Interest in aesthetic dentistry is a continuing area of growth for many dental professionals, and in our experience patients are increasingly willing to request and fund elective aesthetic treatment, such as tooth whitening and additive composite techniques, including composite bonding and veneers.
Dental professionals naturally work to meet the expectations of their patients, but sometimes these expectations can be higher than what can be reasonably achieved. Dealing with patients' dissatisfaction is stressful and time-consuming and can sometimes lead to complaints or even a claim - so here are some tips to try to avoid these situations.
Expectations
It's important to try to find out what the patient hopes the outcome will be and to carefully document all your discussions in the records. This can also include making records of other methods you have used to illustrate potential outcomes, like computer-generated images - but if you're using these, try to make sure they represent a realistic outcome based on the patient's presentation.
Scope and ability
This is an interesting and expanding area, but don't be tempted to offer treatment involving techniques that might be beyond your training and experience, even if the patient expresses trust and confidence in your ability. Consider a referral to an appropriate colleague before embarking on any treatment if you have doubts.
Equally, if it becomes clear during your discussions that you might have difficulty meeting the patient's expectations, try not to be persuaded to start treatment against your better judgement. It may well be in everyone's best interests to decline care and/or to consider a referral at this stage, rather than become involved in what may end up being extended and time-consuming treatment, which may also result in the patient's dissatisfaction.
Unfortunately, colleagues can sometimes feel under pressure from patients whose escalating demands outstrip what is reasonably achievable.
Referral
Referring to another practitioner may also be helpful in resetting the patient's expectations by offering a second opinion or clarification of what may be a realistic outcome. Another practitioner could also offer alternative treatment options that might be beyond your scope or experience, such as orthodontic treatment prior to restorative improvements.
Records
Make careful contemporaneous records and note precisely what the patient is hoping to achieve if they choose to proceed with elective treatment. Be sure to detail your discussions of any limitations and longevity of the proposed treatment and give the patient enough time to ask questions, as well as to go away and consider their options.
Costs
When explaining the costs of the initial treatment, remember to include an explanation of the financial implications of maintenance treatment. Don't forget to offer appropriate advice on the likely deterioration of any restorations, such as chipping and staining over time and the costs of addressing these.
It's best to avoid offering patients lengthy standardised information if you can. Instead, focus on making clear records of your discussions with the individual patient and explaining the risks in their case.
Make sure that all appropriate treatment options, including their risks and benefits, are outlined and recorded. Based on our experience of supporting dental professionals whose treatment has been questioned, it can be extremely helpful to have contemporaneous records demonstrating that the patient's expectations have been noted, a careful assessment has been carried out, and the risks as appropriate to the individual patient have been recorded.
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Assessment and planning
Having your assessment process clearly set out in your records will not only help in the planning of the treatment. If the patient is unhappy with the outcome, you'll also be in a position to demonstrate that you took appropriate steps when planning their care.
Make sure you're fully involved in the treatment planning process. Colleagues are sometimes involved in providing information about patients' treatment and options when they may not be clinically trained or appropriately experienced, which can lead to unrealistic patient expectations.
Discuss your approach with other members of the team so they can respond appropriately to patient queries, and ask colleagues to refer patients directly to you if they have any clinical queries or concerns. These treatments can be lengthy and can involve several appointments - so make commitments clear to patients.
Although composite bonding can be a minimally invasive treatment with very little tooth preparation, if any, there may be situations where it is required, so it's patients should be aware of this before they make their decision. In these circumstances, it is important to be clear with patients that their treatment will not be fully reversible, and they are making a long-term commitment.
Summary
It's generally best to under-promise and over-deliver, as composite bonding techniques in particular can be technically demanding from both the aesthetic and dental health standpoints. Try to make sure you're suitably trained and experienced, and start with less extensive and challenging cases where you will be under less pressure to achieve a particular outcome.
Unfortunately, colleagues can sometimes feel under pressure from patients whose escalating demands outstrip what is reasonably achievable. This can result in multiple additional visits for minor adjustments and additions, which can be stressful and time-consuming.
Members calling the advice line can find it difficult to know when to defer from continuing with treatment if patients have raised concerns about aesthetic treatments. In these cases, considering the option of a referral for a second opinion is often an appropriate next move.
If a patient remains dissatisfied with the outcome of your treatment, a second opinion in the early stages of a patient's dissatisfaction may avoid repeated appointments. Offering a second opinion can also demonstrate to the patient that you're doing your very best to act in their best interests, and that you're happy for your work to be reviewed by a colleague.
It's our understanding that providing direct composite bonding or veneers with or without tooth reduction does fall within the Scope of Practice of a dental therapist. However, it's important to be sure that any colleague offering this treatment can demonstrate appropriate training and competency, either as an undergraduate or postgraduate.
As fellow dentists ourselves, DDU advisers understand the challenging circumstances of everyday practice. But we can also step outside the immediate challenges and are able to offer advice on managing these situations. If you're a member and you need advice, we're here to help.
Dr Sarah Ide
Sarah Ide is one of the dento-legal advisers at the DDU. She qualified in 1992 from Guys and worked there as a house officer before entering general practice as a VT. Sarah worked in independent and private general practice for 25 years and completed an MSc in Aesthetic dentistry at King's. She's been working at the DDU for over six years, initially combining this work with general practice, and now working here full time.
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