The concept of consent arises when a patient seeks advice, care and treatment from a dentist and that dentist carries out an examination of the patient and provides them with details of the treatment required together with the options, benefits and risks as well as the cost of that treatment. This is an on-going conversation that is picked up at every stage of the treatment being provided.

Most dental procedures are carried out without the need for written consent but it is important that a record is made (either by the dentist or dental nurse) of the conversation during which the patient gave their consent.

When seeing a patient for a dental examination there is likely to be implied consent that the patient wishes the dentist to look in their mouth and therefore opens it to facilitate this. When carrying out more invasive treatment such as taking radiographs and providing fillings, the dentist should obtain the express consent of the patient for each procedure.

Certainly when carrying out clinical treatment patients should be informed of the various options which are available to them; the risks and benefits of the options, the likelihood of success, the costs of the treatment as well as the risks of not having a particular treatment carried out.

In Ireland, consent only needs to be obtained in a written form signed by the patient, when the treatment is being provided under general anaesthetic or sedation.

Some employers make it a contractual obligation to obtain the patient’s signature on a consent form for a variety of procedures as well as anaesthesia. The employee has an obligation to respond to the terms of their contract. Indeed in complex cases it is a sensible precaution to have some form of written consent. This would apply to treatment plans for extensive restorative work or for patients undergoing treatment which could pose a significant risk, such as the removal of a lower wisdom tooth.

The signature on a consent form does not automatically imply the patient has provided their consent to the treatment. All it means is that the patient has signed their name and may not in fact have understood the treatment which the dentist had discussed with them.

The best way of ensuring consent has been obtained is to check with the patient if they fully appreciate the details of what has been discussed and to make good notes within the clinical records of both the discussion and the patient’s response.

Read our advice booklet on consent in Ireland

The role of the clinician continues to evolve in the provision of appliances either for the treatment of snoring or to assist in the treatment of Obstructive Sleep Apnoea Syndrome (OSA). 

Dentists may be asked to fit anti-snoring appliances and Dental Protection has frequently been asked if the provision of such devices can be considered to be the practise of dentistry and therefore is within the scope of assistance normally provided to dental members.

Our view is that:

• Dentists are well placed to construct any oral appliance/device provided they have appropriate training to do so.
• The diagnosis and treatment of OSA, other sleep disturbances or snoring conditions does not fall within the definition of the practise of dentistry and therefore falls outside the scope of assistance normally provided by Dental Protection. However, dentists can have an important role in the screening of patients for signs and symptoms which may predict the presence of OSA.
  Read more here.

Patients may request that a dentist provide an anti-snoring device. A member will be entitled to apply for assistance in respect of the provision of such appliances provided the following conditions are met:

1. The dentist has undergone a documented training course in the provision of anti-snoring appliances which includes training in the appropriate screening for OSA.
2. The patient has been properly assessed for the signs and symptoms of OSA in accordance with contemporary standards and such assessment is documented.
3. If the patient exhibits signs or symptoms of OSA, there must be a referral for a medical assessment.
4. Patients should be advised if appropriate of the risks and benefits of anti-snoring appliances including any potential impact on the occlusion and the temporomandibular joints. Documentary evidence of the consent process must be kept.

Where OSA is present, any anti-snoring device should only be provided as part of an integrated treatment plan. Dental Protection will not normally assist when the above conditions are not met in full.

Most patients have an expectation that their dentistry will either be pain-free or that any pain will be managed effectively. Therefore, the provision of a local anaesthetic for a given procedure will initially involve a discussion with the patient about the nature of the procedure being contemplated and what they may expect.

This is an issue of consent. As a clinician, you should not impose your views and provide treatment without local anaesthetic simply because you have considered the matter (as requested by the practice owner) and concluded that the procedure will not be painful and does not require local anaesthetic. 

It is incumbent upon clinicians to respect patient autonomy and an individual’s right to make decisions about their treatment and this would extend to a decision about local anaesthetic.

In any case, the patient’s medical history initially needs to be checked and updated before considering the type of local anaesthetic to be administered.

Our advice booklet on consent is available here. 

If a patient reviews the displayed fees then he or she will have some idea of treatment costs. However most patients would have little or no idea of, for example, the number and type of radiographs required, or the differences between the various types of restorations.  
As well as the requirement to display fees in private practice, the Dental Council Code of Practice: Professional Behaviour and Ethical Conduct states that you must:

• provide an estimate of the cost of treatment options
• get your patient’s agreement before the treatment commences.

It also recommends that you give an estimate of costs in advance and in writing. If the estimate needs to be revised as treatment progresses, you should give a full explanation of the revised costs as early as possible.

The display of fees assists the patient with general information prior to the clinician providing specific information in relation to their specific course of treatment. This avoids any unexpected fees and should assist the clinician in collecting the fees in a timely fashion.