Oral Health Group

“The High-Risk Patient”

November 9, 2017
by Dr. Mark H. E. Lin, BSc, DDS, MSc (Prostho), FRCD(C)

It’s Monday morning, time to review your patients for the day with the rest of your team. As you go through your schedule everything seems uneventful until you recognize the name of the 3 p.m. patient. It’s Mr./Mrs. PITA. This patient comes in frequently with an ever-evolving complaint that is difficult to fully satisfy. Even if the patient is visiting your practice for the first time; your receptionist will often pick up on the red flags over the phone and warn you that they may be difficult to deal with.

After reviewing the patients records you are reminded of the history of challenges associated with fulfilling their expectations and making them happy. Can you relate?


Ultimately as professionals, we want our patients to feel fully informed, and well served. Regrettably with Mr./Mrs. PITA that won’t be easy, or in some cases impossible to achieve. Will they complain about their completed treatment they originally were satisfied with, or will they look for self-perpetuating reasons to be unsatisfied. In many cases, these patients arrive with a preceding chip on their shoulder, unconsciously seeking attention.

It is well documented in scientific studies that there are few common risk factors that will shorten one’s lifespan as well as significantly decrease their overall health and well-being. Common risks factors are diet and nutrition, lack of exercise, excessive alcohol consumption, smoking and of course the most common, STRESS!

This means that the clinical choices we make by accepting or choosing to treat “The High-Risk Patient” can have a significant negative impact on our long-term health, and our overall quality of life.

Take the time to look for these signs early on in your interaction. When you take the time to recognize these difficult patients early on you will be more effective at managing their perceptions while avoiding the initiation of any treatment that will likely become an exhaustive, and costly.

One warning sign that treating this patient will be high-risk is when your new patient has had multiple complaints or has recently seen many other dentists within a short period of time for their clinical situation. Some of these patients may even disclose that they have filed a college complaint against one or more previous dentists.

In these cases, we must put aside any expert ego or professional pride to face the blinding reality that initiating treatment on a chronically dissatisfied patient may not be practical because it will put your sanity as well as your health and license at risk. Therefore, take the time to carefully interview and listen to the patients’ past dental experiences and history of present illness.

According to the Glossary of Prosthodontic Terms, 9th edition, the definition of dental prosthesis is “an artificial replacement of part of the human anatomy restoring form, function and aesthetics”. As such, the artificial alloplastic biomaterials used in dentistry are inferior when compared to the natural dentition. As dentists we must constantly remind ourselves as well as our patients that the natural parts that they were genetically born with did not last in their mouth under their care or lack of maintenance. We are dentists doing the best we can using alloplastic biomaterials to replicate the genetically evolved natural dentition and the masticatory system. All patients should share the risks and develop more realistic expectations about the final clinical outcomes.

Take the time to get to know your new patients with in-depth interview, learn to trust your gut instincts if something doesn’t feel right, use a team approach with referrals to specialists to support the higher clinical challenge and, don’t be afraid to turn away or dismiss patients from your practice when required. In these cases, proper dismissal procedural steps are required to avoid professional abandonment violations. Confirm these rules and regulations with your provincial regulatory body.

In conclusion, it is inevitable that sooner or later we will be seated across from a patient that is difficult to manage. As clinicians, we have the right to refuse these types of patients. Taking the time to properly vet and screen these patients while following the regulatory rules for patient dismissal can significantly decrease the stress in your personal and professional life. Before you accept the patient into your practice, confirm that they have passed the test. As the treating dentist, you should make clear that in order for your dental treatment to succeed, communication, consent and compliance from your patient must be rendered, and all risks discussed before accepting them into your practice. Sometimes not moving forward with these “High-Risk Patient” is best for all involved! OH

Dr. Mark H. E. Lin, BSc, DDS, MSc (Prostho), FRCD(C), graduated from the University of Detroit Mercy for his dental program. He then completed a one-year General Practice Residency program at the Miami Valley Hospital in Dayton, Ohio. He practiced general dentistry for 13 years and then returned to complete his post-graduate training in the specialty of prosthodontics at the University of Toronto. He maintains a full-time specialty practice as a prosthodontist at Dr. Mark Lin Prosthodontic Centre.