How to Tell a Patient Their Previous Dentist Did a Bad Job

How to Tell Your Patient That Their Previous Dentist Did a Bad Job

The Ethical Tightrope Dentists Walk
Dentistry, like all branches of medicine, is as much about communication as it is about technical skill. One of the most delicate challenges dentists face is when they discover substandard, inappropriate, or outright harmful work done by a previous practitioner. The dilemma: how to explain this to the patient honestly, without undermining professional integrity, damaging trust in the profession, or appearing opportunistic.

A patient might present with failed restorations, poorly executed crowns, improperly planned implants, or even aesthetic work that compromises function. The temptation to bluntly state, “Your last dentist did a bad job,” is strong—but such candor, while factually accurate, can backfire. The goal is to communicate truth without malpractice gossip, to advocate for the patient while respecting the profession.

Why This Situation Is So Complex

1. Patient Trust: Patients place enormous trust in their dentist. Telling them their previous provider failed can fracture their trust in dentistry as a whole.
   
   
2. Professional Ethics: Dentists are expected to uphold collegial respect. Criticizing a colleague directly risks violating professional codes of conduct.
   
   
3. Legal Implications: Comments perceived as defamation can spark legal or regulatory complaints.
   
   
4. Emotional Fallout: Patients may feel betrayed, angry, or embarrassed upon learning their previous care was substandard.
   
   
5. Perception of Motive: Patients may suspect you are exaggerating problems to sell treatment.
   

Ethical Principles to Guide Communication
Beneficence – Act in the Patient’s Best Interest
The ultimate priority is the patient’s health. If previous work compromises oral health, you must inform them so corrective action can be planned.

Nonmaleficence – Do No Harm
While honesty is necessary, causing unnecessary distress or undermining professional reputation without evidence is harmful.

Veracity – Tell the Truth
Patients have a right to accurate information about their oral health. Sugarcoating or omitting facts breaches trust.

Professionalism
Respecting colleagues—even in their absence—maintains the dignity of the profession.

Step-by-Step Approach: How to Communicate Professionally
1. Gather Evidence Before Speaking

• Perform a thorough clinical and radiographic examination.
  
  
• Document findings with intraoral photos and radiographs.
  
  
• Avoid premature judgments without objective evidence.
  

2. Focus on the Problem, Not the Person
Instead of saying, “Your previous dentist botched this crown,” reframe as:
“This crown does not fit properly, which may explain why you are experiencing pain and food trapping.”

This shifts the discussion from blame to clinical fact.

3. Use Neutral, Nonjudgmental Language
Examples:

• “The treatment outcome here is not ideal.”
  
  
• “This restoration is not functioning as it should.”
  
  
• “There are some issues that need to be addressed for long-term success.”
  

Avoid adjectives like bad, poor, careless, or unprofessional.

4. Explain Consequences, Not Fault
Focus on what the current state means for the patient:

• “This filling has a gap at the margin, which increases the risk of decay.”
  
  
• “The implant angulation makes hygiene difficult, which can lead to peri-implantitis.”
  

The emphasis is on patient health, not colleague performance.

5. Offer Solutions Immediately
After identifying problems, pivot to solutions:

• “To prevent further problems, we can replace this crown with a better fit.”
  
  
• “There are corrective options to stabilize this implant site.”
  

Patients feel reassured when problems are paired with clear solutions.

6. Handle Direct Questions Carefully
Patients may ask bluntly: “Did my last dentist do a bad job?”
Possible response:
“Every dentist approaches cases differently. What matters now is that the current situation isn’t giving you the results you deserve. My role is to help fix it and ensure you’re comfortable and healthy moving forward.”

This answers without disparaging the colleague while still acknowledging the problem.

7. Provide Written Evidence if Needed
Show patients their radiographs, intraoral photos, or probing charts. Visuals speak louder than opinions. When patients see decay under a crown margin or bone loss around an implant, they accept the reality without needing to hear harsh words.

8. Maintain Empathy
Remember, patients may feel betrayed. Show compassion:
“I understand this may be frustrating to hear. It’s natural to feel upset. The good news is that we can address this together.”

Common Scenarios and Suggested Responses
Failed Root Canal Therapy
Instead of: “This root canal was done incorrectly,”
Say: “This tooth still shows infection. Sometimes root canals do not fully resolve the problem, and retreatment or another approach is necessary.”

Misaligned Implant
Instead of: “This implant was placed poorly,”
Say: “The implant’s position makes hygiene challenging. We can explore whether adjustment or supportive care will help.”

Overcontoured Crown Causing Gingivitis
Instead of: “Your dentist left this crown too bulky,”
Say: “This crown’s shape makes cleaning difficult, leading to gum irritation. Redesigning it can improve both health and comfort.”

Aesthetic Failures
Instead of: “This veneer work is sloppy,”
Say: “The current veneers don’t harmonize with your natural smile. We can plan a more balanced aesthetic result.”

Balancing Ethics with Legal Awareness

• Document Everything: Record findings carefully in patient notes.
  
  
• Avoid Accusatory Phrases: “Negligence,” “malpractice,” and “botched” should not appear in notes.
  
  
• Refer if Necessary: If problems are severe, referral to a specialist provides impartiality.
  
  
• Be Aware of Local Regulations: Some dental boards prohibit disparaging remarks against colleagues.
  

Building Trust Without Damaging Professionalism
Your credibility increases when you strike the right balance:

• Honest enough that the patient feels informed.
  
  
• Respectful enough that you maintain professional integrity.
  
  
• Solution-focused so the patient sees you as an ally, not a critic.
  

Teaching Younger Dentists: Professional Diplomacy
Dental schools increasingly teach communication alongside clinical skills. Professional diplomacy is not about protecting bad dentistry—it’s about safeguarding the patient’s trust while maintaining the reputation of the profession. New graduates must learn that words carry as much weight as drills and scalers.

Case Vignette
Patient: A 45-year-old woman presents with pain under a recently placed bridge.
Findings: The abutments are over-prepared, margins open, and recurrent decay is evident.
Patient asks: “Did my last dentist do a bad job?”
Response: “What I see is that the bridge is not sealing properly, which explains the discomfort. Unfortunately, decay has developed underneath. These things sometimes happen even with good dentistry. What matters now is that we replace this with something more secure to protect your teeth for the long term.”

The patient is informed, reassured, and offered a solution—without overt criticism.

The Fine Line Between Truth and Diplomacy
There are times when substandard care is obvious and indefensible. Still, professionalism demands measured language. The role of the dentist is to heal, not harm further—even if that harm comes in the form of damaging a colleague’s reputation unnecessarily. Truth must be told, but how it is told defines whether the patient walks away feeling empowered or disillusioned.