Leo Briggs explores the reasons behind complaints and claims concerning limited treatment orthodontics, the first in a short series about cosmetic treatments.
The desire for a ‘better smile’ has driven the growing market in adult orthodontics. Particularly treatments that seem to promise quick results.
With 28% of UK adults reportedly considering or having completed orthodontic treatment, it’s a promising opportunity for practices. However, it does come with caveats. Although some people are prepared to pay for straight, even teeth, falling short of their expectations could be costly.
The Dental Defence Union (DDU)’s limited treatment orthodontics files are evidence of patients’ increased readiness to make complaints or demand financial redress when a treatment doesn’t achieve the desired cosmetic result.
DDU analysis
The DDU reviewed around 250 cases notified over a recent four-year period, where limited treatment orthodontic care was provided. We wanted to see whether the number of complaints was increasing and find out the most common allegations so we could advise members. Here are the main findings:
The number of complaints is increasing
The majority of cases were patient complaints but there were also a number of claims and a few GDC investigations.
The number of files opened each year doubled over the period. This trend could reflect the numbers of procedures taking place as much as an increased risk of something going wrong.
Of the notified claims, most were still ongoing although a handful had been settled by the DDU on the member’s behalf. In the settled cases, there was usually little need for costly remedial treatment and compensation amounts tended to be low value (below £5,000).
Causes for concern
The DDU has categorised the complaints by the primary issue raised, although there was some overlap where multiple allegations arose – such as unsatisfactory treatment and communication problems:
Unsatisfactory treatment/dissatisfied patient – 57%
Communication problems/attitude – 18%
Adverse incidents and dental damage – 9%
Delays/cancellations/incomplete – 7%
Disputes between dental professionals/practices – 5%
Failed or delayed diagnosis of periodontal disease/caries – 4%.
Patient dissatisfaction
Most cases (57%) concerned patients who were unhappy with the outcome of orthodontic treatment or another part of the orthodontic treatment plan, such as composite bonding. Dissatisfaction with the aesthetic appearance of their teeth was a common concern but so was frustration with slow progress.
Such cases reinforce the importance of having an honest conversation with patients about what their desires and expectations. It’s important to address any misconceptions at an early stage. Give realistic advice about timing, possible complications, the need for any retention and the chances that teeth will relapse.
In some cases, the patient’s attitude and unreasonable expectations may give real cause for concern. In these situations, the dental professional should carefully consider whether to go ahead.
Breakdowns in patient relationship
Another common factor, closely linked to the first, was allegations of poor communication, rudeness or disputes that arose during treatment (18% of cases). These files highlight the problems that can arise with prolonged treatment plans such as orthodontics, even if they are supposed to achieve faster results.
They include patients who felt they had received misleading advice about timescales, the possibility of changes to the treatment plan or the need for a retainer. A few were unhappy about the attitude of the dental professional when problems arose.
Conversely, we received queries from members who were concerned about poor compliance or non-attendance by a patient. These members wanted advice about a breakdown in the dentist-patient relationship.
Following the pandemic, it was no surprise that allegations of delays, cancelled appointments and incomplete treatment featured too (7%). While most patients were understanding about the shutdown, some felt aggrieved about a lack of communication or reassurance about delays. Particularly when practices reopened with limitations on the care that could be provided.
Adverse events and complications
No treatment is risk free and we were notified of adverse incidents (9%) that occurred when an appliance was being fitted, such as cuts and burns or complications that arose over the course of treatment, including fractured and damaged teeth, gum problems and cavities.
It is not possible to state that the treating dentists were at fault in these cases. But, they do highlight the risks of even minimally invasive procedures and the need for thorough pre-treatment assessment and preparation. And if something does go wrong, it is vital to respond appropriately. Inform the patient straight away, apologise, and provide immediate support to address the short-term and long-term consequences.
It’s essential to make patients aware of the complications that can arise from limited treatment orthodontics. These include demineralisation, periodontal damage, fractures and root resorption, even if the risk is small.
In a few cases (4%), it was alleged the dentist hadn’t diagnosed or treated the patient’s periodontal problems or cavities either before or during treatment. Telling patients what to watch out for and how to contact the practice in an emergency could pre-empt problems. It may also allow you to address them at an early stage for the best outcome.
Disputes
In 5% of cases, the DDU was contacted because there was concern about treatment initiated by a dentist who had since left the practice.
Most associate agreements will make provision for the practice owner to retain a sum of money for a specified period. This can be used to fund the cost of remedying defective treatment.
However, as any orthodontic treatment needs to be carried out by a person who has appropriate training and expertise, it is important to agree how the transfer of care will be handled if an associate departs before this type of treatment is started at the practice.
It’s a good idea for practices to be able to contact departing practitioners so any problems can be resolved.
Refunds and costs
18% of files included a reference to a dissatisfied patient who refused the pay the final cost for treatment or demanded a refund or compensation. While these kinds of disputes are sadly familiar in dental practice, they are more likely with more expensive cosmetic treatments. Especially where patients have unrealistic expectations at the outset.
Providing a ‘cooling off’ period before starting expensive or extensive elective procedures can help avoid patients feeling rushed into a decision. Good communication about costs can also help. For example, it’s important to inform patients that further treatment might be needed and possible additional costs so this doesn’t come as a shock.
You have no obligation to waive fees or offer refunds or remedial treatment. This type of goodwill gesture can resolve complaints without escalation. That said, it’s your prerogative and you can contact your dental defence organisation for help with a dispute.
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