I enjoyed the November JADA article by Dr. Daniel Orr II and Mr. William Curtis regarding "Obtaining Written Informed Consent for the Administration of Local Anesthetic in Dentistry" (
JADA 2005;136: 1568–71
). My congratulations to the authors for a very informative and interesting article.
The authors did an excellent job of providing current information regarding informed consent. However, I disagree with the practice implications that dentists may want to consider obtaining written informed consent for the administration of local anesthetic. While I agree that obtaining informed consent is standard procedure and necessary for many procedures, such as administering general anesthestic and and maxillofacial surgery, I disagree that such is necessary with respect to routine procedures in dentistry.
I believe that implied consent is the standard with regard to the majority of routine dental procedures.1–3 Such procedures as placing amalgam and composite restorations are examples of routine dental procedures that, in my opinion, do not necessitate written informed consent. There is the possibility that your patient may have an allergic reaction to one of these materials. But the risk of such an allergic reaction is extremely rare.4 Furthermore, the health risks imposed in routine procedures performed under local anesthesia are also minuscule.
In theory, the patient could experience needle trauma (neuritis or neuroma), transient amaurosis, needle track infection, a broken needle, an allergic reaction to the local anesthetic and, possibly, a toxic reaction to the local anesthetic. However, these are extremely unlikely, and even more unlikely when the procedures are performed competently.5 Minor adverse reactions, such as minor pain, swelling and bruising, are unlikely but not uncommon5 and, in my humble opinion, unlikely to result in a lawsuit either, with or without written informed consent.
Furthermore, written informed consent involves not only listing and explaining all the possible secondary effects of the procedure, but also explaining valid alternatives to the proposed procedure.2–4 To my knowledge, there are limited alternatives to local anesthesia, consisting of no local anesthesia and no general anesthesia, both of which may lead to even greater patient risk.
The most important question is: Is written informed consent for routine dental procedures beneficial for our patients? Certainly, taking more time regarding this issue is going to increase the price of doing business.
The last question is: Is written informed consent for routine dental procedures such as administering local anesthetic beneficial for dentistry? I think that the authors of the article have certainly given us something to talk about and to think about.
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