Drs. Quarnstrom and Brown have offered excellent comments regarding the limits of informed consent, a dynamic area of dental legal flux that is under constant evaluation.
Perhaps we can expand "balance risk versus costs" to balance risk versus benefit as the consideration for most things done in practice, including patient procedures and provision of informed consent. This is what the article suggests readers do; that is, consider the risk versus benefit of providing or not providing informed consent in one’s own practice setting.
As health professionals trying to practice efficiently, being temporally responsible in the provision of consent is obviously beneficial to all concerned. We also agree that when "devastating" complications occur, a lack of consent is problematic. As the article mentions, the administration of local anesthetic can result in death, and patients also have developed perhaps less devastating morbidity such as nerve damage.1,2
These rare complications also can occur secondary to "endo and surgery" and other dental procedures. Local anesthetics are just another means of producing complications already being addressed during the consent process. It wouldn’t appear to be more time-consuming to add anesthesia to a list of etio-logic factors on the routine written consent that one is already providing for patients.
With regard to implied consent being "standard" in dentistry, what we as dentists believe is only the first step in what is accepted by the community. Once a controversy forms, both defendant and plaintiff will be able to find experts willing to opine about dental standards. Ultimately, lay juries establish what the standards for the community are.
Our study showed that many dentists obtain consent for local anesthesia now. In addition, perhaps the most comparable nondental situation in this country is the practice of physician anesthesiologists, who are trained to obtain consent for the administration of all anesthetics, including head and neck local procedures.3–7
Finally, with regard to obtaining consent for administering anesthetic in dentistry, court experts argue that one treatment or another is what is "ordinarily" done. Courts have found that "ordinary" does not necessarily equate to what the majority of practitioners do.8 Several treatment plans for a particular situation may be acceptable.
The comments of Drs. Brown, Dreiman and Quarnstrom are greatly appreciated.
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