In the battle of Patient vs. Dentist vs. Prosthetic Technician, no one wins
By Joseph J. Massad, DDS
Of all the issues that overshadow the seamless proceedings of the dental profession and other areas of life, the communication gap turns out to be accountable in most situations.
For example, there is the blame game that flares up between dentists and prosthetic technicians when a prosthetic restoration is not acceptable by a patient. Unfortunately, this attitude can be very destructive for dentists, prosthetic technicians, and patients.
Let's review some common complaints from patients' perspective when they experience a variety of negative issues with their newly placed restorations. Some universal comments include — "I can't chew well," "My teeth are not centered to my face," "The teeth look too large (or too small) when I smile," or "There is an uneven show of teeth."
Let's face it; no one feels good being criticized. In cases like these, the dentists may feel embarrassed, and may respond by diverting the blame elsewhere.
Let's face it; no one feels good being criticized. In cases like these, the dentists may feel embarrassed, and may respond by diverting the blame elsewhere. If a patient blames the dentist, the dentist may try to save face by blaming the lab. The laboratory technician, upset by the dentist's claim, may blame the dentist back, claiming that everything fit the model proposed by the dentist, and any discrepancy was the result of the inadequate information provided by the practitioner. This leaves the treating dentist accountable in the eyes of an upset patient.
The important question remains — what can we do to avoid situations like this? Rather than playing the blame game, let me outline a protocol that has been successful in my practice for the last 35 years.
First of all, the responsibility of the dentist must include a thorough patient evaluation, along with a straightforward discussion to determine the patient's expectations. Cosmetic variables must be disclosed to patients before the dentist agrees to perform any definitive treatment.
Dentists can avoid many problems with photographic documentation of a patient's facial display, from a profile to frontal views while at rest, from light smiling to the most vigorous smiling, to determine treatment. Requiring patients to view the photographs with the dentist allows for co-discovery and a trusting discussion regarding what can be feasibly accomplished with dental prosthetics.
Such interactive sessions with patients help determine whether prosthesis alone can alter the inherent facial asymmetry to satisfy a patient's expectations. Certain alterations can and cannot be done to the extent a patient may expect. As an example, visual perceptions of tooth midlines are generally in the eye of the beholder, which is influenced by personal tastes or opinions. One proven prevention method is to not treat. However, reasonable patients can be treated with predictable success, as long as both parties are on the same page.
Avoidance dentistry teaches practitioners to educate patients before treatment that people perceive what is esthetically pleasing differently. The midline is one value that can have many differing opinions. It is good to allow patients to make the final decision before final prosthetic delivery. Once this has been established, the patient should sign a form indicating that he or she accepts certain cosmetic variables, and the dentist transfers the responsibility back to the patient or other decision maker.
When it comes to the prosthetic laboratory, dentists need to discuss challenging cases one-on-one with technicians. With today's technology, this can be accomplished quite conveniently through computer-to-computer video conferencing. In our office, we use Skype and FaceTime to communicate with our technicians on a daily basis. It is easy not only to discuss cases with the technicians, but the technician and dentist can both view the actual models and photos to develop the final prosthetic design.
I have found this to be one of the best ways of communicating with my laboratory. Even with detailed written work authorizations, instructions can be confusing and certain items left out. The clarity of video conferencing will depend on your Internet connection, but in most cases the communication is so clear that you feel like you're sitting next to your technician in the lab.
In order to use this as a tool to communicate with your prosthetic technicians, consider purchasing a camera that is not built into your computer so that you can move it easily to focus on any angle or magnification. This technology is very reasonable in cost, and I justified the cost in a single patient case.
In conclusion, a thorough evaluation including photographic documentation and an open and honest discussion of what you can and cannot offer, in conjunction with a partner-like relationship with your prosthetic technician, can be your biggest edge to consistent and successful prosthetic treatment outcomes.
Dr. Joe Massad may be reached by phone at (918) 749-5600 or by e-mail at [email protected].