10.3 Future Care Needs: Risks of Non-Treatment, Material Misconceptions, and Realistic Expectations

Educating about conditions that will need care (K2031, K2032)

Beyond today's treatment, patients need to know what is coming: a cracked cusp that may fracture, bone loss that will threaten implants, early caries that can be arrested, an aging bridge, or medication-related dry mouth. The codes require this:

• CDA 1.D.1: explain proposed treatment, reasonable alternatives, and the risks of not performing treatment.
• CDA 1F: inform patients of their present oral health status.
• ADA 2.B: a specialist who finishes treatment and has no referring dentist must tell the patient when further care is needed.

Risk-of-non-treatment conversations should be specific: "If we monitor this cracked tooth, the crack may extend below the gumline, and then the tooth might not be saveable. Signs to watch for are pain on biting and cold sensitivity." Vague warnings ("it might get worse") do not let the patient weigh the choice. Record what was discussed and what the patient chose. A patient who waits after an informed discussion has exercised autonomy, and the record shows it.

Correcting misconceptions about materials and treatments (K2033)

Patients arrive with information from social media, friends, and advertising. The ethical duty is to correct misconceptions with accepted scientific evidence, not to exploit or reinforce them.

The Dental Materials Fact Sheet

California builds material education into law:

• The Board must publish a fact sheet comparing the risks, efficacy, and costs of restorative material groups and encouraging patient-dentist discussion (B&P § 1648.10).
• The dentist must give it to every new patient and to patients of record before restorative work, once per update, and on request. The patient signs an acknowledgment, which is kept in the chart (§ 1648.15).
• It covers restorative materials meant to stay in the mouth indefinitely, but not implants, and not surgical, endodontic, periodontic, or orthodontic procedures that use no restorative material (§ 1648.20).

The fact sheet opens the discussion; it does not replace the dentist's own explanation.

Managing expectations (K2034)

Unrealistic expectations drive complaints. The law and the codes both forbid creating them:

• B&P § 651(b)(3): a communication is misleading if it is "intended or is likely to create false or unjustified expectations of favorable results."
• B&P § 1680(l): advertising a guarantee of any dental service, or painless dentistry, is unprofessional conduct.
• ADA Advisory Opinion 5.F.2: avoid statements likely to create unjustified expectations about the results a dentist can achieve.

In the operatory, managing expectations means:

1. Discuss likely outcomes and limits, such as color matching, how long a restoration usually lasts, how long a denture takes to adapt to, and orthodontic retention.
2. Explain the patient's role: home care, recall visits, night guard use, and quitting smoking.
3. Use honest visuals: mock-ups or digital previews labeled as simulations, and before-and-after photos with the § 651 disclosures.
4. Put key points in writing for major esthetic or prosthetic cases, and document the discussion.
5. Check agreement: "What result are you hoping for?" A patient who expects "movie-star teeth" from two veneers needs a different conversation before treatment starts.

Keeping future needs visible

Education works over time, not in one visit:

• Recall findings: tell the patient at each recall about watched areas, such as incipient lesions, craze lines, or pocket depths, and chart them so changes are visible.
• Written recommendations: give a printed or portal copy of recommended care and priorities, especially when treatment is deferred.
• Missed follow-up: when a patient does not return for recommended care, a documented reminder protects the patient and shows the dentist met the duty to inform.
• Medical changes: update the health history, because new medications, such as antiresorptives or anticoagulants, change future risks and options.

Worked scenario

A patient asks for all her amalgam fillings to be replaced because a website says they cause fatigue. She has no amalgam allergy, and the fillings are intact.

• Ethical response: explain the current evidence, give her the Dental Materials Fact Sheet, and discuss the risks of removing sound tooth structure.
• If she still chooses replacement after an informed discussion, the dentist may proceed on her informed request, or decline if they believe it is not in her interest.
• The dentist may not recommend removal to "detoxify" her or claim it will cure the fatigue (ADA 5.A.1, 5.A.2).