When it comes to changing a patient’s appearance, you must be careful not to assume your vision is the same as theirs...
The patient was a very jolly, outgoing lady, happily married and in her thirties. She had protrusive upper anterior teeth with pronounced diastemas. At the suggestion of the dentist, she agreed to have post crowns prepared for all the upper anterior teeth, to reduce the overjet and close the spaces.
Root canal treatment was successfully carried out before any of the preparations were done. The temporary restorations were copies of the original teeth and it was therefore only when the patient had the final restorations fitted that she saw what the finished appearance would be like.
Although she was obviously upset by the wider, shorter, ungainly crowns provided (and said so), the dentist cemented them in place and dismissed the patient. She returned to the surgery later that day with her husband who was vocally disapproving of his wife’s new appearance. The dentist told the couple that the wife had agreed to the treatment and that there was nothing wrong with it.
The claim arrives
Inevitably their lawyer did not agree and a claim was received the following week. Dental Protection was contacted and asked the dentist for both the clinical records and his recollections of the information he had given to the patient. It was clear that both lacked enough detail to show that informed consent had been obtained and the photographs provided by the patient’s lawyer made clear how unacceptable his client found the result.
Finally a settlement was negotiated that involved the replacement of the crowns with new ones similar to the patient’s original appearance.
The cost of providing replacement treatment is enhanced in many instances by the fact that ‘elective’ crown and bridgework will normally require further replacement over the patient’s lifetime. In this case it was argued that the patient had agreed to crowns and would have been liable to further replacement costs herself. This was rebutted by the argument that crowns should not have been provided at all. A compromise was reached.
Changing a patient’s appearance must involve their consent at a level that demonstrates a full understanding of the proposed result. Don’t exaggerate the anticipated result since the more you lead the patient to expect, the more you will need to achieve.