Inside Dentistry
June 2020
Volume 16, Issue 6

Conquering Barriers to Treatment Acceptance in Complex Cases

Enable patients while giving them control in their decision-making

Thomas Bilski, DDS

When patients come into the office for treatment, they may know that their oral health is less than optimal. Or, they may be in the office because they want to increase the beauty of their smiles based on their perceptions of what they see around them. Regardless, clinicians create treatment plans that will bring their patients to optimal oral health and dental wellness. In contrast with nondiscretionary services such as emergency care, most dental procedures are discretionary, so patients do not have to accept treatment plans. There are various reasons why patients reject treatment plans, especially in high-end or complex cases. In order to provide patients with the best treatment possible, dentists should understand how to overcome common barriers to treatment acceptance. When treatment options are presented using a permission-based philosophy with a high level of integrity, the door to achieving greater treatment acceptance swings wide open.

Missed Opportunities

One barrier to effective case presentation is overlooking potential treatment opportunities. Before going into the operatory to talk with a patient, check in with the hygienist who just spent time with him or her to find out if there is anything specific that the patient is concerned about. Choreographing case presentation with hygiene appointments is critical. In addition, before going into an appointment, clinicians should fully review each patient's chart so that they can address any previously diagnosed issues for which the patient has not yet completed treatment. Ideally, dentists should direct patients to complete treatment for all previously diagnosed issues before moving on to treatment for new ones.

Patient Fear

Coming into a practice for an appointment, especially for the first time, can make patients apprehensive. Scared patients are less likely to accept nonvital treatment because they are uncomfortable. In these cases, and many other cases, a treatment coordinator can be a huge help to clinicians in the treatment acceptance process. In Contact: The First 4 Minutes, Leonard Zunin, MD, posits that people decide if they are interested in someone during the first 4 minutes of an encounter. He suggests that, oftentimes, failures in communication can be traced to the first 4 minutes of a conversation. To leave patients with a positive impression, the treatment coordinator should meet them within the first 4 minutes of their arrival at the practice, walk them into a consultation room (ie, a nonclinical setting), make them feel comfortable, and ask them a series of basic questions. Asking patients questions, such as those about insurance information, the reason for their appointment, and how they feel about their dental wellness, is important to develop a relationship, which helps them relax, let go of their fear, and have a more comfortable initial experience. Once the treatment coordinator has finished the initial interview, he or she should deliver the information to the doctor. This information transfer will help the doctor present a more patient-centered treatment plan and increase the likelihood of patient acceptance.

Patient Education

During case presentations, it is important that patients fully understand every step of the proposed treatments. Clinicians will have lower rates of acceptance if they or their treatment coordinators try to explain treatment using advanced clinical terminology. It is very important to use words that patients will understand and deliver them with clarity.

In addition to thoroughly explaining the treatment plan in understandable terms, providing images can serve as an excellent adjunct to help patients better understand the treatment being presented and increase acceptance. Allowing patients to see what their end result could be shows them a solution to their current problems. Clinicians should not begin to attempt to persuade patients to move forward with treatment until they have been fully educated. If patients are overwhelmed by complex concepts that aren't fully explained to them, then they may reject treatment. Once they understand the process, the outcome, and what, if anything, can be guaranteed, then they will feel more in control of their decision and will be more likely to accept.

Socioeconomic Status

Another barrier to treatment acceptance is socioeconomic status; money is the number one reason why patients delay treatment. Complex cases can include considerable use of diagnostics and technology. The incorporation of modalities such as cone-beam computed tomography (CBCT) and restorative diagnostic software have made the process of developing treatment plans for complex cases more accurate and less time-consuming; however, they have also made it more expensive.

Many insurance-based patients will see a large potential treatment bill and simply say they cannot afford it. It is the job of the dentist or treatment coordinator is to show the patient that annually phased treatment is an option. Phased dentistry, or sequenced care, is an approach that provides a road map for the completion of treatment over a time frame of several years, which increases affordability and acceptance.

Another option to help patients afford treatment is third-party financing. Companies such as Lending USA and CareCredit can provide excellent alternatives to other means of obtaining funds for treatment. Helping patients understand the concept that maintaining their oral health is valuable because it improves their overall health and then helping them take control of the decision by providing financing options increases the likelihood of treatment acceptance and completion.


Treatment acceptance is the backbone of all dental practices. When practices excel in case presentation, they achieve higher rates of acceptance. You should never offer an alternative treatment plan until you are certain that the optimum treatment plan will not be accepted. Patients want treatment to be explained with clarity and feel that they are in control of the decision to accept. It is the dentist's job to provide this experience and guide them to optimal oral health.

About the Author

Thomas Bilski, DDS, is a cosmetic dentist and implantologist who practices in Independence, Ohio.

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