Dentist-Patient Relationship and Informed Consent
What you must know
Valid consent has substance and process. Substance: the diagnosis, the nature and purpose of the proposed treatment, material risks, expected benefits, reasonable alternatives (including no treatment), and the likely consequences of refusing. Process: the discussion happens before treatment, in terms the patient can understand, with an opportunity for questions, and it is documented - who consented, when, what was disclosed, and what questions were answered. A signed form is evidence, not a substitute for the conversation; a signature obtained after treatment begins proves little.
Capacity and authority matter. An adult with decision-making capacity consents for themselves. For a minor, the parent or legal guardian consents; an emancipated minor may consent. Do not treat a child on a caregiver's informal say-so. Emergencies permit treatment without express consent only to the extent necessary to prevent serious harm.
The relationship, once formed, cannot be ended by simply refusing to schedule. Ending it requires notice, a reasonable transition (records, referral resources, emergency instructions), and a defined period of continued availability for genuine emergencies.
Traps
- Equating a signed form with informed consent.
- Assuming a dentist must accept every patient; declining non-emergency treatment for legitimate, non-discriminatory reasons is permitted - abandonment is not.
- Letting consent for one procedure cover an unanticipated, materially different procedure.
- Failing to document an informed refusal.
Worked example
A patient declines a crown and asks for a filling on a cracked molar. Document the discussion: fracture risk, the alternatives, the patient's choice, and that the patient may reconsider. That converts a potential liability into a defensible informed refusal - when the record shows the conversation, the consent question usually answers itself.