revolutionising how dental information is shared and consumed. In today’s digital era, the increasing use of social media among dental professionals and students has profoundly influenced professional learning, patient engagement and communication in dentistry (Pereira, 2017; Permpoonputtana et al., 2024; Acosta et al., 2025). The rise of digital technology in healthcare offers vast opportunities for learning and collaboration within the dental profession (Németh et al., 2023). One significant phenomenon within the digital landscape is the sharing of clinical photographs and videos on various social media platforms by dental professionals and dental students (Alqabbani et al., 2025). While the dissemination of clinical cases online facilitates knowledge sharing, patient education, and professional networking, it also presents substantial ethical issues concerning patient confidentiality, consent, and professional integrity (ChiangMai et al., 2006; Palacios-González, 2015; Bahabri and Zaidan, 2021).

The cornerstone of dental practice, as with any other healthcare profession, is to protect patient confidentiality and privacy (Kidd, 2022). Dental professionals are entrusted with the duty to uphold the highest ethical standard in their practice and to safeguard the welfare of their patients, both offline and in the digital world (Ozar et al., 2018; Bailey and Mellion, 2023). However, clinical photography and videography introduce unique challenges in this regard because they can reveal patients’ identities, information, conditions and treatments (Robinson et al., 2014; Jamal et al., 2022). A previous study highlighted the importance of patient anonymity and obtaining explicit patient consent before sharing clinical cases on social media platforms, whether for educational or professional purposes (Chretien and Kind, 2013). Failure to follow these principles can not only negatively impact the dentist-patient relationship but also violate the rules and regulations governing healthcare data privacy (Ozar et al., 2018).

Exploring the perceptions of clinical-year dental students on the ethical considerations of sharing clinical cases on social media can provide valuable insights into their readiness to navigate these complex ethical landscapes as future dental professionals (Kenny and Johnson, 2016; Mani et al., 2023). A study conducted at two Southeast Asian universities, in Malaysia and Indonesia, found that dental students held positive views on e-professionalism when using social media (Kamarudin et al., 2022). Similarly, a survey of practicing dentists and dental students assessing their attitudes toward social media in dental education and practice highlighted the widespread acceptance of social media’s potential benefits for learning and networking, while also raising concerns about patient privacy and professionalism (Aboalshamat et al., 2019). These findings underscore the need for comprehensive educational interventions to guide students in navigating the ethical challenges associated with social media use.

Although existing literature highlights the benefits and ethical concerns associated with sharing clinical cases online, current evidence is predominantly derived from Western or Middle Eastern contexts (Palacios-González, 2015; Bahabri and Zaidan, 2021). While some studies from Southeast Asia, including Malaysia and Indonesia, have explored general e-professionalism and attitudes toward social media among dental students, research exploring the specific ethical perceptions of clinical-year students regarding the sensitive act of sharing clinical cases (visual media) remains scarce. This specific focus is critical, given the high regulatory emphasis on patient confidentiality within the Malaysian Dental Council Code of Professional Conduct (Malaysia Dental Council, 2022). Furthermore, little is known about how these detailed ethical perceptions differ across clinical-year stages (Years 3–5), a period when students transition into real patient care responsibilities, potentially shaping their ethical decision-making. To address this refined gap, the present study aimed to explore clinical-year dental students’ perceptions of the ethical considerations related to sharing clinical cases on social media within a Malaysian context. This study addressed two research questions: (1) How do clinical-year dental students in Malaysia perceive key ethical responsibilities—such as confidentiality, consent, and professionalism—when sharing clinical cases online? and (2) Do these perceptions differ by gender, ethnicity, or year of study?

MATERIALS AND METHODS

Sampling and participation

The present study was conducted among clinical-year Bachelor of Dental Surgery (BDS) students at the Faculty of Dentistry, AIMST University, Malaysia, with the ethical approval code AUHEC/FOD/15/04/2024. A priori sample size calculation was performed for mean comparisons using σ = 1.0 (estimated via the range-fraction method) (Schumm et al., 2017), Δ = 0.55, α = 0.05 and power = 0.80. The required sample was 52 per clinical-year group (Years 3–5), totaling 156, which increased to 174 after allowing for a 10% non-response rate. In practice, a census approach was used: all eligible clinical-year BDS students (Year 3–Year 5; total population N = 215) were invited to participate.

Study design

A cross-sectional study using an online questionnaire was carried out to explore the perceptions of clinical-year dental students on the ethical considerations of sharing clinical cases on social media platforms. The inclusion criteria were as follows: (1). clinical year dental students; (2). dental students who are currently enrolled in the BDS program at AIMST University, Malaysia. The survey link was created in Google Forms and shared with the students via university’s official email and WhatsApp groups administered by academic staff. Participation was restricted to students with institutional email addresses, ensuring that only enrolled clinical-year dental students could access and submit responses. Participants provided informed consent to participate by responding “Yes” to the following item in the introductory section of the survey: “I have read and understood all information given to me about my participation in this study. I voluntarily agree to participate in this study.”

Questionnaire design

The questionnaire used in this study was adopted and modified from previous studies (Abouzeid et al., 2020; Jamal et al., 2022) and was conceptually informed by the principlism framework (Beauchamp and Childress, 2019), which emphasises respect for autonomy, beneficence, non-maleficence and justice as the foundation of ethical decision-making in healthcare. In the context of social media, these principles align with maintaining patient confidentiality, obtaining consent, and upholding professional integrity. The domain structure was also guided by e-professionalism concepts described by Chretien and Kind (2013), distinguishing ethical awareness from personal online practices. It consisted of 2 sections. The first section of the questionnaire covered the demographic data of the participants, including age, sex, ethnicity, and year of study. The second part of the questionnaire consisted of 14 close-ended questions and 2 open-ended questions to explore the perceptions of clinical year dental students of the ethical considerations of sharing clinical case media on social media (Table 1). Each close-ended question had five responses using a five-point Likert scale ranging from strongly agree to strongly disagree. The score distribution was strongly agree: 5, agree: 4, neutral: 3, disagree: 2, and strongly disagree: 1. The modified questionnaire items were validated (content validation) by two experts who are public health specialists with years of experience in conducting quantitative surveys. Cronbach’s alpha coefficients from the study sample for the respective domains were 0.70 and 0.60, indicating acceptable internal consistency, with the latter being modest yet acceptable for preliminary exploratory studies. The questionnaire was pilot-tested among 10 clinical-year dental students from a different cohort within the same faculty to ensure clarity, comprehension, and content validity. These students were not included in the main study sample, and their demographic background was comparable to the study population.

Table 1. Items assessing dental students’ perceptions of clinical case sharing on social media.

Statistical Analyses

The statistical analyses were conducted using the IBM Statistical Package for the Social Sciences (SPSS) for Windows, version 29.0. The mean scores between groups (academic year, sex, ethnicity) were calculated using one-way ANOVA and independent t tests. The level of significance was set at P < 0.05, and content analysis was performed for the open-ended responses. Two investigators (WWT and GSSL) performed preliminary coding using NVIVO 12 software from the respondents’ feedback. Any disagreements in the codes were resolved by the third researcher (HH). All final codes were refined and approved by all members of the research team.

RESULTS

A total of 173 students participated in the study, yielding a response rate of 80.5%. The distribution of respondent characteristics within the study sample is presented in Table 2. Most participants were female, constituting 129 individuals (74.6%), while male participants accounted for 44 individuals (25.4%). Most students were Chinese (n = 138, 79.8%), with the remaining being Indian (n = 33, 19.1%). Regarding the year of study, the sample was relatively evenly distributed, with 60 participants (34.7%) in the third year, 62 participants (35.8%) in the fourth year, and 51 participants (29.5%) in the fifth year.

Table 2. Distribution of respondent characteristics.

Overall, the cohort demonstrated positive perceptions across both domains, with mean item scores ranging between 3.75 and 4.52 in Domain 1 (Clinical Ethics and Professional Integrity) and 2.98 to 4.25 in Domain 2 (Personal Experience and Practice). The highest-rated item in Domain 1 was Item 3 (“importance of obtaining explicit consent”), indicating strong awareness of consent obligations. Conversely, Item 8 (confidence in upholding ethical standards) had a comparatively lower mean score, suggesting potential uncertainty in applying ethical principles in real-world contexts. In Domain 2, students most strongly agreed that there is a need for additional training or guidelines on ethical social media use (Item 10), whereas fewer students reported having personally uploaded clinical materials online (Item 12), reflecting limited real-world engagement despite theoretical awareness.

Table 3 illustrates the comparative analysis of perceptions according to each domain. Across all items in Domain 1, no significant differences were observed in the total mean scores across academic years and ethnicities. However, female subjects demonstrated a significantly greater total mean score than did their male counterparts (P = 0.027).

For Domain 2, no significant differences were noted across most items except for two items. Specifically, item 10 ("I believe there is a need for additional training or guidelines regarding the ethical use of social media in dentistry") showed significant variation across academic years (P = 0.045). Participants in Year 5 reported higher mean scores than did those in Year 3 and Year 4. Additionally, a significant difference was observed between genders (P = 0.029), with females perceiving a greater need for additional training or guidelines than males.

Regarding Item 13, a significant difference was observed across academic years (P = 0.048), with Year 3 students demonstrating greater diligence in ensuring de-identification or anonymisation compared to their seniors. However, no significant differences were found between genders or ethnicities for this item. In both domains, female respondents consistently displayed higher mean scores than did male respondents. No discernible patterns based on academic years or ethnic groups emerged.

Table 3. Perceptions of sharing clinical cases on social media platforms: Comparative analysis by academic year, gender, and ethnicity.

For the open-ended responses, participants felt that the most significant ethical concerns regarding the sharing of clinical cases on social media platforms were patient privacy and confidentiality of information. Some of the quotes were as follows.

“Privacy of the patient's identity is very important to me. I feel most people don’t mind the sharing of their cases provided their identities could not be identified.”

“Exposing patients' oral health conditions violates their privacy. Most people care about their appearance. Patient may sue us.”

When asked about the potential benefits of sharing clinical cases on social media platforms, most participants agreed that they facilitated knowledge acquisition and professional networking. In addition, it also helped in creating awareness among the public.

“Discussing treatment plans professionally helps build self-image and promotes sharing and learning, as not everyone can be exposed to similar cases.”

“Raising awareness about particular dental conditions and treatments, educating the public, and facilitating collaboration among healthcare professionals.”

DISCUSSION

The present study explored the perceptions of clinical dental students towards sharing clinical cases on social media platforms. Clinical-year dental students generally showed positive perceptions of the ethical considerations of sharing clinical cases on social media platforms. Based on the present findings, female students had significantly higher total mean scores in Domain 1. This finding concurred with a previous study conducted among medical students in Iran, where female students had higher awareness scores of patient privacy than their male counterparts (Hosseini-Ghavam-Abad et al., 2019). Similarly, another study conducted among Malaysian undergraduate students found that female students generally exhibited a greater level of ethics than their male counterparts (Rodzalan and Saat, 2016). This finding might explain why, in the current study, female students had higher mean scores for clinical ethics and professional integrity. Furthermore, this could also stem from the higher moral sensitivity and greater empathy among female students (You et al., 2011; Moudatsou et al., 2020) leading to better patient privacy protection behaviours (Xia et al., 2022). Thus, the findings presented a good opportunity for dental educators to develop innovative approaches to engage male students, particularly when dealing with the complex ethical landscape of social media use.

Despite the absence of statistically significant differences, it is noteworthy that the observed higher overall mean scores in Years 3 and 5 compared to Year 4 in perceptions regarding sharing clinical cases on social media platforms could be influenced by their level of clinical exposure and educational progression. Year 3 students, being in their first clinical year, might exhibit heightened caution and sensitivity towards sharing patient cases on social media platforms, driven by their desire to adhere strictly to professional ethics and maintain patient privacy (Nieminen et al., 2022). Conversely, Year 4 students, notwithstanding their greater clinical experience, might not yet have fully developed a comprehensive understanding of the ethical implications of sharing patient cases online, potentially leading to lower mean scores in their perceptions. Additionally, the emphasis on ethics training in Year 5 at the current institution likely contributed to the higher mean scores among these students, as they received targeted education on ethical considerations in the context of upholding patient confidentiality (İlgüy et al., 2015). This heightened awareness of professional boundaries in social media use might consequently foster responsible practices among students (Gormley et al., 2021; Viskić et al., 2021). Although the individual item scores displayed a mixed trend across the years, indicating no consistent pattern, the overall positive perceptions reflected by the scores are rather reassuring.

In the same domain, the most strongly agreed upon item was Item 3: ‘I understand the importance of obtaining explicit patient consent before sharing clinical images and videos on social media.’ Students understood the importance of obtaining explicit consent before sharing clinical cases on social media. This could be due to the early exposure of ethical teaching from the initial clinical years in the undergraduate dental curriculum. Moreover, all clinical-year dental students in Malaysia were requested to adhere strictly to the guidelines of the Code of Professional Conduct set forth by the Malaysia Dental Council (Malaysia Dental Council, 2022) which strongly emphasised protecting patient privacy and information confidentiality. Particularly in section 1.4 (d), which explicitly mentioned that a separate consent had to be obtained prior to sharing clinical cases anywhere in the public domain (such as advertising, public lectures or any kind of media output) (Malaysia Dental Council, 2022).

According to Domain 2 (Personal Experience and Practice), compared to other dental students, Year 5 dental students strongly agreed that ‘there is a need for additional training or guidelines regarding the ethical use of social media in dentistry’ (P = 0.045). Undeniably, final-year dental students were on the brink of entering their professional practice. As a result, they were more aware of their responsibilities and potential consequences of their actions, including those related to social media use, compared to other academic years. Similar results were observed in past studies in which final-year medical students had significant knowledge of medical ethics, were exposed to more ethical dilemmas and were better at recognising them (Johnston and Mok, 2015; Shetty and Vaswani, 2022). Furthermore, for Item 13, ‘I always ensure to de-identifying or anonymising clinical visual media before sharing it on social media.’ A similar trend was observed, where higher overall mean scores were obtained for Years 3 and 5 than for Year 4. Concealing patients’ identities before sharing their photos and videos on social media platforms is of utmost importance for safeguarding patient privacy and personal health information. Moreover, properly deidentified visual media are not subject to the handling standards imposed by the Health Insurance Portability and Accountability Act in the United States (Nettrour et al., 2019). The authors postulated that the lower mean score among Year 4 students could be attributed to the fact that they might be at a stage where they were dealing with more complex ethical cases but had not fully developed the necessary skills to navigate them.

Within the cohort, variations across domains and items provide a nuanced understanding of students’ ethical perceptions and actions. Students consistently recognised the importance of patient consent and confidentiality, reflecting strong awareness of ethical principles. However, lower mean scores on items related to confidence and personal engagement with online case sharing suggest that ethical understanding does not always translate into corresponding action. This perception–action gap indicates that students may lack the confidence or institutional guidance to apply ethical reasoning in real-world digital contexts. Comparable trends have been reported in previous research on AI-related ethics, where dental students demonstrated strong ethical awareness but showed variability in how these principles were applied in practice (Lin et al., 2024). This reinforces the need for structured opportunities in dental education—such as digital professionalism workshops or guided online exercises—to support the translation of ethical understanding into real clinical and digital behaviours.

Although this study aimed to shed light on the perceptions of clinical year dental students on the ethical considerations of sharing clinical cases on social media, several limitations should be acknowledged. First, the study was conducted in a single private dental school in Malaysia, with limited generalisability to other dental students of different demographic backgrounds. Second, voluntary participation may have introduced self-selection and social desirability biases inherent to self-reported online surveys. Nonetheless, restricting access to institutional email accounts helped ensure the authenticity of responses.

Nevertheless, future studies can be conducted nationwide, encompassing both public and private universities, or even across different geographical regions and cultural contexts. Combining qualitative methodology, including interviews and focus groups, helps to yield in-depth data on the complex ethical problems of sharing clinical cases on social media platforms. In addition, the study can be extended to include practicing dentists to enable comparisons of perceptions between dentists and dental students pertaining to this topic. All these recommendations enable a more comprehensive understanding of dental students’ perceptions of ethical considerations related to the sharing of clinical cases on social media platforms, leading to the responsible use of social media platforms.

CONCLUSION

In conclusion, undergraduate clinical year dental students generally showed positive perceptions of the ethical considerations of sharing clinical cases on social media platforms. Compared with male respondents, female respondents obtained a higher overall score in the domain of ‘Clinical Ethics and Professional Integrity’. The current study provides useful information that can help educators, policy makers and professional bodies develop informed guidelines and educational initiatives to help students navigate the difficult ethical problems surrounding social media use. As social media continue to play a crucial role in healthcare, there is an urgent need to address these ethical issues to ensure that fundamental ethical principles and patient-centred care are upheld.

ACKNOWLEDGEMENTS

The authors thank all the participants who agreed to participate in this study.

AUTHOR CONTRIBUTIONS

Dr. Tan Wen Wu: Conceptualization (Lead), Methodology (Lead), Investigation (Lead), Writing - Original Draft (Lead), Visualization (Lead), Project administration (Lead), Supervision (Equal); Dr. Hasnah Hashim: Validation (Lead), Formal analysis (Lead), Investigation (Supporting), Data Curation (Lead), Writing - Original Draft (Supporting), Visualization (Supporting); Dr. Galvin Lin Sim Siang: Conceptualization (Supporting), Methodology (Supporting), Writing - Review & Editing (Lead), Visualization (Supporting), Supervision (Equal).

CONFLICT OF INTEREST

The authors declare that they hold no competing interests.

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