A review of the report "Consent in Dental Care" by researchers Jenny King, Len Doyal, and Shelia Hillier, reveals a valuable glimpse into the realities of informed consent in a sampled cross-section of Great Britain’s dental community. In order to evaluate current attitudes and practices surrounding informed consent within the community, a useful theoretical model of the consenting process is first proposed. This is then used as a framework for categorizing and evaluating information gathered through various means from patients and dental health care providers.

The process of obtaining informed consent is broken down into what the researchers feel are nine essential building blocks or stages: initial introduction, explaining the dental problem, outlining treatment options, communicating risks and benefits, estimating time and cost, inviting questions, reaching mutual understanding, confirming choices, and indicating consent.

Not only is this study aimed at determining to what extent these stages of informed consent are applied in practice, but also at finding out how both parties feel about their interaction leading up to dental treatment. What are the dentists’ concerns and what are the patients’ concerns? What do the patients appreciate most and what does the dentist feel that (s)he has to gain from the process? Also important to the researchers is the question of how informed consent is applied to different distinct groups based on their legal ability to give consent. Four categories of patients were considered individually, representing four different perspectives: adults, adults without a shared language, vulnerable adults, and children under the age of 16.

The findings in this study were based on an analysis of dental clinic observations in adult, special needs, and children’s clinics, from 234 practitioner responses to a dental questionnaire, from twenty interviews with dental practitioners, and from 60 interviews with patients. The researchers were able to make numerous interesting generalizations about specific aspects of the consent process based on patterns which emerged from mostly qualitative and some quantitative analysis of this information.

The conclusions and recommendations of this report will probably not surprise any of its readers. Clearly there is not a consistent or well-structured approach to infor-med consent in dentistry. Practitioners seldom use individual stages or a coherent pattern of any kind to ensure that patients become partners in the decision-making process. Consent is more often assumed than explicitly obtained, and much remains unclarified. Recommendations therefore focus on the need for more explicit consent and a systematic approach to the process. There is a need for clarification and better use of NHS forms, and the suggested development of a consent form. There are also specific recommendations aimed at vulnerable patient groups and with regards to education.

The study is approached with an awareness of an increasingly multi-cultural society and a renewed concern for respect of common moral values. Beyond ‘doing good’ and ‘not doing harm’, it is noted that health professionals have come to embrace the principle of respect for autonomy. Increased awareness of patients’ rights, as well as the real threat of litigation, give the topic of informed consent both theoretical and practical importance. This report cites a recognition of ethical, legal and professional obligations as favoring a dentist-patient relationship that is interactive rather than dentist-led, patient-led or commercial (as described by Ozar & Sokol). However, this general awareness does not yet translate into consistent practices leading to explicit and appropriate consent. This study successfully takes the pulse of the dental community, giving the readership a good idea of how far dentists have actually come, and where we fall short, in terms of adopting attitudes and practices which reflect the importance of informed consent.