Background: Little is known about dentist-patient interactions when engaging in decisions to have dental implants. Indeed, the process by which patients are selected for implant therapies is poorly understood. Although different models of decision making have been used to examine the decisions made in medical consultations these have yet to be explored in relation to the decisions to have dental implants. Likewise the role of power in the decision making process has never been explored in any depth. The aim of this study was to explore the decision making process associated with providing patients with dental implants. Methods: This study involved a cross-sectional ethnographic study using participant observation of dental consultations and follow-up semi-structured interviews of dentists and patients. Convenience sampling was used to select a wide range of consultations. Data were analysed using the framework method, inductive thematic analysis and typology strategy of analysing qualitative data. Results: Three dentists and thirty-two patients contributed in this study. No implant consultation involved a full shared decision making. Elderly patients ‘above 55 years’ with lower education levels tended to experience more paternalistic and interpretative decision making in their consultations. It was also found that power operated in the consultations through the use of authority, influence, manipulation, coercion and hidden decisions in the consultations. Conclusions and clinical implications: Improving the quality of healthcare and cutting undesirable outcomes are central advantages of shared decision making. Respecting patients’ autonomy, facilitating discussion on treatment options and gaining a better understanding and evaluation of patients’ preferences, needs and values are critical if the desire is to employ shared decision making in implant consultations. Reducing the misuse of power is also important. This might be achieved by a range of factors including increasing patients’ awareness, encouraging patients’ participation their consultations and focussing training on dentist interaction skills amongst other things.