Managing Patient Expectations

Question 1

Why can patient expectations be challenging in prosthodontics?

Answer 1

• dentures are not a replacement for natural teeth
• compromise restoration
  • most would prefer a fixed solution
  • dentures are imperfect
  • better than having no teeth at all

Question 2

Why may patients be dissatisfied with their dentures?

Answer 2

• usually related to retention and stability
  
  • most commonly lower dentures
    
    • bilateral free-end saddles
• disconnect between patient and clinician expectations
  
  • clinician aware of limitations
  • patient unaware of limitations
  • requires excellent communication
• reduced self-esteem due to wearing a denture
• negative impacts on socialisation
• aesthetic expectations unmet
  
  • especially partial dentures
    
    • acrylic teeth next to natural teeth
  • loss of bone and soft tissue, not just teeth
• facial aesthetics changed
  
  • due to tooth loss
  • patients attribute to dentures
• decreased chewing efficiency

Question 3

How can dentists improve patient satisfaction concerning dentures?

Answer 3

• managing expectations
  
  • explained well by dentist before treatment

Question 4

How can good communication be used to manage patient expectations of dentures?

Answer 4

• listen to the patient
  
  • worries and concerns
• know the subject
• avoid jargon
  
  • patients may not ask for an explanation
• be attentive
• answer questions
  
  • always honestly
    
    • better to say don’t know than ramble
• respect confidentiality
• be empathic

Question 5

What questions can be asked at the initial assessment to risk assess a denture patient?

Answer 5

• how long ago were your teeth removed?
  
  • longer time means flatter ridge
  • more recently means little denture experience
• how many dentures have you had since you lost your teeth?
  
  • indication of how good a denture wearer they are
  • more dentures tends to indicate difficulties
• how old is the last denture you had made?
  
  • the older the better denture wearer
  • dentures may just be loose or worn
• are you wearing the last dentures you had made?
  
  • if not wearing mist recent must work out the issue
  • identify what the patient likes in the older dentures

Question 6

What should be looked out for at initial assessment for a denture patient?

Answer 6

• thorough examination and palpation of denture bearing areas and degree of resorption
  
  • important even though edentulous
• key features
  
  • severely resorbed ridges
  • tori
  • prominent/overactive mentalis muscle
  • mylohyoid ridge
    
    • sharp?
    • resorption means closer to ridge edge?
  • genial tubercles
    
    • resorption made more prominent?
    • denture extension causing discomfort
  • pain on ridge palpation

Question 7

How can expectations be managed for a denture patient?

Answer 7

• effectively communicate that compromise is required
  
  • adjust expectations before treatment starts
• repeat key messages throughout treatment
• record what you say in records
  
  • include patients reply
• try not to give false hope
  
  • will reduce chance of disappointment

Question 8

What key statements can be used to manage patient expectations for dentures?

Answer 8

“I’m sorry to say that you may never be able to wear a denture that meets all your expectations to your complete satisfaction”

“Unfortunately, it is highly unlikely that you will ever feel that your denture is as firm as natural teeth”

“You are going to need much perseverance in trying to cope with your dentures and it is likely that it will be a very difficult time for you”