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Accelerating treatment – accelerating risk?

21 September 2022

Dr Annalene Weston, Dentolegal Consultant at Dental Protection, explores whether striving to meet patient demands means our profession is racing to the bottom or rising to the top.

The impact of consumerism is evident across many areas of our lives. How we eat, how we access information and how we communicate. Perhaps then it is inevitable that people are now approaching healthcare with the same consumer expectations, wanting their treatment quicker, cheaper, more conveniently than before, definitely pain free and absolutely on their own terms. Naturally, practitioners strive to meet this demand and these expectations.

There is a raft of direct-to-consumer marketing promising to meet exactly all the expectations of the consumer, as stated above. It may be that this is at least partially responsible for the increased inclination of the profession to meet these consumer desires. After all, “the public gets what the public wants”, and if we as a profession don’t provide it, then our patients will go and find someone who will. But in doing so, are we placing consumer expectations above clinical parameters, and does meeting this demand come with an unseen price? Or perhaps a cost? And if so, to whom?

Many disciplines of dentistry are evolving at, well, breakneck speed, with procedures having fewer steps (think bonding), quicker time frames (think milled restorations) and the legitimate options for one-stage procedures (think RCT and implants) than ever before. There can be no doubt that the ability to provide more timely treatments is welcomed by practitioners and patients alike. There can also be no doubt that accelerated treatments are a sensible option for many patients. But they are not without risk.

Convenience dentistry is no longer only available through adverts on Instagram, and is readily seen in everyday practices. Nor is it a new concept. Immediate dentures were in many ways the original ‘accelerated dentistry’ as in this treatment modality, often steps were missed through necessity (as it is hard to try a denture in when the teeth are still in situ) in order to reach an end goal more quickly. Can we extrapolate this experience to accelerating treatment always means skipping steps? Not necessarily, and if it does, it is important to remember that it does not necessarily mean these steps are skipped in a deleterious way. For example, the ability to scan a tooth to then mill a crown directly, and skip a physical impression, a potentially unpleasant or unsatisfactory temporary crown, and the delay whilst the lab construct the definitive restoration would not be grieved by many practitioners or patients.

Regretfully, as many practitioners will be aware, immediate dentures do attract a significant amount of patient dissatisfaction, as the patient doesn’t necessarily have the outcome they were expecting, through no fault of the practitioner. Can we perhaps extrapolate then that accelerated treatments often lead to patient dissatisfaction? This too does not hold true.

Patient expectations about the outcome they can legitimately expect need to be appropriately set as part of the consent process. This is particularly true in accelerated treatment, as the outcome can, in some circumstances, actually be that which has been termed a ‘compromised treatment’. And while compromised care can be acceptable with patient consent, the key to this acceptability is the consent. The patient needs to meaningfully understand what they are getting, and why, and what the alternative options applicable in their case are. Failure to obtain valid consent, coupled with the failure to achieve the patient's expectations, is a true recipe for disaster.

Further, poor case selection can lead to unsatisfactory outcomes, dissatisfied patients and patient harm. When selecting to move through treatment more quickly, or bypass stages altogether, a prudent practitioner ensures appropriate case selection at the offset. This means they can avoid finding out later that a one-stage treatment was never going to work for Mrs X, or a compromised outcome was never going to satisfy Mr Y. It also means they can avoid the attention of a critical third party, such as the regulator or a lawyer.

In short, as with all dentistry consent is key, as is reaching a correct diagnosis to create an appropriate treatment plan. Each discipline of dentistry carries with it its own unique risks and, in certain circumstances, accelerating the treatment truly accelerates these risks.

To increase understanding of this, Dental Protection has developed the accelerated risk webinar series, exploring the risks of accelerated treatment in orthodontics, implants, endodontics and indirect restorations. You can access these through your online learning platform.

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