Can a dental procedure take 25 years off a person's appearance? One patient thought so—and filed a lawsuit when the results were not what she envisioned.
Posted in Dental Insights on Thursday, May 15, 2025
Caroline Orvis, a vibrant and well-connected 67-year-old, took great care in her appearance. Her deep red hair and occasional references to cosmetic procedures suggested a commitment to maintaining a youthful look.
Dr. Bell treated Caroline from October 2009 to April 2011—starting with a full-mouth reconstruction of approximately 20 teeth incorporating upper and lower fixed bridgework. This work came at a significant cost and was paid for out of Caroline’s own pocket.
While there was no initial documentation about Caroline’s expectations, the records noted she had numerous complaints about the appearance of her new teeth.
Patient Consults a Different Dentist
In April 2011, Caroline left Dr. Bell’s care and immediately went to see another dentist, Dr. Michael. Caroline told Dr. Michael that she did not like her appearance after Dr. Bell’s work, which was why she was seeking Dr. Michael’s care. She also had vague complaints of TMJ pain, which she attributed to the poor quality of Dr. Bell’s work.
After explaining these concerns to Dr. Michael, Caroline pulled out a photograph of herself taken 25 years earlier. She showed the picture to Dr. Michael and told him she wanted her teeth to look like they did in the picture. She wanted all of Dr. Bell’s work redone.
Caroline said she understood the time and expense issues related to the procedures as she had recently had similar work done by Dr. Bell. She explained she had the financial means and really wanted to achieve a more attractive appearance.
Dr. Michael, hesitant to be too blunt with a new patient, explained he could redo the work, but that the result might not be the same as the picture. He told her he would do his best to address her concerns, and he felt he could achieve better aesthetics than she had now.
Dr. Michael’s records contained a copy of the photograph but no documentation of the conversations. Nor were there any records of Caroline’s oral or written consent to the treatment.
Over the next year, Dr. Michael proceeded to redo the bridges placed by Dr. Bell. During that time, Caroline’s constant complaints about the appearance of her teeth were noted in the records. She wanted her teeth to be much whiter than Dr. Michael recommended for her age and she felt the new reconstruction made her teeth look like “Chiclets.” Dr. Michael redid at least one bridge in an attempt to satisfy Caroline, but she left his care in 2012.
Around that same time, she went to yet another dentist for her TMJ complaints. That dentist eventually diagnosed her with TMD, and treatment was given for that condition.
Lawsuit Commences
Caroline’s next stop was her lawyer’s office, the firm where her husband was a partner. Although Mr. Orvis did not personally handle his wife’s claim, his partner did. In late 2012, Caroline sued both Drs. Bell and Michael, alleging breach of contract and dental negligence.
Over the course of the case, Caroline’s attorney sought to pit Dr. Michael against Dr. Bell. Dr. Michael refused to criticize Dr. Bell’s prior reconstructive work, but unfortunately, that left him with no explanation for why he would redo a full-mouth reconstruction other than for purely aesthetic purposes. This played into Caroline’s claim that Dr. Michael never told her she wouldn’t look like she did in her 25-year-old photograph.
In the lawsuit, Caroline Orvis made demands for:
- $25,000 in damages for Dr. Michael’s work
- $19,000 for Dr. Bell’s work
- Additional cost for her TMD treatment
Had she known she wouldn’t end up looking dramatically younger, Caroline contended she never would have agreed to the time, cost and pain associated with these two courses of care. Specifically, she claimed both dentists “guaranteed” she would look like the picture she brought in, and that they both assured her the work would be done within four to six months. Moreover, she alleged Dr. Michael failed to diagnose and treat the TMD problem and made the condition worse.
The Defense Weighs In
Drs. Bell and Michael countered that they had acted appropriately, that Caroline clearly needed the restorative work due to the condition of her mouth, and that her options for restoration were limited. According to both dentists, the restorative work was successful and the cosmetic result was good.
Drs. Bell and Michael both felt Caroline Orvis’ expectation for her appearance was not reasonable, and they had discussed this with her. They were adamant that they never would have guaranteed Caroline that she would look 25 years younger as a result of the restorative work, and they never would have promised the work would be completed in the time she claimed.
Throughout discovery in the case, Caroline identified almost 20 dentists she had seen over time. These treaters’ records showed that Caroline had similar issues with many of them. She was often dissatisfied and hopped from practitioner to practitioner. Because of the large number of treating dentists, the discovery process was prolonged.
None of these dentists were critical of the defendants, and neither Dr. Bell nor Dr. Michael criticized each other’s care. The defendants both retained well-qualified experts who strongly defended the care provided by both dentists.
Case Finally Goes to Trial
In 2016, after the experts had been deposed and the case was close to trial, Caroline flew to Ohio to treat with a dentist named Dr. Yellen who rendered opinions critical of Drs. Bell and Michael. Caroline’s counsel then identified Dr. Yellen as another expert, and the defense objected to this late attempt to bolster Caroline Orvis’ case. The court agreed and barred Dr. Yellen’s testimony from trial.
Finally, in 2017, the case proceeded to a jury trial. The trial lasted approximately a week and a half, and Drs. Bell and Michael were found not liable in the care and treatment of Caroline Orvis. Though she appealed, an appellate court affirmed the jury verdict in 2019—seven years after the case commenced.
What Can We Learn?
Informed consent. It was a huge risk to pursue such an expensive and involved course of care without the patient’s full informed consent about the risks, benefits, alternatives and recommendations. This is especially true given that Caroline Orvis’ dissatisfaction with her appearance was the only true basis for the redo of the reconstruction.
Guarantees. While they are used for products like a lawn mower or a washing machine, the human element and the subjectivity of individual expectations should steer dentists away from using such terms.
Physician communication. Dr. Michael should have discussed the case with Dr. Bell, and he should have been wary of redoing a full-mouth reconstruction so soon after Dr. Bell’s treatment. A conversation between the two dentists may have shed light on the fact that this patient’s expectations were unrealistic and she would never be satisfied.
Referral. The minute the patient complained of TMJ discomfort, she should have been referred to a specialist. Cosmetic treatment should have been discontinued until the joint was comfortable.
Documentation. Both Drs. Bell and Michael should have had more detailed documentation, especially given the cost of the treatment and Caroline Orvis’ constant dissatisfaction. In particular, the photograph should have contained a note signifying that the patient was told she would never look 25 years younger.
Evaluation. Rather than beginning treatment immediately, Dr. Michael should have required Caroline to take time to think about the pros and cons of redoing the work.
Aesthetic focus. When a patient is overly concerned with aesthetics, the dentist should not only document existing clinical conditions, chief complaint, treatment options, and informed consent, but also provide prosthetic try-ins and receive/document patient approval (i.e., aesthetic appearance) before finalizing a permanent prosthesis.
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.