The importance of open conversations with implant candidates

05 December 2023 (Last updated: 5 Dec 2023 14:24)

There are a number of things which clinicians must consider when assessing implant candidates’ suitability. Conducting and recording a thorough clinical assessment, as well as having open conversations with each patient are key. Conversations should include discussing what the patient can expect from treatment, including any potential risks, and giving them time to ask any questions they may have. Additionally, clinicians must make accurate clinical records of each consultation, to protect themselves in the event that a patient complains about their treatment. 

 

Effective monitoring in implant consultations

During each implant consultation, there are a number of key factors which must be discussed and assessed to ensure that each patient is a good candidate for dental implants. For example, if the patient is a smoker, clinicians should explain that smoking can increase the risk of implant failure and provide cessation advice. Or, if clinical assessment reveals that the patient has active periodontitis, clinicians should recommend that this is treated and stabilised prior to considering dental implants to ensure the best chances of success.[i]

Additionally, there are a number of factors which must be assessed at each follow up appointment, to ensure there is an accurate record of the implant’s situation. Monitoring the patient’s satisfaction with their prosthesis at each appointment, regarding aesthetics, functionality, and cleanability can help to determine if changes are needed. Clinicians should also record any inflammation in the soft tissues surrounding the implant, the patient’s oral hygiene, bleeding on probing scores, the depth of any pockets, occlusion, mobility, contact points and emergence profile, and take radiographs annually for the first three years of function.[ii] Each of these allow clinicians to understand any potential issues, and advise the patient about future treatments or management techniques that may be required to maintain their oral health.[iii]

 

The value of nuanced discussions with patients

Dental implant treatment is unique in that, when compared to many other restorative options, it is expensive and elective. As such, dental implant patients are likely to have very high expectations. While this is to be anticipated, it’s important that this is managed, to ensure that the patient understands the limitations of the treatment, and to help avoid disappointment if their ‘perfect’ smile cannot be achieved in the way that they had hoped. Conversations surrounding what to expect should be completely personal to each patient, depending on their initial situation, and what they perceive to be a good outcome. In order for the patient to provide consent, they must be fully informed about the treatment, and what they can realistically expect to happen, in addition to any risks and complications.[iv]

This also enables them to ask any questions they may have as a result of these conversations, and it’s important to allow patients the time to do this. It can also be helpful to send patients a summary of their appointment and information about treatment options afterwards – keeping lines of communication open, should they have any additional queries, or if they would like more time to reflect on the information and consider their options. 

 

The importance of vigilant clinical records

All records of consultations must be contemporaneous, accurate, and complete[v] in order to be acceptable to the GDC. Traditionally, this has required either a dentist on their own, or with the assistance of their dental nurse, to write notes during the appointment. However, this process could leave room for information to be missed, which may become tricky should a patient make a complaint. Additionally, physically taking notes during each appointment may mean that clinicians are distracted, and unable to fully engage with their patients. 

Audio recording may be a helpful adjunct for many clinicians. This allows them to engage in nuanced conversations with their patients without the need to constantly take thorough notes at the same time.[vi] Some modern recording systems are even able to transcribe the audio, making it simple to see what was discussed. Additionally, this provides the opportunity for clinicians to listen back to previous appointments prior to seeing patients, to refresh their memory, and learn from their experiences. Most valuably, of course, is the benefit of a completely accurate and contemporaneous record of each appointment, exactly as it happened. This offers additional context too, enabling clinicians to hold a record of the tone of all conversations had, and get a sense of the patients’ feelings towards treatment options and plans. 

Members of the Association of Dental Implantology (ADI) benefit from a 20% discount on a Dental Audio Notes subscription. The software package for audio recordings is designed to support consultations by providing a comprehensive record of the appointment. Dental Audio Notes also manages storage, security, and privacy of data, for total peace of mind. As such, clinicians only need to press ‘record’ and begin their appointment, and Dental Audio Notes will take care of the rest in a secure and compliant manner. 

Keeping accurate records of all appointments, including dental implant consultations, is essential for providing patients with high standards of care. In order to be sufficient, records must be accurate and contemporaneous, making audio recordings a fantastic adjunct to written notes, supporting the clinician in the event that they need to refer back to a previous appointment. 

 

References

[i] Curtis, Donald A., and Steven J. Sadowsky. "How should we communicate implant treatment risk to a patient?." The Journal of the American Dental Association 150.6 (2019): 481-483.

[ii] Karifala Tarawali. Maintenance and monitoring of dental implants in general dental practice. Dental Update 2023 42:6, 707-709. https://www.dental-update.co.uk/content/restorative-dentistry/maintenance-and-monitoring-of-dental-implants-in-general-dental-practice/ 

[iii] Barrak, F., Caga, D. & Crean, S. What every dental practitioner should know about how to examine patients with dental implants. Br Dent J 234, 309–314 (2023). https://doi.org/10.1038/s41415-023-5574-6

[iv] ADI. A dentist’s guide to implantology. Accessed Dec 23. 

https://www.adi.org.uk/_userfiles/pages/files/a-dentists-guide-to-implantology.pdf 

[v] General Dental Council. Standards. Accessed Sec 23. https://standards.gdc-uk.org/pages/principle4/principle4.aspx 

[vi] Reddy, Sandeep, John Fox, and Maulik P. Purohit. "Artificial intelligence-enabled healthcare delivery." Journal of the Royal Society of Medicine 112.1 (2019): 22-28.

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