Unrealistic expectations

A young woman pleaded with her dentist to do something about her discoloured teeth.

The dentist gave oral hygiene advice, including suggesting that she stop smoking and avoid drinks that cause discolouration. The patient was impatient to start bleaching treatment so the dentist agreed to bleach her teeth, but cautioned her against expecting an instant 'Hollywood smile'. 

The treatment proceeded uneventfully. However, three weeks later, the patient returned complaining her teeth did not look any whiter. When questioned, she admitted that she was still smoking and hadn't given up her considerable coffee habit. She requested another course of bleaching but the dentist explained that unless she followed his advice the procedure would not produce a sustained improvement.

The patient agreed to think about what he had said, but later complained and demanded a refund.

How we helped


With our help, the dentist responded to the complaint by explaining that the advice and treatment provided had been appropriate and satisfactory. He declined the demand for a refund. Nothing further was heard from the patient.

Learning points


While dentists need to consider the clinical risks of treatment compared to the potential benefits, with purely aesthetic treatments, patients may have their own view on whether the result has met their expectations. Therefore, it is particularly important for dental professionals to discuss with patients what they hope to achieve and the various factors that may affect the end result.

We suggest that you do the following:

  • Discuss all the possible treatment options with your patient before beginning a procedure, including the option of no treatment. It is important the patient understands what is going to happen and the potential risks, side effects and complications, such as any possible pain or discomfort. Give them the opportunity to ask questions about what is involved with treatment and check they have a realistic idea of what can be achieved. 
  • Allow the patient a cooling-off period and consider providing some information for him or her to take away and read.
  • Keep a careful record of all discussions with the patient.
  • Advise the patient of the steps they need to take to improve their dental health. Explain the prognosis if they fail to comply with the advice and check that they have understood your advice.
  • Consider whether it is in the patient's best interest to continue with the treatment or whether you should suggest a different option if you believe they are unable or unwilling to co-operate with your advice, or have unrealistic expectations which will be impossible to achieve.
  • Be prepared to refer the patient for a second opinion or to take advice from a senior colleague.

Our Advice

Tooth bleaching is included in the DDU subscription for dentists.

We are also pleased to be able to provide dentists with indemnity for botulinum toxin and non-permanent resorbable dermal fillers* performed to the lips or the face but excluding the neck or any other part of the body.

Dentists wishing to do such procedures must be suitably trained. We do not insist that you register with CHKS/IHAS or hold an IHAS Quality Mark.

You should exercise caution when considering a patient's suitability for a cosmetic procedure, as this case illustrates.

*only products approved by the United States Food and Drug Administration (FDA) in the United States of America.

This guidance was correct at publication . It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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