dental implants

How do you communicate to patients what dental implants are in a way that balances how involved the procedure, aftercare and patient commitment must be without overwhelming them or scaring them?

As professionals, we have an obligation to always present a clear and unbiased picture to any patient of any treatment. If a patient knew that a crown placed on a cracked tooth may not actually save a tooth, would that scare them away from receiving care?1 Maybe. Maybe not. There are many types of cracked teeth, and some of the teeth we think are easily salvageable end up being extracted.

Looking at this another way, would you rather know everything about a procedure you are about to undergo or only the things you wanted to hear? This is also a gray area where we must guide our patients based on our knowledge of their understanding of their condition, the terminology we use and other factors. We must inform the patient of the reality of any treatment choice they make.

If dentists were to list every possible outcome for every possible treatment option based on every possible situation, not only would we overwhelm our patients, but we would also never have time to provide care. We must choose — within the standard of care — the salient points that neither favor nor disfavor, persuade nor dissuade, a patient from choosing any type of treatment, including dental implant treatment. Again, this starts with understanding the patient’s wants, needs and concerns, a thorough dental and medical history, and a complete dental evaluation. If we take the time to do this, we can establish trust.

In essence, it is not about scaring or overwhelming anyone; it is about informing the patient in a way that helps them understand what they are choosing and what their role must be in the treatment process, including the care they take of themselves and what is provided to them after the treatment.

Reassurance is another way of convincing someone of something. It is an emotional feeling. Yes, we reassure our patients on a regular basis; it’s not unusual to do this.

However, when it comes to reassuring a patient about something which has no merit, we cross a moral and ethical line.

Each year, the number of injuries from dental implants has been increasing. This can be confirmed by using the Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database, which, although accessible to the public, is difficult to use.2 This presents an uncomfortable problem for general dentists. The number of failures following implant placement has been rising dramatically, and more and more implants are being placed by general dentists. Some research even suggests that the failure rate of dental implant placement may be higher for general dentists than it is for our specialist colleagues.3 What’s more nebulous is the definition of “implant failure.” This question and others like it are complicated and often difficult to definitively answer.

As general dentists, when we walk into the arena of placing dental implants, we are held to a standard of care. This standard of care then includes what our specialist colleagues provide. Reassuring a patient, in my opinion, has almost no place in the discussion. We must answer openly and honestly any question a patient may ask about our training and experience. If a patient would be better served by a specialist, then so be it. Put yourself in the patient’s shoes; would you want somebody reassuring you that the operation you are having “can be done” by the surgeon, but a surgeon who specializes in the procedure may obtain a better outcome? It is quite true that there are many general dentists who are extremely competent in the placement of dental implants, and perhaps more so than some, or perhaps many, of our specialist colleagues.

So, the path to providing care with dental implants is unclear. The factors involved are numerous. We must know our limitations and responsibilities. If we do, and we can provide the standard of care, then perhaps a little reassurance is appropriate. Just be careful about crossing lines that may become problematic. How do you communicate with patients if the need to refer arises midway through treatment?

I had a new patient recently who told me that she chose not to receive dental care for many years because of a bad experience. This is not uncommon for us to hear, and it’s unfortunate. According to her, she had broken a tooth that had a previous root canal and crown. She went to a dentist at the end of a day for an extraction, which the dentist told her he could perform. She reported that the dentist “worked and worked on her for hours” before finally summoning an oral surgeon to complete the procedure. Perhaps her details were a little skewed, but maybe they weren’t.

You haven’t practiced dentistry very long if you have not started a procedure that you thought would go a certain way, only to find it going severely wrong in a hurry. This can happen to anyone in our profession. And it may certainly be true for implant placement procedures.

Given the scenario I mentioned, if you were the patient, what would you have preferred? In my opinion, it would have been perfectly acceptable to have found a stopping point in the procedure and then referred the patient to someone who could continue the care and finish it. For me, I would not have thought badly of the person who tried to help me, especially if it was done with honesty and integrity. In fact, I might have respected them even more. Our patients are like us, and we are like our patients. In my own experience as an expert witness in dental malpractice cases (something I don’t like to do), many litigation matters could have been avoided if the dentist just apologized. We may think that patients expect perfection; what they expect is much different.

Whether the treatment we are providing involves dental implants or not, honest and open communication is paramount to being a proficient dentist. Referral is not an indication of failure; it is an indication of maturity and professionalism.

Don Deems, DDS, FAGD, PCC, known as The Dentist’s Coach®, is a trained professional, personal and business coach, and a practicing dentist. He is also the AGD Impact Team Building columnist.

This article was originally published in the July 2022 issue of AGD Impact. It was printed with permission from the Academy of General Dentistry.

References

1. Mamoun, John S., and Donato Napoletano. “Cracked Tooth Diagnosis and Treatment: An Alternative Paradigm.” European Journal of Dentistry, vol. 9, no. 2, 2015, pp. 293-303.

2. “Manufacturer and User Facility Device Experience.” U.S. Food & Drug Administration, accessdata.fda.gov/ scripts/cdrh/cfdocs/ cfmaude/search.cfm. Accessed April 10, 2022.

3. Da Silva, John D., et al. “Outcomes of Implants and Restorations Placed in General Dental Practice.” Journal of the American Dental