Managing unrealistic expectations – Linda Greenwall

Aesthetic Dentistry Today editor-in-chief, Dr Linda Greenwall BEM, examines one of the perils of aesthetic dentistry: how to manage unrealistic patient expectations

Undertaking aesthetic dentistry is, in many cases, an elective treatment. Therefore it is essential that the aesthetic dentist communicates well with the patient, to understand exactly what it is that patient is requesting and whether or not is possible to meet their expectations.

Communication between dentist and patient needs to be clear. There should be an open dialogue between both parties to understand the patient’s needs clearly. The dentist and members of the dental team can explain through the use of photography, digital smile design, wax-ups, mock-ups, and composite trials, how the teeth will look before undertaking the elective treatment. This way the patient has a clear understanding of what they can expect to receive when treatment is complete.

Patients need to be informed of the risks and benefits of the treatment, the disadvantages and advantages, and to understand what is and is not possible. It is important to note whether the patient has realistic or unrealistic expectations so they are not disappointed with the outcome. When it is not possible to meet the patient’s needs, it is important to explain that.

Sometimes it is best not to undertake any treatment than to treat a patient with unrealistic expectations who will never be happy with the outcome. Perhaps the reasons are not the dentistry, but external problems in the patient’s life.

Spotting patients with unrealistic expectations

Patients with unrealistic expectations can crop up frequently, due to the nature of aesthetic dental treatment, and sometimes there are warning signs. One warning sign is a patient who requests teeth whitening to the whitest shade on the bleaching shade guide, or beyond the normal and natural shade of white teeth.

There exist unrealistic shades of super-white bleach such as ‘Tippex white’, ‘toilet bowl white’ , ‘Chiclet white’ and ‘paper white’ – all of which are unnatural.

Another sign is the patient that travels from dentist to dentist trying to get one to agree to treatment that is not possible, or to flatter the dentist to say that they know that they will be the one that can solve the problem.

This is part of a syndrome that has been documented in literature, particularly when related to bleaching. Termed ‘bleachorexia’ or ‘bleachoholic’, the patient moves from dentist to dentist seeking whiter and whiter teeth.

We assess the shade from the whites of the eye (the sclera) to match the whites of the teeth during whitening treatments, and we know we reach the bleaching endpoint once the whites of the eyes match the shade of the teeth. When bleaching goes beyond this shade, the result may not look natural.

We can spot these ‘bleachorexic’ patients  because they arrive in the office with six sets of bleaching trays and their teeth are much whiter than the sclera of their eyes. It is important that the dentist is clear about what will and will not happen when it comes to whitening the teeth to the level of whiteness that is requested.

What happens when things go wrong?

It is best not to start treatment on this cohort, but if the dentist agrees to go ahead it is important that clear written information and further terms and conditions are listed as part of the documentation, and that careful and detailed notes are recorded.

It is essential to undertake risk management with the assistance of a defence organisation for advice to avoid getting into problems, and to make sure that the patient clearly understands the financial commitment and the realistic outcome of what will be undertaken.

Avoiding the pitfalls

Don’t forget that there are new guidelines that started in January for CPD, and reflection on learning is essential as part of the learning cycle to ‘plan, do, reflect, record’. For further information visit the GDC website.

Each dentist requires a personal development plan and the need to increase the number of verifiable hours across the five-year cycle. Further guidance is the requirement to make an annual statement of CPD hours completed, even if zero hours have been completed for that year; the requirement to align CPD activity with specific development outcomes; and the requirement for professionals to plan CPD activity according to their individual ‘field(s) of practice’, which for dentists who undertake restorative and aesthetic dentistry, is more CPD training.

Linda Greenwall BEM



This article was originally published in the February 2018 issue of Aesthetic Dentistry Today. Read more articles like this in Aesthetic Dentistry Today and gain three hours’ verifiable CPD with every issue. Click here to subscribe or call 01923 851 777. Get in touch via Twitter @AesDenToday or

Linda Greenwall

Linda Greenwall

Author at Aesthetic Dentistry Today

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