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Consent in 2016

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by Joseph Fell
Consent to a dental procedure used to be straightforward. The dentist told the patient what was to be carried out, and the patient agreed verbally. Hey presto; consent obtained. Not so in 2016!

GDC standards for the dental team states that registrants are required to "find out what your patients want to know as well as what you think they need to know". The recent Supreme Court case of Montgomery v. Lanarkshire Health Board endorsed this view and stated that health care professionals are required to treat their patients, "so far as possible as adults who are capable of understanding that medical treatment is uncertain of success .... accepting responsibility for the taking of risks affecting their own lives".

A recent case comes to mind. An eleven year old was referred by his general dental practitioner to a specialist centre for two dental extractions to be carried out utilising general anaesthesia, as the patient was very anxious. The eleven year old attended with his mother for an assessment visit, when a generic consent form was signed by the mother which stated that the operation was "dental extractions under G.A." The operation took place one week later when four teeth were extracted. After healing, the young man was referred for assessment to an orthodontist who was somewhat surprised to see a goodly number of teeth missing. The treating dentist had decided to extract all four permanent molars to alleviate "future crowding". However, she had omitted to inform the mother of this at the assessment visit, and asked the mother to consent to "dental extractions". Unfortunately, the young man had a condition called "congenital partial anodontia" (failure to develop one or more teeth), and would never have had orthodontic "crowding".

The consent process had not involved the mother fully in the dialogue. The consent was, in my opinion, not valid, and therefore, the extraction of the two extra molar teeth, negligent. A financial agreement was arrived at.

Consent requires dialogue, involvement and time to fully make the patient aware of all treatment options and outcomes. Dental practitioners would not practice 1970's dentistry in 2016, nor should they practice 1970's consent in 2016.