Module 5: Behavior Guidance
Special Care- Behavior Guidance

5.2 Informed Consent

Informed consent is the process of getting permission before conducting a health care intervention on a person. An oral health professional will ask for consent by providing the patient or, in the case of a minor or incompetent adult, parents, with relevant information about diagnosis, treatment needs, and potential consequences of the prescribed treatment so that an educated decision about treatment can be made by the child or parents. Informed consent is essential in the delivery of health care. The informed consent process allows the patient or parents to participate in and retain autonomy over the health care received. Informed consent also may decrease the practitioner’s liability from claims associated with miscommunication. 2

All behavior guidance decisions must be based on a subjective evaluation, weighing benefit and risk to the child. Need for treatment, consequences of deferred treatment, and potential physical/emotional trauma must be considered. Decisions about the use of behavior guidance techniques other than communicative guidance cannot be made solely by the oral health professional.

Oral health professionals should be aware of the cultural and linguistic backgrounds of their patients and families and should ensure that information is available in simple language using culturally and linguistically competent formats to help parents in the decision-making process. 2

Statutes and case law of individual states govern informed consent. Some states allow oral discussions, which should be documented in the medical record, while others may require written consent. Oral health professionals should review applicable state laws to determine their level of compliance. 2

Behavior guidance decisions must involve a legal guardian (hereafter referred to as “parents”) and, if appropriate, the child. The oral health professional serves as the expert about oral health care (i.e., the need for treatment and the techniques by which treatment can be delivered). Parents share with the oral health professionals the decision about whether to treat and must be consulted about treatment strategies and potential risks. The successful completion of diagnostic and therapeutic services requires the cooperation of the oral health professional, parents, and the child.

Key Fact

Parents share with the oral health professional the decision about whether to treat and must be consulted about treatment strategies and potential risks.

It is important that the dentist inform parents about the nature of the technique to be used, its risks and benefits, and any alternative techniques. Information should be provided about the diagnosis, the prognosis, the reasons for treatment, the nature of the treatment, and alternatives. Showing parents and the child a photograph or a video clip of what will happen during the procedure may increase understanding or prompt questions. All questions must be answered to parents’ satisfaction. Discussions must take into consideration cultural and health literacy issues, and forms should be written in plain language in the family’s primary language or should be carefully reviewed by a trained interpreter.

For informed consent, the following conditions must be met:

  • The oral health professional must actively engage parents and the child (if the child is able to understand) in a verbal exchange to clarify issues, ask/answer questions, and verify parents’ and the child’s comprehension. This should be done in the family’s primary language, with the assistance of a trained interpreter, if needed.
  • The oral health professional may not use deception or coercion to gain parents’ consent.
  • Parents making the decision must be considered “competent” to understand the information and to make a decision.
  • Parents must clearly communicate their choices.

Parents have a right to know which option the oral health professional recommends. The oral health professional is not obligated to present options considered unacceptable.

A signature on a form does not necessarily constitute informed consent. Informed consent implies (1) providing information to parents and (2) obtaining parents’ consent before administering treatment.