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Thursday Troubleshooter: Dental practice needs letter stating risks of partial treatment

May 26, 2016
This dental practice needs to help their patient realize the risks of only having temporary crowns. The patient refuses to return for her subsequent treatment. What should they do to reach out to her?

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QUESTION: We have a patient who had four crowns done in our office. She wrote a check and it bounced. We called her several times, and after two calls over the course of two weeks she answered and said to never call her again.

Now our problem—we can handle the returned check through our attorney. What we need is a letter stating the risks of having only temporary crowns on her teeth. Do you offer any sample letters?

It is extremely unfortunate when these situations happen. While a letter explaining the hazards of keeping temporary crowns should certainly be sent, I believe it’s also important to communicate the value of the doctor's time and treatment to patients.

The letter should address these concerns:
• Doctor's concern for patient's long-term health and welfare
• Long-term prognosis of teeth without a permanent crown
• Probability of fabricated crowns not fitting if temps come off and tooth structure is compromised
• Probability of unnecessary extra expense if temps are left in place

When concluding, tell the patient she's dismissed if she does not reply or ignores the letter within so many days. Credit her account for a portion of the work because the permanent crowns were not seated. Provided your signed financial arrangement explains any fees associated with the expense of dealing with a third party to receive financial restitution, I would charge the patient's account these fees also.

Fortunately, this is not a typical occurrence for most dental practices, but it does happen. To avoid this problem in the future, it would be wise to either collect payment in advance and allow adequate time for the payment to be processed, or use a check verifying system in the practice. (Electronic verifications can be expensive, so shop around with local banks for rates.) Another option is to stop accepting checks, however, I understand that this is not always doable for small practices.

Emphasize concern for the patient's health and well being, and allow her to explain any circumstances that may have led to this situation. This may help her continue care and make financial arrangements to reimburse the practice for treatment rendered.

ANSWER FROM JULIE VARNEY, Consultant, Morado Dental Academy:
This is a “temporary situation” if you put a great solution in place. Start by sending the patient a certified letter that she must sign for. This provides a record that you tried to reach her, and this records the outcome of that communication. In the letter state your concern for the uncompleted crowns that have been placed with only temporary coverage. Explain that a temporary crown provides protection for a very limited time frame, which is mainly for limited protection and esthetics purposes while the lab is making the final crown restorations. Temporaries are made with an acrylic or plastic material that can’t withstand a long length of time chewing and grinding food.

While temporaries provide limited protection of the remaining tooth structure, the tooth structure over time will start to break down, become sensitive, or even decay. Results may require the tooth to undergo additional procedures, or might lead to tooth loss which leads to future out-of-pocket expenses. After you’ve addressed these concerns, offer to have the patient call the office to schedule an appointment to complete the treatment, and discuss her financial responsibility and offer payment options. By addressing your true concern for the teeth and uncompleted crowns, this might help the patient understand the need to complete treatment and take care of her financial responsibility.

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