Quick Guide To Consent

Guide to consent to dental treatment
• Make sure the patient is given enough information about the risks
You must seek and benefits of all reasonable treatment options (including no
treatment) before treatment starts.
consent before any
• Patients have a right to information, and their questions should be
investigation or answered truthfully and fully.
treatment, and • Confirm they still understand the risks and benefits of the procedure
to be performed at every appointment during each course of
certain criteria treatment.
must be fulfilled • Make sure the patient understands the cost of any proposed
treatment.
for consent from a
• Record all conversations about the risks and benefits of treatment
patient to be valid. options in the patient's notes.
14 September 2022 Consent must be:
• voluntary, made by the person themselves and free from pressure

from others
• informed, with the person having all information about the nature,
purpose, benefits, material risks of and alternatives to the proposed
treatment, along with the likely outcome of no treatment
• the person must have capacity and be able to understand the
information provided and use it to make an informed decision
When seeking consent to treatment, the question of whether the

information given to a patient is adequate is judged from the
perspective of a reasonable person in the patient's position.
For the purposes of consent, the Montgomery ruling replaces the

previous test applying from the cases of Bolam and Sidaway.
When obtaining consent, dental professionals have a duty to take

reasonable care to ensure that patients are aware of 'material risks'
and understand their implication.
Valid consent: legal duty

You have a legal duty to obtain patient consent by making sure the
patient is aware of any material risks involved in the proposed
treatment, and of any reasonable alternatives.
This follows the Supreme Court judgment in Montgomery v
Lanarkshire Health Board [2016 UKSC 11], which ruled that when
discussing the benefits and risks of various treatment options with
patients, clinicians must:
• provide information about all material risks

• disclose any risk to which a reasonable person in the patient's
position would attach significance.
Before Montgomery, a dental professional's duty to warn patients of

risks was based on whether they had acted in line with a
responsible body of dental opinion; this was known as the Bolam
test.
The Bolam test, or Hunter v Hanley in Scotland, still applies to

assessing standards of care in wider negligence cases.
Material risks
According to the Montgomery judgment, "the test of materiality is
whether, in the circumstances of the particular case, a reasonable
person in the patient's position would be likely to attach significance
to the risk," or the dentist is reasonably aware that the patient in
question would be likely to attach significance to it.
• Whether a risk is material depends on more factors than its

frequency or magnitude.
• A material risk is patient-specific; the nature of the risk, the effect of
its occurrence on that individual patient's life and the importance
of the beneficial aim of treatment should all be considered.
Valid consent: ethical duty

One of the key principles of the GDC's 'Standards for the dental
team' is the need for dental professionals to share information with
patients, such that patients can make a decision.
As a dental professional, you also have an ethical duty to discuss

material risks with patients when obtaining consent for treatment.
Include all necessary information
The information patients might want to know before they consent

includes, but is not limited to:
• options for treatment and why you think a particular treatment is

necessary and appropriate for them
• consequences, risks and benefits of the treatment you propose
• the prognosis and what might happen if treatment isn't given
• whether treatment is guaranteed, how long for and any exclusions
that apply.
Failing to give correct or sufficient information when obtaining
consent might breach your duty of care. A patient could be entitled
to compensation if it is proved there was a negligent failure to
inform, and they suffered harm as a direct result.
Give the patient time
• The patient must be given a reasonable amount of time to consider

the information in order to make a decision.
• It's a good idea, particularly with complex, elective or cosmetic
treatment, to obtain consent at an earlier date than that of
treatment, to allow a 'cooling off' period in which a patient can think
over their decision and/or take advice.
• Make sure you are confident the patient is not under any coercion
or pressure to give, or withhold, consent.
• It's best to reconfirm consent with the patient immediately before
treatment.
Be clear about costs
• Explain the cost of any examination, investigation or treatment

before it starts. This includes whether treatment is being carried out
on the NHS, privately or on some other payment basis.
• A patient who agrees to pay the bill has not necessarily consented
to treatment.
Look out for change
• If a patient's condition alters significantly between initial consultation

and treatment, causing a change in the nature, purpose, or risks of
the procedure, you must explain the changes, obtain consent again
and record them.
• A change in the cost of treatment should be reviewed with the
patient.
Keep documentation
• Keep all written consent documents with the patient's records and
make a contemporaneous note in the record of your discussions
with the patient.
Obtaining consent
• It is a general, legal and ethical principle that all members of the
dental team providing treatment should obtain consent before
starting treatment.
• Where this is not practicable, another appropriately qualified dental
professional familiar with the proposed treatment should obtain
consent. You should make sure this other professional understands
the risks and benefits and follows the GDC's guidance on consent.
• All members of the dental team have a responsibility to verify that
consent has been properly obtained before starting treatment.
Implied consent
Consent to dental examinations is implied when, for example,

having been told what is planned and properly advised, the patient
voluntarily sits in the dental chair and opens their mouth.
Express consent
For procedures other than dental examinations, including

radiographs, the patient's express consent (oral or written) is
needed.
When a patient has given oral consent to treatment, you should

make a note in their clinical record of the advice given, including
any risks and benefits and likely outcomes, and the fact that the
patient has understood and consented. This is particularly important
where treatment is significant and not routine.
Written consent must be obtained for treatment under conscious

sedation or general anaesthetic, as set out in the GDC's guidance.
It is also advisable to gain written consent for photographs which
are to be used outside of a patient record e.g., on a social media
post, practice website, or in a presentation. This allows patients to
be clear about what their photos will be used for.
Evidence of consent
• Although a consent form may not always be necessary, you may

want to consider using one in case documentary evidence is
needed in the event of a dispute.
• A patient's signature on a treatment plan or consent form is not
consent in itself, and is not as important as the quality of
explanation and information given to - and understood by - the
patient.
• A signature on a treatment plan or consent form may provide
evidence that consent has been obtained, but remember that
consent is an ongoing process, not just a signature.
• A consent form or treatment plan shouldn't be altered after a patient
has signed it. If you need to make changes to a planned procedure,
discuss with the patient in full and, if necessary, have them sign a
new form.
Emergency treatment
During treatment, you should only carry out procedures to which a
patient has expressly consented. The only exception is emergency
treatment necessary to prevent serious harm or to safeguard a
patient's life.
This information is intended as a guide. For the latest dento-legal

advice relating to your own individual circumstances, please contact
our dento-legal team on 0800 374 626 or email
advisory@theddu.com

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Guide to consent to dental treatment

14 September 2022 Consent must be:

• voluntary, made by the person themselves and free from pressure

When seeking consent to treatment, the question of whether the

For the purposes of consent, the Montgomery ruling replaces the

When obtaining consent, dental professionals have a duty to take

Valid consent: legal duty

• provide information about all material risks

Before Montgomery, a dental professional's duty to warn patients of

The Bolam test, or Hunter v Hanley in Scotland, still applies to

• Whether a risk is material depends on more factors than its

Valid consent: ethical duty

As a dental professional, you also have an ethical duty to discuss

Include all necessary information

The information patients might want to know before they consent

• options for treatment and why you think a particular treatment is

Give the patient time

• The patient must be given a reasonable amount of time to consider

Be clear about costs

• Explain the cost of any examination, investigation or treatment

Look out for change

• If a patient's condition alters significantly between initial consultation

Consent to dental examinations is implied when, for example,

For procedures other than dental examinations, including

When a patient has given oral consent to treatment, you should

Written consent must be obtained for treatment under conscious

• Although a consent form may not always be necessary, you may

This information is intended as a guide. For the latest dento-legal

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