Informed Consent

Board takeaway

• Authority. Obtain a voluntary, informed decision from the person authorized to make it before treatment.
• Discussion. Explain the diagnosis, proposed care, benefits, material risks, alternatives, and no treatment; check understanding and document the discussion.
• Revisit. Seek the child’s assent when possible, and update consent when the plan changes.

Who can decide?

Confirm legal authority

• AAPD uses “parent” broadly: legally authorized biological/adoptive parents, persons granted parental rights by statute, parents with legal custody, court-appointed guardians, persons with limited health care decision authority, and foster parents. Actual authority depends on law and court orders.
• Either parent generally may consent, unless a court order provides otherwise. Emancipated minors can consent independently.
• A grandparent, stepparent, babysitter, family friend, or accompanying noncustodial parent may lack authority. Foster caregivers and caregivers of state wards also require verification; obtain relevant guardianship orders.

When the decision-maker is absent

• Consider consent by proxy or power of attorney for recurring visits with another adult. AAPD advises attorney consultation when choosing such forms.
• Telephone consent is an option: discuss every consent element with the parent and document it in the chart. A witness should preferably confirm and document the conversation.

Capacity and participation

• Intellectual disability does not automatically establish incapacity. Some adults require a guardian; where state law allows, supported decision-making lets the individual retain decision authority while consulting chosen trusted advisors.
• Use age-appropriate explanations with older children/adolescents and seek assent. Young children lack the cognitive ability for the full consent discussion; parental permission remains essential unless an applicable exception exists.

What must be disclosed?

• Explain observed oral disease, treatment need, the nature and purpose of proposed treatment, expected benefits, and risks.
• Discuss professionally recognized or evidence-based alternatives, including no treatment, and their risks and benefits. Clarify misconceptions and assess comprehension.
• State disclosure standards differ: what a reasonable patient would want, what a reasonable practitioner would provide, a hybrid, or what this particular patient wants to know.
• Regardless of the standard, disclose information material to the decision and warn of death or serious bodily injury when these are known procedural risks.
• The source generally excludes remote adverse consequences of simple procedures when the profession commonly recognizes them as remote. This is not a blanket exception for serious known risks.
• Avoid minimizing risk. A discussion on a separate day from treatment can support deliberation.

Communication and remote consent

• Adapt information to cultural, linguistic, physical, and cognitive needs; ask about communication ability and needed accommodations before treatment.
• Professional interpretation, language-line services, or sign language services may be necessary. Translation apps should not replace professional interpreters for consent.
• The source states that federally funded practitioners, and practitioners in many states, must provide these services without patient charges; verify applicable requirements.
• Booklets, videos, and models can supplement the discussion.
• Video consent discussions may be used when patient privacy requirements are followed. A cited randomized trial found comparable comprehension with video and in-person encounters; it concerned research consent and does not establish every teledentistry workflow's equivalence.

Decision map: consent authority

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An accompanying caregiver is not automatically authorized. Verify parent/guardian or other legal authority and applicable exceptions. Provide understandable disclosure, resolve questions and communication barriers, and document the voluntary decision. A signed form does not replace the process; a changed plan requires renewed discussion.

Written forms and ongoing consent

• AAPD recommends written consent before treatment even when local law does not mandate it. The source reports that most states require written consent; others require chart documentation of the discussion.
• Use understandable, procedure-specific language. Broad authorization for whatever treatment the dentist considers necessary is insufficient.

Eight written elements

• Include all eight source elements:
  • Patient's legal name and birth date.
  • Decision-maker's legal name, relationship, and legal authority.
  • Diagnosis.
  • Nature and purpose of treatment.
  • Treatment benefits and risks.
  • Recognized/evidence-based alternatives, including no treatment, and risks of each.
  • Acknowledgment that questions were asked and adequately answered.
  • Signature spaces for parent, dentist, and staff witness.

Separate procedures and changed plans

• For multiple procedures, use separate consent/refusal forms or clearly separated procedure-specific areas; restorative and extraction risks differ.
• Separate detailed written consents for sedation, general anesthesia, and protective stabilization increase awareness of significant risks.
• Some consents, particularly sedation/anesthesia, have limited validity periods. Check the dental board or treating institution; the source supplies no universal expiration interval.
• Update consent when the plan changes—for example, pulp therapy becomes extraction because a primary tooth is nonrestorable. Whether the update may be oral or must be written depends on state law.

Informed refusal

• When proposed and alternative care are refused, explain the consequences of declining treatment.
• Document refusal in the chart and attempt to obtain a signed refusal for the record.
• Refusal does not remove standard-of-care obligations. If refusal conflicts with proper care, a second opinion may be recommended and/or dismissal considered.
• Suspected dental neglect must be reported to appropriate authorities.

Evidence and scope

State statutes, case law, court orders, and institutional rules govern consent authority and compliance. AAPD’s best practice supplies the communication and documentation framework; apply the relevant rules to proxy authority, emergency exceptions, consent validity, and changed treatment.

Common board traps

Answer aloud

Grandmother brings a child for extraction. What must you establish?

Verify legal decision-making authority before obtaining extraction consent.

• Review relevant court orders or valid proxy authorization; accompaniment alone is insufficient.
• Complete documented parental telephone consent with a witness is an option where appropriate.
• Explain diagnosis, procedure, benefits, material risks, alternatives, and no treatment; seek child assent when possible.

A tooth consented for pulp therapy is nonrestorable. What is the next step?

Obtain updated consent for the changed plan before extraction.

• Explain nonrestorability, the revised procedure, risks/benefits, alternatives, and consequences of no treatment.
• Pulp-therapy consent does not automatically authorize extraction.
• Whether the update must be written depends on applicable law; sedation/anesthesia consents may also have institution-specific validity periods.

What makes a written dental consent adequate?

A procedure-specific form documents a voluntary, understood discussion; a signature alone is insufficient.

• Identify patient, date of birth, decision-maker, relationship, and legal authority.
• Record diagnosis, treatment nature/purpose, benefits/risks, and recognized alternatives including no treatment and their risks.
• Include acknowledgment of answered questions and parent, dentist, and staff-witness signatures.
• Separate procedures clearly; use detailed consents for sedation, general anesthesia, and stabilization.

How do you adapt consent for language or cognitive barriers?

Provide accessible communication and verify understanding without assuming disability means incapacity.

• Use professional language/sign-language interpretation when needed; translation apps are not substitutes for consent interpreters.
• Facilitate supported decision-making where permitted and involve an authorized guardian when required.
• Use age-appropriate explanations and seek assent while confirming who legally consents.

The parent refuses all recommended care. Is signed refusal enough?

No. Document informed refusal, but continue standard-of-care responsibilities.

• Explain consequences, confirm understanding, document questions/decision, and seek a signature.
• Consider second opinion or an appropriate transfer/dismissal process when refusal conflicts with proper care.
• Assess and report suspected neglect as required; refusal alone does not settle the neglect assessment.