Informed consent for paediatric dentistry differs globally

Anisha Hall Hoppe, Dental Tribune International

Thu. 14. March 2024

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CAPE TOWN, South Africa: When it comes to paediatric dental care, the understanding of informed consent varies in different countries. Although the American Academy of Pediatric Dentistry provides specific guidelines on ensuring informed consent for paediatric patients, similar guidelines are often not easy to find in other countries. A new multinational study delves into the complexities of obtaining informed consent in dental care, particularly in the context of paediatric dentistry where consent and assent take on unique dimensions because of the involvement of minors and their guardians.

Informed consent plays a key role in ensuring patient autonomy and ethical treatment. Based on responses from around the world, the study sheds light on challenges and variations in obtaining informed consent for paediatric dental care, highlighting the importance of early dental intervention for better health outcomes.

Data was collected via an online survey among dental professionals from 13 countries. The authors compared and analysed the different approaches and legal frameworks governing informed consent in these countries. They found notable variations in informed consent practices. In some, age is the sole criterion for determining the ability to give consent, whereas in others, additional factors, including the child’s understanding and maturity, are considered.

Of particular note is the discrepancy in the legal age for self-consent among the countries surveyed. For instance, Tanzania, South Africa, India, Kenya, Malaysia and Brazil rely on age as the main determinant, whereas in Singapore, the UK and the US, the concept of Gillick competence is applied, assessing the child’s understanding regardless of age.

The regulations on overriding consent in emergency scenarios, where the dentist acts in the best interests of the patient, vary and are often not clearly defined, leading to ethical and legal dilemmas. Cultural beliefs and practices in countries like Nigeria, Tanzania and South Africa pose additional challenges to obtaining informed consent, sometimes conflicting with professional ethical standards. Furthermore, different countries require different processes when parents do not consent or when they cannot agree. The issue of consent could even be taken to court as a case of potential neglect should the dental clinician determine the treatment essential.

The paper suggests the need for clearer global guidelines to detail when dentists can act in the best interests of a patient, to establish what constitutes a dental emergency and to determine the process of overriding consent. It also underscores the complexity and variability of informed consent practices in paediatric dentistry globally and highlights the necessity for clearer guidelines and further research to ensure ethical and efficient dental care for children and patients with special needs. The authors emphasised the critical role of informed consent at the intersection of legal rights, ethical practice and patient care.

The study, titled “A pilot study on the global practice of informed consent in paediatric dentistry”, was published on 1 March 2024 in Frontiers in Oral Health.