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I recently received an email from an acquaintance asking for my opinion on his recent emergency dental visit with a dentist he had never previously met before. He felt that the dentist was more interested in upselling their dentistry than the wellbeing of their patients which really bothered him.

First of all, I do not want us, as dental professionals, to intentionally upsell our dentistry to our patients for financial gain. However, we as dental professionals also need to provide the patient with different treatment options after the examination, based on the diagnosis. In most cases, there is more than one option to treat or address the issue. For example, a tooth that is abscessing due to decay can be treated with a root canal treatment, followed by a filling and then a crown with posts. Alternatively, the tooth can be extracted. If extracted, the gap can be left alone (risk of future issues like shifting and movement of the adjacent teeth, overeruption of the opposing tooth, reduced chewing efficiency and neuromuscular issues involving the TMJs), supported with an implant and crown, inserting a fixed dental bridge or using a removable partial denture.

As health providers, we should take the time to thoroughly show and explain the different treatment options, their pros and cons, the procedures involved, discomforts and potential complications. We should also answer all questions patients may have and do our best to ease any worries or fears.

Before the dentist can recommend an option as the best option for the patient, the dental provider should understand the patient’s main concerns, their expectations, their financial situation and the patient’s anxiety level. Most patients will provide that information to the dentist voluntarily or after being asked appropriately. If the patient’s main concern is to eliminate pain temporarily, has limited financial resources and does not want any gaps in his mouth, then the dentist should recommend a treatment plan based on the information provided.

In the process of communication between the patient and dentist regarding the patient’s oral health conditions and appropriate treatment for the issues, there may be some broken links that could result in misunderstandings, both for the dental provider and the patient.

The dental provider should be empathetic and understand the patient’s wants and needs. The patient should be clear with their dentist about their main concerns and their priorities. This way, both the dentist and the patient are on the same page. The dentist can then prioritize the proper treatments for the patient based on what appears to be most important for them.

There are many incidents that can occur where dentists and patients can lose understanding.

For example, a patient went to see a dentist for a lost filling in their molar. After the dentist reviewed the health status and dental history of the patient, the dentist proceeded to examine the tooth and take an X-ray of it. The dentist noticed that most of the tooth had been missing and that the remaining structure appeared to be weak. There was no evidence of pulpal damage and infection. Because of the clinical findings, the dentist recommended that the patient should receive a crown as the “ideal” treatment for the tooth. However, the cost would total over a thousand dollars. Because the dentist knew that the pulp of the tooth would start to act up in the future due to the absent part, he went on to tell the patient that the tooth may need a root canal treatment in the future and that it would entail an additional one thousand dollars. The dentist even mentioned that a filling, which was going to cost less, could be an option for now but that the tooth and filling would likely break soon, and hence it was not a recommended treatment. If the dentist hadn’t gone on to explain to the patient about the different treatment modalities and their respective pros and cons under the circumstances, the patient would feel that the dentist was trying to upsell their treatment. If the patient didn’t tell the dentist about previous dental experiences with fillings and crowns, their understanding of the matter and their financial situation, the dentist wouldn’t know how to propose the best treatment for the tooth under those circumstances.

Furthermore, the dentist noticed that other teeth in the patient’s mouth had a lot of stains and tartar, a few other cavities and missing teeth. The dentist thus told the patient that he should undergo further X-rays and examinations to verify overall oral health, receive at least two more appointments for thorough scaling and root planing, have the other cavities filled and get some implants to replace the missing teeth. In this scenario, both dentist and patient successfully worked together to determine the best course of action for their health.

There is one final element that could affect treatment recommendation – the expertise and facilities of the dental provider. If the dental provider tends to refrain from recommending treatments that the provider is not good at or has a lack of skill in, this can prove to be hurtful to the patient’s health and lead to situations that aren’t in their best interests. For example, if the dentist is skilful in placing implants, he will tend to recommend more implants to the patient as their first choice over more traditional treatments like bridges and removable dentures.

I believe most dentists care about the oral wellness of their patients and do not upsell dentistry. It is the broken two-way communication that affect a patient’s misunderstanding of the intention of the dental profession towards his/her treatments.

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