The scene

A newly qualified dentist saw a 78-year-old man with toothache as an emergency while his daughter sat outside in the waiting room. The patient’s front tooth was sensitive to heat and tender on percussion and a radiograph confirmed the dentist’s diagnosis of a periapical abscess. When they discussed treatment options and risks with the patient, he was adamant that he wanted to avoid extraction as he was proud of having his own teeth and would be embarrassed to have a gappy smile. As they felt the patient’s oral health was generally good, his medical history showed no cause for concern and the radiograph was supportive, the dentist was able to extirpate the nerve and made an appointment for him to continue with root canal treatment.

Later that day, the patient’s daughter called the practice and asked to speak to the dentist. She demanded to know why they hadn’t extracted the tooth and accused the practice of exploiting her father by encouraging him to have pointless treatment.

The dentist was upset but explained they couldn’t discuss the patient without his permission. The daughter responded that she had a right to know as she was family and responsible for her father’s care.

DDU advice

The patient had demonstrated the capacity to understand the different treatment options and communicate his decision so the dentist was right to conclude that he had given valid consent.

And although root canal treatment can have a higher risk of complications for older patients, in this case the dentist had no reason to believe the treatment was inappropriate or not in his best interest, given the patient’s overall health and wish to save the tooth.

This is in line with GDC guidance which says, “You should take patients’ preferences into account and be sensitive to their individual needs and values” and “you must treat patients fairly as individuals and without discrimination.” (Standards for the dental team, paras 1.22 and 1.6

As the patient has capacity to consent to treatment, the dentist must also seek his informed consent to discuss his care with someone else. The patient would need to understand what the dentist was going to disclose, the reasons and potential consequences. The discussion and the patient’s response should be recorded in his notes. If he consents to the dentist sharing information with his daughter, the dentist will need to ensure that she understands the need for confidentiality.

The patient’s daughter would not normally have a right to know the details of her father’s healthcare. If the patient had legally appointed her to make welfare decisions on his behalf under a lasting power of attorney (LPA), then it would be appropriate to discuss his healthcare with her if he lacked capacity at the time.

What happened next

The foundation dentist spoke to their supervisor who reassured them that they would have done the same thing if they had seen the patient. On their advice the dentist contacted the patient about what had happened. He agreed to talk to his daughter directly and explain his wishes.

The following week the daughter accompanied her father to his RCT appointment and apologised for losing her temper. At the same time, the patient gave permission for the practice to involve his daughter in discussions about his dental care and this was recorded in his notes.

This is a fictionalised case compiled from actual DDU case files.

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