Cases that seem to start out great can go sideways when we least expect it. In this post, Dr. Nosti discuses a recent case in his practice and how he resolved a potentially disastrous situation.
Read on to learn from the story of a patient who wasn’t satisfied with the whiteness of her veneers and began to feel distrust because of this.
Cosmetic Case Miscommunication
Recently I had a cosmetic case where the patient wanted her teeth whiter than what I would have chosen for her or would have personally wanted for myself. She didn’t present that way at first, nor was she initially unhappy with her transitional veneers (temporaries). As a matter of fact, she absolutely loved them the first week or so and then became somewhat fixated on her teeth being as white as possible.
This was further complicated by the fact that the patient lived approximately three hours from my office. She created a story in her mind where she became worried that her final result would not meet her desires, and she consistently said in conversations that she left my office without a discussion of how white her teeth would be.
Expectations of Procedures: Miscommunication Problem #1
The patient went home and researched shade selections available via Dr. Google. She saw photos of shade guides and then expected that I should have shown her a shade guide and communicated what her final shade would be via a shade guide.
This is something I do not do because the patients see the shade guide and almost always want to choose a 010 or BL1 shade even though this color is too white for 98% of the population. Even when you hide these, they examine the next shade and question if BL2 or 020 is the whitest possible shade. Clearly seeing there is a number system, patients are intelligent enough to determine that you aren’t being honest and showing them all the choices available.
Due to this, I do not allow patients to see the shade guide. This is normally not an issue because patients respect my opinion and my choice of what shade they can tolerate.
I simply stated that the shade guide we use is better than something we hold in our hands and guess if it is going to look good. The temporaries are indeed a shade guide and if she would like the definitive restorations whiter than the transitional veneers, we can easily accomplish this.
Sensing a Lack of Communication: Miscommunication Problem #2
Despite clearly and definitely discussing shades (which is how we chose the temporary), she felt that this wasn’t discussed.
I referred back to our decision of choosing the whitest possible temporary material for her transitional veneers and how this was based off both our initial consultation conversation, as well as the conversations we had the day of her preparation visit. I also very politely asked her a series of questions to understand why she felt this way:
- “I received a text message the day following your visit when we placed the transitional veneers saying that you loved the appearance and the color was perfect. Can you share with me what has changed in the past week?”
- “The shade of your transitional veneers is something we use as a communication tool. Are you aware that we can still make changes to the definitive restorations?”
- “At your next visit when we try in the definitive restorations, are you aware changes can still be made?”
Distance Issues: Miscommunication Problem #3
The patient might’ve potentially gotten nervous that the distance from my office could be a road block to achieving her desired result. I overcame this problem by asking the patient which form of communication she prefers prior to dismissing her with transitional veneers.
I text messaged her (her choice method of communication) often throughout the transitional phase to make sure she felt in control of the situation and felt that I was providing her the attention she needed. When it came time for the appointment to seat the definitive restorations, I made sure she had her husband present at the visit so that he could offer his opinion on the appearance of the final restorations.
I was honest with her and informed her that the shade she preferred was slightly whiter than what I would have chosen for her. We tried the restorations in and I allowed her to roam around my office to see herself in various lights, including going outside in the sunlight to make sure she was happy with the result prior to cementing the restorations in place.
Despite having definitive restorations whiter than what I would have personally chosen, the patient and her husband were ultimately in charge of the decision. I chose not to try to force my opinions on the patient and allowed her to make the decision for herself while having my recommendation and opinions heard for her education. In the end, the patient and her husband were completely thrilled with the result.