Risk Management Tools & Resources


Great Expectations: Mitigating Challenges in Cosmetic Dentistry

Great Expectations: Mitigating Challenges in Cosmetic Dentistry

Laura M. Cascella, MA, CPHRM

Cosmetic dentistry can help patients address numerous issues with their teeth, such as alignment, color, shape, position, and more. These services can reduce patients’ insecurities about the way they look and improve their self-esteem and overall quality of life.

Although dentists may find that helping patients address cosmetic issues is very rewarding, they also should stay alert to risk management concerns that are inherent in cosmetic dentistry. Failure to properly screen patients, manage expectations, and communicate clearly and truthfully can increase the risk of patient complaints, requests for refunds, and even litigation. Consider the following case study:

The patient was a 57-year-old female who was seeking cosmetic treatment for tooth discoloration. She was quite anxious and called the dental office for reassurance four times prior to her first appointment. She accepted the dentist’s recommendation for several veneers on her upper front teeth. After selecting the color and having a “try-in,” the dentist seated the veneers.

A week later, the patient returned crying and very unhappy. She said the veneer color was wrong and “awful.” The dentist replaced the veneers two more times for the same reason. The patient then began calling the office at least twice a day demanding a refund and complaining about the dentist.

The dentist spoke with a MedPro senior risk solutions consultant. Together, they discussed the options of giving the patient no refund, giving the patient a partial refund, or giving the patient a total refund. Ultimately, the dentist wanted the patient to stop calling and using up staff time and resources, so he provided a total refund.

Cosmetic dentistry is not considered high risk in terms of litigation exposure, but it does present unique challenges. Patients seeking cosmetic services likely have a significant emotional investment in the final results, and their expectations of a procedure might not align with reality (as a result of social media, advertising, lack of understanding, etc.). Because insurance often does not cover cosmetic treatments, patients also might make substantial financial investments, which can further elevate their expectations.

Emotional and financial investments, combined with inflated expectations, can lead to situations in which patients are more critical of the results they receive, more demanding about what they want, more vocal about any dissatisfaction, more likely to write negative reviews, more apt to request or demand refunds, and/or more willing to file board complaints or malpractice cases.

Thus, dental providers who offer cosmetic services should consider the following strategies as part of a prudent risk management approach:

  • Implement a patient screening and selection process. Look for potential red flags, such as a lengthy history of prior providers, dissatisfaction with previous cosmetic services, statements that indicate unrealistic expectations, and potential signs of body dysmorphic disorder.
  • Be exceedingly thorough in the treatment planning process, and use a shared decision-making approach throughout.
  • Be candid and honest about expected results and outcomes. Don’t overpromise results or promote idealized outcomes.
  • Use the informed consent process to educate the patient, set realistic expectations, and identify the patient’s goals and expectations (as well as your ability to fulfill them).
  • During the informed consent process, discuss the total length of the care plan and what to expect visually and physically along that timeline.
  • Thoroughly document the informed consent process in the patient’s record as well as any other treatment planning discussions with the patient and any patient education efforts. Ask patients to sign informed consent forms verifying that the process took place and that they understand important details related to treatment.
  • Clearly define and discuss the patient’s responsibilities throughout care and treatment, and ask them to confirm their willingness to adhere to the care plan. Consider using patient agreements for purely cosmetic treatment plans.
  • Be transparent about expected costs and any additional costs the patient may incur if the care plan changes.

Finally, dentists should be aware that patients who are not satisfied with initial cosmetic work, followed by one or more attempts to fix the issue, are unlikely to be happy with additional remedial efforts. In these cases, dentists should consider discontinuing further treatment and determining whether to issue a partial or full refund, depending on the situation. For more information, see MedPro’s Refunds & Waivers guideline.

MedPro insureds who have questions about managing risks associated with cosmetic procedures may contact their senior risk solutions consultant or MedPro’s Risk Solutions Center at 1-833-ASK-RISK (1-833-275-7475), email AskRisk@MedPro.com, or schedule an appointment at www.medpro.com/dynamic-risk-tools (click on “schedule appointment with risk consultant”).

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