Valid consent and orthodontic treatment


Share / Export Citation / Email / Print / Text size:

Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine


ISSN: 2207-7472
eISSN: 2207-7480





Volume / Issue / page

Volume 37 (2021)
Volume 36 (2020)
Volume 35 (2019)
Volume 34 (2018)
Volume 33 (2017)
Volume 32 (2016)
Volume 31 (2015)
Related articles

VOLUME 35 , ISSUE 1 (May 2019) > List of articles

Valid consent and orthodontic treatment

Maurice J. Meade * / Annalene Weston / Craig W. Dreyer

Citation Information : Australasian Orthodontic Journal. Volume 35, Issue 1, Pages 35-45, DOI:

License : (CC BY 4.0)

Published Online: 20-July-2021



Valid patient consent is a legal and ethical principle that is fundamental to healthcare provision. Oral health practitioners (OHPs) must understand the principles that need to be addressed to ensure that the consent given by a patient is valid. Failure to obtain consent may result in a negligence claim or a complaint of professional misconduct against the OHP. Orthodontic treatment is mostly elective but is not without risk to the patient. Obtaining and maintaining valid consent for orthodontic treatment presents additional challenges in comparison with other dental procedures as the treatment lasts over a longer time and is most commonly performed in adolescents. In addition, prospective patients need to be informed regarding ‘lifelong’ management in the retention phase to minimise the risk of relapse. The present paper outlines the principles of valid consent with particular regard to orthodontic treatment in the adolescent patient. OHPs must ensure that they are satisfied that the competent patient has the capacity to voluntarily consent. Clinicians must also recognise that valid consent is not a one-off ‘tick the box’ procedural exercise but an ongoing process of effective information sharing in light of changing laws and an ever-changing scientific evidence base within a patient-centred model of healthcare.

Content not available PDF Share



1. Gallacher AA, Ward S. Informed Consent: A Changing Paradigm? Orthod Update 2017;10:146-8.

2. Bayliss CL. Informed consent: what’s new? Dent Update 2017;44:109-13.

3. Khoury BS, Khoury JN. Consent: a practical guide. Aust Dental J 2015;60:138-42.

4. Dental Board of Australia. Policies, Codes, Guidelines and FAQ. Viewed 30 August 2018, .

5. Tyson J. Obtaining consent in orthodontics: difficulties and considerations. Prim Dent J 2016;5:73-5.

6. Kennedy I, Grubb A. Medical Law. London: Butterworths, 2000.

7. Khoury BS, Khoury JN. Dentistry and criminal law. Aust Dental J 2017;62:295-300.

8. Dental Protection. Consent. Brisbane: Dental Protection Ltd, 2014;1-20.

9. Wood F, Martin SM, Carson‐Stevens A, Elwyn G, Precious E, Kinnersley P. Doctors’ perspectives of informed consent for non‐ emergency surgical procedures: a qualitative interview study. Health Expect 2016;19:751-61.

10. Collier A. The management of risk. Part 2: good consent and communication. Dent Update 2014;41:236-41.

11. Main BG, Adair SR. The changing face of informed consent. Brit Dent J 2015;219:325-7.

12. Dell’Oro K, Mata J. Case study – the law of consent for treatment to children. Viewed 30 August 2018, informed-consent/case-study-the-law-of-consent-for-treatment-tochildren>.

13. Policy Statement 5.15 – Consent to Treatment (Including ADA Guidelines for Consent for Care in Dentistry). In: Australian Dental Association, editor.: St. Leonards, Sydney: ADA; 2016. p.1-14.

14. Montgomery v. Lanarkshire Health Board (Scotland) 2015. UKSC 11.

15. Williams JC, Atack NE, Dhaliwal RD. Who wears the braces? A practical application of adolescent consent. Br Dent J 2015;218:623-7.

16. Sharma P. Informed consent in orthodontics: A Prospective RCT comparing two methods of information delivery. J Educ Ethics Dent 2013;3:81-7.

17. Campbell OJ, Gill DS, Naini FB. Informed Consent and orthodontic treatment. Orthod Update 2008;1:70-6.

18. Burke S, Kwasnicki A, Thompson S, Park T, Macpherson A. Consent and capacity—considerations for the dental team part 1: consent and assessment of capacity. Dent Update 2017;44:660-6.

19. Gabe J, Olumide G, Bury M. ‘It takes three to tango’: a framework for understanding patient partnership in paediatric clinics. Soc Sci Med 2004;59:1071-9.

20. Lai SM, Parekh S, Mason C, Roberts G. The accompanying adult: authority to give consent in the UK. Int J Paediatr Dent 2007;17:200-4.

21. Etchells E, Sharpe G, Walsh P, Williams JR, Singer PA. Bioethics for clinicians: 1. Consent. CMAJ 1996;155:177-80.

22. Adewumi A, Hector M, King JM. Paediatric dentistry: Children and informed consent: a study of children’s perceptions and involvement in consent to dental treatment. Brit Dental J 2001;191:256-9.

23 Australian Institue of Family Studies. Section 8; Medical Procedures for Children: Loane Skene. Viewed 30 August 2018,>.

24. Gillick v. West Norfolk and Wisbech Area Health Authority. All Engl Law Rep 1985;3:402-37.

25. Re Marion (re Marion (1991) FLC 92-193, #801) FLC 92-193, Secretary of the Department of Health and Community Services v JWB and SMB.

26. Elliston S. The best interests of the child in healthcare. London: Routledge-Cavendish, 2007.

27. Thomas N, O’Kane C. When children’s wishes and feelings clash with their ‘best interests’. Int J Child Rts 1998;6:137-54.

28. Perry J, Johnson I, Popat H, Morgan MZ, Gill P. Adolescent perceptions of orthodontic treatment risks and risk information: A qualitative study. J Dent 2018:74:61-70.

29. McCabe MA. Involving children and adolescents in medical decision making: developmental and clinical considerations. J Pediatr Psych 1996;21:505-16.

30. Stewart C. Advanced directives, the right to die and the common law: recent problems with blood transfusions. Melb Univ Law Rev 1999;23:161-83.

31. Re Bridges [2001] 1 Qd R 574

32. Stewart C, Biegler P. A primer on the law of competence to refuse medical treatment. Austr Law J 2004;78:325-42.

33. The Guardianship Act 1987 (NSW), S. 14.

34. Guardianship and Management of Property Act 1991 (ACT), s 7.

35. Guardianship and Administration Act 2000 ((QLD), #725), s. 12.

36. Guardianship and Administration Act 1986 (Vic), s. 22.

37. Guardianship and Administration Act 1993 (SA), s. 29.

38. Guardianship and Administration Act 2000 (WA), s. 43.

39. Guardianship and Administration Act 1995 (Tas), s. 20.

40. Adult Guardianship Act 1988 (NT) s. 8.

41. Guardianship and Administration Act 1993 (SA), s59.

42. Guardianship Act 1987 (NSW), s. 44.

43. Abdelkarim A, Jerrold L. Litigation and Legislation. Risk management strategies in orthodontics. Part 1: Clinical considerations. Am J Orthod Dentofacial Orthop 2015;148:345-9.

44. Kalsi JS, Hemmings KW, Cunningham SJ. Patient-centred care: how close to this are we? Dent Update 2018;45:557-68.

45. Wong L, Ryan FS, Christensen LR, Cunningham SJ. Factors influencing satisfaction with the process of orthodontic treatment in adult patients. Am J Orthod Dentofacial Orthod 2018;153:362-70.

46. Ireland A, Willmot D, Hunt N. An introduction to dento-legal issues and risks in orthodontics. Brit Dent J 2015;218:197-201.

47. Meade MJ, Millett DT. Vacuum-formed retainers: an overview. Dent Update 2015;42:24-6, 28-30, 33-4.

48. Benson PE, Javidi H, DiBiase AT. What is the value of orthodontic treatment? Br Dent J 2015;218:185-90.

49. Patel A, Burden DJ, Sandler J. Medical disorders and orthodontics. J Orthod 2009;36 Suppl:1-21.

50. Meade MJ, Millett D. Retention protocols and use of vacuum-formed retainers among specialist orthodontists. J Orthod 2013;40:318-25.

51. Brons S, Becking AG, Tuinzing DB. Value of informed consent in surgical orthodontics. J Oral Maxillofac Surg 2009;67:1021-5.

52. Alani A, Kelleher M. Restorative complications of orthodontic treatment. Br Dent J 2016;221:389-400.

53. Rinchuse DJ, Jerrold L, Rinchuse DJ. Orthodontic informed consent for impacted teeth. Am J Orthod Dentofacial Orthop 2007;132:103-4.

54. Williams A, D’Cruz L. Risk management for general dental practitioners providing orthodontic treatment. Prim Dent J 2016;5:50-5.

55. Chester v. Afshar (2004) UKHL 41

56. Bolam v. Friern Barnet Hospital Management Committee (1957) 1 WLR 582.

57. Rogers v. Whitaker (1992) 175 CLR 479 at 490.

58. Rosenberg v. Percival (574, #668) 205 CLR 434 at 434-40.

59. Edwards A, Elwyn G. Shared decision making in health care: Achieving evidence based patient choice. Second edition. Oxford: Oxford University Press, 2009.

60. Mulley AG, Trimble C, Elwyn G. Patients’ Preferences Matter. BMJ 2012;345:e6572

61. O’Connor AM, Edwards A. The role of decision aids in promoting evidence-based patient choice. In Edwards A, Elwyn G, eds. Evidence-based patient choice: inevitable or impossible? Oxford: Oxford University Press, 2001;220-42.

62. Parker K, Cunningham SJ, Petrie A, Ryan FS. Randomized controlled trial of a patient decision-making aid for orthodontics. Am J Orthod Dentofacial Orthop 2017;152:154-60.

63. Kang EY, Fields HW, Kiyak A, Beck FM, Firestone AR. Informed consent recall and comprehension in orthodontics: traditional vs improved readability and processability methods. Am J Orthod Dentofacial Orthop 2009;136:488.e1-13.

64. Harwood A, Harrison JE. How readable are orthodontic patient information leaflets? J Orthod 2004;31:210-9.

65. Arora A, Lam AS, Karami Z, Do LG, Harris MF. How readable are Australian paediatric oral health education materials? BMC oral health 2014;14:111.

66. Thomson AM, Cunningham SJ, Hunt NP. A comparison of information retention at an initial orthodontic consultation. Eur J Orthod 2001;23:169-78.

67. Carr KM, Fields HW Jr, Beck FM, Kang EY, Kiyak HA, Pawlak CE et al. Impact of verbal explanation and modified consent materials on orthodontic informed consent. Am J Orthod Dentofacial Orthop 2012;141:174-86.

68. Mortensen MG, Kiyak HA, Omnell L. Patient and parent understanding of informed consent in orthodontics. Am J Orthod Dentofacial Orthop 2003;124:541-50.

69. McMorrow SM, Millett DT. Adult orthodontics: a quality assessment of Internet information. J Orthod 2016;43:186-92.

70. Patel U, Cobourne MT. Orthodontic extractions and the Internet: quality of online information available to the public. Am J Orthod Dentofacial Orthop 2011;139:e103-9.

71. Stephens R, Ryan FS, Cunningham SJ. Information-seeking behavior of adolescent orthodontic patients. Am J Orthod Dentofacial Orthop 2013;143:303-9.

72. Hafez HS, Shaarawy SM, Al-Sakiti AA, Mostafa YA. Dental crowding as a caries risk factor: a systematic review. Am J Orthod Dentofacial Orthop 2012;142:443-50.

73. Addy M, Dummer PM, Griffiths G, Hicks R, Kingdon A, Shaw WC. Prevalence of plaque, gingivitis and caries in 11–12‐year‐ old children in South Wales. Community Dent Oral Epidemiol 1986;14:115-8.

74. Seehra J, Fleming PS, DiBiase AT. Orthodontic treatment of localised gingival recession associated with traumatic anterior crossbite. Aust Orthod J 2009;25:76-81.

75. Andrade AS, Gameiro GH, DeRossi M, Gavião MBD. Posterior crossbite and functional changes: a systematic review. Angle Orthod 2009;79:380-6.

76. Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint (TMJ) disorders. Cochrane Database Syst Rev 2010;7:CD006541.

77. Thiruvenkatachari B, Harrison JE, Worthington HV, O’Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children. Cochrane Database Syst Rev 2013;11:CD003452.

78. Ericson S, Kurol PJ. Resorption of incisors after ectopic eruption of maxillary canines: a CT study. Angle Orthod 2000;70:415-23.

79. Seehra J, Yaqoob O, Patel S, O’Neill J, Bryant C, Noar J et al. National clinical guidelines for the management of unerupted maxillary incisors in children. Br Dent J 2018;224:779-85.

80. Hassan T, Naini FB, Gill DS. The effects of orthognathic surgery on speech: a review. J Oral Maxillofac Surg 2007;65:2536-43.

81. Seehra J, Fleming PS, Newton T, DiBiase AT. Bullying in orthodontic patients and its relationship to malocclusion, self-esteem and oral health-related quality of life. J Orthod 2011;38:247-56.

82. Shaw WC, Meek SC, Jones DS. Nicknames, teasing, harassment and the salience of dental features among school children. Br J Orthod 1980;7:75-80.

83. Feu D, Miguel JA, Celeste RK, Oliveira BH. Effect of orthodontic treatment on oral health-related quality of life. Angle Orthod 2013;83:892-8.

84. Bernabé E, Tsakos G, Messias de Oliveira C, Sheiham A. Impacts on daily performances attributed to malocclusions using the conditionspecific feature of the Oral Impacts on Daily Performances Index. Angle Orthod 2008;78:241-7.

85. Booth-Mason S, Birnie D. Penetrating eye injury from orthodontic headgear—a case report. Eur J Orthod 1988;10:111-4.

86. Meade MJ. Sports mouthguards and orthodontic treatment. Dent Update 2018;45:848-58.

87. Isaacson KG, Thom AR, Atack NE, Horner K, Whaites E. Orthodontic radiographs: guidelines for the use of radiographs in clinical orthodontics. 4th edn. London: British Orthodontic Society, 2015.

88. Hain M, Longman L, Field EA, Harrison JE. Natural rubber latex allergy: implications for the orthodontist. J Orthod 2007;34:6-11.

89. Rahilly G, Price N. Current products and practice: Nickel allergy and orthodontics. J Orthod 2003;30:171-4.

90. Bartzela T, Türp JC, Motschall E, Maltha JC. Medication effects on the rate of orthodontic tooth movement: a systematic literature review. Am J Orthod Dentofacial Orthop 2009;135:16-26.

91. Rahman S, Spencer RJ, Littlewood SJ, O’Dywer L, Barber SK, Russell JS. A multicenter randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: Part 2: Pain perception. Angle Orthod 2015;86:149-56.

92. Ertan Erdinç AM, Dinçer B. Perception of pain during orthodontic treatment with fixed appliances. Eur J Orthod 2004;26:79-85.

93. Polat Ö. Pain and discomfort after orthodontic appointments. Semin Orthod 2007;13:292-300.

94. Bavbek NC, Tuncer BB, Tortop T, Celik B. Efficacy of different methods to reduce pain during debonding of orthodontic brackets. Angle Orthod 2016;86:917-24.

95. Zachrisson BU. Cause and prevention of injuries to teeth and supporting structures during orthodontic treatment. Am J Orthod 1976;69:285-300.

96. Brignardello-Petersen R. Very low certainty evidence suggests small benefits of tooth extraction compared with nonextraction in patients undergoing orthodontic fixed appliance treatment. J Am Dent Assoc 2018;149:e137.

97. Iared W, da Silva EM, Iared W, Macedo CR. Esthetic perception of changes in facial profile resulting from orthodontic treatment with extraction of premolars: A systematic review. J Am Dent Assoc 2017;148:9-16.

98. Driscoll-Gilliland J, Buschang PH, Behrents RG. An evaluation of growth and stability in untreated and treated subjects. Am J Orthod Dentofacial Orthop 2001;120:588-97.

99. Greene CS, Klasser GD. Screening orthodontic patients for temporomandibular disorders. In: Kandasamy S, Greene C, Rinchuse D, Stockstill J, eds. TMD and Orthodontics. Springer, Cham, 2015.

100.Chen J, Wan J, You L. Speech and orthodontic appliances: a systematic literature review. Eur J Orthod 2017;40:29-36.

101.Carter LA, Geldenhuys M, Moynihan PJ, Slater DR, Exley CE, Rolland SL. The impact of orthodontic appliances on eating—young people’s views and experiences. J Orthod 2015;42:114-22.

102.Littlewood SJ, Millett DT, Doubleday B, Bearn DR, Worthington HV. Retention procedures for stabilising tooth position after treatment with orthodontic braces. Cochrane Database Syst Rev 2016:CD002283.

103.Nanda RS, Kierl MJ. Prediction of cooperation in orthodontic treatment. Am J Orthod Dentofacial Orthop 1992;102:15-21.

104.Daniels AS, Seacat JD, Inglehart MR. Orthodontic treatment motivation and cooperation: a cross-sectional analysis of adolescent patients’ and parents’ responses. Am J Orthod Dentofacial Orthop 2009;136:780-7.

105.Heymann GC, Grauer D. A contemporary review of white spot lesions in orthodontics. J Esthet Restor Dent 2013;25:85-95.

106.Bukhari OM, Sohrabi K, Tavares M. Factors affecting patients’ adherence to orthodontic appointments. Am J Orthod Dentofacial Orthop 2016;149:319-24.

107.Azzeh E, Feldon PJ. Laser debonding of ceramic brackets: a comprehensive review. Am J Orthod Dentofacial Orthop 2003;123:79-83.

108.Bernardi S, Continenza MA, Macchiarelli G. Microscopic evaluation of the enamel surface after debonding procedures: An ex vivo study using scanning electron microscopy. Microscopie 2018;29.

109.Gkantidis N, Christou P, Topouzelis N. The orthodontic– periodontic interrelationship in integrated treatment challenges: a systematic review. J Oral Rehabil 2010;37:377-90.

110.Alstad S, Zachrisson BU. Longitudinal study of periodontal condition associated with orthodontic treatment in adolescents. Am J Orthod 1979;76:277-86.

111.Weltman B, Vig KW, Fields HW, Shanker S, Kaizar EE. Root resorption associated with orthodontic tooth movement: a systematic review. Am J Orthod Dentofacial Orthop 2010;137:462-76.

112.Meeran NA. Iatrogenic possibilities of orthodontic treatment and modalities of prevention. J Orthod Sci 2013;2:73-86.

113.Kindelan SA, Day PF, Kindelan JD, Spencer JR, Duggal MS. Dental trauma: an overview of its influence on the management of orthodontic treatment. Part 1. J Orthod 2008;35:68-78.

114.Bauss O, Röhling J, Rahman A, Kiliaridis S. The effect of pulp obliteration on pulpal vitality of orthodontically intruded traumatized teeth. J Endod 2008;34:417-20.

115.Wishney M. Potential risks of orthodontic therapy: a critical review and conceptual framework. Aust Dent J 2017;62 Suppl 1:86-96.