Kiran Madesha, Legal Advisor, dentalcorp; Kristy Pilatzke, Risk and Compliance Officer, dentalcorp
Every dentist aims to please by providing their patients with optimal treatment outcomes. This dedication to success can sometimes lead a dentist to offer patients a guarantee (a promise of a satisfactory outcome) or a warranty (a time-limited agreement to replace, repair or refund a defect in material or workmanship). Other dentists may feel obligated to offer a guarantee or warranty when practicing in a competitive market or in response to a patient’s request. Whatever the reason, it is essential to remember that in healthcare—and dentistry is no exception—results are never guaranteed. Despite one’s best efforts, patients may still end up dissatisfied.
Guarantees or warranties are most often offered for restorative or prosthetic treatments such as implants, crowns, bridges, fillings, or veneers. However, the success of treatment depends on many factors, a number of which lie outside the dentist’s control, including the patient’s oral hygiene, substance use, the presence of comorbid conditions like osteoporosis or dementia, adherence to post-operative instructions, and dental trauma. Dentists who have practiced long enough know that the human body is always capable of surprises, and treatments may fail for no apparent reason. Even in the best conditions, dental restorations and prostheses may need to be replaced after a certain amount of time.
Patients also play an important role in the success or failure of their own treatment outcomes. Occasionally, a patient will reject a perfectly executed denture or bridge, to cite just two examples, due to subjective, evolving aesthetic preferences, the way they feel, fit, or function. Whether or not they follow their aftercare instructions is also a key factor, and dentists should be very careful to avoid arrangements that may disincentivize patients from looking after their dental treatments or overall oral health.
While being accountable is the hallmark of a true professional, dentists should avoid creating unreasonable expectations for patients. Practitioners should keep the following in mind when managing treatment outcome expectations with patients.
- Never guarantee success. Certain dental regulatory authorities deem it unethical to guarantee the success of dental treatment or services. Guaranteeing dental treatment may invalidate your professional liability insurance, and an ill-advised guarantee could leave a dentist personally liable for not only the cost of remedial work—including work done by other dentists—but even legal defense fees.
- Obtain informed consent. Even with extensive experience and foresight, dentists are just as human as their patients, and as such, should obtain the patient’s informed consent prior to commencing any dental procedure. As every dentist should know, informed consent requires the disclosure of not only the benefits of treatment but also all material risks, costs, and reasonable alternative treatments. Possible material failure or subjective dissatisfaction are two risks that dental professionals ought to address prior to commencing a treatment plan.
- Avoid open-ended promises like “I’ll take care of everything”. Even after treatment has failed, simply redoing the same treatment may not be prudent or feasible. In such situations, the only assurance that may fairly be conveyed to a patient is that the clinicians will use all their professional judgment, training, and experience to seek the desired outcome. If a dental laboratory is willing to provide a free replacement bridge or denture, that benefit can be passed on to the patient. However, such benefits should not be phrased as a guarantee of the underlying work or a promise to fix anything else that might possibly go wrong. If the lab fees for a replacement crown, for example, would be waved, such a “material warranty” must be clear, provided in writing, and accompanied by a statement that it is not a guarantee of the underlying treatment’s success.
Managing patient expectations is the key to success in dentistry. To that end, dentists must do their best to ensure patients fully understand the associated risks and limitations of any proposed treatment by engaging in an appropriate informed consent process and avoiding promises that may be impossible to uphold.
About the Authors
Kiran Madesha is a licensed lawyer with the Law Society of Ontario and works as a Legal Advisor at dentalcorp on the Compliance team. Kiran holds a Bachelor of Laws degree from the University of Liverpool and a Master of Laws degree with a concentration in Health Law from the University of Toronto.
Kristy Pilatzke is an experienced quality and compliance professional with over 13 years of experience in regulated healthcare industries, from pharmaceuticals manufacturing and specialty pharmacy to acute care. She currently holds the position of Risk and Compliance Officer at dentalcorp. Kristy holds a Master of Science in Healthcare Quality from Queen’s University.