Trust is a word you do not often see mentioned in a research paper in the BDJ, yet the fascinating and important paper by Chapple et al (page 321 in this issue) on Exploring dental patients' preferred roles in treatment decision-making - a novel approach draws some interesting observations about the role of trust between patients and dentists and its possible effects.

The paper describes research carried out at the University Dental Hospital of Manchester and a general dental practice in Chester. Twenty patients in each site were asked to choose how involved they would like to be and then how involved they felt they actually were in decisions about their treatment. Choices ranged from not feeling involved at all through a range of involvement to the other extreme of the patient making the final choice about treatment. Perhaps not surprisingly most patients wanted an equal sharing of responsibility between the dentist and the patient but felt the dentist often played a more dominant role.

When asked about what they felt really happened the patients in hospital felt far less involved in their treatment decisions than those in general practice. The authors of the paper suggest that one possible reason for this is that hospital patients seem to trust their dentist more. They point out that in the hospital patients trust is mentioned by nine out of the ten patients in their comments, usually in a positive light and normally as a reason for the more passive role the patients feel appropriate. In other words the patients seem happy to leave treatment decisions to the dentist because they trust him or her.

In contrast, trust had a more negative connotation for the patients in general practice, reinforcing their desire for more involvement in their treatment decisions because the patients felt they were not so happy to trust the dentist. The researchers postulate this perceived lack of trust may, in part, be due to the negative perceptions of dentists in the media where the only news worth reporting is bad news (as we all know only too well). If this is true then perhaps the media should reassess its approach to reportage in dental healthcare, rather than focusing on stories that supposedly the public 'have a right to know' - but I digress!

One possible conclusion that could be drawn from this paper is that when patients trust their dentist they are happier to play a passive role in treatment decisions. The authors of the paper never make this claim, but I found myself wondering if people might make this assumption, and more importantly if it was really true. I also found myself wondering if this was a good policy for dentists to follow.

We all recognise the patient who blithely states, when confronted with a choice of treatment options, "You're the expert - what would you do?" This may imply the patient trusts you, but is it best for the patient if you succumb to the temptation to give an answer. We may all know what we think is best for the patient, or perhaps what we really would do if we had to make the choice about our own mouth, but is this right?

We may well know what we think is clinically best, but overall we cannot make a choice for someone else.

Treatment decisions involve more than just the clinical situation, as we all know when faced with the media 'exposure' of a reporter visiting a number of dentists and discovering they are given a number of different treatment plans. Of course this will happen because the patient's wishes, attitudes, beliefs, objectives, environment, job, family, economic circumstances etc all play a role in any treatment decision. But how can anyone else but the patient take all these into account? We may well know what we think is clinically best, but overall we cannot make a choice for someone else. In fact to do so may be more damaging in the long run for the patient.

Could it be that the trust a patient has for a dentist should mean the patient knows the dentist will provide the relevant knowledge the patient needs to make the decision and then in turn the dentist trusts the patient to take responsibility for the final treatment choice? And that is all.