Lowering the possibility of unhappy denture patients

I say to the patient that "your new dentures will be well engineered lumps of plastic. They look like teeth but don’t work like teeth - like a prosthetic hand/leg, they will not work like natural teeth. I will make them to the very best technical standard; however, I am heavily reliant on you getting used to them. Just like learning to drive a car or learning a new skill (like golf, football, golf, violin, chess etc) it takes time to get used to them. You will need to work with them rather than against them”.

The role of neuromuscular control cannot be over emphasised. The adaptability of humans is incredible. I inform my patients of their role in the success of the dentures.

Managing expectations is 50% of the success with dentures. 50% is technical.

The patients’ role in the success varies from 20 - 70% depending upon the mouth anatomy, their attitude and their history of denture wearing. The role of Rowan (my dental technician) and I varies from 80 - 30% in the overall success. I tell the patient this. The fees I charge for complete dentures range from £6.5K – 12.5K GBP.

I discuss their role in the success of dentures regularly; at a Zoom or telephone consultation, at the in person consultation, in a treatment consent letter, during the treatment process, at the fitting appointment in person, in a denture care instruction leaflet and in a personalised Loom video at the end of treatment.

If these factors are discussed with the patient prior to starting, they are seen as a diagnosis; if they are explained once the problem arises after denture provision, they can be seen as “an excuse” (meaning I am on the back foot).

Examples of topics worth discussing are:

1. The dentures will be sore

2. The dentures may cause alteration to speech

3. The dentures are a prosthetic replacement – analogous to a prosthetic hand

4. Adaptation is required (neuromuscular control is discussed)

5. Saliva flow changes

6. Chewing and eating techniques – chopper not a grinder

7. Cheek, lip and tongue biting

8. Potential feeling of unaccustomed fullness

9. Looseness

10. One year warranty

This above list is not exhaustive.

I have refunded one patient I made metal based partial dentures for. This is in the past 16 years of having a referral practice. The patients I see can be very challenging because they are mostly referred. I have stopped treatment part way through and refunded a handful of patients, if they don't understand their role and don't trust me. Sometimes I only find this out after I have seen them 2 or 3 times once I get to know them.

Interestingly, I have not refunded any patient in the past 16 years for complete dentures. I do have to remake dentures if the first set are not right though. I DO NOT CHARGE THEM FOR THIS - I CARRY ON UNTIL THEY ARE RIGHT. This happens for 1 in 25 C/C patients. I then use Mk 1 as prototypes, keeping the good parts and changing the bad. For one patient I had to make 4 sets of complete dentures before achieving success.

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