Orthotown May 2018 - 18

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In some cases, with hesitant but reasonable parents, a therapeutic diagnosis is perfectly fine.
This, however, is not one of those cases. I never start cases if the treatment plan is rejected ...
this is a harbinger of things to come. After all, you'll never regret the ones you never treated! I
would explain my reasoning and offer them the two options. If you don't think non-extraction
is a good option, do not continue to treat the case. ■
3/27/2018

Hykorthodontiscs
Member Since: 01/10/17
Post: 3 of 18

Thanks for your input. I totally agree with you. This is giving me an unnecessary headache!
I thought I made myself clear at the initial consult. I said, "I don't think that you are a good fit
for our office and I strongly recommend you to go talk to other orthodontists in the area." They
came back later and said they trusted my plan and wanted to start.
But now they are back again. They are asking me to try non-extraction as much as possible,
but if I have to take four teeth out, they will follow. I still don't feel comfortable seeing this
patient. I again recommended visiting other clinics and we can arrange transfer if they are happy
elsewhere. Unfortunately, I put braces on already, and the family insists staying at our office.
First, do you think it's wise to try to send patient away after I placed braces on? Also, how
do you send patients away at consults without making it sound like I'm refusing to treat them?
Thanks again. ■
3/27/2018

Fenrisúlfr
Member Since: 02/25/09
Post: 4 of 18

This is a huge red flag. They are dictating treatment and trying to usurp your role as the
expert. What happens if they refuse extractions and are unhappy with how things turned out? If
they want to stay, they will need to fall in line with your recommendation.
Absolutely! I have done it before. Cut your losses before the teeth move too much. There
seems to be a clear lack of trust or refusal to acknowledge the situation. If you feel uncomfortable
treating the case, I'd offer to transfer, or debond and refund. You are not refusing to treat them,
they are refusing to be treated by you! Recommend a second/third opinion if they don't want
to accept your plan. If they give you the heebie-jeebies, hike up your fee (downside is that word
may get around) or offer stricter terms. Sometimes you just have to flat-out bite the bullet and tell
them that your office is not a good fit for their needs, and you don't think you can make them
happy. Always cut your losses early! If they come around, you could continue, but never ignore
your gut instinct. It has saved me a ton of grief, but I had to learn some lessons the hard way! ■
3/27/2018

Hykorthodontiscs
Member Since: 01/10/17
Post: 5 of 18

I've been out practicing for only a few years as an associate and sometimes I find it hard to
manage these types of patients. This patient is so eager to stay at our office now that I'm telling
them to go find another orthodontist, but I will try hard to have this patient transferred out.
Thanks again for your advice! ■
3/27/2018

Fenrisúlfr
Member Since: 02/25/09
Post: 6 of 18

No worries. I have been in the same position as an associate and had to learn firsthand how
challenging these situations can be. I had to flat-out refuse to continue seeing some of these type
of problem patients. Now, if I see a hint of cray, I just head 'em off at the pass. ■

3/27/2018

emac
Member Since: 11/21/11
Post: 7 of 18

Don't fool with a fool. If you must, I would tell them that the 5s are very undersized and
not good teeth. Taking them out will remove the poorly formed teeth and allow you to create a
healthy stable dentition. The laterals appear to be mismatched, so make sure you let them know
recontouring or bonding may be needed. ■

3/27/2018

MAY 2018 // orthotown.com

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