Dental patients need ‘cooling off period’

A common allegation in complaints and claims notified to the Dental Defence Union (DDU) is that the patient was not fully informed of the risks of treatment beforehand or given enough time to discuss their concerns.

In the latest edition of the DDU Journal, dento-legal adviser Susan N’Jie discusses the importance of giving patients a ‘cooling off period’ before proceeding with treatment, and consent protocols which can help inform the consent process.

Consent can be a tricky area for dental professionals to navigate.

With many more people undergoing elective treatments for aesthetic purposes, it’s absolutely vital that dental professionals go through the necessary procedure to obtain appropriate and valid consent before proceeding with any treatment.

Patients must receive a clear explanation of the proposed treatment, the cost, and any risk and alternative treatments – and then allowed a period of time in which to consider whether they wish to proceed.

The DDU understands that some patients may wish to know very little about their treatment, while others will want their dental professional to go through every aspect, including all possible complications.

Either way, dental professionals must ensure that they give the patient all the appropriate information and enough time to make a decision.

Contemporaneous notes should be kept of conversations with the patient, as without these, it can be more difficult to defend a claim where the validity of the consent obtained is in dispute. A signed consent form may not, in itself, benough to prove that the patient was fully informed at the time.

Susan N’Jie said that: ‘A reasonable cooling-off period gives the patient a chance to reflect on their decision and seek advice. During this time, you may want to provide explanatory leaflets to support any discussion and to ensure that the patient is as informed about their treatment as possible. This is particularly valuable when you’re proposing costly aesthetic treatments such as veneers or implants.

‘It’s important to remember that obtaining consent is not a one-off event. Dental professionals should be confirming at every appointment during the course of the treatment, that the patient understands the risks and benefits and that they can change their mind at any time. It’s also advisable to have consent protocols which help to ensure consistency across the dental team.’

The DDU advises dental professionals to consider undertaking the following checks as part of the process for obtaining consent:

• Who has primary responsibility for obtaining consent and who is involved in providing treatment?
• Is the patient under 16 and if so, are they ‘Gillick competent’? If not, who has parental authority and has this been obtained?
• Has the patient been given written information to take away with them?
• Has the advice given been entered in the patient’s notes, including any warnings given?
• Has the patient been given a ‘cooling-off period?
• Have you explained the cost of the treatment, including whether treatment is being carried out on the NHS or privately?
• Has the (named) dental professional re-confirmed consent with the patient immediately before treatment begins?
• Have you informed the patient that refusal to consent will not affect their right to receive reasonable and proper care but may mean that the original treatment plan has to be revised or abandoned?

If the patient’s condition has changed significantly between initial consultation and treatment, has the dental professional explained how the changes affect the nature, purpose or risks of the procedure and obtained consent again?

Also in this issue of the DDU Journal, head of the DDU, Rupert Hoppenbrouwers discusses the GDC’s review of its fitness to practise procedures and DDU dento-legal adviser, Mark Phillips investigates the delicate art of delivering bad news.

For more information or to request a copy of the journal please visit

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