Section 7Dental Dilemmas
Teenage toothache DDU advice
One afternoon, a teenage boy called into the The adviser explained that it is possible for children
dental practice on his way home from school under 16 to consent to treatment, but it is up to the
complaining he had been suffering from toothache individual dental professional to decide whether any
all day. He said the pain was so severe that he was minor is mature enough to appreciate properly the
unable to tolerate the heat of his school dinner, nature of the treatment. The dental professional needs
and was almost in tears. to be sure the minor understands the purpose of the
Unfortunately, all the dentists were treating patients and
treatment, the potential risks and the alternatives, and is
the receptionist sent the boy away because he was alone
capable of making a balanced judgement (known as
and she believed he was too young to consent to
Gillick competence). That ability will vary with age, the
treatment or sign an NHS form.
individual’s intelligence and maturity, and the complexity
of the procedure proposed.
The next morning, the practice owner received a call
from the boy’s mother who was very angry that her son
In this case, whether or not the child had the capacity to
had not been seen as an emergency. She said she was
consent to the necessary treatment, it might have been
minded to ‘take the matter further’. She claimed that by
possible, with the patient’s permission, to contact the
the time she had arrived home from work the previous
patient’s parent at work and obtain authority for any
evening, her son was extremely distressed and the
treatment.
practice had closed for the day. Equally, a lack of capacity to consent, or a failure to make
The dentist contacted the DDU for advice about how to
successful contact with a parent, would not in themselves
respond.
be reasons to withhold emergency treatment for the
relief of acute pain. In such circumstances it would be
appropriate to consider whether relief of pain could be
achieved using a reversible procedure, and in any event
the least invasive procedure should generally be chosen,
consistent with achieving the goal of pain relief.
Given that the patient had been left in pain, the adviser
suggested that it would be appropriate for the practice
to contact the mother straightaway to apologise and
offer an appointment as soon as possible to provide any
urgent necessary treatment.
It was suggested the practice should then carry out a full
investigation of the incident, following which they
should write to the patient’s mother explaining what
went wrong and setting out the steps taken to prevent a
repeat of the problem. This might include further
training for reception staff on how to deal appropriately
with emergencies and unaccompanied minors, and
clearer information for all patients on these topics,
including advice on accessing emergency treatment
outside surgery hours.
“The dental professional needs to
be sure the minor understands the
purpose of the treatment…”
36
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