FORGOT Bonding Agent - how to tell patient

[SunflowerRae]

Tooth #31 DOF composite, no assistants. Etched, GI liner placed, flowable, composite, check margins, explorer detects need for repair at distal box seal - begin to repair, notice my applicator for use to apply my bonding agent is not wet with bonding agent - oh crap - did i forget to place bonding agent?? thinking thinking - yes, I forgot to place bonding agent - look at the time, not enough time to fix it before clinic ends for the day - proceed with repair and dismiss patient. Tell clinic instructor and note in chart, talked to several faculty and students to ask what to say to patient, called to inform patient but left a message no answer. I plan to replace it. I'm on the end of just be honest, but I also don't want to sound incompetent, WHAT WOULD YOU TELL THE PATIENT being that they don't understand dental materials, would you try to explain it and give them an option to leave it or redo?? I used bonding agent on the end of my condenser so that composite would not stick to my instrument so some of the margins are probably sealed. APPRECIATE YOUR THOUGHTS!

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[browncrack]

This restoration is leaking. I can redo this at no cost. You might even want to consider amalgam...

 

[armorshell]

What would you want if you were the patient? I'm guessing you'd want the dentist to own up to it and give you a functional restoration.

No one needs to understand dental materials to get that their "filling isn't glued in"

 

[cybermech]

"There seems to have been a problem with the filling material such that it will probably fail within the next few weeks to months... as it is a problem on my end, I will replace the filling at no charge with another white filling that should stay this time, or give you the option of an amalgam, which I believe is a more durable restoration compared to white fillings."

 

[tinman831]

Better that you redo the filling now for free rather than pay for a root canal that might be needed because of the recurrent decay and possible pulpal infection.

 

[armorshell]

Not sure why everyone's trying to hop over to the amalgam train. It's not like there was a failure of the material in this case, it was purely operator error (Though one that would have been avoided if amalgam were used in the first place).

 

[Oracle DMD]

Not sure why everyone's trying to hop over to the amalgam train. It's not like there was a failure of the material in this case, it was purely operator error (Though one that would have been avoided if amalgam were used in the first place).

 

[SeattleRDH]

"There seems to have been a problem with the filling material such that it will probably fail within the next few weeks to months... as it is a problem on my end, I will replace the filling at no charge with another white filling that should stay this time, or give you the option of an amalgam, which I believe is a more durable restoration compared to white fillings."

+1

Be honest. Everyone makes mistakes. Better to make them now while you're in school. If your patient gives you a hard time tell them you're still learning. If they still give you a hard time tell them they shouldn't be going to a school for dental work.

 

[SunflowerRae]

Any more thoughts are appreciated. Yes I am in dental school so that is kind of a fall-back, but I know stuff like this can happen in private practice so just wanted to know how you handle these dilemma's (ie. wordage). I know there are several ways to say things, and variety in your answers is what I was asking for everyones thoughts on.

 

[HupHolland]

+1

Be honest. Everyone makes mistakes. Better to make them now while you're in school. If your patient gives you a hard time tell them you're still learning. If they still give you a hard time tell them they shouldn't be going to a school for dental work.

+1 +1....

That's the line I use on all my patient's when they become impatient with the flow of treatment. If you want to be treated faster, go to private practice and easily pay >2x the amount.

Hup

 

[Streetwolf]

When patients hear the words "it will be free" they usually are understanding about anything else you said in that last sentence.

 

[SeattleRDH]

When patients hear the words "it will be free" they usually are understanding about anything else you said in that last sentence.

Yes and no. Some will say: "Why didn't you do it right the first time?"

Don't take it personally. Some patients can be mean and rude. Mostly they just hate going to the dentist if they don't need to. Just tell them it's better a re-do than a root canal.

 

[DrJeff]

Tooth #31 DOF composite, no assistants. Etched, GI liner placed, flowable, composite, check margins, explorer detects need for repair at distal box seal - begin to repair, notice my applicator for use to apply my bonding agent is not wet with bonding agent - oh crap - did i forget to place bonding agent?? thinking thinking - yes, I forgot to place bonding agent - look at the time, not enough time to fix it before clinic ends for the day - proceed with repair and dismiss patient.Tell clinic instructor and note in chart, talked to several faculty and students to ask what to say to patient, called to inform patient but left a message no answer. I plan to replace it. I'm on the end of just be honest, but I also don't want to sound incompetent, WHAT WOULD YOU TELL THE PATIENT being that they don't understand dental materials, would you try to explain it and give them an option to leave it or redo?? I used bonding agent on the end of my condenser so that composite would not stick to my instrument so some of the margins are probably sealed. APPRECIATE YOUR THOUGHTS!

Step #1, if something like this happens again (and I'm pretty sure that it never will after your experience) - tell the instructor 1st, then I'd bet that there would be time in clinic to fix the problem right then and there

Step #2 - gotta fix it, and soon. It will leak, since I think it's a pretty safe bet that while you may have gotten bonding agent via the condenser at/on the occlusal/facial margins, that you didn't on the gingival margin, and that's the problem spot. Just tell the patient, whatever you want 'I need to replace that filling I just did for free because .......(you don't like the contour/looks like there might be a void in the filling material/ or even I think I forgot to put the "glue" under the filling) 99% of the time, patients are fine with this, and while it may not be for the exact same reason/situation there will be multiple times in your career that honest errors will occur

 

[ChubbyBaby]

Tooth #31 DOF composite, no assistants. Etched, GI liner placed, flowable, composite, check margins, explorer detects need for repair at distal box seal - begin to repair, notice my applicator for use to apply my bonding agent is not wet with bonding agent - oh crap - did i forget to place bonding agent?? thinking thinking - yes, I forgot to place bonding agent - look at the time, not enough time to fix it before clinic ends for the day - proceed with repair and dismiss patient. Tell clinic instructor and note in chart, talked to several faculty and students to ask what to say to patient, called to inform patient but left a message no answer. I plan to replace it. I'm on the end of just be honest, but I also don't want to sound incompetent, WHAT WOULD YOU TELL THE PATIENT being that they don't understand dental materials, would you try to explain it and give them an option to leave it or redo?? I used bonding agent on the end of my condenser so that composite would not stick to my instrument so some of the margins are probably sealed. APPRECIATE YOUR THOUGHTS!

don't feel too bad. this has happened to me... TWICE!!

 

[1992Corolla]

What's bonding agent? I think the tooth needs to be extracted.

 

[dentalman]

When you screw up (and you did, and you will again.) Advice that I heard is to talk as if you were talking on a television station. Say it honestly, but word it well.

If you feel the need to call to reschedule, something like "After you left, I was discussing with my professor the restoration we just finished, and I came to realize I left out a simple but important step. We came to the conclusion that the best thing to do is to fix the filling now instead of waiting. Of course, there will be no charge for you. I apologize for the inconvenience." Then, when you are all done, give them a $10 gift card for the hassle of the extra trip.

Or, if you feel like it can wait until the next checkup. "There is a margin on the filling that is not up to my standards, and I need to fix it for you. We will fix it for you and there will no cost."

I wouldn't even go into the detail with the bond. You could, but who cares. The filling won't hold up, it needs to be fixed.

 

[dentalman]

Wow, I just saw the 5+ year member logo. Damn, I'm old now!

 

[Stomatolojka]

Bravo me likie!

"There seems to have been a problem with the filling material such that it will probably fail within the next few weeks to months... as it is a problem on my end, I will replace the filling at no charge with another white filling that should stay this time, or give you the option of an amalgam, which I believe is a more durable restoration compared to white fillings."

 

[ChubbyBaby]

.... give them a $10 gift card for the hassle of the extra trip.

You loco?

 

[SeattleRDH]

When you screw up (and you did, and you will again.) Advice that I heard is to talk as if you were talking on a television station. Say it honestly, but word it well.

If you feel the need to call to reschedule, something like "After you left, I was discussing with my professor the restoration we just finished, and I came to realize I left out a simple but important step. We came to the conclusion that the best thing to do is to fix the filling now instead of waiting. Of course, there will be no charge for you. I apologize for the inconvenience." Then, when you are all done, give them a $10 gift card for the hassle of the extra trip.

Or, if you feel like it can wait until the next checkup. "There is a margin on the filling that is not up to my standards, and I need to fix it for you. We will fix it for you and there will no cost."

I wouldn't even go into the detail with the bond. You could, but who cares. The filling won't hold up, it needs to be fixed.

Somebody's worked in customer service...

 

[teeth63a]

When something doesn't come out as planned I have three phrases:


1) "Mrs Unaware, despite my best efforts..."
"...I couldn't completely close the gap so you'll have to floss really well"
"...I couldn't get the root tip out since it's locked in so deep and I don't want to do more harm than good by digging it out, so I've decided to leave it there"
"...the instrument created a small hole in the sinus, but I'm doing everything I can to close it up so it'll heal nicely"
"...I tried to avoid the nerve, but the cavity is so deep, the tooth needs a root canal procedure"

2) "Mrs Unaware, I got good news! And even better news! The good news is that I took out the cavity and put a brand new filling in there. The better news is that I think I can make this filling even better. I know it's a humbug, but I'd like to redo this filling at another appointment."

answers:
"Ok, Dr Hack, whatever you say"
"Why Dr Hack, what's wrong?"

responses:
"Well, I don't think it'll bond just right"
"Well, it looks like the band moved and now there's a slight gap between the teeth"
"Well, under this light it looks like the shade is different"

3) I use this one for crowns mostly: "Mrs Unaware, I'm a perfectionist, and I want you to have the best possible crown. Unfortunately I don't think that this is it...there's a problem with the margin/bite/whatever. I know it's a humbug, but I'd like to redo this again at no cost to you."


Moral of the story, don't put the blame on yourself OR the patient. And in some cases the blame is obvious on one or the other. In other words, it's like golf...it's never the swing, its the club's fault. Crappy swings are always the fault of a crappy clubs. Blame the material, the band, the light, the lab.

Phrase is in such a way that you're the hero and you're looking out for the patient (as you should be) no matter whose fault it is. Sweeten the deal with a gift (like a gift card) as someone mentioned.

Come off positive and upbeat. If you say "oh oh", "oh ****", or have the grim reaper look on your face, and shaking your head slowly, the patient KNOWS SOMETHING went wrong.

NEVER use the word FREE. Say "at no additional cost to you".

They know you're a human being. They may not expect perfection, but they deserve to know if the work is not up to par.



I'm realizing that I should go into patient management consulting. Maybe I'll write a book LOL.




EDIT: as DrJeff said the weak point will be at the margins. While etched but unbonded tooth will have some degree of adhesion, fluid will eventually leak, causing thermal sensitivity. If for whatever reason you couldn't communicate with the patient, and the patient shows up 2 weeks later and says it still hurts, you're off the hook with an explanation, just redo it.

EDIT: The most humbling thing for a patient to say is "Dr, I'm sorry to keep bothering you, but this tooth that you worked on still hurts" (whether or not its the operator's fault). They hold you in such a high regard, they think they're bothering YOU! I always tell patients "no problem, I'm here for you and I want you to be happy, so let me take a look at it".

 

[goosestuff]

However you explain it, make it short and sweet.

 

[GoGatorsDMD]

Be honest and make it right. It gets just a little worse, you could be in surgery and tell someone "sorry we have to open your abdomen back up because we left a sponge".

 

[dentalman]

You loco?

Not as loco as someone who is sophisticated and furry.
Obviously, this is not necessary, it is just something nice that is not expected. How would you feel if you had to make an extra trip to the dentist?

Recommended reading: "Raving Fans" "positively outrageous service"

 

[KPK]

Instead of thinking so much over it, just call the patient again & redo it !!!
don't bang yourself too much over it!

 

[lemoncurry]

I would turn on the charm and make some humorous comments about how this is a dental school and how we're still just students and sometimes we miss a step or two, blah blah blah and replace it at no charge. Luckily (knock wood) i haven't had to replace a filling yet for that reason.

 

[BombayBDS]

"There seems to have been a problem with the filling material such that it will probably fail within the next few weeks to months... as it is a problem on my end, I will replace the filling at no charge with another white filling that should stay this time, or give you the option of an amalgam, which I believe is a more durable restoration compared to white fillings."

+2. thats what u shuld do.

 

[BombayBDS]

When something doesn't come out as planned I have three phrases:


1) "Mrs Unaware, despite my best efforts..."
"...I couldn't completely close the gap so you'll have to floss really well"
"...I couldn't get the root tip out since it's locked in so deep and I don't want to do more harm than good by digging it out, so I've decided to leave it there"
"...the instrument created a small hole in the sinus, but I'm doing everything I can to close it up so it'll heal nicely"
"...I tried to avoid the nerve, but the cavity is so deep, the tooth needs a root canal procedure"

2) "Mrs Unaware, I got good news! And even better news! The good news is that I took out the cavity and put a brand new filling in there. The better news is that I think I can make this filling even better. I know it's a humbug, but I'd like to redo this filling at another appointment."

answers:
"Ok, Dr Hack, whatever you say"
"Why Dr Hack, what's wrong?"

responses:
"Well, I don't think it'll bond just right"
"Well, it looks like the band moved and now there's a slight gap between the teeth"
"Well, under this light it looks like the shade is different"

3) I use this one for crowns mostly: "Mrs Unaware, I'm a perfectionist, and I want you to have the best possible crown. Unfortunately I don't think that this is it...there's a problem with the margin/bite/whatever. I know it's a humbug, but I'd like to redo this again at no cost to you."


Moral of the story, don't put the blame on yourself OR the patient. And in some cases the blame is obvious on one or the other. In other words, it's like golf...it's never the swing, its the club's fault. Crappy swings are always the fault of a crappy clubs. Blame the material, the band, the light, the lab.

Phrase is in such a way that you're the hero and you're looking out for the patient (as you should be) no matter whose fault it is. Sweeten the deal with a gift (like a gift card) as someone mentioned.

Come off positive and upbeat. If you say "oh oh", "oh ****", or have the grim reaper look on your face, and shaking your head slowly, the patient KNOWS SOMETHING went wrong.

NEVER use the word FREE. Say "at no additional cost to you".

They know you're a human being. They may not expect perfection, but they deserve to know if the work is not up to par.



I'm realizing that I should go into patient management consulting. Maybe I'll write a book LOL.




EDIT: as DrJeff said the weak point will be at the margins. While etched but unbonded tooth will have some degree of adhesion, fluid will eventually leak, causing thermal sensitivity. If for whatever reason you couldn't communicate with the patient, and the patient shows up 2 weeks later and says it still hurts, you're off the hook with an explanation, just redo it.

EDIT: The most humbling thing for a patient to say is "Dr, I'm sorry to keep bothering you, but this tooth that you worked on still hurts" (whether or not its the operator's fault). They hold you in such a high regard, they think they're bothering YOU! I always tell patients "no problem, I'm here for you and I want you to be happy, so let me take a look at it".

thats EXACTLY what people want to hear.
As long as it isn't used frequently, it'll work!!

 

[drgioiadds]

I think you really should have told the px before they left. If I am not completely satisfied with a restoration and am short on time, I always tell my px that I will get them back to do whatever (most often its fix a contact). I always reassure them that they should be fine until we get them back.