Dentists are being advised to discuss the risks of orthodontic treatment with their patients and to try to manage their expectations.
The Dental Defence Union (DDU) is advising dental practitioners that as well as discussing possible side-effects and complications, it is important to take into account patient expectations of what will be achieved when providing orthodontic treatment. 
In an article in the latest edition of the DDU Journal, Dr Tony Ireland, NHS consultant, professor of orthodontics and a member of the DDU’s Dental Advisory Committee, explains that patients should be warned about the likely success of the initial treatment, particularly when using clear aligning appliances.
Dr Ireland said: ‘Dentists do habitually warn orthodontic patients about common side-effects such as toothache, soft tissue trauma, root resorption and alveolar bone loss. They also explain how patients can avoid risks of decalcification, gingivitis and periodontitis through good oral hygiene and avoiding sugary or acidic food and drink.
‘However, it is also important to take into account patient expectations, not only of the anticipated outcome but what level of compliance is expected from them if a satisfactory result is to be achieved.
‘Patients will naturally expect the teeth to move to their predicted positions, but this is not always the case. When using clear aligners, a further course of treatment with a fixed appliance might be necessary and patients should be warned about this in advance of the treatment as part of the consent process. Patients should also be given an idea of the anticipated overall treatment time and provided with written information about all of the associated risks of treatment. Dentists should keep accurate notes of these discussions in the patient’s record.'
In a case example accompanying the article, a man in his twenties with protruding incisors complained after not achieving the desired result with a removable aligner. The patient asked for a refund saying he felt the treatment was a failure. He complained that the dentist had said the treatment would be unobtrusive but that the effect on his speech had made him a ‘laughing stock’ at work and he could only wear the aligner overnight.
With the help of the DDU, the dentist responded to the patient by explaining that the treatment couldn’t work unless he wore the appliance for the required amount of time each day. The dentist thought the speech problems could be overcome but given that he may not have given the patient sufficient warning about the difficulties he might encounter, he offered to refund the cost of the first aligner as a gesture of goodwill, which resolved the complaint.
1. ‘Orthodontic risks’, Dr Tony Ireland, DDU Journal, September 2012 www.the-ddu.com