Whenever health professionals perform services, they must ensure they have authorization to proceed. Consent is agreement by the patient (or in the case of minors, the patient's parent or guardian) to undergo a dental procedure or series of procedures. Informed consent implies that the patient has been provided with an explanation of the benefits and risks of the proposed procedure(s), including alternative treatments, and of the risks of non-treatment, in terms and in a language that the patient (or parent or guardian) can understand.
Consent may be oral or written, but oral consent raises greater problems with credibility. The health professional should obtain a written general consent for routine services, either as part of the medical history form or on a separate form. Written consent should be signed by the patient (or parent or guardian) and ideally also signed by a witness.
Informed consent should be thought of as a communication process where a patient, with the advice and support of a health professional, makes decisions concerning the treatment to be received. The process helps develop trust between the health professional and the patient, and the communication is often the most important discussion a health professional will have with a patient.
Typically, the patient presents for service, gives a brief description of needs and concerns, receives a preliminary diagnostic examination or a complete examination, and participates in a discussion of what treatment needs to be provided. The patient sits in a position of apparent willingness to receive oral health services. This is implied consent. Consent also may be implied by circumstances, that is, an emergency or disability, such as mental incompetence due to psychological reasons or drug or alcohol abuse, where the patient is incapacitated and time is of the essence.
Another example of implied consent is the treatment of an avulsed tooth in a child when the parent or guardian is not available to give consent (e.g., if the child is brought by school personnel). The short window of opportunity for successfully re-implanting an avulsed tooth makes time of the essence. The dentist may choose to re-implant the tooth under implied consent and then document in the health record how the nature of the treatment necessitated immediate care.
Expressed consent involves a meeting of the minds as required when entering into any contract. Expressed consent is accomplished by disclosure of all material facts necessary for the patient to make an informed decision. The health professional’s duty to reveal risks and alternatives is measured by what the patient needs to know, explained in in terms and in a language that the patient (or parent or guardian) can understand.
Sometimes the health professional will begin a procedure with the patient's consent and cooperation, but then something may happen to change the situation. In most instances, the patient can withdraw consent, and the health professional must respect that wish. However, the withdrawal of consent must be timely. If the health professional is already in the middle of an irreversible procedure (e.g., dental extraction), it may be too late to withdraw consent.