The theory of consent to medical or dental treatment

CHILDREN IN DENTISTRY

CHILD PROTECTION:

1.1 Revelations in recent years have shown that some individuals in Ireland, who had responsibility for the care and welfare of children, took advantage of the situations they found themselves in and abused the very children they were expected to care for and protect.

1.2 Abusers came from all walks of life and included healthcare workers who previously would have been trusted implicitly.

1.3 Parents are understandably worried at these developments and are reluctant to allow their children to be separated from them when receiving dental treatment.

The Council considers it appropriate at this time to give guidance to dentists and other members of the dental team on the management of children who are receiving dental treatment.

2.1 It has been traditional in dentistry to allow the dentist to determine how s/he wished to practise and often this included the routine exclusion of parents from the dental surgery during the dental treatment of the child.

2.2 In the light of the revelations referred to a blanket ban on parents from the dental surgery is no longer sustainable or justified. On the contrary, parents must be advised of and given the right to accompany their child into the dental surgery and remain with him/her during the course of dental treatment.

2.3 It would be deemed good practice for the parent to accompany the child for the initial meeting with the dentist and the completion of a medical/dental history. The parent should remain in the surgery during the examination and diagnosis stages and give consent to any proposed treatments.

2.4 Should a parent waive the right to remain in the surgery during the child's treatment a third person, who could be a dental nurse, must be in attendance at all times while the child remains in the surgery. Should the dental nurse have to leave, the parent or another person must take her place.

2.5 In exceptional circumstances a dentist may decide that the completion of dental treatment is not possible because of the presence of the parent in the surgery. In such circumstances a full explanation of how the parent's presence impedes treatment should be given and alternative treatment options given.

2.6 Children with behavioural problems may use the presence of a sympathetic parent as a means of disrupting or refusing to co-operate with dental treatment. An experienced practitioner, skilled in the management of such patients, may with appropriate explanation request the parent to remain outside the surgery while treatment is being provided. It would be desirable in such circumstances that a facility be provided to enable the parent to observe what is happening in the surgery unseen by the child patient.

CHILD ABUSE:

3.1 Dentists may on occasion suspect that a child who attends for treatment has been abused. They should always be alert to such possibility especially if they discover bruising to the face or mouth or damage to the teeth and there is a reluctance to explain the cause or where the explanation given is not credible.

3.2 Each health board has appointed designated officers to deal with cases of suspected abuse and a dentist who has reasonable suspicion of abuse should contact the health board immediately or, alternatively, the local Garda Station. Failure to act may result on the child suffering continuous abuse and long term emotional and/or psychological harm.

3.3 Under the Protection for Persons Reporting Child Abuse Act 1998 a person who reports suspected child abuse "reasonably and in good faith" is granted immunity from civil liability.

The Dental Council
57 Merrion Square
Dublin 2
May 2003

Updated 28.12.2005

1.1	Revelations in recent years have shown that some individuals in Ireland, who had responsibility for the care and welfare of children, took advantage of the situations they found themselves in and abused the very children they were expected to care for and protect.
1.2	Abusers came from all walks of life and included healthcare workers who previously would have been trusted implicitly.
1.3	Parents are understandably worried at these developments and are reluctant to allow their children to be separated from them when receiving dental treatment.

2.1	It has been traditional in dentistry to allow the dentist to determine how s/he wished to practise and often this included the routine exclusion of parents from the dental surgery during the dental treatment of the child.
2.2	In the light of the revelations referred to a blanket ban on parents from the dental surgery is no longer sustainable or justified. On the contrary, parents must be advised of and given the right to accompany their child into the dental surgery and remain with him/her during the course of dental treatment.
2.3	It would be deemed good practice for the parent to accompany the child for the initial meeting with the dentist and the completion of a medical/dental history. The parent should remain in the surgery during the examination and diagnosis stages and give consent to any proposed treatments.
2.4	Should a parent waive the right to remain in the surgery during the child's treatment a third person, who could be a dental nurse, must be in attendance at all times while the child remains in the surgery. Should the dental nurse have to leave, the parent or another person must take her place.
2.5	In exceptional circumstances a dentist may decide that the completion of dental treatment is not possible because of the presence of the parent in the surgery. In such circumstances a full explanation of how the parent's presence impedes treatment should be given and alternative treatment options given.
2.6	Children with behavioural problems may use the presence of a sympathetic parent as a means of disrupting or refusing to co-operate with dental treatment. An experienced practitioner, skilled in the management of such patients, may with appropriate explanation request the parent to remain outside the surgery while treatment is being provided. It would be desirable in such circumstances that a facility be provided to enable the parent to observe what is happening in the surgery unseen by the child patient.

3.1	Dentists may on occasion suspect that a child who attends for treatment has been abused. They should always be alert to such possibility especially if they discover bruising to the face or mouth or damage to the teeth and there is a reluctance to explain the cause or where the explanation given is not credible.
3.2	Each health board has appointed designated officers to deal with cases of suspected abuse and a dentist who has reasonable suspicion of abuse should contact the health board immediately or, alternatively, the local Garda Station. Failure to act may result on the child suffering continuous abuse and long term emotional and/or psychological harm.
3.3	Under the Protection for Persons Reporting Child Abuse Act 1998 a person who reports suspected child abuse "reasonably and in good faith" is granted immunity from civil liability.