Friday, July 31, 2009

What's should I do ? If my patient wants high quality, look nature, prefect BUT very cheap.

It happens often enough in any dental practice. A patient walks in to have a new denture done. He tells you all the horrible things the old denture is doing to him. He wants those things rectified. You faithfully design a different denture that addresses all his concerns.

Patient’s Denture Wish List
1. Teeth that look new
2. Teeth that look real
3. Whiter teeth
4. Teeth with more bite
5. Sexier teeth

When the new denture is ready, the patient, spits it out, can’t tolerate for one second and start comparing the “merits” of old denture with the demerits of what you’re just done. It doesn’t matter if you pull out that wish list written in the patient’s own handwriting and signed against “sexier teeth”. They think the new teeth you’re giving them just ain’t sexy.

Most dentists will reel from the shock of seeing a happy, enthusiastic patient walk in for the first visit, only to be entertaining a critical and uncooperative one at the end. Can these cases be spotted at the beginning and weeded out before taking the case? I find it difficult. During initial examination, the dentist may be able to establish how the patient felt and what the patient wanted at that point in time. They may feel that their old denture had teeth which were too short. They wanted longer teeth, bigger teeth, whiter teeth… Even if the dentist could read their minds at that point in time, he would have seen that they wanted longer teeth. But once the longer teeth are issued, they begin to sound funny, feel funny and chew funny, they may decide to take issue with their new dentures in the most unexpected ways, saying that it’s uncomfortable, unstable and just not right.

The vast majority of dentures do require some adjustment before issue. Nothing is perfect - especially a set of new dentures to which the patient is not accustomed. In the vast majority of cases, patients are satisfied after adjustments are made. If the new dentures are significantly longer, larger or thicker than the old ones, then a period of adaptation (with 100% patient participation and cooperation) is required. Only in rare cases are redoing the denture necessary. If the patient is agreeable to a redo of the denture, this time without such a great departure from their old set of dentures, then, an amicable conclusion is still possible. And it usually ends up amicably. Even if the patient is unwilling to bear the cost of the redo, the dentist would still be in the position to end off with a satisfied patient - something more important to the dentist than making a profit out of every single case.

Just for the sake of job satisfaction, many dentists are willing to redo dentures. But not all patients allow the willing dentist to redo. What if the patient declares that he has lost all confidence in the dentist even before wearing the denture for any reasonable length of time (less than an hour)? He is not asking for a redo. He is asking for a refund.

Reading their minds now, the dentist may see a totally different patient from the very nice and accommodating one on the initial visit. So mind reading doesn’t help. What might help, is a third eye that can look into the future and predict trouble and unpleasant responses from initially nice and friendly patients. How I wish I can do that.

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