5 RULES OF GDP ORTHODONTICS
BY DR LESTER ELLMAN BDS FFGDP RCS , DIRECTOR ORALIGN
1 CAREFUL ASSESSMENT OF THE PATIENT Sometimes when one attends a course on a topic which offers an interesting diversion from the routines of day to day practice , one becomes excessively focussed on that particular aspect and consequently we see problems and solutions which we have not previously noticed . This is particularly true in relation to cosmetic dentistry . I well remember taking a course at the Eastman on submucosal implants which made me focus on trying to provide them on any patient who had an ill- fitting upper denture instead of honing my technique on getting accurate impressions with muscle trimming and occlusal balance .
What I am really saying is that it is natural to look at patients with a somewhat jaundiced eye just after learning something new . The next masterclass will alter our focus yet again .
So , with this clearly in mind , it is essential that , when talking to patients about potential orthodontic treatment , you undertake a thorough assessment and make accurate , contemporaneous notes of what was said including the possibility of iatrogenic tooth damage or changes to the patient ’ s profile . It seems to be important to be absolutely certain that all pros and cons are clearly understood by the patient – though how you can be sure of this is a moot point .
2 CAREFUL EXPLANATION OF THE PROCESS Given the above and the ruling changes which emerged from the Montgomery Case about what constitutes patient consent ( See : https :// www . medicalprotection . org / uk / for-members / news / news / 2015 / 03 / 20 / new-judgmenton-patient-consent ) all persons undertaking treatment are affected and that includes us dentists ; it is essential to give as full an explanation of the treatment process as the patient will allow you to give . Some patients , especially those who have been recommended to you for a particular procedure , often do not want an in-depth discussion about the process . But , if this is the situation ensure that this is written in the case notes .
It will help if you can supply your patients with photographs and leaflets showing the process so that they have something to take away and digest and can ask questions about should that be required . But , the ruling is that this is not enough on its own to constitute advice leading to ‘ informed consent ’.
Usually Oralign will supply a projected outcome image which can be shown to the patient for their approval . However , it is vital that you explain the changes because patients are not usually familiar with observing their own dentition .
3 SELECTING THE RIGHT CASES As in most things in life , careful selection is most useful in avoiding complaints or patient dissatisfaction . Over the last couple of years , Oralign has come across a couple of cases where patient expectation has crept up as the results begin to emerge . I suppose one could liken it to watching a pupa of a cabbage white butterfly break open and expecting a red admiral to emerge . Realism gets suspended and disappointment takes over even when the result is exactly as promised .
This can be a particular problem when patients say they just want treatment to one jaw and the disadvantages of this are clearly pointed out e . g . increased overjet because the upper teeth have been moved forward a little to make space for an imbricated incisor . Had both jaws been treated , the overjet could have been maintained at its original level as the teeth would have moved in line with each other .
The moral , we have learned , is if the treatment really requires that both jaws are treated to get the best results both aesthetically and functionally , then insist that this is the treatment plan which has to be undertaken or do not take on the treatment – it will lead to misery for you and for the patient . You will find yourself in the dilemma of having pointed out the disadvantages of single arch treatment but the patient will claim a failure to comprehend and that will cost you time and money . The patient will convince themselves that you were not competent and misled them ( untrue ) which leads them to denigrate the service you gave and tell the story of their ‘ failed ’ treatment to the amusement of all who hear it . But , the net effect will be that the patient ’ s acquaintances will not roll up for treatment and will continue to spread the story . Oralign wants you to achieve success and gain patients who will become ambassadors for your treatment . u
32 Dental Practice Magazine