Can a dentist treat a child in the absence of either medical history or parental authority?
The scene
A 12-year old child attended a practice in Scotland as an emergency, in pain from a lower molar. The family was new to the area and had only just registered with the dental practice. As the child's mother had to go into hospital, a neighbour kindly offered to accompany him to the emergency appointment. She didn't know the boy well and so couldn't confirm his medical history. The dentist called the DDU for advice about treating the patient without a medical history.
DDU advice
The DDU adviser explained that there were several issues involved in this case:
- What is the child's medical history?
- Is it safe to treat the child?
- Is the child fit and well enough to treat?
- Is he competent to consent to treatment?
The neighbour would not have authority to act on behalf of the parent in hospital unless the parent had formally delegated that authority, and therefore it is necessary to assess whether the child's dental pain can be safely treated with valid consent.
Except in life-threatening circumstances, a current medical history is necessary before any medical or dental treatment can take place. The dentist could call the child's GP and ask them to confirm if the child is taking any medication or has any condition that might preclude dental treatment in general dental practice. Ideally, the information should be confirmed by fax or email.
If the dentist cannot access the child's GP, they could consider trying to contact one of the parents by telephone. While not ideal, a valid medical history and authority to treat a minor can be obtained by telephone from a parent who has parental responsibility, following appropriate explanations.
Once the medical history has been assessed and if the child is considered fit and well enough to undergo dental treatment, but parental authority cannot be obtained, the next question is whether the child himself can consent.
A child under 16 years of age may be able to make decisions about their own treatment and care if they are what is termed 'Gillick competent' – that is, they are mature enough to understand what is involved in their treatment and make a balanced judgement. In Scotland, the rights of people under the age of 16 to consent to treatment are governed by the Age of Legal Capacity (Scotland) Act 1991, section 2(4). This states that a competent person under the age of 16 can consent on their own behalf to medical treatment, providing they are capable of understanding the nature and consequences of the treatment.
If he is considered competent, then the dentist may rely on his consent and go ahead with treatment, but it may be wise to restrict the treatment to that which is immediately necessary, pending involvement of the child's parent.
If parental consent cannot be obtained and the child is not Gillick competent then treatment immediately necessary to protect the child's health and well-being can be provided in the patient's best interest, although the dentist must be prepared to justify their clinical decision to treat the child if called upon to do so by the parents, the courts or the GDC.
The DDU adviser explained that as the child is in pain, the General Dental Council would expect them to act at all times in the best interests of the patient, which could include emergency dental care to relieve a child's dental pain, if that was clinically necessary and appropriate.
The child's condition may require a number of visits to the dentist. Should the mother's hospital stay be prolonged and should there be nobody else with parental responsibility available, then a detailed treatment plan could be provided to the mother and the dentist could request a letter of authority from the mother to allow a responsible adult to act on her behalf when bringing the child to future appointments. This would allow definitive treatment to be offered to the child as required.
Angela Harkins
Dento-legal adviser
This page was correct at publication on . Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.