Part of the TCO role doesn't always involve discussing treatment with new patients, it can mean that you have to deal with situations where patient's are not altogether happy with the treatment they have received.
I'm lucky to say that I’ve only had to deal with a few patients that have complained. An important part of my job is to make sure that patient's feel they have been listened to, not only in their first consultation, but every appointment after that. So this means that if a patient is unhappy with anything to do with the service they have been provided, then I need to listen to the reasons. Only once I have heard the reasons, can I start to help deal with the problem. “The Customer is always right“, as they say, so I must never make them feel like they are in the wrong or accuse in them in any way.
The company I work for used to focus on the denture and general dentistry side, we only started offering the dental implants in 2008/2009. This meant that the staff all had a lot to learn about implants. Our treatment plan letters needed editing to make them suitable for implant treatments. Unfortunately some things were not included in this letter straight away, reason being that we were still learning about the necessary information that was needed in the template of this letter.
We had one patient who came in for a consultation, she had been told by her general dentist that some of her natural teeth were grade III mobile and would need to be extracted. The patient had to consider the treatments available to replace these teeth, she could consider a denture or possibly implants. After the first consultation, where the implant procedure and denture stages was explained and an approximate costs given, she decided to have a CT scan taken to determine bone levels for the implant option. Our Implantologist advised that there was no infection present, and that implants could be placed at the time of extracting the mobile teeth. The only problem was that this patient was a heavy smoker. Smoking reduces the blood supply to the bone and soft tissues, so the failure rate of dental implants will be higher. These risks were explained to the patient, and knowing these risks, she still decided to undertake treatment.
Extracting the teeth and placing the implants went as smoothly as possible. Due to the patient being a smoker, it was decided not to immediately load the implants with temporary crowns. The implants were out of the patient's smile line, so the soft tissues were sutured over the implants for the healing period. A 6 month healing period is required to allow for bone integration, but throughout this time, we will monitor the patient to ensure everything is going to plan. Once the healing period has been completed, we will take a OPG to review the bone around the implants, if there has been sufficient "fusing" then we can expose the implants and start the construction of the permanent restoration. This patient had healed well, so the next few appointment were scheduled to expose and construct the permanent crowns. The patient was thrilled with the end result, the crowns looked brilliant and she now longer had the worry of having gaps. We stressed again the risks of smoking when considering any dental treatment, and advised that she would need to take up a regular hygiene maintenance with her own GDP to ensure that the implants were well looked after. Obviously we would like to see all of our patients for regular maintenance, but we do have a lot of referral patients, so therefore the patient will return to their own dentist for any general dentistry and hygiene visits.
Unfortunately this patient returned to us within two years complaining of some inflammation around one of her implant. We took a x-ray and discovered that there had been substantial bone loss around the implant. This implant would need to be removed, and a healing period of approximately 2 months would be required before we could replace the implant. The probable cause of this failure was due to the smoking. The patient was quite upset and anxious about having to sit through another placement procedure. She was worried that we could replace this implant for it to fail again in the future. I was asked to see this patient to listen to her concerns, explain her options and book the next appointment. Even though we had explained the risks, these were not explained clearly enough in our treatment plan letters, so therefore we replaced the failed implant at no additional cost to the patient. A plus side to this story, is that the patient was so concerned about losing any further implants, that she has now quit smoking.
Another well known saying - "You learn from your mistakes" is definitely relevant in this situation. Not only is each patient made aware of the risks of smoking when considering dental implants, our letters now clearly state that we do not guarantee any implant treatment for smokers. If an implant was to fail, then we would charge to replace it. This is not a punitive measure, but simply stating yet another fact as to why smoking is bad for your teeth.
Diary of a TCO Series: