Should I ever adjust a case fee after presenting it to the patient? No, and if you do, you are not the painless dentist you claim to be. Decide on every fee adjustment up front, during treatment planning, before the patient ever hears a number. That is the moment to ask whether unusual clinical factors or unusual patient behaviors change the fee. If they do, fold it in now. If you skip that decision and try to raise the fee after the fact, you have created an administrative root canal for the patient, and you have broken the painless promise. People [...]