“Have a seat, we will take care of you.” an Introduction to Informed Consent in Dentistry

Rather than a reassuring moment, taking a seat on a dental chair can be stressful for some people. It can be associated with perceived or actual past bad experiences and people are not at their most receptive to important information. However, it is also the moment where your clinician explains, in layman terms, what they think may have happened, what is in fact happening, what may happen in the future, and what is necessary to solve or prevent problems…

A consultation is a meeting where both sides get to know each other (first impressions last) and exchange information. The patient wishes to explain their issues. The clinician needs to listen carefully and collect information – verbal, subliminal or implied, body language, and unspoken information as well as clinical, x-ray, photographic, and video information, all in the time allocated. Experienced clinicians know how to do this well.

LCIAD’s Approach to Clinical Data Protection

At LCIAD, we believe that the accurate collection of clinical data starts at the first point of contact and continues throughout the first consultation period. However, it is the time we spend on this information collection, how we document and collate it, and how we study it after the patient has left the practice that forms the basis of successful care and treatment at LCIAD.

Our ability to look holistically in your presence but just as importantly after you leave, ensures that no rock is left unturned, and decisions are made based on knowledge and collected facts rather than suppositions based on limited data. This brings consistent, reliable outcomes that our patients have benefited from over the years and continuously educates the clinical team and upskills everyone, every day, over time.

The Importance of Knowledge in Dental Care

The patient is then truly empowered to decide the best way forward for them with all the information available and can truly provide “informed consent” to any proposed treatment with a full report of the identified condition, its likely evolution, and what systematic steps can be taken to achieve and consistently maintain all aspects of oral and general health.

We have a unique way to standardize the language spoken between the clinical team and the patient and this paves the way to a well-structured plan of action. It is not a coincidence that our practice was chosen to provide the “ideal” new patient treatment planning journey for educational purposes for the largest education dental portal in the UK (Dentinal Tubules 8 Part New Patient Consultation and treatment planning series 2021)

We require knowledge for all other aspects of life: buying a house, the specs of a car, the kids’ school and university, the learning of a new skill, the machinery available at the gym and how to use it effectively and safely.
Knowledge is power and the knowledge used to decipher the information that you provide us and the clinical data that we collect as a standard for every single patient that we accept at LCIAD really does make a long-term difference to the outcome of your treatment and long-term care.

Understanding the importance of informed consent and the role of knowledge in dental care is crucial. At LCIAD, we are committed to empowering our patients through comprehensive information and communication…

Welcome to LCIAD.

Frequently Asked Questions (FAQ’s)

Q: Why is informed consent important in dentistry?

Informed consent is crucial in dentistry to ensure that patients are fully aware of their condition, treatment options, and the potential of taking action doing nothing.

Q: How does LCIAD collect and use clinical date?

The collection of Clinical Data at LCIAD begins at the first point of contact and continues throughout the consultation. This data is then meticulously studied to form the basis of effective care and treatment.

Q: What LCIAD’s approach to patient communication unique?

LCIAD has developed a standardised communication method that helps us when forming a detailed, structured and informative treatment plan.

Q: How does knowledge empower dental care?

Knowledge empowers patients by giving them the information they need to make informed decisions about their dental treatment.

by DR GUSTAVO SILVA General Dental Surgeon and Implant Surgeon LMD DDS MSc Gustavo has held surgical and restorative dental posts, most recently as Lead Dental Surgeon for the referral practices of two large dental corporate bodies over the last decade where he oversaw the specialist teams. He is known for his kind, humorous and gentle manner and we are delighted that he has joined LCIAD after 10 years of close friendship. More About Dr Gustavo Silva

The endeavour to capture high-quality dental images transcends mere artistic inclination. It serves as an indispensable instrument for diagnosis, treatment planning, and documentation, while also functioning as an educational tool for patients and an invaluable record in medico-legal circumstances.

The Technical Foundations of Dental Photography and the Importance of Selecting the Appropriate Equipment and Settings

Investing in a full-format digital SLR camera equipped with a 100 mm macro lens with 1:1 capability is not an extravagance but a necessity. The SLR camera allows manual control over aperture, ISO, and shutter speed, thereby providing the flexibility to capture highly detailed images.

The use of ring flashes or side flashes facilitates a uniform dispersion of light. The proper flash system can mitigate shadows and bring out subtle details in the images, which may prove significant in clinical assessment.

Proper calibration of these settings is pivotal for capturing images that are neither overexposed nor underexposed. A deeper understanding of this trilateral relationship can enable one to capture images with accurate colour reproduction and an optimal depth of field.

Mastering the techniques

Effective dental photography is also dependent on the ability to position the patient and assistant optimally. This facilitates not only the capture of images from the correct angle but also contributes to patient comfort.

The use of intraoral mirrors and retractors can aid in obtaining photographs from challenging perspectives. These tools are critical for capturing comprehensive images of posterior regions and occlusal surfaces.

Consistency in Dental Photography, Post-Production and Archiving: The Non-negotiable Requirements

Consistency in photographic technique ensures a reliable clinical record. It also lends credibility to your practice, substantiating your claims in both clinical and legal settings.

While Photoshop allows for a wide range of manipulations, it’s critical to adhere to ethical guidelines that prohibit the alteration of clinical facts. Photoshop should primarily be utilised for tasks such as colour correction, rotation, cropping, and brightness adjustment.

The Adobe Bridge software allows for the systematic archival of photographs. Features such as batch renaming, keyword tagging, and dating facilitate easy and indispensable retrieval and organization.

Branding your Practice and Engaging your Audience

A well-designed PowerPoint or Keynote presentation serves as an extension of your brand. Customized templates resonate with your practice’s philosophy and can make your case presentations stand out.

The utility of these presentations is not restricted to patient education. They can also serve as compelling tools for peer-to-peer knowledge sharing, be it in study clubs, seminars, or international conferences.

Conclusion: The Symbiotic Relationship between Dental Photography and Effective Patient Care

Mastering dental photography and presentation techniques serves to elevate the standard of patient care you can offer. These skills empower you to document clinical findings, plan treatments more effectively, and communicate these plans convincingly to both patients, your laboratory and peers.

For Those Looking to Deepen their Expertise

For professionals eager to deepen their understanding and hone their skills, LCIAD Academy’s upcoming Dental Photography and Presentation Course on 20-21 October 2023 tutored by me, Dr KORAY FERAN and my colleague Dr SHIRAZ KHAN, offers an intensive, hands-on training program that covers these topics in depth.

Frequently Asked Questions (FAQ’s)

Q: What is the significance of using a full-format digital SLR camera?

The full-format digital SLR allows for a larger sensor size, providing better low-light performance and an enhanced image detail.

Q: Is using Adobe Photoshop mandatory for dental photography?

The use of Adobe Photoshop is not mandatory in dental photography, but the versatility it offers in post-production can substantially elevate the quality of your images.

Q: How crucial is patient / clinician / assistant positioning?

Accurate positioning of all parties is critical or diagnostic accuracy and the validity of images when used in clinical records.

Q: What is the role of presentation in dental practice?

Presentations can serve multiple purposes, from educating patients and securing informed consent, to serving as a tool for professional developments and peer-to-peer learning.

Q: Is your upcoming course suitable for beginners in dental photography?

Yes, absolutely. The course is designed to offer value to clinicians at all levels of expertise in dental photography.

So, are you ready to take your dental photography and presentation skills to the next level? Your next opportunity is just around the corner with the upcoming course :

Dental Photography and Presentation Course on 20-21 October 2023

I hope to see you there.

by DR KORAY FERAN Clinical Director and Principal Dental Surgeon BDS MSc FDSRCS FCGDent FICD Koray qualified in 1989 from Guy’s Dental Hospital, winning the Final Year Prize for overall excellence and the S.J. Kaye Prize in Oral Medicine and Pathology. He remained at Guy’s for two separate House Surgeon appointments in Prosthetic Dentistry and Oral and Maxillofacial surgery until 1991 when he went into general practice in North London. About Dr Koray Feran

A colleague from dental school days, Dr Jane Lelean, who is now a respected practice coach assisting dental surgeon colleagues to improve the quality of service in their practices, recently posted this familiar parable to a dental Facebook site:

“PAY FOR EXPERTISE WHEN YOU NEED A JOB DONE

CLIENT – How much will it cost to do this job?
CONTRACTOR – £2,800

CLIENT – That’s too expensive for this job!
CONTRACTOR – How much you think it should cost?

CLIENT – £800 max! It’s a simple job!
CONTRACTOR – I can’t do the job for so little.

CLIENT – People in your line of work want to make a huge profit!
CONTRACTOR – I’m sorry you feel this way. Why don’t you do the job?

CLIENT – But, I don’t know how to do any of that.
CONTRACTOR – For £900, I can teach you everything you need to know to do the job. You can then use £800 to do the job, and you’re still saving £1,100. Also, you will obtain all the knowledge and the experience for the next time you need to do this job.

CLIENT – Deal!
CONTRACTOR – Great! To start, you need to buy tools. You will need a chipping hammer, a nail gun, a laser, a drill, a mixer machine, PPE, and some other things.

CLIENT – But, I don’t have any of those tools and I can’t buy all that for just one job!
CONTRACTOR – Ok. I can rent you my tools for another £300. You’re still saving £800.

CLIENT – That’s cutting my savings, but I will rent your tools.
CONTRACTOR – Perfect! I’ll be back Saturday and we can start.

CLIENT – Wait! I can’t Saturday. I only have time today.
CONTRACTOR – I’m sorry, I only teach others on Saturdays. I have to prioritize my time and my tools need to be in other jobs I have during the week.

CLIENT – Ok then. I will sacrifice my family’s plans on Saturday.
CONTRACTOR – Right, me too! Oh, I forgot. If you’re going to do the job yourself, you need to buy the materials. There’s a high demand nowadays, so your best bet is to get a truck and be at the hardware store by 6am before other contractors get there.

CLIENT – At 6.00in the morning?! On Saturday? That’s too early for me. I don’t even have a truck!
CONTRACTOR – I guess you’ll have to rent one. By the way, do you have some helpers to help you load the truck?

CLIENT – You know what? I’ve been thinking. Probably is better for you to do the job. It’s better to pay you to do the job right and not having to go through all that hassle.
CONTRACTOR – Good thinking. Sign here and let me get to work.

This is the truth. People are not just paying for a job, they are paying for knowledge, experience, tools, time, family sacrifices, and other things you bring to the table. Don’t let anybody dictate your worth, be confident in what you ask your clients to pay.”

This post on a dental Facebook site has garnered at the time of writing over 200 likes from members of our profession because it strikes a chord. My comment was “now who wants to put this on their practice website?”

My colleague Dr Jane Lelean’s response was “Koray Feran, I dare you”

I accepted.

On the face of it, it is a simplistic view of how humans in general tend to want their own efforts to be highly valued (“Surely I am due a pay rise”) but are less ready to place a high value on the efforts of others (“How much??!!”).

Why is this?

The obvious answer is that individuals are fully cognizant of all of the time, effort and cost invested in doing the job that is their responsibility but are less cognizant of the time effort and cost invested by others since they only see the product and not the process, or the thought and knowledge and personal cost behind it.

We are regarded as an expensive practice compared to most.

Yet we are very busy. I routinely work a full four-day clinical week booking over a month ahead which starts at 7:30 in the morning and usually ends well past 8 o’clock in the evening plus at least an additional 30 hours of administrative time on Fridays (which is meant to be my admin day) but also Saturdays and Sundays which also turn out to be admin days due to the volume of work at the practice.

But what am I doing during this additional 30 hours? Am I getting paid for it? If you had to work most Fridays, Saturdays and Sundays, would you do it for free?

The fact of the matter is that for those four days of clinical dental care to go seamlessly, there is an enormous amount of work that goes on in the background to ensure that the best care is organised. As a profession, we are expected to deliver a high level of care. But what does this really mean?

For most patients, it means that we carry out their dental work in a safe environment, painlessly, as quickly as possible and to the highest possible standard that stands the test of time. But how about the advice we give? Would you be willing to pay £5,000 for advice that saves you £50,000? Or spend £50,000 now to save you £100,000 over the next 10 years? Most people would. But very often our thought, knowledge and advice is not valued. Half of the population still do not visit a dental surgeon. Those that do still not attend for hygiene visits as often as advised despite the fact that it has been repeatedly and unequivocally proven that regular hygiene care in the long run saves substantially more time and money and biological cost than not attending.

It is simply human nature not to attach importance to something unless it is an immediate problem.

We photograph and study every patient’s case. We prescribe appropriate imaging, so we have all the information about a patient’s case. We spend hours diagnosing the issues that patients are not even aware of and communicating our findings. We document everything, including during treatment.

Our advice is based on extensive knowledge that our patients do not have. Our advice and proposals are based on extensive experience that our patients do not have. After more than 30 years in practice, it is possible for me to look at a patient and be able to tell why they are in this situation and what situation they will be in 5, 10, 15 and 20 years down the line. We have well over a century of accumulated clinical experience at LCIAD. Our knowledge and experience allows us to guide each patient to do the best thing for their future dental and general health.

Yet we are occasionally faced with the response “that is too expensive” or “I can get the same thing abroad for 1/5 of the price.”

The same thing? Exactly the same thing? The same knowledge, thought, experience, care, commitment, accountability, skill, case documentation, time, teamwork, transparency, quality of materials and outcome, safety, communication and long-term support and guarantees?

Do these patients really think that they can obtain the “same thing” for 1/5 of the cost?

It is heart-breaking when patients have a little knowledge, and you know that their train of thought to save money will end up in their condition being far worse in the long term by having something inappropriate carried out elsewhere where the objective is immediate financial gain rather than long-term patient health and well-being. This trend is getting worryingly more frequent with younger patients having their mouths irreversibly mutilated by dental clinics abroad or even locally with the promise of a Hollywood smile.

Our view at LCIAD is that from the moment you make contact with the practice and attend for a consultation, we put our name to and are responsible for the dental care that you receive. Our professional efforts are our signature on the future and another brick in the wall of our reputation which has taken many years to build. We are recognised and respected for it.

We advise what we advise so that 5, 10, 15 and 20 years down the line you observe and understand the value of the advice and the quality of the clinical care that has been lavished on you. Our patients are genuinely grateful when after a lifetime of constant dental work, a course of treatment at LCIAD renders them healthy, stable and without the need for frequent dental work for many years after completion of treatment.

Our team spend hours in the background discussing your case to the finest detail, obtaining the correct information to be able to make correct diagnoses and decisions, right down to how each tooth is treated as conservatively as possible to restore and maintain it, ensuring that we do not over-prepare or overheat teeth that can cause long term pulp damage, maintaining teeth where possible rather than extracting them just to be able to place dental implants, properly isolating teeth during treartment and correctly using bonding agents so that when we bond our crowns and overlays, they do not come off or leak and cause sensitivity or new decay, ensuring that you are presentable and functioning for the duration of treatment by investing in durable provisional restorations, using guided surgery for dental implants, ensuring the use of quality laboratory work that fits well and looks natural and a myriad of other skills.

Quality always comes at a price. Always. The NHS dental service is collapsing due to underfunding because proper patient care cannot be delivered for peanuts. Dental health is very cheap. Don’t consume sugar or acidic drinks frequently, clean your teeth properly, don’t smoke and have regular check ups and hygienist visits to ensure your bite remains stable and any problems are prevented and treated early.

But when dental health is compromised, the work required to put it right is time-consuming and requires consummate skill.

The question should not be “how much does it cost?” but “what is the long-term value of investing in quality borne of experience and genuine care and what is the real cost of substandard work”.

“The quality is remembered long after the price is forgotten” is a saying attributed to Aldo Gucci. “The bitterness of poor quality is remembered long after the sweetness of low price has faded from memory” is attributed to Benjamin Franklin. We agree.

You only have one set of teeth. Let’s look after them properly. In the long run there is little that is personally costlier than cheap dentistry or neglect.