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Engaging in Difficult Conversations

Addressing problem areas with patients is never fun, but it’s critical orthodontists tackle these conversations as soon as possible. Early discussions can help keep patients from unrealistic expectations and prevent allegations, thereby mitigating the risk of a negative claim.


Many conditions that occur during treatment can be prevented with good hygiene and routine dental care. Nevertheless, when a patient experiences root resorption, bone loss, periodontal issues, unplanned treatment outcomes, or a need for orthognathic surgery, orthodontists must advise the patient—and parents when needed—as soon as the issue is discovered. If the conversation is avoided, the situation could grow worse, which may lead to a claim being filed.


Develop a friendly, professional alliance. The orthodontist-patient relationship should invite questions and discussion with shared goals for treatment. An initial conversation outlining the treatment plan, as well as doctor and patient responsibilities, helps assure more realistic outcomes. It can also make a difficult conversation easier, since potential problems are more likely to be discussed earlier in treatment. You also may be able to recommend a solution before an issue becomes serious.


Encourage discussion by asking permission. Remember: your expertise is needed, but many people “shut down” when told what to do. By asking permission to discuss the issue, you are inviting the patient to become a part of the solution and take responsibility for the outcome.


Use your expertise to offer possible solutions. It’s important to reassure the patient while being firm about ways to handle the problem. Discuss possibilities and determine the next steps together. By trying to understand your patient and encouraging involvement, you are more likely to enlist cooperation for future treatment.


Document everything, and consider terminating treatment when necessary. Some patients will not cooperate with treatment, which can result in serious damage to their teeth. That’s why it’s important that policies and procedures be set to address these situations before they arise. Having proper protocols and giving appropriate notice also mitigates the risk of allegations that could affect your career or reputation if a termination or negative outcome occurs.


These tips may also be helpful when handling employee issues. Remember to discuss expectations at the onset whenever possible and encourage open conversations. Whether the difficult discussion is with a patient, parent, or employee, it’s critical to document everything. Learn more about how AAOIC can help!



Ahmad Abdelkarim, Laurance Jerrold. "Risk management strategies in orthodontics. Part 1: Clinical considerations." American Journal of Orthodontics & Dentofacial Orthopedics 148.2 (2015): 345-349. Web. June 2018. <>.


—. "Risk management strategies in orthodontics. Part 2: Administrative considerations." American Journal of Orthodontics & Dentofacial Orthopedics 148.3 (2015): 511-514. Web. June 2018. <>.


Carol A. Jahn, RDH, MS. 5 tips for engaging orthodontic patients and getting better compliance. 13 May 2014. Web. 20 June 2018. <


Taylor, Emily. Tips for Discussing Orthodontic Treatment with Patients. 7 September 2017. Web. June 2018. <