Body Dysmorphic Disorder in Dentistry: Recognizing and Managing Patients with BDD
In dentistry, our primary goal has always been to help patients achieve healthy, confident smiles.
However, some individuals develop an excessive preoccupation with perceived flaws in their dental appearance, leading to distress and unrealistic expectations. This can be a sign of Body Dysmorphic Disorder (BDD)—a mental health condition characterized by obsessive concerns over minor or nonexistent imperfections.
I encountered this personally in my practice only once, but the experience was so impactful that I felt compelled to share my story. My hope is to help other office managers recognize the signs of BDD and avoid the challenges we faced due to our failure to identify it early on.
When a Smile Becomes an Obsession
It all began with a beautiful young woman who came in for a cosmetic consultation, seeking closure of the space between her front teeth. We noticed that she had undergone several other cosmetic procedures to alter her appearance, but at the time, we didn’t see this as a red flag. Instead, we viewed it as part of a personal transformation—one made possible by her recent financial success, allowing her to make the changes she believed would boost her confidence.
As a cosmetic and family dental practice, we specialize in enhancing smiles, so when a patient expresses a desire for aesthetic improvements, we typically don’t question it.
She sat in the chair, tears streaming down her face, as she shared how the gap in her teeth had affected her entire life. Closing that space and perfecting her smile had been her lifelong goal. She even brought in magazines and pictures of celebrities, showing us exactly the kind of smile she wanted.
Piece of cake, right?
We did everything by the book! We developed a comprehensive treatment plan, took before photos, reviewed smile designs, and let her choose the one she liked best. We even ordered diagnostic casts from the lab, displaying the design in wax on a model of her teeth. We went the whole nine yards!
She was thrilled with everything—excited to schedule the treatment and eager to pay. What more could we ask for?
Facing Unexpected Disappointment
On the big day, when we delivered her permanent veneers, she left the office in a noticeably different mood than before. Throughout her previous appointments, she had been upbeat and excited, but this time, something felt off. We chalked it up to exhaustion from the procedure and didn’t think much of it.
A week later, she returned for a routine follow-up to check her bite and make any necessary adjustments. To our shock, she seemed disappointed and downcast.
Then came the bombshell—she wasn’t happy with her new smile. Stunned, we handed her a mirror and gently asked what specifically she didn’t like, reminding her that we had followed the exact design she had chosen. But to our disbelief, tears welled up in her eyes as she murmured, “I don’t know, I can’t quite put my finger on it. Maybe I just want my gap back… but maybe just smaller than it was before.”
We were floored.
What followed was weeks of back-and-forth—adjustments, modifications, and attempts to meet her evolving expectations—which we soon learned was an impossible feat. Despite our best efforts, we ultimately settled with her out of court.
In the end, it was a devastating outcome for everyone involved: an unhappy patient, an unhappy dentist, and an unhappy office manager. The real issue wasn’t the work we had done—it was our failure to recognize that this patient was suffering from BDD.
Protecting Your Practice While Supporting Patients
As dental professionals, it is crucial to recognize the signs of BDD, understand how it can impact treatment decisions, and approach affected patients with care, sensitivity, and ethical responsibility. As office managers, we are the first layer of protection to our dentists, so it’s imperative that we educate ourselves and be alert to signs that a patient may have BDD.
There are several steps I have implemented to help protect my practice from getting caught in the pressures of treating a patient experiencing BDD.
Knowing what I know now, I take a much more proactive approach when assessing patients during their initial consultation call. I carefully evaluate their concerns and gather as much history as possible to determine whether their expectations are proportionate to the actual dental issue.
During the consultation, I ensure that a dental assistant is always present with the dentist, and that detailed notes are taken.
I have made it a priority to educate my staff about this case and the signs and symptoms of BDD. By recognizing these red flags early, we can address concerns before scheduling treatment or moving forward with any procedures.
Our office has now adopted a procedure to obtain consent before treatment. My team and the doctor now verbally review and require patients to read and sign a detailed consent form. This document outlines all procedures, associated risks and benefits, potential discomforts and inconveniences, treatment expectations, decision-making capacity, and includes a witness signature.
By staying informed, fostering compassionate communication, educating your team, and implementing comprehensive consent protocols, you protect not only your practice but also your patients. These steps help prevent dissatisfaction, legal disputes, and the emotional toll that can come from treating a patient with unrealistic expectations.
About the Author
Amanda Matthews, MAADOM
Amanda Matthews is a dedicated and experienced dental office manager in Bethesda, MD, where she has been a valued member of the same practice for over 22 years. Passionate about enhancing patients’ lives through smile transformations, she is committed to helping individuals improve their self-confidence and overall well-being.
With expertise in patient relations, billing and insurance processing, and fostering team engagement in charity events, Amanda plays a crucial role in maintaining the smooth operation of the office while ensuring a welcoming and supportive environment for both patients and staff.
