3 patients who may not be candidates for complex dental care

ByChris Salierno, DDS

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Complex care cases take a great multidisciplinary team. The restorative dentist, specialists, laboratory technicians, and hygienist work together to effectively plan, execute, and maintain advanced dental therapy. But one critical member of the team that we often forget is the patient. All of the academic and technical skill in the world won’t help a patient who isn’t ready to be helped.

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Unfortunately there are patients who present significant obstacles to treatment. Let’s put aside minor personality conflicts, financial hardships, and dental phobias for the moment and consider the true barriers to complex care. Some patients are not ready to undergo long, complicated dental therapy without causing themselves and the dental team significant distress. At best, this distress makes everyone’s live miserable throughout the course of treatment. At worst, we end in litigation.

This can all be avoided. A wise health-care provider will actively listen to his or her patients during the initial examination and consultation. Instead of simply figuring out how to fix some broken teeth, the dentist can engage his or her patients in thoughtful conversations. If certain red flags appear, the dentist can end the relationship before treatment has begun.

1. The Delusional

Consultations are about managing expectations. We educate patients about cost, length of treatment, functionality, cosmetics, maintenance, postoperative discomfort … the list goes on. Some folks have unreasonable expectations that cannot be managed. Although we can document conversations about the anticipated outcomes of our care, it won’t prevent a patient from becoming irate if we don’t achieve something that is unachievable. Patients may ask you to cut corners to meet an unrealistic time deadline or to continually refabricate restorations that don’t transform them into a celebrity. If a dentist and a patient cannot agree on reasonable expectations during a consultation, it may be advisable not to begin treatment at all.

2. The Dictator

The dentist-patient relationship is built on mutual trust and respect. Dictators lack this trust and respect and think that they can be the masters of their own dental destiny. Perhaps they or a relative had a negative experience with a dentist. Perhaps they are anxious about the unknown. Perhaps they are just control freaks. Regardless of the reason, they cling to a misinformed opinion about how dentistry should be done. Dictators become frustrated when the dental team cannot perform their duties in the exact way they demand.

3. The Downer

Some people are never happy. No matter how excellent the care, they will find something to be miserable about. The potential pitfall is that we lose our objectivity when it seems as though the patient will never be appeased. At try-in visits we ask patients what they don’t like about their restorations and they respond: “Everything.” Downer patients will take up significantly more chairtime and drain the team of energy.

Dentists delight in details. We love the precision of good marginal fit and the balance of symmetrical papilla. But even the finest ceramic crowns will never be as good as the dentin and enamel they recreate. Perfection is never achieved, so we settle for excellence. Complex care cases can fall even further from perfection, as they require the skills of an entire team of professionals to restore beauty and function. As dentists we must carefully screen patients who require complex, multidisciplinary care. These cases often take many months (or even years) to complete, cost more than the patient is accustomed to paying for dental care, and are more invasive than traditional dentistry. Patients who exhibit the aforementioned traits may not be candidates for complex care.

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Chris Salierno, DDS - dentist Chris Salierno, DDS, is a general dentist practicing in Melville, N.Y., and co-editor of Surgical-Restorative Resource™ e-newsletter. He lectures and writes about practice management and clinical dentistry. Additional content is available on his blog for dentists: www.thecuriousdentist.com. You may contact Dr. Salierno by email at drsalierno@gmail.com.

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