No Means No - Restoring Excellence

No Means No


Jul 07
no means no

So I have this case and the patient refuses ortho, how should I treat it?

In the last two days, I've been sent a lot of messages asking for help treatment planning cases. Sometimes I can answer them. Sometimes I can't.

Now, I'm not squeamish about de-enamelising a tooth if I have a good reason. However, decapitating the dentine and the pulp is a bit too far even for me.

So when I get sent pictures of lateral incisors in complete crossbite, and asked how to restore it, I say ortho. When I get told that the patient doesn't want ortho, and what else can we do, I suggest saying no.

But there is an art to saying no.

You have to have conviction. You have to have intense eye contact (culture permitting). And preferably, you have to have the pain of a procedure that you've done, and always regretted, to give you gravitas.

So the patient that wants you to chop half their incisor off, do root canal therapy, and a wonky looking crown that corrects massive ortho problems and will be a disaster hygienically, mechanically and aesthetically will say "but I don't want braces".

And here is what you say.

No. I won't do a veneer/crown/slaughter here. It is a bad idea. It is such a bad idea, that even if you pay me double, I will not do it. However, if you go to enough dentists, you will probably find someone who will.

Then print out a picture and show them how much of the tooth you have to cut off to make it work.

Then the piece de resistance.

You are 35 now. But probably when you are 45, you will still want a front tooth. If I chop it off like this now, you'll end up losing the tooth and at some point I'll do an implant and I won't be able to fit the implant in get orthodontics. Besides, implant wear out too.

Lastly, when you say it, don't pussy foot.

Don't use weasily academic language.

No saying "well, the biologic cost of this procedure is quite high and jefferson 2008 showed a lovely study that you are more likely to have signifcant negative sequelae with reduced survival rates. " Or other academic waffle.

Just look em in the eye, and tell em straight. And mean it in your heart as you say it.


About the Author

Dr Lincoln Harris has been completely focused on excellence and quality from the beginning of his career as a dentist. He established the first private dental practice in Bargara – Harris Dental Boutique in 2000. Since graduation he has trained extensively in Aesthetic Implant Techniques and Full Mouth Rehabilitation to attain immense skill and knowledge. With his vast dental knowledge Dr Harris coaches and trains dentists from all over the world on complex aesthetic dentistry, surgical techniques and business management. Dr Harris is the founder of RIPE. Restorative Implant Practice Excellence: Full Protocol group an international forum of over 70,000 members worldwide. The purpose of the group is to share information and excellence in the dental industry. He has also lectured in multiple cities throughout Australia, North America, Asia, Singapore, United Kingdom and Europe.

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