Many adults are currently overweight or obese. Naturally, this has some impacts on how we can physically practise dentistry, and there are also some additional considerations regarding the treatment of bariatric patients that may not be obvious at first blush. Dr Annalene Weston, Dentolegal Consultant at Dental Protection, talks through a recent case
The dental setting is already a stressful environment for many, and a conversation about a patient’s weight may be the last thing they want when they attend for a check-up.
Some patients may not consider themselves to be overweight or obese. Likewise, some bariatric patients may have experienced societal discrimination against them in the past regarding their weight.
But why do we need to discuss it in the first place? It all comes down to safety – specifically the safe weight that a standard dental chair can carry, which varies chair to chair.
There are many businesses that rely on seating to provide their services to members of the public. The airline industry is one where the issues associated with obesity have already been the subject of discussion, with some airlines requiring passengers of a certain size to purchase two seats side-by-side for their flight. This usually produces a response from the passenger concerned who may feel they have been discriminated against, while the airline will often consider the request to be one of common sense and fairness to other passengers.
Dental chairs need to be mechanically sound; however, they also have a maximum loading weight which should be observed. Most medical equipment, such as operating tables and hospital beds, are constructed to cope with a maximum load of up to 140kg. Equipment liability insurance may be invalidated beyond specified safe limits, so you might want to check the loading limit for your own dental equipment, to ensure you safely treat your patients.
Dr L had been treating Mr and Mrs J for many years. Both husband and wife were tall and had been incredibly active in their youth. The passage of time, however, had led to injury and a general slowing down, and ultimately some weight gain. Dr L had never considered whether Mr and Mrs J were over the safe weight of the chair – which was 135kg – and certainly didn’t think to ask.
During Mrs J’s six-monthly examination, as the chair reclined an audible crack was heard, accompanied by the chair lurching downwards, as plastic casing of the chair fractured under the patient. Though unharmed, Mrs J was distressed by the events, despite Dr L’s assurances.
Dr L was sympathetic about the event and felt he ought to have broached this difficult subject to avoid the upset in the first instance. It led to a more frustrating issue, however, as Mr J, the larger of the couple, was scheduled in for implant surgery the next week. Though Dr L would likely be able to get his chair repaired in time, his greater concern was whether the chair would break during this procedure, and the harm that could be caused to Mr J during surgery if it did.
Dr L had no option but to contact Mr J and advise him on why he would require a referral and so contacted Dental Protection for some advice on how to best proceed.
Declining to treat a patient who exceeds the weight limit for the equipment in the surgery needs to be handled sensitively. Dental Protection is aware of dentists who have been accused of discrimination when they have declined to treat an overweight patient.
Equally, some of our members have been sued by patients who were injured as a result of the sudden collapse or breakage of a dental chair, so it is a risk that needs to be addressed.
Fortunately, Dr L had a long-standing relationship with Mr J and was able to talk through his concerns respectfully. Critically, Dr L did not let on that the weight limit of the chair had come to light during the treatment of Mrs J, as naturally this would have been a breach of her privacy. Mr J was understanding of Dr L’s concerns, and somewhat reluctantly accepted the offer of a referral to a colleague who was better equipped to treat him safely.
What to do
Our primary consideration as a dental practitioner always needs to be for patient safety, and as bariatric patients are becoming increasing commonplace, it would be prudent for a practitioner to know where the closest centre with a bariatric dental chair is to enable appropriate referral. This requires a sensitive discussion with the patient so that they appreciate the reasons for such a referral and does not form the view that the dental team is being obstructive or discriminatory.
Another option to consider is better equipping ourselves to treat bariatric patients in our own clinic as dental chairs with a weight limit of 198kg are now available.
• Be sure to check the operating limit of you own chair
• Determine the weight of your patient
• Highlight the safety issue respectfully
• Where necessary make a referral to a practice or clinic more suitably equipped