What exactly is informed consent?

Looks confusing…your dentist has a lot to explain!

In dentistry (as in medicine), dentists have the obligation to fully explain planned treatment options before beginning treatment. The pros and cons of undertaking dental treatment should be explained to the patient’s satisfaction so a proper choice about what to do can be made. Also, possible risks of accepted treatment should be discussed.

In dentistry, we tend to fully explain complicated procedures, and may even ask patients to sign a form stating they fully understand everything explained. Sometimes when we are completing “simple procedures” like dental cleanings or fillings, we do not expect a form to be signed, as we expect a patient understands what treatment will take place. However, this does not mean that possible complications shouldn’t be explained as well. For example, sometimes when removing an old filling which was “not bothering” the patient before treatment, the tooth may be sensitive afterwards, the tooth may actually be cracked under the old filling, or decay may extend into the nerve of the tooth…all of these occurrences may lead to the need for further treatment after what seemed like a simple procedure. If you are the patient, you would probably like to know these things are possible before beginning treatment!

What is Informed Refusal?

This means that a patient always has the right to refuse recommended treatment. In fact, when we explain treatment options to our patients, “no treatment at all” is always discussed as an option! Of course, there are often consequences to “no treatment”, and these are always discussed with the patient as well.

We have had some patients in our practice who refuse things like dental x-rays, yearly examinations, and dental hygiene appointments; refusal of these poses a problem in our office as they may prevent us from fully diagnosing problems and/or allowing our patients to have mouths healthy enough to have other treatments completed successfully. As well, the Royal College of Dental Surgeons of Ontario (RCDSO) requires a dental patient to have a “recall examination” once per 12 months, otherwise a dental hygienist is not allowed to complete a “cleaning” appointment for that patient. Also understand that only a dentist, not auxilliary staff of any kind, may diagnose dental disease.

Don’t want to sign a Refusal of Treatment?

Please know that this type of document serves to protect both the patient and the dentist or dental team taking care of you! The bottom line is the dental patient should always have choice whether or not to pursue treatment of any kind. Also, the dental team needs to keep proof for recordkeeping purposes (and by rule of the RCDSO) that a patient was offered diagnostic procedures and/or treatment and fully explained the pros and cons of treatment or no treatment.

Typically, when a Refusal of Treatment is signed, the treatment recommended was deemed important by the dentist. In fact, in our office the only times we ask a patient to sign a refusal of treatment occur when we feel the consequences of no treatment will cause significant harm to the patient or will significantly affect our ability to diagnose or treat dental disease. For example, when a patient refuses routine x-rays in our practice, this prevents us from seeing anything going on either inside a tooth or under the gum tissue, which could prevent us from properly diagnosing dental infections. Untreated dental infections can spread beyond the mouth, causing illness to other areas of the body.

Questions?

If you need more information about the Informed Consent or Informed Refusal process, please feel free to ask or comment below! The more information you have, the better decision you can make about your dental health!  Andrea Stevens is a cosmetic and family dentist in practice in Kanata, Ontario.  If you have dental questions, you can call her at 613-271-7091 or visit her at kanatacosmeticdentist.com Please also feel free to leave comments or questions below, and Dr. Stevens will be happy to answer!