If You Want a Guarantee, Buy a Toaster by Mike Gow BDS (Gla) MFDS RCPS (Gla) MSc Hyp (Lon) PGCert (Edin), Editor, DentaltownUK magazine

In the 1990 film The Rookie, Clint Eastwood’s character, Nick Pulovski, says: ‘If you want a guarantee, buy a toaster.’ While it is probably unwise to say it this bluntly to any of your patients who ask about guarantees for treatment, what do you say?

This topic of dental treatment guarantees crops up from time to time on the Dentaltown message boards and in dental social media groups. Most dentists agree that it’s generally unwise to offer a written guarantee for most dental treatment; some go so far as to tell patients that the only guarantee they will offer is that at some point it will fail—it is just a question of ‘when’ rather than ‘if’. The general consensus, therefore, is to avoid giving any guarantee. What do you say?

For most of the dentistry I provide, I favour a verbal statement along the lines of, ‘My expectations are that the restoration should last five-plus years, but if any issues occur within the first year that are not due to parafunction, habits, misuse or lack of care—and you’ve attended all your check-up appointments in that time— then I’ll correct it or replace it at no charge, as a gesture of goodwill’.

I feel it’s important to use the words ‘five-plus’ when giving lifespan expectations. Many dentists say, ‘five to 10’. The risk is that if you say this, the patient will hear ‘10’ or feel that if it fails at five then this was at the low end.

I know this now, because it has happened to me with a failed restoration after some seven years and the patient saying, ‘You said it would last 10 years’. Saying ‘five-plus’ avoids those issues. Specifically stating that this offer is a ‘gesture of goodwill’ is important, also, because it highlights that it is not a guarantee. This needs to be crystal-clear to the patient.

Obviously, there can be a degree of flexibility in your gesture of goodwill. In reality, if something fails within the second year, the same criteria are met and I really wouldn’t have expected something to fail so soon,

I’ll consider the merit of extending the gesture of goodwill in that case.

Alternatively, depending on the restoration, timespan and case, I’ll sometimes compromise and charge a small fee to cover materials costs for the repair or replacement. I often find that it is useful to have this option if you find yourself in a grey area (e.g., an unexpected ‘early’ failure in Year 2 or 3) in a regular attender with good oral hygiene on no parafunction or habits, etc., that may have affected longevity.

Patients will often accept this as a fair compromise when you explain that the restoration failed earlier than you expected but after your usual goodwill period, despite the fact that you were happy with your work, felt the patient had been looking after it well and they had been attending regular check-ups. If it’s a crown (or other lab-made restoration/prosthetic) that has failed earlier than expected, depending on the case and reasons for failure as above, there is the option of just charging the lab fee to the patient for a remake.

Fortunately, it doesn’t happen very often to me, but when it does I feel it’s a good investment to ensure my patients feel that they have been looked after and dealt with in a fair way. How you deal with ‘failures’ and issues is obviously up to you and your practice policy; however, bear in mind that it can be an opportunity to be a practice builder.

Patients with issues whom you bluntly tell (Clint Eastwood voice optional), ‘If you want a guarantee, buy a toaster’ will be more likely to complain, and to tell others to avoid you. Patients who feel looked after are more likely to feel satisfied, remain loyal and recommend you to their friends and family. Be clear, however, that what you offer is a goodwill gesture rather than a guarantee.

There are some fantastic articles in this issue of DentaltownUK. Thank you again to all our contributing authors, and also to our sponsors. I would especially like to take this opportunity to thank our Student Editor, Kishan Sheth, who is finishing his final exams and will graduate this year.

We are delighted that Sheth has accepted a position on the honorary editorial board and will continue to work with us.

We also look forward to working with a new student editor after the summer! If you are a dental student and are interested in the highly coveted role of becoming DentaltownUK’s next student editor, please go to the Student Section in this issue to find out more.?