On 10 September 2026, the General Dental Council published Heavy is the Head: Complaints about dental crowns – sharing insights and learning. Drawing on illustrative examples from complaints and concerns casework, the article explores recurring issues around assessment, treatment planning, communication, consent and clinical records.
The GDC is careful to state that this article does not itself set clinical standards or provide clinical guidance. Nevertheless, the cases offer useful lessons for everyday dental practice and not only for clinicians providing crowns.
At their heart is a broader question:
If a patient later challenged a treatment decision, would the clinical record show not simply that they signed a form, but that they genuinely understood the decision they were making?
Why crowns are worth talking about
Crowns remain commonplace in restorative dentistry.
The 2023 Adult Oral Health Survey for England reported that 27% of adults examined had at least one tooth restored with a crown. Among adults aged over 65, that figure was 58%.
They also continue to feature in complaints. According to the GDC, crowns accounted for 12% of allegations in Fitness to Practise cases arising from single-patient complaints during 2025, ranking fifth overall in that dataset.
That does not make crown treatment inherently problematic. Appropriately planned crowns remain an important part of restorative dentistry.
What the GDC examples demonstrate is how familiar treatment can become difficult when clinical decision-making, patient expectations, communication and documentation do not align.
Previous experience does not replace a fresh consent discussion
In the first GDC example, the patient had previously received a crown elsewhere in their mouth. Their prior experience appears to have been treated as sufficient familiarity with the procedure.
The GDC clinical adviser was critical of the absence of evidence of a meaningful contemporary consent discussion.
This is an important distinction.
A previous crown may help a patient understand some aspects of treatment, but it does not make consent transferable from one tooth to another.
The clinical circumstances may be different. The prognosis may be different. Different treatment alternatives may be available. Most importantly, what matters to the patient may be different this time.
The GDC's current standards on obtaining valid consent state that clinicians should document discussions involved in gaining consent. They also make clear that consent is an ongoing process rather than a one-off event and require clinicians to check that patients have understood the information given to them.
So “you've had a crown before” may be part of the conversation.
It should never replace it.
Reasonable alternatives need to be part of the decision
One of the central issues raised in the first GDC case was whether a full-coverage crown was the only reasonable treatment approach.
The GDC clinical adviser highlighted the invasive and irreversible nature of crown preparation and considered whether less invasive approaches, including composite repair or partial-coverage restorations, may have been appropriate in the circumstances described.
This takes us beyond the specific case and into one of the fundamental principles of modern consent.
In Montgomery v Lanarkshire Health Board, the Supreme Court established that reasonable care should be taken to ensure a patient is aware of material risks associated with the recommended treatment and of any reasonable alternative or variant treatments. What is material depends upon the particular patient and their circumstances; it cannot simply be reduced to a percentage.
The GDC's communication standards similarly require dental professionals to explain treatment options — including delaying treatment or doing nothing where appropriate — together with their risks and benefits.
For crown treatment, therefore, informed consent is not simply an explanation of how a crown is prepared and fitted.
The patient should understand why that treatment is being recommended for their tooth, what its important risks and limitations are, and what reasonable alternatives are available.
What the patient wants matters, but it does not replace professional judgement
The second GDC example involved a patient seeking improvement to several heavily restored upper front teeth.
Having researched treatment online, the patient expressed a strong preference for full-coverage crowns. The subsequent concerns described by the GDC included incomplete assessment and diagnostic work-up, unrealistic or inadequately managed expectations, aesthetic and occlusal problems, and an absence of documented discussion of material risks.
This situation will be recognisable to many clinicians working in modern private practice.
Patients increasingly arrive having researched treatments, viewed before-and-after cases on social media or formed a clear view about the procedure they would like.
Their preferences matter. But patient autonomy does not mean simply providing the treatment requested.
The clinician remains responsible for assessment, diagnosis, appropriate treatment recommendations and explaining the limitations of those options. If expectations are unrealistic or the requested treatment is not appropriate, that also needs to be discussed.
For aesthetic and restorative treatment in particular, good consent should explore not only what treatment the patient wants, but what they expect that treatment to achieve.
That conversation can be crucial.
A technically acceptable restoration may still result in significant dissatisfaction if patient and clinician began with fundamentally different expectations.
Consent starts before the consent form
Another important theme running through the GDC examples is the connection between assessment, treatment planning and consent.
The cases raise concerns around baseline clinical assessment, radiographic information, periodontal condition, occlusion and diagnostic work-up.
This matters because consent is sometimes treated operationally as the final stage before treatment:
Assessment → Treatment plan → Consent form → Treatment
A more useful way to think about meaningful consent is:
Assessment → Diagnosis → Reasonable options → Patient priorities → Discussion → Decision → Confirmation → Treatment
You cannot meaningfully explain the rationale, risks and alternatives to treatment unless the clinical decision itself has been properly informed.
Equally, excellent treatment planning may be difficult to demonstrate later if the reasoning and patient discussion were poorly documented.
Good clinical decision-making and good consent are not separate processes.
They reinforce one another.
A signature is evidence of consent, not the entirety of consent
This is perhaps the most important point.
The GDC states that although a signature on a consent form can be important in verifying that consent has been given, it is the discussions with the patient that determine whether consent is valid.
Its record-keeping standards also require contemporaneous, complete and accurate records, including appropriate detail about discussions with patients and evidence that valid consent has been obtained.
There is therefore an important distinction between:
Having a signed consent form
and
Having evidence of a meaningful consent process.
A good record should help demonstrate why treatment was recommended, which reasonable alternatives were discussed, which risks and limitations were material to the patient, what the patient hoped to achieve, what questions arose and how the eventual decision was reached.
The objective is not simply to generate more documentation.
It is to create a clearer record of a better conversation.
What should a good crown consent process demonstrate?
There is no single consent script that can make consent valid for every crown case. The discussion has to remain individual to the patient, the tooth and the proposed treatment.
As a practical framework, however, clinicians should consider whether their consent process demonstrates:
- why the treatment is being recommended, including the diagnosis and treatment objectives;
- what the proposed treatment involves, particularly irreversible aspects;
- the important benefits, limitations and material risks relevant to that patient;
- the reasonable alternatives, including more conservative treatment, delaying treatment or no treatment where appropriate;
- realistic aesthetic and functional expectations;
- anticipated maintenance and the possibility of future repair, replacement or additional treatment;
- relevant fees and foreseeable financial implications;
- the patient's individual priorities and concerns;
- an opportunity to ask questions and consider the information; and
- evidence that understanding was checked and the patient's decision documented.
This should not become an exhaustive generic list delivered identically to every patient.
The purpose of consent is to help this patient make an informed decision about this treatment.
Where digital consent can genuinely help
Technology can strengthen this process when it supports, rather than attempts to replace, the clinician-patient conversation.
Giving patients structured information before treatment creates the opportunity to review important information away from the pressure of a busy surgery. They can revisit it, consider their questions and arrive at the subsequent discussion better prepared.
Clear Consent was built by dentists around that principle.
For individual clinicians, digital consent forms, patient-facing AI consent videos and comprehension checks can help deliver important information in a more structured and consistent way. The patient can engage with information before treatment, while the subsequent clinical discussion remains individual to them.
For practices, standardised consent workflows can help reduce variation between clinicians and create a more organised approach to consent across the dental team. Digital documentation, e-signatures, multi-language functionality and an audit trail can also make the process easier to review and manage.
But technology is only part of the answer.
Clear Consent is an adjunct to, not a replacement for, clinician-led consent. The treating clinician remains responsible for assessing the individual patient, discussing the material issues relevant to them, answering questions and satisfying themselves that valid consent has been obtained before proceeding.
The strongest model is therefore not digital consent instead of conversation.
It is better information before the conversation, a more focused conversation with the clinician, and a clearer record afterwards.
The lesson extends far beyond crowns
The GDC's recent crown cases should not make clinicians fearful of providing crowns.
The more useful lesson is that even apparently routine dentistry can become difficult when the record does not clearly demonstrate why treatment was recommended, what alternatives were considered, what mattered to the patient and what they understood before agreeing to proceed.
The same principle applies to implants, composite bonding, veneers, orthodontics, endodontics and many other treatment decisions.
Consent should not be something we complete immediately before dentistry begins.
Done properly, it is part of good dentistry itself.
More than a signature
Clear Consent helps dental professionals provide clearer information, create more consistent consent workflows and maintain a more organised record of the consent process.
Explore Clear Consent for dentists or get started with Clear Consent.
For further articles exploring consent, communication and professional risk in modern dental practice, visit the Clear Consent blog!
Source note
This article refers to Heavy is the Head: Complaints about dental crowns – sharing insights and learning, published by the General Dental Council on 10 September 2026; the current Standards for the Dental Team; the 2023 Adult Oral Health Survey for England; and the Supreme Court judgment in Montgomery v Lanarkshire Health Board.
The GDC states that its crown complaints article is intended to share insights from complaints and concerns casework and does not itself set or provide clinical standards or clinical guidance. This article is written for general educational purposes and should not be treated as individual legal, regulatory or clinical advice.