A patient’s consent is only considered “informed” if the patient has been sufficiently educated by his or her dental practitioner to enable him or her to make a reasoned choice whether to proceed with a particular dental procedure or treatment. In order for the patient to make a reasoned choice the dentist should include the prognosis, alternative goals and means of treatment, success and failure rates, benefits and material risks of the treatment, possible alternative treatments and consequences, and the risks of refusing the treatment.
 
It is understood that informed consent is not required for standard, straightforward dental procedures and treatment. However, informed consent is required for complex dental procedures and treatment. The RCDSO Guideline - Educational Requirements & Professional Responsibilities for Implant Dentistry provides definitions and examples of complex dental treatments, and the minimum corresponding dental education and experience required to conduct those treatments.  The NBDS does not provide definitions for complex and straightforward dental procedures, nor minimum education and experience requirements to conduct complex dental procedures.
 
The NBDS does not provide a standardized dental consent form; the content of a consent form is left to the discretion of the dentist.  Commonly observed shortcomings in dental consent forms include:

a. consent forms are generic (one size fits all); these forms do not accurately describe the dental procedure and treatment to be performed;
b. the consent form does not indicate if the proposed complex dental treatment was reviewed and confirmed by a specialist;
c. the consent form does not state the education and experience of the dentist who is to perform the complex dental procedure and treatment;
d. consent forms do not provide the comparative risk of the complex dental procedure and treatment undertaken by the general dentist providing the treatment versus a specialist. (Physicians provide levels of risk when they present treatment options; the risk is based on the complexity of the case and competency of the physician.)

Sample Dental Consent Forms:
sample_-_dental_consent_form_-_implant_surgery.jpg
sample_-_dental_consent_form_-_general.pdf
 
Below is an excerpt from a consent form used in New Brunswick which is supposed to inform the patient of the risk of their procedure:

“I have further been informed of the possible risks and complications involved with surgery, drugs, and anesthesia. Such complications include pain, swelling, infection and discoloration. Numbness of the lip, tongue, chin, cheek, or teeth may occur. The exact duration may not be determinable and may be irreversible. Also possible is inflammation of a vein, injury to teeth present, bone fractures, sinus penetration, delayed healing, allergic reactions to drugs or medications used, etc.”
 
Clearly the consent form excerpt above is for the protection of the dentist, not the protection of the patient.
 
In New Brunswick it is common practice for a general dentist to take on complex clinical cases rather than referring the case to a specialist.  The dentist is able to attempt any clinical procedure providing he/she feels confident to conduct the procedure.  Have the patient sign a consent form, and they are good to go.  If there is poor outcome for the patient, it is not the dentist’s fault because the patient signed a consent form. 

We are indeed fortunate that surgeons do not behave like dentists.