Throughout their years of practice, dentists will occasionally encounter a dental patient who refuses to take their professional advice. So, what is the best course of action for dentists to both prioritize patient safety and minimize liability?

Document, document, document. Here’s how.

Let’s say the dentist notices an issue during a dental visit, makes a differential diagnosis and gives the patient their professional advice to take some sort of action — which the patient refuses. First, the dentist needs to clearly explain the potential consequences the patient could face if the advice is ignored.

If the dental patient still refuses to take the advice, the dentist should then have the patient sign an informed refusal form. This document acknowledges that the patient has received information about the risks of refusing treatment and still does not consent. The dentist should document the conversations that take place and include that documentation and the refusal form in the dental record.

MLMIC can provide insureds with both informed consent and informed refusal forms to download and use in their practices. Getting these forms signed by the patient, whether the patient consents or refuses, is an important part of explaining the risks and benefits of a procedure to patients and acknowledging their understanding.

What if the patient refuses to sign the informed refusal form? Then, the dentist needs to document all the more thoroughly regarding the information given to the patient, the effort to have the patient sign an informed refusal form and the ultimate decision of the patient not to do so. On the signature line where the patient should have signed, the dentist can write “Patient refuses to sign” and note the date. Having a second staff member present to corroborate these conversations and decisions would be beneficial in the event of a claim.

In another scenario, a patient may request a procedure that the dentist does not recommend or advises against. In this case, the dentist should refuse to provide this treatment and should refer the patient to another dentist. Again, this conversation and the decision process should be thoroughly documented in the dental record.

The moral of this story is to document, document, document. The dental record is an important place for dentists to keep track of their conversations with patients, the professional advice given and patients’ actions and decisions. It is also an important part of the litigation process if a claim is made.

MLMIC insureds can request informed consent and informed refusal forms for use in their practices. Policyholders also can contact a team of risk management professionals 24/7 at no additional cost by calling (844) MMS-LAW1 or emailing

For more information related to risk management, visit the MLMIC Dental blogThe Scope: Dental EditionDental Impressions and our Twitter and LinkedIn pages.