My 2-year-old child attends preschool, and with that comes the enrolment of all parents in the class WhatsApp group. The group is used by the teacher and Principal to make announcements and send reminders to parents. Thankfully the group is set up such that only the group administrators (i.e., the school staff) can send messages to the group.

One day, a message in the group grabbed my attention because it started off with a tooth emoji – and I am only used to seeing tooth emojis in my dental WhatsApp groups, not my child’s preschool group. The message, from the class teacher, read as follows:

Hello families 🦷

There is a little treat from the dentist for your child in their bags! Please check their bags! 😁

Thank you 😃

Firstly, I wasn’t aware that there’d be a dentist at the school on the day and my initial thought was to wonder what exactly the dentist did to my child. Secondly, I was curious as to what the “treat” could be, but that curiosity was short-lived, due to a follow-up message from the teacher, which was simply a photo of a re-sealable plastic bag containing a sample of a well-known toothpaste for sensitive teeth, two yellow pencil erasers with emojis embossed on them, and a dentist’s business card. I suspected that this would lead to a barrage of messages from parents on the group, but I was comforted when I remembered that the group settings were restricted.

Despite that, a few minutes later, my private direct messages started to light up, from none other than my lovely wife who is also a dentist. She pointed out to me what I had, and what any other reasonable dentist would have noted; that the toothpaste in the picture was not suitable for 2-year-olds. I suppose my wife figured, given that I advise on medico- and dentolegal issues daily (and apart from the fact that my child was directly involved), who better for her to contact than me for advice in this situation.

I must admit however – and perhaps this was because it was such a personal matter – that I found myself being less certain and assertive in my advice to my wife. Despite my background as a lawyer and the stereotypical perception that that entails always looking for an argument, I tend to avoid personal conflict wherever possible. In that light, I reasoned with my wife: perhaps the dentist had informed the school or left a note in the goodie bag which expressly stated that the toothpaste was not for children (there was no such note). To that, my wife’s rebuttal was that the WhatsApp message did not make that clear, and parents who might not be as discerning or knowledgeable might not know better. I couldn’t argue with this point. So after a short discussion, we agreed that my wife would contact the teacher and bring it to her attention that the toothpaste was not suitable, and that the school could then use their discretion as to the way forward.

A few hours later, the teacher sent the following message to the group:

“Hi Parents. Please note the toothpaste sent home today is for adults and not children.”

We were pleased to see this message. Nonetheless, my wife considered contacting the dentist directly to let him have a piece of her mind, but after some counsel by her significant other, decided against it; the dentist would presumably have already been contacted by the school to confirm that the toothpaste was not suitable, prior to the school sending their final message on the WhatsApp group, and would hopefully have learnt his lesson about being cautious regarding what to hand out at school visits and how to convey information to lay people.

The child’s best interests

School health outreach programmes are admirable initiatives aimed at improving learning and strengthening communities by addressing specific healthcare needs. When dentists do this noble voluntary work, the goal is presumably to improve oral health awareness in a community. That it is done voluntarily and without remuneration should be lauded. It is a service to the community. But the scenario described earlier hopefully demonstrates that this fact alone does not shield well-intentioned practitioners from the potential pitfalls which come with such endeavours.

The overarching principle is that a child’s best interests are of paramount importance in every matter concerning the child. The first thing that a dental professional should ensure, before examining or advising a child, is that they have the informed consent of a person who is legally competent to give such consent, which in most instances is the parent or guardian of the child. 

Once the issue of consent is clear, there are further matters to bear in mind. The information on health promotion, prevention and treatment should be relevant and in a format accessible to children, giving due regard to the needs of disabled children. So for example, simply handing out free toothpaste, some stationery and a business card to toddlers would not satisfy this requirement. Remember always that whatever you say or give to a child, must be in their best interests. Whose best interests is served by handing a business card to a toddler at a preschool? And what about photos of children online?

Social media photos – privacy and consent

Social media has made it effortless to publicise things. I have seen clinicians post pictures of children – be they patients or pupils at school visits – on various social media platforms (WhatsApp statuses, Instagram, Facebook, TikTok etc). When I see these images, I always hope that my colleagues have taken into account the basic principle of informed consent. We need to have the consent of the parent or guardian of the child before posting the child’s photo online. This is both a legal and a professional ethical requirement. A photograph of a child constitutes the child’s personal information. By posting the child’s photo online, you are processing their personal information. The law prohibits the processing of personal information of children (i.e., the posting of their images online), unless prior consent of a legally competent person (in most cases the parent or guardian) has been obtained.

It appears that some dental professionals are aware that it is unacceptable to post photos of children on social media without proper consent. I say this, because I often see clinicians posting photos of children with their faces blocked out either by an opaque shape or, more commonly on social media, by an emoji. While this technique may potentially be effective in de-identifying the child for purposes of the law, this doesn’t absolve the clinician from other applicable professional and ethical duties. Dental professionals should get written consent from patients before posting photos of them online, whether or not they believe that the patient can be identified by the photo. For children, written consent of the parent or guardian, and assent of the minor, is recommended.

Conclusion

Dental professionals who dedicate their time, effort and resources to school outreach programmes, generally do so voluntarily and with the best interests of the community at heart. It is often a labour of love. These clinicians should be celebrated, and sadly don’t always receive the recognition that they deserve. This article is not intended to discourage such efforts. It is simply a reminder that if one does get involved in such initiatives, one should always ensure that it is done with the appropriate prior consent, and that the information and resources given to children must be relevant to and easily accessible and understood by children. Always act in the child’s best interests and unless you have their parents’ or guardians’ permission to post their photos online, don’t.

If you must post a photo about your day at the school, perhaps a photograph of the entrance or some of the staff (with their consent) and an appropriate caption beneath the photo, will suffice. It is not difficult to see how, if circumstances were slightly different, the dentist who attended at my daughter’s preschool could have found themselves having to explain their conduct to the HPCSA if a complaint had been lodged by aggrieved parents.