Assessing Capacity for Dental Decisions

Capacity assessment is decision-specific and time-specific. A patient may have capacity for a simple examination but not for choosing between complex implant options. Capacity can be affected by acute pain, infection, delirium or severe anxiety, and may return when the situation is calmer.

The two-stage test

• Stage one: is there an impairment or disturbance in the functioning of the mind or brain?
• Stage two: does that impairment mean the person is unable to make this specific decision when it needs to be made?

A person is unable to make the decision if they cannot understand, retain, use or weigh the relevant information, or communicate the decision by any means. Communication may be spoken, written, signed, gestured, supported by pictures, or assisted through another appropriate method.

Dental nurses should avoid labelling a patient as lacking capacity. They should observe and report. Useful observations include repeated misunderstanding, inability to weigh options, distress that prevents engagement, improved understanding with visual aids, or times of day when the patient is more settled.

Things that do not by themselves prove incapacity include slow speech, unusual wording, need for an interpreter, a diagnosis of dementia, disagreement with the dentist, or choosing an option the team would not choose. These factors may indicate a need for better support but do not automatically mean the patient cannot decide.

Who assesses capacity for dental treatment?

Capacity is not a general label. It is about this patient, this decision, this information, and this time.