See how failure to manage expectations became a major problem for one dentist as his patient pursued the perfect smile.
Posted in Dental Insights on Wednesday, October 7, 2026
Erin Brody, a woman in her 30s, was working as a massage therapist in a spa in an affluent neighborhood. She recently quit smoking and had not had regular or consistent dental care in the past 10 years.
Erin felt her teeth were unattractive due to stains and with large gaps between her upper and lower front teeth. Right across the street from the spa was a sign for Dr. Ben Cooper's dental office, “The Perfect Smile." Erin asked around and received rave reviews about Dr. Cooper’s work.
Dentist Makes Treatment Recommendations
On those recommendations, Erin went to see Dr. Cooper at The Perfect Smile and told him about the stains and gaps she disliked. After an examination, Dr. Cooper said that he had concerns in addition to appearance. A few of her posterior teeth had decayed fillings, one had a fracture and her overall periodontal health was lacking.
Dr. Cooper told Erin he would like to address the fillings and periodontal conditions before working on the appearance of her front teeth. However, they could start improving the appearance of her badly stained teeth through scaling and root planing.
Once Erin’s mouth was healthy, they could then attend to the appearance of her front teeth with crowns, orthodontia, or veneers. Dr. Cooper recommended veneers as the most timely and cost-effective option. It was also the least intrusive.
Erin was not initially in favor of the recommended treatment plan because she was very concerned about finances and felt the appearance of her front teeth was a priority. She told Dr. Cooper she would agree to the scaling and root planing to help her teeth look better, but she wanted to have the veneers placed right away.
Dr. Cooper reluctantly agreed to this request once Erin assured him that she would complete the treatment plan after the veneers were placed. Dr. Cooper offered her a significant discount to entice her. He also believed that if Erin was pleased with the work and the way her teeth looked, she would recommend him to her coworkers and clients at the spa.
All went well with the scaling and root planing. The improvement in the appearance of Erin’s teeth was significant. Erin’s periodontal condition improved, and she was pleased to hear that Dr. Cooper thought her outcome would be very good with her continued commitment to regular dental care and oral hygiene.
Patient Unhappy with Veneers
Next came the veneers. Dr. Cooper took impressions and discussed the types of veneer he intended to place — larger than Erin’s natural teeth to help close the gaps. They were also a subtle shade lighter so they would appear brighter but still match her existing teeth. The veneers were placed and Erin seemed enthusiastic about the appearance of her teeth.
About a week later, Erin had lunch with a friend who said, “Your teeth look really big. Are they supposed to look that way?” The friend also commented that she thought Erin’s new teeth would be whiter.
When Erin returned for her next follow-up visit, she told Dr. Cooper her teeth felt funny when she bit down and seemed big and bulky. Dr. Cooper agreed to make some adjustments, but warned that too much scaling would make the veneers look unusual.
Over the course of three more visits, Erin became even more displeased with her veneers. She continued to complain that they didn’t look or feel right, the color was off, and she felt self-conscious about her smile.
Unpaid Balance is an Issue
Erin had paid for a small portion of her dental work, but still had a significant amount outstanding. When asked about the bill after her third follow-up appointment, Erin responded that she was not going to pay it until she was satisfied with the appearance of her front teeth.
Dr. Cooper had his office manager, MaryAnn, call Erin to address the unpaid balance. Erin told MaryAnn that she had never really liked the appearance of her veneers or how they felt. MaryAnn reminded Erin she had really liked the way they looked when they were initially placed and that the office had deeply discounted the charges. Erin became angry and mentioned hiring a lawyer. MaryAnn responded that if Erin did not pay her bill, they would have no choice but to sue her for the money owed. After this conversation, Erin never returned to see Dr. Cooper.
Erin went to another dentist in the area, Dr. Franklin. Erin told Dr. Franklin that she had never approved the veneer work done by Dr. Cooper. During the exam, Dr. Franklin noted that Erin had Class 2 periodontal disease in her anterior teeth. He also noted that the periodontal condition for most of her posterior teeth was even more severe. Erin told Dr. Franklin that she was very dissatisfied with the appearance of her front teeth, and that she did everything Dr. Cooper told her to do.
Both Sides Take Legal Action
Dr. Cooper and Erin exchanged nasty text messages, which prompted Dr. Cooper to send Erin’s case to a lawyer for collection. In response, Erin filed a counter claim for malpractice. This counter claim attached a report from the subsequent treating dentists who opined that Dr. Cooper acted improperly by:
- Failing to obtain informed consent
- Failing to do a proper and comprehensive dental treatment plan prior to cosmetic work
- Placing the veneers before the periodontal condition was resolved
- Failing to send Erin to a periodontist to manage her periodontal condition
- Placing veneers that were too big and bulky, resulting in a poor appearance of the anterior teeth.
Dr. Cooper reported the malpractice claim to his carrier and was assigned an attorney to handle the negligence counter claim. Dr. Cooper’s personal lawyer would continue to handle his collection case.
Dr. Cooper denied the malpractice allegations, asserting that he did, in fact, attempt to properly treat the dental health issues first, but Erin disagreed. He also responded that he properly treated the periodontal condition, Erin understood the risks and alternatives, and she knew what her veneers would look like and approved them prior to placement. He asserted that the veneers were properly placed and a good option.
A review of Dr. Cooper’s chart showed that he obtained the patient’s written informed consent. However, the general informed consent form he used did not address the dentist’s process for performing the work, the chronology of the work or the anticipated appearance of the teeth after the work was completed Nowhere in his record did he document any discussion of alternative forms of care for the anterior teeth.
Moreover, Dr. Cooper’s records did not include periodontal charting to show Erin’s periodontal condition when she first came to see him. There was also no documentation to indicate that Erin approved of the veneers before Dr. Cooper placed them. Dr. Cooper said he would have shown her the work up by showing her the models, and she would have approved the shading of the veneers at that time. Unfortunately, Dr. Cooper disposed of these models. Therefore, there was no documentation that Erin preapproved the treatment.
In addition, the records contained nothing to verify that Erin was happy with the way her teeth looked immediately after the veneers were placed.
Once the counter claim for malpractice was filed and answered, Dr. Cooper’s lawyers discussed whether to seek dismissal of the collection matter in exchange for dismissal of the malpractice counterclaim. Although Dr. Cooper was very confident in his case, he reluctantly agreed to this tactic. He was worried that news of the suit could harm his reputation and curtail his business. In addition, Dr. Cooper realized his documentation was scant at best.
After receiving Dr. Cooper’s concurrence, the defense team met with the plaintiff’s attorney, and all agreed to drop the collection action in exchange for dismissal of the malpractice claim. Dr. Cooper was not happy with this result, but he understood the possible ramifications if the case progressed and experts criticized his care. Because no money was paid on the negligence claim, no report was made to the National Practitioners’ Data Bank.
What Can We Learn?
Patient Selection
It is important to have positive patient selection and be aware of the pitfalls of allowing a patient to dictate care. Cooperative patients who respect you and your treatment plan are paramount to the success of the process.
During the initial visit, the patient should be advised of the treatment plan. The patient should agree with your plan or be referred to another practitioner. In some cases, cosmetic procedures shouldn’t start at all until other conditions are brought under control. Putting profit over quality decision making must be avoided.
Reducing treatment costs to entice compliance is not advisable. At the initial visit, the patient should be informed of the expected costs of the treatment and the payment options available.
Cosmetic Expectations
A dentist must also manage patient expectations with esthetic changes. Generally speaking, patients cannot evaluate the technical/clinical aspects of quality of care as they do not possess the skills to do so. However, they can evaluate tooth shape, size, color, shade, etc.
Third-party comments can have an impact on personal acceptance. Before performing cosmetic procedures, the dentist should recommend that the patient bring in a friend or family member whose opinion they value to discuss the esthetic choices. This helps patients have confidence in their decisions.
In this case, the name of the practice “The Perfect Smile” also reflected an absolute and an implied guarantee. It is important that a dentist’s marketing avoids these types of statements.
Angry Patients
Discussions with angry patients should be handled by the dentist rather than the office manager or another staff member. The dental provider can then work to resolve the issue.
What’s more, communication with dissatisfied or angry patients should be made with voice communications — not via texting or social media. Texting and social media do not reflect the care and voice intonations that live conversation provides and that might soothe or reduce the frustration of both parties.
Documentation
It is essential that dental records include documentation of the informed consent process. This should outline the discussion of procedure(s), treatment options, potential complications and known risks, and the patient’s consent to proceed with treatment.
Effective documentation will detail the treatment plan, including a timeline for the treatment plan and a description of the care. The plan needs to include documentation about the patient interaction, complaints at each visit, and discussion about the progress of the treatment plan.
Dr. Cooper’s lack of documentation — especially on issues of the pre-operative periodontal evaluation, alternative treatments, and the failure to obtain patient approval and consent prior to the procedure — was especially problematic. Also, the fact that Dr. Cooper no longer retained the models he used to show the patient what the veneers would look like created yet another hurdle for his lawyers. Had Dr. Cooper better documented his record and maintained the models he showed to Erin, he would likely have more of a defense to bolster his collection case and to fight the malpractice case.
Because his records were so poorly documented, Dr. Cooper’s decision to let the collection action go was the best possible solution given the alternatives.
About the Author
Linda J. Hay is a partner in the Chicago office of HeplerBroom, LLC. Ms. Hay has practiced in the professional liability defense arena for more than 25 years and has tried numerous cases to verdict. She is actively involved in a variety of defense bar, professional liability and risk management organizations.
Although this case study is based on a real case, names, dates and details have been changed to protect patient and doctor privacy.