Aesthetic Dentistry Expert – balancing ethics and expectations

Health before beauty: Manrina Rhode discusses how to navigate the balance between ethics and expectations, and why you should always avoid compromising to please your patient.

Today, we’re going to talk about balancing ethics and patient expectations. I think we’ve all had those patients come in who want a treatment from us and it’s not necessarily what we think is the right thing for them to do.

For example, you’ll have a patient who’s got gingivitis and they want to have 10 veneers. But you know that you have to fix their gum health before you can do their smile makeover.

They then start arguing with you saying they don’t have time to have hygiene appointments every two weeks or every month to get their oral hygiene right. They might need their small makeover in time for a wedding or party, or an important birthday that they have this summer. They may try to push you to do the work without getting their health work done first.

A disaster waiting to happen

We’ve all been there, right? It’s tempting! You’ll start looking at them and think, ‘Okay, have you got a high smile line? Will it show? What are the risks if I don’t treat your gum disease before the smile makeover? Am I going to end up having to replace the work? Maybe I can do the work…’

You find yourself trying to reason in your mind about how you can give this patient what they’re asking you for. Because that’s who we are, right? We provide a service and we want to help our patients when they tell us they’ve got a deadline.

But there’s so many risks associated with that. As clear as you might be, we also know that patients don’t always understand that you’ll need to fix gum disease and you will get some recession later on.

You can explain that to the patient, you can write it in a contract, you can get the patient to sign that for you. But if and when that does happen and your small makeover is no longer perfect within six months of it being done, you don’t really have a leg to stand on.

If your work is imperfect and they want their money back, or they want you to replace your work free of charge, whether you’ve had that contract signed or not, you are liable to provide the patient with the correct treatment. So don’t compromise. Don’t compromise to please your patients.

Health before beauty

Not only that, but don’t try and actually do a smile makeover on a patient that has any form of gingivitis. Bleeding gums are impossible to take an accurate impression off. It’s impossible to put temporaries on without getting blood underneath them, which then makes them look black and really strange.

God forbid you get blood on cementation phase and get black underneath your veneers where there was a little drop of blood that spread in with the cement. There’s just so many disasters that are waiting to happen by taking a shortcut.

I know it’s tempting when patients want it. But as clinicians, it’s so important to remember the importance of doing things correctly and ethically – and health before beauty.

But I also think health equals beauty – helping patients understand the importance of the health of their mouth so that they can then have their perfect smile makeover.

I tell my patients about what we can do. But then I tell them, ‘You won’t see me until your gums are perfect, until my hygienist signs you off and tells you you’re perfect.’ Then you put the onus on them. It’s important to take the reins back and stay in control. Stick with what’s important to you.

Do the best for the patient

There’s also that difficult conversation in aesthetic dentistry if a patient wants porcelain veneers or composite bonding and their teeth aren’t perfectly aligned. You want them to align their teeth before you do that work for them, and they’re trying to convince you that they don’t want pay for the brace, they don’t want to wait another three or four months to straighten the teeth first.

They just want you to go ahead and do the work. And then you need to work out the repercussions of that as well. It’s really tempting to just be like, ‘Well, yeah, actually, I just want to do the fun bit of work too.’ But you’ll make your life so much easier by doing your treatments in the correct way and insisting they have their realignment first.

Back in the day, I think in 2008, I remember this whole change of working to a more conservative way of doing cosmetic dentistry. And before then – I’ll be really honest with you – we would just cut the teeth wherever we needed to do elective root canal treatments and do their small makeovers for them.

That’s the way things were done back then. And then all these other brands of alignment came in that made alignment easier for GDPs to do. I was working with an orthodontist back then, but we only used to refer to him in really extreme cases. Now, there’s so many options available.

To do dentistry in that way now would be completely unethical. To not get them to aligned prior to your treatments is not what you would do for yourself. It’s not what you would do for your family.

Don’t do it for your patients. Even though they might think that you’re doing the best for them by doing what they want. You’re not.

Catch up with previous Aesthetic Dentistry Expert columns:

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