It’s Really Not Just About Teeth

I recently had a consultation in my office with a patient who had completed her orthodontic treatment approximately 4 months ago.  She was now suddenly unhappy about her resulting smile and was requesting that I address the problem and retreat as necessary to her satisfaction.

We always have a consultation when at the final evaluation appointment where patients or parents will sign a consent that they are happy with the finished results before we remove all orthodontic appliances and provide final retainers.  She had agreed everything was to her satisfaction.

How would you handle this new request, 4 months later?

I will share with you how I handled it….and admittedly not very well….

It was a Monday first of all and over the weekend I had received news about a friend who had died of cancer the previous week.  It brought back memories of my mother’s death from cancer about a year ago who I still miss and grieve about every single day.  So I was sad and down on this Monday morning and not quite feeling my usual self.

As doctors we are supposed to leave our personal problems at the door when we arrive at the office to take care of our patients, but we all are human and sometimes you just do not feel quite like yourself.  This was definitely one of those days.

You could say I was “not in the mood” to deal with a patient concerned about a very small (less than a millimeter) issue about her smile.

I told her I was having a hard time actually seeing the problem and that compared to how her teeth looked from the beginning, she had come a long way and had a beautiful smile.  No one would even notice the issues she was concerned about.

She said she it bothered her a lot and that she wanted it fixed.

I dug my heels in deeper and said that in my professional opinion I could not solve the issue.   It had to do with the size and shape of her teeth, and that retreatment could open up all kinds of other problems trying to correct this very small one.

Still, she insisted.  I was firmly entrenched in my position.

My mind was thinking about my friend and her family that lost her so early, I was thinking about my mom who was diagnosed with cancer and gone in 6 months. I was thinking of all the “BIG” problems people have with their dental or overall health.  This was so small and inconsequential to me…plus it was the first time she had ever mentioned this issue.

But not to the patient. This was a big problem!

I encouraged her to look at back at her original photos and be happy with her beautiful smile and not worry about such a small issue that did not affect the health of her teeth or her bite.

The battle was over and she left the office.

I could tell she was disappointed, but as her doctor and knowing her for 2 years I felt she would come to see that her concern was so minor that she really did have a beautiful smile and go about her life happy and have confidence in herself and her new beautiful smile.

It would turn out not to be the case.

Within 24 hours a review was posted on social media and I was mentioned by name by this patient.  It was not pretty of course.  She was mad and she wanted me to fix it.  She did not get what she wanted and now social media lends itself to venting.

It made my week even worse and my anxiety about the situation now was all I could think about.

Mid week, I woke up in a sweat in the middle of the night and had this thought running through my head.  It was not about her smile or her teeth, Donna.  There is something else going on!

Why would a patient who 4 months previously was happy, signed off on appliance removal suddenly start complaining about her smile and specifically a new issue?

It wasn’t about her teeth!

That morning I made the decision to reach out to her and apologize for my lack of willingness to help her.  I sent an email with the apology and invited her to come back in for a new scan and another set of aligners to address her concern.

A reply came within 1 hour.

She totally understood.  She had just lost her dad 6 months previously so suddenly and was of course still grieving his loss. She accepted my apology and would definitely take my offer for retreatment.

Could the drama, the bad review and eventually my apology have been avoided from the start?


It was time to step back and evaluate how this process and other patient or parent complaints could be handled in the future to avoid this from happening at all.

This is the strategy we are now using when these types of situations arise.

First, records are taken including photos and necessary x-rays if deemed appropriate to the situation.

The patient is scheduled with the treatment coordinator for this record taking process.  He or she will document all the patient’s concerns.

The patient or parent will be informed that the records will be reviewed by the doctors and a formal consultation scheduled after their thorough review and possible consult with their family dentist if necessary.

Gathering the data and giving the doctor a chance to review everything during a non-patient period, will allow more clarity in the analysis of the patient’s concerns.

Once a thorough evaluation has occurred, the patient will be rescheduled for a follow up consultation with either the treatment coordinator or the doctor depending on the specific concerns and the compliant fully addressed and handled effectively with a clear decision.

Having the time to gather the facts and the data and allowing the patient to vent to the coordinator is helpful in getting the real issues out in the open, so a decision that can be a win win for both parties can be found.

Sharing this story with readers certainly is a humbling experience for me.  We all have interactions every day with customers, clients, patients, parents, employees, our children, spouses and other family members.

Step back, gather the facts and additional data and then address their concerns showing sincerity that you are listening and want to make it right for them.

I learned a valuable lesson that day, it’s not always about the teeth!