Why cultural sensitivity matters in consent

Biju Krishnan explains the impact that differences in patient background can have on consent in dentistry, and why cultural sensitivity is essential to fulfil legal and ethical obligations.

‘You want to do what to my tooth?’ is not a question we want to hear halfway through our best attempt at explaining a root canal. But behind that raised eyebrow or politely confused nod may lie a far deeper issue than dental anxiety: a mismatch between clinical intention and cultural understanding.

In our increasingly diverse patient population, consent is no longer a matter of ticking a box and trusting the patient ‘got the gist’. True informed consent, the kind that actually holds up legally and ethically, must go beyond simply telling. It must ensure understanding, respect for beliefs, and space for values that may not mirror our own.

And yes, it’s more complex than ever. But thanks to emerging tools that check and reinforce patient understanding – not just record a signature – it’s becoming easier to do this well.

From legal obligation to ethical opportunity 

On paper, informed consent requires that the patient understands the nature, benefits, risks, and alternatives of a treatment. But in practice? It often involves navigating language barriers, cultural frameworks, and family dynamics that shape how information is received.

Take the example of Mr H, a 67-year-old man with limited English proficiency who nods through your treatment plan, largely translated by his teenage grandson. Post-op, he’s livid – not because the outcome was poor, but because he had no idea a tooth was going to be removed. The grandson ‘simplified’ the message to ‘they will fix it’.

The issue often stems not from malice but from misalignment between what’s communicated and what’s understood. This underscores the importance of structured tools that support clear, consistent communication. Digital consent platforms can guide clinicians with evidence-based scripts and offer patients concise, often multilingual explanations, followed by comprehension checks. The goal is more than completing a form – it’s ensuring mutual understanding. 

Culture, belief and tradition  

Dental treatments touch on more than enamel. In some cultures and religions, teeth are linked to identity, dignity and even the afterlife.

• Body integrity and burial traditions: for some orthodox Jewish and Islamic patients, maintaining the body whole – even after death – is vital. Extractions can raise serious concerns unless sensitively addressed
• Gender roles: in some communities, female patients may decline treatment from male dentists or defer decisions to male relatives. This isn’t passivity – it’s cultural structure
• Fasting: patients observing Ramadan may avoid procedures during daylight hours, especially those involving water, anaesthetic, or ingestion
• Blood-related restrictions: Jehovah’s Witnesses may refuse surgical interventions involving blood transfusions or derivatives – even when medically advisable.

A deeper understanding of a patient’s traditions and customs is essential, as it shapes how information is received, processed, and acted upon. Tools that provide tailored, patient-accessible content – particularly in multiple languages and cultural contexts – help mitigate these gaps. They make it easier to approach sensitive issues with both clarity and respect.

Language: the great divide 

Communication breakdown is one of the biggest threats to valid consent. Dental terminology is a minefield for many patients.

‘You’ll need an apicectomy under local anaesthetic’ might sound like wizardry to someone unfamiliar with even basic dental concepts – especially in a second language. The risk is particularly high when we rely on ad hoc interpreters – well-meaning family members who may filter or rephrase clinical details. This can lead to incomplete understanding, and sometimes, entirely wrong decisions.

Digital consent tools offer a safety net. Instead of relying solely on verbal explanations, they supplement conversations with visual aids, videos, and interactive text, designed to be accessible to patients with varying levels of health literacy. Crucially, many such platforms incorporate a ‘check for understanding’ feature – where patients answer simple questions to confirm they grasp the essentials. It’s not a test; it’s validation that consent is truly informed.

Values, assumptions, and the unexpected

Not all challenges to consent are cultural. Some are deeply personal: 

• A staunchly vegan patient who refuses any product derived from animals – including polishing pastes or denture materials
• A patient opposed to fluoride on philosophical grounds
• An elderly gentleman who refuses anaesthetic because ‘real men don’t need it’.

These aren’t obstacles – they’re insights. When patients express values that influence treatment preferences, it’s an opportunity to build trust. Listening without judgement, exploring safe alternatives, and clearly documenting these preferences shows that we respect the individual behind the mouth.

Once again, tools that provide flexible consent pathways, allowing clinicians to adjust treatment options and flag patient-specific concerns, make it easier to meet patients where they are.

Why bother?

Because culturally attuned consent doesn’t just tick a legal box – it improves outcomes. Patients who feel heard and understood are more likely to: 

• Accept and complete treatment plans 
• Comply with post-op care 
• Recommend the practice to others 
• Avoid litigation or complaints.

In a world of online reviews and regulatory scrutiny, there’s a tangible business case for ethical clarity.

Five steps towards better cultural consent 

• Know your community: understand the demographics and beliefs that shape your patient base
• Use interpreters, not relatives: better yet, use validated tools with multilingual content and structured guidance
• Ask before assuming: a simple, ‘What are your thoughts about this?’ can open up crucial conversations
• Use technology: digital consent platforms don’t replace communication – they enhance it, document it, and safeguard it 
• Keep learning: cultural competence isn’t a one-off training – it’s a mindset. 

Less guesswork, more good work 

Let’s be honest: none of us got into dentistry dreaming about paperwork and legal disclaimers. However, consent isn’t just a form – it’s a bridge. A bridge between what we know, and what the patient understands.

So when you next reach for that consent form, remember: it’s not just a document, it’s a dialogue. One that can be better supported – and less risky – with the right tools and the right attitude.

In the end, being culturally sensitive isn’t about walking on eggshells. It’s about walking beside the patient, not ahead of them. 

Visit www.dentistry.co.uk/consent to get started with Dentistry Consent.

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