For years, consent in dentistry was too often treated as something to be completed rather than something to be achieved.
A form was presented. Risks were listed. A signature was obtained. The paperwork was filed.
Yet a signature can confirm that a document has been signed; it cannot, by itself, prove that a patient understood the proposed treatment, appreciated the risks that mattered to them, considered the reasonable alternatives or had a meaningful opportunity to ask questions.
The Supreme Court’s decision in *Montgomery v Lanarkshire Health Board* in March 2015 placed that distinction at the centre of UK healthcare law. Although the case arose from obstetric care rather than dentistry, its effect has been profound across clinical practice: consent must be built around the individual patient’s right to make an informed choice, not simply the information a clinician ordinarily chooses to disclose.
For dental professionals, the practical message is clear. Valid consent is not a document or a single moment. It is an informed, individualised and properly recorded process.
What happened in the Montgomery case?
Nadine Montgomery was a woman of small stature who had diabetes and was expecting a larger-than-average baby. Her obstetrician recognised that vaginal delivery carried an increased risk of shoulder dystocia, a complication in which the baby’s shoulders become lodged during birth. Mrs Montgomery was not advised of that risk or of the possibility of an elective caesarean section.
Shoulder dystocia occurred during delivery. Her son was deprived of oxygen and sustained severe disabilities. Mrs Montgomery brought a clinical negligence claim, arguing that she should have been informed of the risk and the available alternative.
The Supreme Court found in her favour. Its judgment stated that clinicians must take reasonable care to ensure patients are aware of the **material risks** of recommended treatment and of any **reasonable alternative or variant treatments**.
That wording altered the focus of consent. The central question was no longer merely:
What would a responsible body of clinicians ordinarily disclose?
It became:
What information would this patient reasonably need in order to decide?
That distinction moved consent away from a predominantly clinician-led model and towards a conversation grounded in patient autonomy.
Montgomery did not make consent patient-centred overnight
It would be too simplistic to suggest that patient-centred consent began with one court case.
The General Dental Council’s *Standards for the Dental Team*, effective from September 2013, already required dental professionals to obtain valid consent, explain relevant options and costs, determine what patients want to know, check their understanding and document the consent process.
Montgomery nevertheless gave these principles considerable legal force. It made clear that decisions about risk cannot be left entirely to professional custom. Clinical expertise remains essential, but it does not displace the patient’s right to decide which risks they are willing to accept.
That remains highly relevant. In February 2026, the GDC reported that failure to obtain valid consent and failure to document consent had collectively featured in approximately 3–4% of considerations presented at the Dental Professionals Hearings Service over recent years. The GDC also cautioned that the true proportion may be higher because consent concerns can emerge as investigations develop.
Consent, in other words, is not an abstract legal concern. It continues to appear in contemporary dental regulation and professional scrutiny.
What is a “material risk” in dentistry?
Montgomery did not define materiality by means of a fixed percentage.
A risk is material when either:
- a reasonable person in that patient’s position would probably attach significance to it; or
- the clinician knows, or should reasonably know, that the particular patient would attach significance to it.
The Supreme Court also explained that materiality is sensitive to the circumstances and characteristics of the patient. The likelihood of a complication matters, but so do its potential consequences, the patient’s priorities, the expected benefit of treatment and the alternatives available.
This is especially important in dentistry, where the same complication may carry very different significance for different people.
Consider a patient contemplating implant treatment in the aesthetic zone. A comparatively uncommon soft-tissue complication may be particularly important to someone whose principal concern is the appearance of their smile. Altered sensation may carry greater weight for a professional musician, singer or public speaker. The possibility of prolonged treatment may be decisive for someone who is moving abroad, undergoing other medical care or working to a fixed personal deadline.
Materiality is therefore not synonymous with frequency. A low-probability event may still be material when its consequences would be serious or especially relevant to that patient. Conversely, presenting every remote or theoretical complication without context can obscure rather than improve understanding.
The clinician’s task is not to recite the longest possible list. It is to identify the information that enables this patient to make a meaningful choice.
Consent requires dialogue, not information overload
The Montgomery judgment expressly rejected the idea that consent can be achieved by overwhelming patients with technical information or routinely asking them to sign a form.
Instead, the court described the clinician’s advisory role as a dialogue. Information must be comprehensible and must help the patient understand their condition, the anticipated benefits and risks of treatment, and the reasonable alternatives.
This distinction matters when developing consent materials.
A twenty-page form written in dense clinical language may contain a great deal of information while communicating very little.
Good consent information should support the clinical conversation by helping the patient to:
- understand what is being proposed and why;
- compare its benefits, limitations and material risks;
- consider reasonable alternatives, including delaying or declining treatment where appropriate;
- relate that information to their own priorities;
- formulate questions; and
- reach a voluntary decision without pressure.
The GDC similarly requires dental professionals to communicate at a level patients can understand, recognise individual communication needs, encourage questions and satisfy themselves that the patient has understood the information given. It specifically includes delaying treatment or doing nothing among the options that may need to be explained.
Must every possible dental treatment be discussed?
No. Montgomery does not require dentists to discuss every treatment that could theoretically be performed.
This point was clarified by the Supreme Court in *McCulloch v Forth Valley Health Board* in July 2023. The court held that determining which alternatives are clinically reasonable remains an exercise of professional skill and judgement. A clinician is not obliged to present options that are not considered clinically reasonable, provided that judgement is supported by a responsible body of professional opinion.
However, once the range of reasonable alternatives has been identified, the patient should be told about all of them—not merely the option preferred by the treating clinician. This can include no active treatment where that is a reasonable option.
For dentistry, that might mean discussing:
- restoration, endodontic treatment or extraction for a compromised tooth;
- a removable prosthesis, conventional bridge, resin-bonded bridge, implant or acceptance of a space;
- monitoring, repair or replacement of an existing restoration;
- orthodontic, additive restorative or more invasive restorative approaches;
- treatment now, treatment later or no treatment, where clinically appropriate.
The purpose is not to transfer clinical diagnosis to the patient. Dentists remain responsible for assessing suitability, explaining their recommendation and excluding inappropriate interventions. The patient’s role is to decide between the reasonable options after receiving information that reflects what matters to them.
What Montgomery means in everyday dental practice
The most important effect of Montgomery is not the need for longer consent forms. It is the need for better questions, clearer conversations and more reliable systems.
Before proceeding, the treating clinician should be able to answer five practical questions.
1. Have we understood this patient?
A generic discussion cannot reveal whether the patient’s overriding concern is appearance, treatment longevity, avoiding surgery, preserving tooth tissue, minimising cost or completing care within a particular timeframe.
Understanding the patient’s objectives is part of determining what information may be material.
2. Have we explained the reasonable options?
The discussion should include the proposed treatment, clinically reasonable alternatives and, where relevant, the consequences of delaying or declining care.
The clinician may still make a clear recommendation. Patient-centred consent does not require professional neutrality or the absence of clinical judgement. It requires the patient to understand that other reasonable choices exist and why one option is being recommended.
3. Have we explained the risks in a meaningful way?
Simply naming a complication may not communicate its significance.
Patients may need to understand what the complication could mean in practice, whether further treatment might be required, whether the outcome could be temporary or permanent and how it might affect function, appearance, time or cost.
4. Have we checked understanding?
“Do you understand?” is a weak test. Many patients will say yes because they are anxious, do not wish to appear difficult or do not know what they have misunderstood.
More useful approaches include asking the patient to summarise the options in their own words, explain what matters most to them or identify the main risks they have considered.
GDC Standard 3.1.4 requires dental professionals to check and document that patients have understood the information provided. :contentReference[oaicite:7]{index=7}
5. Can the record show how the decision was reached?
The clinical record should demonstrate more than the existence of a signed form. It should reflect the patient’s concerns, the options considered, the material risks discussed, questions asked, advice provided and the patient’s eventual decision.
The GDC states that, although a signature is important evidence that consent was given, the discussions with the patient determine whether that consent is valid. It also requires contemporaneous, complete and accurate records.
Consent is an ongoing process
Consent can change as treatment develops.
A patient may revise their decision when new diagnostic information becomes available, when the treatment plan changes, when an unexpected finding arises or when the likely cost, duration or prognosis alters. They may withdraw consent before or during treatment.
The Care Quality Commission’s dental consent guidance, updated in June 2024, reiterates that consent must be voluntary, that sufficient information and time must be provided, and that patients may withdraw consent at any point. SDCEP also describes consent as an ongoing process rather than a single event.
For longer courses of treatment—such as implant dentistry, orthodontics, complex restorative rehabilitation or phased periodontal care—it is therefore sensible to revisit consent at appropriate stages rather than relying indefinitely on an earlier signature.
The operational problem for dental practices
None of this is difficult to accept in principle. Delivering it consistently across a busy practice is harder.
Different clinicians may explain the same procedure in different ways. Important details can be missed when appointments overrun. Patients may receive information while anxious, numb or under time pressure. Printed forms are often skimmed shortly before treatment. Discussions may be comprehensive but recorded only as “risks and benefits discussed”.
These are not necessarily signs of poor intentions. They are predictable weaknesses in systems that rely heavily on memory, individual habits and limited chairside time.
Practice owners therefore need to consider consent as a clinical governance workflow, not merely a collection of forms. The objective should be a consistent baseline of high-quality information combined with individual clinical discussion and documentation.
A sound workflow should make it easier to do the right thing every time, while preserving the clinician’s responsibility to tailor the process to the patient.
How Clear Consent can support a Montgomery-aligned workflow
Clear Consent was built by UK dentists around a simple principle: consent should be more than a signature.
The platform allows practices to send patients clear information before treatment through digital consent forms and AI-powered consent videos. Patients can review the information in their own time, rather than encountering it for the first time immediately before a procedure.
Comprehension checks can help identify whether key information has been understood. Patients can raise questions, while multi-language support can improve accessibility for those who would benefit from receiving information in another language. E-signatures, practice branding and an organised audit trail help practices maintain a more consistent and readily reviewable consent pathway.
For practice owners, standardised workflows can reduce unwarranted variation between clinicians and locations. For treating dentists, they can provide a structured foundation for the individual conversation.
There is, however, an important limit. No platform, document or video can replace clinical judgement or the dialogue required for valid consent. A digital record that information was sent and viewed does not, on its own, prove that a patient understood it or that the material risks for that individual were addressed.
Clear Consent should therefore be used to strengthen—not substitute—the clinician-led process. The treating professional must still consider the patient’s circumstances, discuss reasonable alternatives, answer questions, confirm understanding and ensure that consent remains valid when treatment begins.
That distinction is central to responsible consent technology.
Frequently asked questions
Does a signed dental consent form prove valid consent?
Not by itself. A signature is useful evidence that the patient agreed to treatment, but the GDC states that the discussions taking place during the consent process determine whether consent is valid. The wider record should show what was explained, what mattered to the patient and how understanding was checked.
Does Montgomery mean dentists must disclose every possible risk?
No. The duty concerns material risks rather than every conceivable complication. Materiality depends on the probability and seriousness of the risk, the nature of the treatment, the reasonable alternatives and the circumstances and priorities of the individual patient.
Can another team member obtain consent on the dentist’s behalf?
Other team members can support patient education and the consent pathway within their competence. However, the treating clinician must not simply assume that valid consent has already been obtained. The GDC makes each professional responsible for ensuring valid consent before carrying out treatment or an investigation.
More than a signature
Montgomery did not make consent a defensive paperwork exercise. Properly understood, it did the opposite.
It reinforced that consent belongs to the patient. The clinician brings diagnosis, evidence, experience and professional judgement. The patient brings their own values, priorities, circumstances and willingness to accept risk. Valid consent emerges when those two perspectives are brought together through a clear and properly documented conversation.
For dental practices, the strongest response is not simply to add more wording to existing forms. It is to design a consent process that gives patients time, presents information consistently, encourages questions, tests understanding and supports individual clinical dialogue.
That is the difference between recording a signature and supporting an informed decision.
Clear Consent: More than a signature.
Learn how Clear Consent supports dentists:
https://www.clearconsent.co.uk/dentists
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https://www.clearconsent.co.uk/practice-owners
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