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Registration Number: {{org_field_registration_no}}

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Consent to Dental Treatment Policy

1. Purpose

The purpose of this policy is to ensure that all individuals living at {{org_field_name}} are supported to access and receive dental treatment in a manner that is lawful, ethical, person-centred, and compliant with the Regulation and Inspection of Social Care (Wales) Act 2016, the Social Services and Well-being (Wales) Act 2014, the Mental Capacity Act 2005, and expectations set by Care Inspectorate Wales (CIW). This policy outlines how we seek, record, and review valid consent for dental treatment, including where individuals have fluctuating or impaired capacity, and how we ensure access to oral healthcare that promotes dignity, wellbeing, and physical health.

2. Scope

This policy applies to all staff at {{org_field_name}} involved in the planning, facilitation, documentation, and delivery of support for individuals receiving dental treatment. This includes care staff, nurses, team leaders, the Registered Manager, and where relevant, advocates, family members, and visiting dental professionals. The policy covers all forms of dental treatment, including routine check-ups, emergency dental care, hygienist visits, denture fittings or adjustments, and specialist referrals.

3. Related Policies

This policy should be read in conjunction with:
CHW07 – Person-Centred Care Policy
CHW08 – Dignity and Respect Policy
CHW09 – Consent to Care Policy
CHW11 – Safe Care and Treatment Policy
CHW13 – Safeguarding Adults from Abuse and Improper Treatment Policy
CHW21 – Medication Management and Administration Policy
CHW39 – Mental Capacity and Deprivation of Liberty Safeguards Policy

4. Policy Statement

All individuals have the right to be involved in decisions about their dental care and treatment. An individual aged 16 or over must be presumed to have capacity to make a particular decision unless it is established, in accordance with the Mental Capacity Act 2005, that they lack capacity to make that decision at the time it needs to be made. An individual must not be treated as unable to make a decision unless all practicable steps to support them to make the decision have been taken without success, and they must not be treated as lacking capacity merely because they make a decision that others consider unwise.

Where an individual has capacity to make the relevant decision, dental examination or treatment must not proceed without their valid consent. Consent must be voluntary and informed and the individual must be provided with information appropriate to their communication needs and level of understanding.

Staff at {{org_field_name}} support individuals to understand information, express their wishes and communicate with dental professionals but do not provide consent to dental treatment on behalf of an individual unless a member of staff separately holds specific lawful authority to make that decision.

Where an individual aged 16 or over lacks capacity to make a particular decision concerning dental treatment, the decision must be made in accordance with the Mental Capacity Act 2005. The person responsible for making the treatment decision must act in the individual’s best interests and consider whether the purpose can be achieved in a less restrictive way. Any valid and applicable advance decision to refuse treatment, registered health and welfare Lasting Power of Attorney with relevant authority, Court-appointed deputy with relevant authority or applicable decision or order of the Court of Protection must be identified and respected.

Family members, friends, carers and advocates may be consulted where appropriate as part of the decision-making process but do not have automatic legal authority to consent to or refuse dental treatment on the individual’s behalf solely because of their relationship with the individual.

5. Supporting Access to Dental Services

{{org_field_name}} will put arrangements in place to ensure that individuals are placed under the care of a registered dental practitioner and are supported to access dental treatment, advice and other healthcare services as necessary.

The individual’s wishes, preferences, communication needs and any relevant existing dental arrangements will be taken into account when arranging dental care. Where an individual requires assistance to access a dental service, staff will provide appropriate support, including support to arrange and attend appointments or to access domiciliary or specialist dental services where these are required and available.

Oral health needs will be considered as part of the individual’s assessment and personal planning arrangements. The level of assistance required with oral healthcare will be clearly recorded in the personal plan and reviewed when the individual’s needs change and as part of the required review of that plan.

Individuals will be encouraged and supported, where necessary, to care for their teeth, dentures and mouth. Appropriate oral healthcare supplies required to meet the individual’s assessed needs will be readily available and maintained in suitable condition.

Oral healthcare will be monitored as part of day-to-day care where the individual’s assessed needs require this. Staff will take timely action where concerns are identified, including concerns such as pain, swelling, bleeding, oral infection, mouth ulcers, damaged or lost teeth, difficulties with dentures, difficulty eating or drinking, or suspected dental decay. Where appropriate, the individual will be supported to obtain advice or assessment from a registered dental practitioner without unnecessary delay.

Records of relevant dental consultations, treatment, advice, recommendations and resulting actions will be maintained as part of the individual’s care records and personal plan as appropriate.

6. Obtaining and Supporting Valid Consent

The dental professional proposing an examination, investigation or treatment is responsible for ensuring that valid consent or other lawful authority for the proposed intervention is in place. Staff at {{org_field_name}} will support this process but will not assume responsibility for providing clinical consent on behalf of the individual.

Before dental treatment is undertaken, the individual must, so far as applicable to the proposed treatment and their circumstances, be supported to understand information about:

• what is proposed;
• the purpose of the proposed treatment;
• the material risks and expected benefits;
• any reasonable alternatives, including the option of no treatment where applicable;
• the likely consequences of accepting or declining treatment; and
• their right to ask questions, seek further information and refuse or withdraw consent.

Information and communication support must be appropriate to the individual’s needs, level of understanding and preferred method of communication. This may include the use of plain language, easy-read information, visual or communication aids, British Sign Language, interpretation or translation services, or other appropriate communication support.

Reasonable steps will be taken to meet the individual’s language needs, including their Welsh language needs. Staff will communicate relevant language and communication requirements to the dental professional before the appointment wherever practicable.

Consent may be communicated verbally, in writing or through other reliable means of communication. The method used must enable the dental professional to be satisfied that the individual’s agreement is voluntary and informed.

An individual with capacity may refuse dental examination or treatment even where other people consider that refusal to be unwise. Staff must respect such a decision, ensure that the individual has been offered appropriate information and support, and record the refusal and any subsequent advice or action required.

Consent is an ongoing process and may be withdrawn at any time by an individual who has capacity to make the relevant decision. Staff must immediately communicate any withdrawal or apparent withdrawal of consent to the dental professional.

7. Dental Treatment Where There Are Concerns About Mental Capacity

An individual aged 16 or over must be presumed to have capacity to make a decision about dental treatment unless it is established that they lack capacity to make that particular decision at the time the decision needs to be made.

Before concluding that an individual lacks capacity, all practicable steps must be taken to support the individual to make the decision. This includes providing information in an accessible form, adapting communication, choosing an appropriate time and environment, using communication aids or specialist support where necessary and allowing sufficient time for the individual to understand and respond.

Capacity is decision-specific and time-specific. A diagnosis of dementia, learning disability, mental illness, cognitive impairment, communication difficulty or any other condition does not, by itself, establish that an individual lacks capacity.

Where capacity to consent to proposed dental treatment is in question, the dental professional responsible for the proposed treatment will normally be the relevant decision-maker and must ensure that capacity is appropriately assessed in relation to that particular treatment decision. Care staff will provide relevant information and practical support and will share observations about the individual’s usual communication, understanding and functioning where this is relevant and lawful.

Where the individual lacks capacity to make the particular decision, staff must establish, so far as reasonably practicable, whether there is any existing legal authority relevant to the proposed treatment. This includes:

• a valid and applicable advance decision to refuse the proposed treatment;
• a registered health and welfare Lasting Power of Attorney whose authority extends to the particular healthcare decision;
• a Court-appointed deputy whose authority extends to the particular decision; or
• a relevant decision or order made by the Court of Protection.

The existence and scope of any such authority must be verified before relying upon it.

A family member, friend, next of kin or advocate does not have legal authority to consent to or refuse treatment on behalf of an adult who lacks capacity merely because of their relationship with the individual. Their views should, however, be sought where appropriate and practicable as part of establishing the individual’s wishes, feelings, beliefs and values and determining their best interests.

Where no person has lawful authority to make the particular healthcare decision on the individual’s behalf, the relevant decision-maker must determine whether the proposed treatment is in the individual’s best interests in accordance with the Mental Capacity Act 2005.

A best-interests decision must, so far as relevant:

• consider all relevant circumstances;
• consider whether the individual is likely to regain capacity and whether the decision can safely wait;
• involve the individual as fully as reasonably practicable;
• consider the individual’s past and present wishes and feelings;
• consider relevant beliefs and values that would be likely to influence the individual’s decision;
• take account of the views of appropriate people involved in the individual’s care or interested in their welfare;
• consider any valid legal authority held by an attorney or deputy; and
• consider whether the desired outcome can be achieved in a way that is less restrictive of the individual’s rights and freedom of action.

Where the criteria in the Mental Capacity Act 2005 require the involvement of an Independent Mental Capacity Advocate, an appropriate referral must be made.

Where there is serious disagreement, uncertainty about legal authority or a dispute that cannot be resolved concerning capacity or the individual’s best interests, appropriate legal and professional advice must be sought and an application to the Court of Protection considered where necessary.

Any proposed restraint, sedation or restrictive intervention connected with dental treatment must have separate lawful justification. It must not be used solely for staff convenience or because an individual is refusing treatment. Where restraint is proposed in connection with care or treatment for an individual who lacks capacity, the requirements of the Mental Capacity Act 2005 and the service’s policies concerning restraint and restrictive practice must be followed.

8. Documentation

Accurate and up-to-date records relating to dental care, consent and mental capacity will be maintained in accordance with the service’s record-keeping arrangements and the individual’s personal plan.

Where relevant, records will include:

• the dental concern, appointment, assessment or treatment proposed;
• information provided to the individual and the communication support used;
• the individual’s consent, refusal or withdrawal of consent where relevant;
• any concern about the individual’s capacity to make the particular decision;
• the outcome of any decision-specific capacity assessment and the identity and professional role of the person responsible for that assessment;
• the practicable steps taken to support the individual to make the decision;
• details of any valid and applicable advance decision to refuse treatment;
• details of any relevant registered health and welfare Lasting Power of Attorney, Court-appointed deputy or Court of Protection decision or order, including confirmation that the person’s authority covers the particular decision;
• where the individual lacks capacity and a best-interests decision is required, the decision reached, the identity of the decision-maker, the people consulted, the individual’s known wishes, feelings, beliefs and values and the reasons for the decision;
• any disagreement or dispute and the steps taken to resolve it;
• advice, treatment or recommendations provided by the dental professional;
• any required follow-up arrangements; and
• any changes required to the individual’s personal plan or risk assessment.

Dental consent forms or other documentation supplied by the dental service will be retained or referenced within the individual’s records where appropriate and in accordance with information governance requirements.

Capacity and consent will not be treated as permanent or general determinations. Where another treatment decision is required, or where there is reason to believe that the individual’s ability to make the decision has changed, capacity and consent must be considered in relation to that specific decision and at the relevant time.

9. Emergency Dental Treatment

Where an individual requires urgent or emergency dental assessment or treatment, staff will take prompt action to obtain appropriate professional dental or medical assistance and will not delay necessary assessment or treatment unnecessarily.

Where the individual has capacity to make the relevant treatment decision, their consent remains necessary notwithstanding the urgency of the situation.

Where an individual aged 16 or over lacks capacity to make the relevant decision and treatment is required, any decision or action taken must comply with the Mental Capacity Act 2005 and must be in the individual’s best interests. Only treatment that is necessary and proportionate in the circumstances should be provided, and consideration must be given to whether the objective can be achieved by a less restrictive means.

Where practicable and where doing so would not cause an unsafe delay, the relevant professional should identify and consider any valid and applicable advance decision to refuse treatment and determine whether an attorney acting under a registered health and welfare Lasting Power of Attorney, a Court-appointed deputy or the Court of Protection has relevant decision-making authority.

Family members or other people interested in the individual’s welfare should be consulted where appropriate and practicable, but consultation must not cause an unsafe delay in necessary emergency treatment and a relative or next of kin does not have automatic legal authority to provide consent.

Staff will provide appropriate first aid, comfort measures and prescribed or otherwise lawfully authorised pain relief within the limits of their role and competence while professional assistance is being obtained.

The circumstances of the emergency, action taken, professional advice obtained, decisions made and any subsequent treatment or follow-up requirements will be recorded promptly in the individual’s care records and reflected in the personal plan or risk assessment where necessary.

10. Training and Competency

All staff receive training in the principles of consent, the Mental Capacity Act, and communication support techniques as part of their induction and annual development. Staff are expected to understand their role in facilitating access to dental care and supporting individuals to make informed decisions. The Registered Manager ensures that staff are confident in these areas through supervision, observation, and reflective practice.

11. Dignity and Emotional Support

Dental treatment can be distressing or uncomfortable for some individuals. We ensure that emotional support is offered before, during, and after any appointment. Care is taken to respect personal preferences, provide reassurance, and promote a calm environment. For individuals with cognitive impairments, familiar staff may accompany them to appointments to reduce anxiety. Where someone expresses fear or concern, we seek to explore the reasons and adapt our approach.

12. Liaison with Dental Professionals

We work collaboratively with local dental services, ensuring they are aware of each individual’s communication needs, medical history, and support requirements. Consent forms provided by dentists are reviewed in advance and discussed with the individual. Any recommendations made by dental professionals are incorporated into care plans and followed up in a timely and coordinated way.

13. Quality Monitoring and Review

The Registered Manager oversees compliance with this policy through audits of care records, incident reviews, feedback from individuals and families, and supervision meetings. Any concerns about the consent process, access to treatment, or outcomes are addressed promptly. Consent practices are reviewed as part of the Quality of Care Review and during CIW inspections, with clear evidence provided to inspectors.

14. Policy Review

This policy will be reviewed annually or sooner in response to changes in legislation, guidance from CIW, feedback from stakeholders, or incidents involving consent to dental treatment. Updates will be shared with all staff through internal briefings and training.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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