The dangers of promising perfect teeth

expectationsSarah Ide, DDU dentolegal adviser advises orthodontic practitioners to ensure patients have realistic expectations about their smiles.

As orthodontic treatment has become more sophisticated and patients have so much more choice, it has become possible to do more than simply correct malocclusions caused by overcrowded or crooked teeth. This is particularly apparent when you open any celebrity magazine and a series of ‘perfect smiles’ greets you.

The challenge for practitioners is ensuring that anyone coming to you for advice has realistic expectations. Particularly about what orthodontic treatment can and cannot achieve.

DDU research has shown that many patients will complain if they are disappointed with the outcome of their treatment. In addition, a significant proportion of complaints feature allegations of poor communication with patients saying they were unaware about possible pain, discomfort or complications, or the implications of retention.

Here are just a few of the ways you can identify and address any mismatch between a patient’s wish list and what you can realistically achieve.


The time element often heavily markets modern orthodontic treatment. The promise of a quick result attracts many patients. However, limited treatment orthodontic appliances may not be suitable in every case. So, it should always be clear that a full consultation will be necessary.

It is therefore important not to over-sell specific options or make inflated claims in your marketing.

In its professional standards, the British Orthodontic Society (BOS) reminds members of the orthodontic team that, ‘They have a professional duty to comply with both the GDC guidance on advertising, the ASA code of practice on advertising and the MHRA’s Blue Guide. A breach of regulations may be a criminal offence. Civil or criminal action may be taken in the worst instances.’

The GDC tells dental professionals, ‘You should only recommend particular products if they are the best way to meet a patient’s needs. If you endorse products, you must ensure that you only provide factual information about the product which can be verified by evidence. You should take care not to express or imply that the whole profession shares your view.’

Initial consultation

Patients coming to you are likely to have been influenced by a variety of sources. For example: TV, magazines and social media where there are plenty of scope for misunderstanding.

A patient may appear well informed. However you still need to listen to their concerns about appearance, comfort, cost, and so on. It’s important to establish an honest and open dialogue from the outset, so you understand the patient’s priorities and can provide relevant advice. The BOS states: ‘Realistic objective setting is the responsibility of both the patient and practitioner; and you should document all aims of the treatment in the clinical notes.’ 

Ultimately, you should not agree to treat a patient unless you are convinced that the proposed treatment is reasonable, in line with current accepted practice, in the patient’s best interests, and within your training and experience. Be wary if your initial conversation with the patient gives you cause for concern about their expectations or their likely compliance with treatment.

Obtaining consent

The consent process enables you to ensure patients know exactly what to expect from treatment. To correct any misconceptions and warn patients about anything that they might want to know. Like, the possibility that it may take longer to achieve the desired result. Also, the chance that the treated teeth will relapse. Take this opportunity to advise the patient that a referral may become necessary at any point in the treatment with the patient’s consent.

The BOS expects orthodontic practitioners to have a ‘full case discussion’ with the patient. It states that ‘a description of the risks, benefits and limitations of each treatment option must be fully discussed and documented’.

It stresses the need for ‘clear explanations in language that can be understood by the patient and/or their guardian’. In addition, patients should have a ‘cooling off’ period to consider their options. As well as the opportunity to discuss their treatment plan at any time.

Provide patients with more opportunities to reflect on their treatment options and raise questions. If you do, it is more likely that they fully engage with the decision-making process. They will be aware of the risks that matter to them.

Revise plans if necessary

Once treatment has started, you need to be alert to signs that the treatment is not going as planned. If it’s unlikely the patient’s expectations can be achieved with a particular appliance within the expected timeframe, it’s better to be upfront with them. You can then reassess your plan or arrange a referral with the necessary consent.

If you leave it to the patient to raise concerns, you will damage their trust in you. Particularly if you have promised them perfect results.

From a dentolegal perspective, managing patients’ expectations is key to ensuring patients are happy with the result of treatment and to reducing the chances of a complaint or a claim.

As ever, effective and honest communication goes a long way to increase the chances of a successful outcome for you and the patient.

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