What to Do When a Patient Declines Treatment
When scaling and root planing is recommended to a patient with periodontal disease, do we need to give prophylaxis as an option? Presently we do not, but the dentist is concerned that patients may not return if we insist they receive treatment for their periodontitis.
Patients with periodontal disease should be presented with a variety of treatment options, including the risks of not pursuing any treatment. The decision to decline treatment should be thoroughly documented. The patient must sign a statement acknowledging his or her understanding of the potential consequences of untreated periodontal disease. Despite this refusal, the patient can continue to receive care and should be closely monitored based on the agreed-upon recare schedule. If the patient’s condition worsens, the dentist must decide whether to continue treating the patient or to dismiss him or her from the practice, ensuring all legal requirements are followed to avoid issues related to patient abandonment.
When presenting scaling and root planing to a patient, offering a prophylaxis as an alternative may not be the central concern. The focus should be on maintaining consistent care, reinforcing the need for periodontal treatment, and closely monitoring the patient’s oral health. Providing ongoing care allows for continued education, relationship-building, and improved communication. Patients should never feel pressured into treatment. Some patients may need additional time to fully comprehend and process the proposed treatment. Maintaining open communication and offering continued care may eventually lead to acceptance of recommended treatment.
Refusing to provide care to patients who have declined treatment may result in a lost opportunity to guide them toward better health. Patients faced with the choice between immediate periodontal therapy or being referred elsewhere may opt to forgo treatment altogether. In such cases, they may no longer have access to an oral health professional who is actively working to encourage necessary care.
Patients often face barriers, such as financial concerns, insurance limitations, fear, pain, shame, or lack of trust. These obstacles can take time to address. We need to recognize that our ideal treatment goals may not always align with what the patient is initially ready to accept. Offering an alternative treatment may provide the necessary time to address barriers, build rapport, and educate the patient effectively.
In cases where a patient declines ideal periodontal treatment, an informed refusal document should be completed, signed by both the patient and the dentist. This document should confirm that:
- The patient has been diagnosed with periodontal disease.
- Recommended treatment options have been explained.
- The patient acknowledges the risks of refusing treatment and understands that alternative procedures will not address the diagnosed disease.
- The patient’s condition will be re-evaluated at each ensuing visit.
- The patient should also be placed on a shorter recare schedule to facilitate closer monitoring.
- The patient has been informed that if his or her periodontal condition worsens, the dentist may discontinue treatment in accordance with appropriate legal protocols and without patient abandonment.
Dental hygienists play a critical role in identifying periodontal disease, working closely with patients, and supporting the dentist’s recommended treatment plan. By advocating for alternative solutions when appropriate and maintaining clear communication, dental hygienists can help ensure that patients have autonomy in their care. Ultimately, while not all patients will accept ideal treatment right away, providing alternative care options, fostering trust, and maintaining open communication can support the goal of guiding patients toward optimal oral health in the long term.
From Dimensions of Dental Hygiene. May/June 2026;24(3):46
