Informed consent

Consent can only be obtained by someone who has sufficient information about the patient and the treatment options they are considering, including the risks, benefits and alternative options. In practice, this means that only the dentist can obtain consent to treatment from a patient. The hygienist may also obtain consent where the patient is attending for periodontal treatment; though in practice consent will have been obtained by the dentist first and is being confirmed by the hygienist.

We aim to provide each patient with sufficient information, in a way that they can understand, to allow them to decide about their care. We use various communication tools to ensure that the patient understands what is being suggested. In particular we:

• Show patients intra-oral photographs of their mouth and teeth so that they can see what the dentist sees;
• Show patients their x-rays and explain what we’ve found on them;
• Use 3D models to explain disease processes and treatment options;
• Ensure that we have up to date information on our website to help patients understand their choices;
• Provide patients with written treatment plans/estimates; and
• Provide patients with information leaflets and emails telling them about the treatments they’re proposing to have.

In our discussions with patients, we explore what they want to know to help them make their decisions and explain:

• Why we feel the treatment is necessary;
• The risks and benefits of the proposed treatment;
• What might happen if the treatment is not carried out; and
• The alternative treatment options and their risks and benefits.

We encourage patients to ask questions and aim to provide honest and full answers. We always allow patients time to make their decisions.

We always make sure that the patient understands either if they are being treated via the NHS or on a private fee basis.There are statements on the practice website and in the “welcome” letters and emails that make clear the the differences between practice treatment on a private basis and on an NHS basis.

We also make sure that the patient knows what the costs will be, both verbally and, where a patient decides to embark on a course of treatment, we provide a written treatment plan/estimate (supported by information leaflets or emails about their treatments).

Where changes to the treatment plan are needed, we obtain the patient’s consent, including to any changes in the costs. We then provide an amended treatment plan/estimate.

 

Voluntary decision making

Decisions about their care must be made by the patient – and without pressure. Most people will feel able to reach decisions and give consent quickly – usually at the same appointment where treatment is recommended. However, patients must always be given as much additional time as they feel they need in order to reach a decision. This is why we follow up discussions on treatment with costed treatment plans/estimates and further information leaflets and emails.

We respect the patient’s right to:

• refuse to give consent to treatment, and
• change their minds after they have given consent (consent is ongoing and can be withdrawn at any time).

When this occurs we will not put pressure on the patient to reconsider but where we feel it is important, we will inform the patient of the consequences of not accepting treatment and explore with them any further alternatives that may be available.

 

Ability to give consent

Every person aged 16 or over has the right to make their own decisions and is assumed to be able to do so, unless they show otherwise.

Children under 16 years may be able to give informed consent to examination and treatment, too. We always try to involve children in discussions about their treatment, even if they are not able to give fully informed consent on their own (refer to Child Protection Policy and Guidance).

If a child is able to make decisions about their treatment and wishes to do so, we will respect their privacy and right of confidentiality – in other words, if a 15-year-old is competent (and wishes) to make decisions for themselves, we will respect their right to do so and will not share information about their treatment with their parents without their permission (refer to Confidentiality Policy).

Where we have doubts about a patient’s ability to give informed consent, we will follow the assessment procedure set out in BDA Advice Note 63 “Assessing Mental Capacity” and seek advice from our defence organisation.

Where someone other than the patient (eg the patient’s guardian) needs to be involved in a decision about their care (eg because the patient cannot give valid consent) we will identify them and ensure that they are involved.

 

Decisions requiring patient consent

Examples of decisions that require patient consent are:

• Carrying out examinations and diagnostic tests, including soft tissue exams, perio charting, vitality testing, cold-testing, taking photographs, taking x-rays, etc;
• Administration of topical and injectable local anaesthetic prior to commencement of treatment procedures;
• Commencement of treatment procedures, including placement of fillings; preparation for crowns, bridges, veneers, inlays, onlays; root canal therapy; extractions; scaling and polishing, etc;
• Making referrals to other service providers; and
• Prescribing medicines; in particular the prescription of antibiotics.

Examples of decisions that do not require patient consent are:

• Observance of standard procedures that are essential to good practice: for example, cross infection control procedures (use of gloves, masks, eye protection, etc); and
• Matters of purely professional technique, such as selection of appropriate materials and instruments: for example, it would not be necessary to consult the patient over correct choice of elevators, endodontic files, cements and adhesives; HOWEVER, a patient should be consulted about issues that will affect outcomes in a manner that is obvious to them, such as shade selection for fixed and removable prosthodontics.

 

Written, verbal and implied consent

Written consent: The guidelines issued by the General Dental Council (Standards for the Dental Team, paragraph 3.1.6) require dentists to obtain written consent where a patient is to receive treatment under general anaesthetic or sedation, but not otherwise. We do not undertake these procedures within the practice and refer patients to other service providers where they become necessary. Accordingly, we do not normally ask patients to give written consent. We may ask for written consent where there are unusual or exceptional circumstances, but this would be a rare event.

Implied consent may be inferred from a patient’s actions. For example, a patient’s actions in booking and attending an appointment and then by sitting in the dentist’s chair may tend to indicate that they consent to a procedure; but this will rarely be enough in itself. We only rely on implied consent in limited circumstances. For example:

• A patient may be considered to have consented to a dental examination because they booked the appointment, attended for it and sat themselves down in the chair. However, the dentist always clarifies with the patient that they are going to have an examination before they lie the patient back and begin. It is important to note that while implied consent may be sufficient in the case of a dental examination, this implied consent cannot be taken to extend to attendant diagnostic tests, such as x-rays.

• Where a patient invites a spouse, parent, friend, carer, etc to join them in the surgery during an appointment, their actions imply that they consent to this other person being privy to what happens and what is discussed.

Verbal consent is by far the most usual form of consent to treatment that we encounter. Following explanations from the dentist or hygienist, a patient will usually communicate their decisions about treatment verbally. We make a record of this in the patient’s notes.

We support the process of obtaining verbal consent by providing treatment plans/estimates to the patient and also by providing information leaflets and emails explaining more about the process of treatment, risks and benefits, alternative treatments, etc. This is almost always done after an examination (when treatment needs have been identified and discussed) and before active treatment is undertaken (usually at a later appointment). Providing further information in this way gives the patient another opportunity to consider what we are planning to do and to ask for more information or change their mind before treatment begins.

References: Principles of Patient Consent (GDC); Standards for the Dental Team (GDC) – particularly Principle 3; Mental Capacity Act 2005