We read with great interest the recent letter by Mathew et al.1 which highlighted the liability paradox arising when clinicians and artificial intelligence (AI) systems disagree. We share their concern and agree that urgent regulatory and governance frameworks are required to ensure AI remains a support tool rather than a liability trap in dentistry. Building on this important discussion, I would like to extend the debate to the wider ethical and governance challenges posed not only by AI but also by emerging immersive technologies in dental education and practice.2,3,4,5,6

As these technologies become increasingly embedded in dental curricula and clinical workflows, their ethical dimensions demand urgent and sustained attention. Concerns surrounding patient data privacy, algorithmic bias, transparency, and accountability are well-documented in healthcare AI discourse. In dentistry, these issues intersect with the profession's duty of care, professional integrity, and the safeguarding of vulnerable populations, particularly in educational and preventive public health contexts.

Algorithmic bias poses a risk of perpetuating inequities in care if training datasets are not representative of diverse populations. Similarly, overreliance on AI outputs could undermine independent clinical reasoning among students and dentists, raising questions about competency development. In the case of dentists, there is the additional legal uncertainty of accountability when a decision reliant on AI yields negative results for patients. Robust governance should therefore mandate explainability in AI decision-making, enable bias detection and mitigation, and integrate ethics training into dental curricula to foster critical appraisal skills alongside technological proficiency.

Immersive technologies introduce additional, underexplored ethical challenges. Virtual learning environments that incorporate social presence and avatar embodiment such as the metaverse can amplify the risk of cyberbullying, harassment, and psychological harm, particularly for adolescents and other vulnerable groups. Unlike traditional online platforms, immersive environments blur physical and virtual boundaries, complicating legal and ethical accountability. In oral health promotion, where sustained engagement is essential, negative experiences could discourage participation and erode trust in digital interventions.

Addressing these risks requires a proactive approach. Institutions and developers must embed ethical foresight into the design and governance of AI and immersive platforms which includes implementing clear behavioural standards, transparent consent processes, data security safeguards, and real-time monitoring systems for interactive environments. The transformative potential of AI and immersive technologies in dentistry can only be realised through their responsible and equitable integration. We advocate for interdisciplinary collaboration between dental educators, ethicists, technologists, and policymakers to establish comprehensive ethical frameworks.

These frameworks should be anchored in the principles of transparency, accountability, equity, and patient-centred care, consistent with the Hippocratic ethos of safeguarding patient welfare, thereby ensuring that technological innovation serves to strengthen rather than erode the professional and ethical foundations of dentistry.