Having the difficult conversation: When patients opt for no treatment

by | Apr 11, 2023 | Dental Assistant, Dental Hygienists, Dental Job, Dental Professionals | 0 comments

Inevitably some patients will opt to refuse treatment they could very well need to preserve their dental health. This blog post comes from Susan L. Quan, MPH, MBA, RDH over at DentistryIQ and provides helpful tips for dental professionals dealing with patients who refuse essential treatment.

“Ask any dental professional why they chose dentistry as a career, and the answer is often, “I want to help people.” This is especially true for dental hygienists. We have a clear understanding of what a healthy mouth looks like, and we want that for every one of our patients. We are trained to identify early signs of disease so treatment can be rendered and larger problems avoided.

However, in a business that is driven primarily by pain, it can be a challenge to help patients see what we want for them. For example, it is difficult for some patients to see why a painless open margin on a crown can be problematic. With these patients, it can even feel like we want treatment for them more than they want it for themselves, leaving us frustrated when they decline treatment. So, what should we do when this happens? And how we can be helpful even when patients say “no” to treatment?

A closer look at the problem

Every dental hygienist has a certain percentage of patients who are truly prevention-minded. They accept treatment recommendations because they trust our professional judgment. These patients make our days easier. We get to feel that we’ve saved a person from a future dental emergency. Examples of this include identifying a marginal breakdown around an old restoration, recommending a crown to address a fracture before a tooth breaks, or treating gum disease before a tooth is lost. We may feel even more accomplished if a larger treatment plan like implants or orthodontics is accepted.

You might also be interested in: Handling informed refusal of periodontal treatment

Although patients have similar problems, they are very different in whether they accept, postpone, or decline treatment. Even worse than refusing treatment is when they give you the impression that they accepted treatment recommendations during the appointment, only to decline scheduling at the front desk or cancel a scheduled appointment after leaving the office. But this is a reality that we have to deal with.

It’s the patients who aren’t easy who show us that case acceptance is a tricky thing. There are so many considerations and potential barriers that influence it. Case acceptance involves more than just saying “yes”—factors like how we identify problems, propose treatment, and ultimately complete treatment. These factors also include clinician values, patient values, standards of care, communication, timing, and financial concerns. I’ve intentionally listed financial factors last. This is because I believe firmly that of all the factors, financial considerations should almost never determine whether treatment is done or not. Even in rare cases when finances are an impossible barrier to overcome, there are treatment avenues to pursue. For the majority of patients in our everyday practice, it is the other factors that prevent them from completing proposed treatment.

Saying “no” is a patient’s right

It’s challenging, but we must first accept that saying “no” to treatment is a patient’s right. In other words, no treatment is a treatment option. This may come as a surprise to many of you. As consumers of health care, we can all think of other times when people are put in a position to choose to accept proposed treatment. A good example is vaccination. The health benefits of vaccinations are very clearly presented in the literature. However, there is a certain percentage of people who still choose to decline vaccinations for themselves or their children. Right or wrong, they have the right to make that choice.

In dentistry, we face similar opposition. People will choose not to pursue treatment for a variety of reasons. It is incumbent on the dental professional to present the evidence for and against treatment, allowing dental consumers to make an informed choice regarding their oral health. All case presentations must include an option for no treatment. And when patients ultimately choose this option, we will just need to be OK with it. Before this point, however, it is our professional responsibility to present all treatment considerations and effectively enable patients to make the right decision.

A closer look: Factors that influence treatment acceptance

Before we discuss the “no treatment” option, we must remember the other factors influencing treatment acceptance: values, communication, standards, and timing. In presenting proposed treatment, dental hygienists must first answer the following questions:

  • What is our practice’s standard of care in this situation?
  • What is my personal value system in this case, and does this align with my patient’s value system?
  • What are the patient’s values for making health-care decisions? Is the patient driven by pain? Is the patient motivated to be prevention-oriented?
  • Is my communication style received well by the patient?
  • Is there anything I need to know about this patient’s communication style for which I need to adapt in order to effectively reach him or her?
  • Is there anything in this patient’s life right now that is influencing his or her decision to accept proposed treatment?

These questions so often influence a patient’s decision-making process that we must address them. Not doing so can lead to frustration when we cannot understand why a patient declines a treatment. Getting the answers to these questions throughout the appointment will also shape how we present, so let’s break down these questions a bit more.

Values and decision-making

Values influence every aspect of decision-making. Many times, what the dental professional values and what a patient values are diametrically opposed. Dental professionals believe in preventing pain, whereas patients often do not act until there is pain. In these cases, getting to treatment acceptance means helping the patient see that untreated conditions can result in greater pain. It sounds like a simple concept to us. But patients don’t always see it that way.

In these cases, the dental hygienist may need to state how pain can manifest when decay enters the nerve chamber, or when an abscess starts forming on the root, or when a tooth cracks off. Patients may need to be reminded that dental emergencies can happen at the most inopportune times, and that these conditions are better treated in a controlled situation rather than waiting for an emergency.”

Read the rest of this helpful article over at DentistryIQ for more helpful tips in dealing with patients in difficult treatment situations.


Holli Perez 

DirectDental- How it works for Dental Professionals
DirectDental- How it works for Dental Offices
DirectDental Home Page