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The business of dentistry

15 March 2019
Dr Raj Rattan, dental director at Dental Protection, explains the importance of managing the relationship with patients when working in a general dental practice.

At the heart of every valued human interaction lies the notion of trust. Our world could not function without it.

Trust is one of the most important constructs in the dentist-patient relationship. It creates longer and more stable professional relationships, reduces the incidence of conflict, promotes satisfaction, reduces complaints, and builds loyalty. It is, therefore,one of the key drivers of success in general dental practice.

What is trust?

There are many definitions of trust that identify credibility, benevolence, confidence in honesty, and reliability as key components that can lead to trust being established. We make promises to our patients and our patients expect us to keep them. They expect us to be knowledgeable, skilful and competent. As Joseph Graskempner noted in his article in JADA: “dentists should gain the patients’ trust in them as reasonably knowledgeable, reasonably talented, caringdental health providers”.1

Can trust be quantified?

Degree of trust created = (R x C x I) / SO

R= reliability, C= credibility and I= intimacy are multipliers and self-orientation (SO) is the divisor.

Significantly, the greater the divisor, the lower the quantity of trust generated.

Credence markets

In economic terms, dental services fall into the category of credence goods. Patients don’t always know whether they need the suggested treatment, and in some cases even after they receive the treatment, they cannot be sure of its value. This is because the ‘buyer’does not have the knowledge of the ‘seller’ –a feature of the dentist-patient relationship referred to as ‘information asymmetry’. It is this asymmetry that makes the credence goods market particularly challenging because it may give rise to aberrant behaviours.

It is interesting to note the comments made in 2012 by Brown and Minor in their paper‘ Misconduct in Credence Good Markets’.2 “Providers of technical advice are common in the automotive, medical, engineering,and financial services industries. Experts benefit from customers trusting and buying their advice; however, experts may also face incentives that lead them to provide less than perfect recommendations. For example, a mechanic can provide a more extensive fix than warranted and a dentist can replace a filling that has not failed.”

The need for regulation to protect the consumer in the credence space is implicit. Another challenge is that perceptions of clinical success and failure in this market are largely subjective for patients, because there is no external verification. It is only because of trust that patients do not routinely seek to independently verify every transaction and clinical outcome.

Key components of building trust 

Building trust should underpin a practice’s risk management strategy. Without this, any business risks loss of market share and loss of reputation. Trust can be built by making a commitment to:

a. Meet patient needs and preferences when it comes to service delivery.

b. Ensure patients feel cared for – we use the phrase care and treatment in our everyday language and tend to focus on the technical elements of treatment. Remember to show them you care.

c. Get it right when patients most need you– when they are in distress.

d. Manage expectations and create experiences built on continuity of care with individual clinicians. This builds relationships and fosters trust.e. Improve communications – both clinical and non-clinical.

f. Ensure there is transparency in pricing.

g. Empower your frontline staff – the first contact with the team will form lasting impressions.

The consumer mantra has long been “caveat emptor” (buyer beware). It is not appropriate for the business of dentistry. It should be replaced with “credat emptor” – let the buyer trust.


1. Graskemper JP. ‘A new perspective on dental malpractice:practice enhancement through risk management’ J Am DentAssoc. 2002 Jun;133 (6): 752-7.
2. Brown J, Minor DB. ‘Misconduct in Credence Good Markets’,The National Bureau of Economic Research Working PaperNo. 18608. Revised in October 2013.