Informed consent measures can help patients better understand what’s at stake with complex treatment protocols. Standardizing the informed consent process in the office helps dentists reduce their liability by improving patient involvement and satisfaction. 

 By Ty M. Galvin, D.D.S. and Michael A. Gile, D.D.S.

For preventive treatment such as cleanings, dentists can reasonably count on having a patient’s verbal implied consent. When procedures become more complex, however, patients must acknowledge the risks involved and dentists must do what they can in order to insulate their practices from liability.

Informed consent measures help achieve both objectives.

A two-fold process, informed consent entails a verbal detailed discussion surrounding the dental issues uncovered during examination. It also involves securing a written, signed document acknowledging the patient’s understanding of the diagnosis, the proposed procedure, any alternative treatments and the risks involved should you proceed with the recommended course of action.

Take a patient who needs a root canal and subsequent crown, which requires reconstruction of a tooth over multiple visits. You’ll want to let them know as much as possible about the procedure to help avoid misunderstandings and/or potential legal action.

Signed informed consent documents not only help confirm that the communication between dentist and patient about a pending procedure is understood, but also add a layer of protection against risk to your practice.

5 best practices for informed consent

While guidelines vary among states, there are no prescribed laws requiring formal informed consent processes, making it harder to know what should be included, but the dentist-patient communication is the critical part of consent. Here’s a list of best practices to shore up your internal protocols regarding informed consent.

1. Know the procedures that require an informed consent agreement. Since informed consent is procedure driven, understanding the types of procedures that require documentation is important. Here’s a recommended list of procedures that should trigger the need for informed consent:

• Biopsy and refusal
• Composite fillings
• Cosmetic treatments
• Extractions
• Implants
• Oral surgery
• Nitrous oxide sedation
• Endodontic procedures
• Pulpotomies
• Intravenous sedation
• Crowns and bridges
• Refusal of recommended treatment
• Refusals of x-rays
• Silver amalgam fillings
• Temporomandibular joint therapies
• Laser therapy
• Clear-tray orthodontics
• Removable prosthetics
• Scaling and root planning
• Optional preventative treatments

2. Consider any and all extenuating circumstances. The list of specific dental procedures must be addended when performing routine and preventive care procedures in special situations, including:

• Procedures involving minor children. If a parent is not present to establish written informed consent, permission can be obtained over the telephone as long as it is well-documented in the chart. Often the person bringing a child to their dental appointment may not be a legal guardian and cannot make decisions on their behalf.
• Procedures on patients with diminished mental capacities or debilitating physical conditions. Guardians or caregivers can provide informed consent but if these parties are not present, secure written consent in advance of the visit.
• Procedures performed on patients who are non-English speakers. In these situations, validate the clarity of messaging within multilingual documentation and/or enlist the help of a translator.
• Procedures performed on patients with hearing impairments, or protected classes under the Americans with Disabilities Act. Guardians, caregivers and translators may also relay or give consent.

3. Standardize the process. Creating a single policy streamlines the informed consent process within your dental practice. A team effort between professional and administrative staff allows for tailoring policy to your operational capacities. Your practice should outline each procedure that may fall under the umbrella of an informed consent designation. Every staff member participating in the endeavor should band together to reach a common goal of minimizing liability to the practice.
4. Understand the elements to address in a consent agreement. The informed consent process should revolve around both the practitioner-patient discussion and the language included in the document provided for signature. In both iterations, you’ll want to cover details about the procedure itself, the risks and benefits of the treatment, alternatives to the proposed procedure and the consequences of refusing any treatment. Give the patient an opportunity to raise additional questions and time to read the prescribed agreement before signing. At each stage of the process, document all communications and patient concerns. Having designated informed consent agreement forms ready for all procedures that will require one is key.
5. When in doubt reach out to a risk manager. The nature of every informed consent situation can’t be consistently predicted. For example, one parent may consent to a procedure for a minor child while the other parent does not concur. To help adequately protect your practice from any legal or financial fallout, securing the opinion of a risk professional may help reduce your exposure to adverse consequences. Remember, you have the right to refer the patient to another practice or discontinue existing treatment if you do not receive informed consent.

The common denominator

Throughout all interactions between dentists and patients, clear, concise and open two-way communication around procedures and risks is the goal. When it comes to procedures requiring informed consent agreements, this informative practice helps ensure that dentists, patients and support staff are all on the same page.

For additional guidance on navigating and securing informed consent, contact PPP Risk Management and visit the risk management page for informed consent sample forms.

This information is intended for informational purposes only. Nothing contained in this publication is, nor is intended to be, legal or dental advice. Professional Protector Plan for Dentists is not liable for any injury, loss, damage or expense arising out of or in connection with the use of this information.