- History, examination, risk assessment, and treatment planning -
M. L. Hunter and H. D. Rodd
3.1 INTRODUCTION
The provision of dental care for children presents some of the greatest challenges
(and rewards) in clinical dental practice. High on the list of challenges is the need to
devise a comprehensive yet realistic treatment plan for these young patients.
Successful outcomes are very unlikely in the absence of thorough short- and long-
term treatment planning. Furthermore, decision-making for children has to take into
account many more factors than is the case for adults. This chapter aims to highlight
how history-taking, examination, and risk assessment are all critical stages in the
treatment planning process. Principles of good treatment planning will also be
outlined.
3.2 CONSENT
Consent to examination, investigation, or treatment is fundamental to the provision of
dental care. The most important element of the consent procedure is ensuring that the
patient/parent understands the nature and purpose of the proposed treatment, together
with any alternatives available, and the potential benefits and risks. In this context,
where clinician and patient/parent do not share a common language, the assistance of
an interpreter is essential.
Key Point
A signature on a consent form is not consent if the patient/parent has not been given
and understood the relevant information.
In the United Kingdom, for the purposes of medical and dental treatment, a child is
defined as being less than 16 years of age. If a child is subjected to examination,
investigation, or treatment without the consent of an individual who has parental
responsibility, this can constitute an assault, actionable in civil or criminal law as a
breach of the human right. While most children will attend the dental surgery
accompanied by an adult, it is important to bear in mind that this individual will not
always have parental responsibility (the Children Act 1989 sets out the persons who
may have parental responsibility for a child).
Key Point
It is essential to establish what relationship exists between the child and the
accompanying adult at the outset. Foster parents do not automatically have parental
responsibility. In circumstances where a child is a ward of Court, the prior consent of
the Court is required for significant interventions.
In an emergency, it is justifiable to treat a child without the consent of the person with
parental responsibility if the treatment is vital to the health of the child. For example,
while it may be acceptable to replant an avulsed permanent incisor, the parent should
be contacted before proceeding to other forms of treatment.
Using the principle of Gillick competence, a child under the age of 16 years can give