Explaining the risks: Not ‘How’ but ‘When’

Have you given much thought to your discussions with patients regarding the risks of the dental treatment that they are undergoing? If you haven’t, you really should. Explaining dental treatment and the risks is all part of setting your patients’ expectations. Do this well and you have a happy patient. Do it poorly and you have a complaint. Naturally, you’re going to want to do this well every time. So how is this done?

Why don’t we consider this story that I have just made up about Dr Sidebottom. Dr Sidebottom is a fictional dentist that I was having a chat with last week. Although he doesn’t exist, his story is based in facts and personal experience (mine, not his).


Last week, Dr Bernard Sidebottom was describing a patient who he had recently fitted new dentures for. Bernard proudly recounted how he had explained to the patient when he fitted the dentures that new dentures are like a new pair of shoes. It takes time to get used to them and they can rub a bit at the start. He then continued to blame the patient who was becoming increasingly annoyed about needing further adjustments since the dentures were fitted. The patient had only been twice to ease the denture so the dentist didn’t understand why the patient was unhappy. He had explained that the denture would take time to feel comfortable, just like a new pair of shoes.

The mistake that Dr Sidebottom had made when explaining the issues with new dentures was not how he had explained things. It was when.

I have to say that, personally, I do not like the ‘new shoes’ metaphor. I find it slightly insulting to a patient’s intelligence. If you tell a patient that a new denture will feel odd for a while and will take some time to feel comfortable, they will understand and accept that. I don’t believe that you need to go into the whole ‘new shoes’ metaphor. However, whatever you want to say is fine by me.


How you explain risks is not as important as when. Dr Sidebottom explained the potential issues of a new denture on the day the denture was fitted. To the patient, this is no longer an explanation; this is a excuse. When making a denture, you have several appointments to discuss what the denture is going to look and feel like before you come to fit. If you explain problems once the denture is finished, you are now just making excuses.

This is the same for any dental treatment. If you fracture an upper molar tooth during an extraction and explain that sometimes these teeth require referral for surgical removal because they have three roots, you are making excuses. If you inform the patient that the tooth is likely to fracture before you start, you are explaining the risks and demonstrating to the patient that you have experience of these scenarios. Big difference.

When are you going to explain that the tooth may die due to the size of the cavity? When are you going to explain that you may fracture a file? When are you going to explain that, whatever you try, the patient may require an extraction in future?

You need to explain before you start and at every appointment until treatment is complete. Tell you patients whatever analogies you want. Just make sure that you explain them at the start rather than the end of treatment. Remember, explaining risks at the end of treatment are not explanations at all; they are just excuses.

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