Explaining the Pros and Cons of Indirect Materials to Patients

You know the pros and cons of the materials inside and out, but your patients don’t. So here are some tips for communicating the pros and cons of indirect materials to help patients understand and accept your treatment plan.

You might think, “Most of my patients don’t care what I use, so why even have this conversation?” This question is fair, and the answer is simple: don’t have it. You should count yourself lucky that you have built enough trust with your patients that this conversation isn’t necessary.

For all the other clinicians that do not have patients who do whatever you say because you said so, here are some tips for communicating the pros and cons of indirect materials to patients:

Recognize that taking time for patient education is essential.

 It’s easy to dismiss this part of the restorative process; after all, clinicians have a lot of demands on their time. Who has the time to educate patients on the materials you will use in the mouth? However, research indicates that having patient education conversations improves patient health outcomes by building patient self-efficacy, which describes the patient’s belief that they can affect success in something by their behavior. It also improves patients’ health literacy, which is the patients’ ability to get the proper care they need, understand why it is necessary, and act on the healthcare advice their clinicians offer. No matter how scarce your time is, understand that the time you invest in patient education, the better your patient outcomes.¹

Assert your opinion. 

Patients want you to choose the right material for the right treatment. Most of them probably don’t know there are different options for their crown unless they know someone with a gold tooth. Despite this, telling patients what you are doing and why is never wrong. Instead, it builds trust and strengthens your relationship, making it easier for them to believe you have their best interest at heart and that your treatment plan is best for them.

Bear in mind that cost is almost always a factor. 

The restoration cost is an immediate and critical concern for most of your patients making it essential to explain why the treatment is necessary now, what it can mean to their long-term health, and the resulting invoice if patients ignore the situation. It may be pertinent to have a patient financing program that offers more fiscal flexibility.

Go for the gold, but have a fallback position. 

It never hurts to ask patients if they want gold for their finished restoration. Gold is an excellent indirect restorative material for inlays, onlays, crowns, and fixed bridge, by providing a good seal against leakage, while the high corrosion resistance prevents tarnishing. Gold has high strength and toughness and requires removing less healthy tooth structures for the prep. Importantly, patients tolerate gold well.² Still, gold is expensive (see #3, above), so having a fallback position of ceramic, metal-ceramic, or base metal alloys is a good strategy also.

Remember that pre-surgical education results in better outcomes. 

Setting the proper patient post-surgical expectations is crucial to the patient’s perceptions of the outcome. A 2015 Gallup poll suggests that patients whose clinicians developed appropriate post-surgery expectations had higher satisfaction with their procedures (72%) and fewer problems post-operatively (8%) than patients whose clinicians did not (39%, 27%, respectively).³ Taking the time to explain what patients can expect after the indirect restorative treatment can lead to a smoother post-procedural experience for everyone involved.

Prepare your laypeople’s terms. 

A 2020 study found a correlation between higher patient satisfaction in congestive heart failure patients when they received detailed discharge instructions that made it clear when they needed to return to the hospital.⁴ It is not unreasonable to assume that having the equivalent for post-operative or post restorative instructions could have the same effect for your patients. An essential component is patients understanding what you mean when you are explaining something. Healthcare professionals have a level of knowledge and expertise that exceeds most patients’ so you must avoid clinical explanations and feature laypeople’s terms to communicate effectively.

Consider professional interpreters for some patients. 

Just under 26 million people in the U.S. have limited English proficiency (LEP). LEP patients might not be able to understand even your laypeople’s terms for the care and materials you recommend, the patient expectations you want to set, and your proposed treatment plan.⁵ Research suggests that using professional interpreters reduces disparities in care for LEP individuals and improves their clinical outcomes.⁶ Finding an interpreter service could be an excellent way to facilitate improved communication and patient outcomes with these patient populations. Plus, regulations from Section 1557 of the Affordable Care Act and the Americans with Disabilities Act might require it, and the ADA has helpful tips on facilitating this in your dental practice.⁷

Consider making a web page about it. 

Your website is an excellent tool for patient education, particularly in today’s digital age. Creating a material-specific landing page that details the pros and cons of each indirect material available for restorations can help communicate the details to patients. You can showcase images of each material in a finished restoration so patients can see the differences. For example, show patients a finished #30 crown in all-ceramic, metal-ceramic, cast-gold, and base metal alloys for side-by-side visual comparison. If you have an interested patient—or one that did a bunch of Googling before getting in the chair—you can refer them to the website for more details.

Don’t forget the power of multi-modality. 

Combining mediums for patients is an excellent way to ensure the patient understands your treatment plan and materials choices. You will likely discuss this with your patients while in the operatory. If you have an image of the tooth that you can display on a screen for the patient to see, it will help solidify your words. Videos, graphics, or before/after photos of other patients can help patients too, and even a pad and paper can assist. Stick figures can communicate complex ideas, too.⁸

Confirm effective communication. 

We have all been there; someone who is an expert has explained a complicated topic to us as simply as they could, but we still don’t get it. It happens in your chair, too. Patients might nod and say they understand, but that might only be partially true, or worse, not at all. One way to improve communication is to have patients explain back to you what you said using their own words. That will allow you to correct any miscommunications and steer them toward genuine understanding. In cases where the patient is too young or unable to do this, engage with the caregiver and have them repeat it back. The second memory will be helpful and can help patients feel supported, which can be helpful at decision-time.⁹

Reference

1. Paterick TE, Patel N, Tajik AJ, Chandrasekaran K. Improving health outcomes through patient education and patient partnerships. Proc (Bayl Univ Med Cent). 2017;30(1):112-113. doi:10.1080/08998280.2017.11929552

2. Direct and indirect restorative materials. The Journal of the American Dental Association. 2003;134(4):463-472. doi:10.14219/jada.archive.2003.0196

3. The Benefits of Pre-Surgery Education. Gallup.com. 2015. Accessed July 7, 2022. https://news.gallup.com/businessjournal/183317/benefits-pre-surgery-education.aspx

4. Anderson PM, Krallman R, Montgomery D, Kline-Rogers E, Bumpus SM. The Relationship Between Patient Satisfaction With Hospitalization and Outcomes Up to 6 Months Post-Discharge in Cardiac Patients. J Patient Exp. 2020;7(6):1685-1692. doi:10.1177/2374373520948389

5. Asmussen N. Barriers to Dental Care: Race, Language, Income, Geography. Dentaly.org. 2022. Accessed July 7, 2022. https://www.dentaly.org/us/access-to-dental-care-racial-minorities/

6. Tang, A.S., Kruger, J.F., Quan, J., & Fernandez, A. (2014). From Admission to Discharge: Patterns of Interpreter Use among Resident Physicians Caring for Hospitalized Patients with Limited English Proficiency. Journal of Health Care for the Poor and Underserved 25(4), 1784-1798. doi:10.1353/hpu.2014.0160

7. Using an Interpreter in Your Dental Office. Ada.org. Accessed July 7, 2022. https://www.ada.org/resources/practice/practice-management/using-an-interpreter-in-your-dental-office

8. Liebel A. 10 ways to communicate a complex idea in patient education. 2018. Accessed July 7, 2022. healthcommunicationpartners.com. https://healthcommunicationpartners.com/ten-ways-complex-idea-patient-education/

9. Schelkun, MPH R. Jumo Health: Health Education Resources for Children and Families. Jumohealth.com. 2022. Accessed July 7, 2022. https://www.jumohealth.com/news/patient-education