Why it's good to tell patients "most dentistry is elective"

Dr Michael Sernik, July 2011  

The Problem

Here’s what most skilled dentists do. They bond well with the patient and develop rapport. They spend a lot of time in the exam explaining the treatment that they recommend. They get the patient back for an extra consultation and have prepared a beautiful treatment plan. The net result: if the patient is not really interested, the patient is too embarrassed to give an honest ‘NO’ because the dentist has spent all this time with them. The dentist has made saying ‘no’ too difficult. So instead we get polite evasion. This is when the patient says they are very interested and then uses a range of tactics to defer treatment indefinitely: (I need to think, I need to talk to my wife, I need to check finances etc) the problem is that there is no way to distinguish between real obstacles and polite evasion. We think all the obstacles are real.

Sometimes the patient, who seemed quite happy at the appointment, goes home and thinks it all over. They feel bad that some psychological pressure was put on them. They don’t want the treatment. They did not feel comfortable saying so and the net result is that this negativity gets transferred back onto the dentist. The patient starts to tell others how they went to a slick dentist who tried to rip them off. Then when they go to get a second opinion, they relay this story to the new dentist who naturally tries to prove that he is not like the first dentist. He underdiagnoses and the patient now has more fodder for the tale.

The Solution

In the patient’s mind, the only essential treatment is treatment that gets rid of pain. In the dentist’s mind most of what we do is essential. This might seem like semantics, but this difference forms the root of many problems.

The most common complaints that patients make about dentists is that dentists do treatment that is not necessary.

To try and convince someone that something 'is necessary’ is philosophically impossible. Are teeth necessary? Millions of people have no teeth and have no dentures. Are legs necessary? Kurt Fearnley has no legs, yet he trekked one of the worlds hardest treks: the Kokoda Trek without legs. When we simply come out and tell patients that most of what we do is elective, not essential, something interesting happens. The ownership of the dental condition falls into the patient’s lap and we totally avoid a cascade of problems.

We would never go to a shoe store and simply say to the salesperson ‘choose my footwear.’ The range from slippers to flip-flops to hiking boots is too broad. So we can say to our patients that “there are so many choices of treatment that it can be difficult for the dentist to simply prescribe a solution. The same condition can have a range of solutions that can spread from spending nothing to spending tens of thousands.

For some people the best option is the lowest cost. For others the best option is many thousands of dollars. It's all elective. If I were to prescribe the technical and cosmetic best, then it will usually cost many thousands and then the patient might incorrectly think I am saying they need to spend thousands. So what I can do is explain the problem, explain the choices and support the patient with whatever they choose.”

What does this achieve?

The patient will never say that I tried to talk them into unnecessary treatment.

I will never be slandered at dinner parties and lumped in with dentists who tried to sell unnecessary treatment. I won’t appear on a social network as a ripoff dentist to avoid.


We create polite evasion by inadvertently making it too difficult for the patient to give us an honest 'no'.

We are obliged to make recommendations for essential treatment. (Pain relief and life threatening conditions).

When we try and recommend treatment for conditions that the patient views as elective, we run the risk of appearing to be selling something. Patients are hypersensitive to dentists trying to sell unnecessary treatment. We defuse the whole problem when we make it clear that most of what we do is elective.

Footnote: If you have created appropriate concern regarding the outcome of their dental condition, you will find that the patient now wants a solution badly. The more you tell them the treatment is elective, the more they will insist that they really want it!

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