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Explain yourself!

15 July 2014
Something that sounds simple and straightforward to the dentist may be unintelligible to the patient. Avoid later troubles by ensuring the patient understands what you’re talking about...

An upper chrome-cobalt denture was fitted for a patient who had only three upper anterior teeth remaining after the removal of four posterior teeth due to periodontal disease. The patient had great difficulty in tolerating palatal coverage, so the original chrome-cobalt denture had a skeleton design.

The dentist felt that full coverage was now necessary to aid the limited retention of the denture, following the loss of the posterior teeth. She explained to the patient that the design of the new denture would need to change, while reassuring him that the use of chrome-cobalt could still keep the bulk on the palate to the absolute minimum. Unfortunately the explanation to the patient of what ‘full palatal coverage’ involved was not totally understood.

Unexpected changes

When the denture was fitted, the fit and retention were surprisingly good but the patient immediately expressed dissatisfaction with the full palatal coverage and said he had not been led to expect such a fundamental change in the design.

A few weeks later, the dentist was persuaded to cut back the palatal coverage at the patient’s insistence; however, the retention worsened significantly and the denture became unwearable. This time the patient said he had understood that the cutting back of the denture would reduce its tightness, but he had not been led to expect such a dramatic loss of fit and retention.

There was nothing wrong with the original dentistry but this patient’s expectations were over-optimistic all along. After the first problem arose, the dentist should have been alerted to the need to ensure that the patient’s expectations were held in check during the second phase.

Learning point:

Patients may not like to hear bad news from us, but it is much better that they should hear it before the treatment starts than to discover it for themselves afterwards

Avoid cases like this by attending one of our Risk Management Workshops.
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These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits dental members enjoy as part of their subscription. 
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