What a Dentist Should Do When a Patient is Fearful

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Fear and dentistry seem to go hand in hand.  Whether the fear comes from childhood experiences or is solely psychological, fear is a real thing that patients often bring with them to their appointments.

Here’s what most dentists and their teams fail to remember: people have two biological, automatic reactions when dealing with fear, FLIGHT or FIGHT.

Those patients that are in flight mode often look and sound like this:

  • Sound, they don’t make sounds, not even when asked questions. They are struggling internally to keep it together.  They also know the more conversation had during their experience, the longer they will be there.  Their goal is to get out!
  • Often show a nervous twitch by moving their feet, bouncing their leg, moving their hands, etc.
  • Ask, “How much longer?” or “What’s next?” or even “Are you almost done?”  They can’t wait to get to the door and RUN.
  • Avoid talking about same day treatment, say they want to schedule another appointment and then don’t schedule.

Flight patients are harder to notice because they are stealthy.  Meaning, they don’t let on that they are afraid.  These patients leave you wondering ‘what’s wrong with them’ or ‘with you’ because their appointment was like pulling teeth, and not the literal kind.  You can’t help but reflect on how awkward their appointment was for you and the team.

To effectively work with people in flight mode:

  1. Know the signs.  You and your team need to be able to recognize patients in flight mode.
  2. Offer calming methods to reduce fear and stress (music, laughter, warm blankets, dim lighting, stress balls, show comedies, etc) if you think they are a flight patient.
  3. Be assertive and ask, “I’m curious Mr. X.  How nervous are you about being here today?” The problem addressed is the problem solved.  Until the fear is addressed, the patient can’t truly listen and take in what you are saying about their oral care.
  4. Demonstrate confidence in your clinical skills. So often when a patient isn’t giving off the right vibe dental teams back away, feeling awkward and it throws them off their game.  They start second guessing their movements and begin to put further psychological stress on themselves which makes everything even more uncomfortable.  Know that your training and experience has uniquely prepared you for this moment with this patient.  You know how to connect, offer painless procedures, and provide a comfortable, caring environment.  Trust in that and move on.
  5. Don’t reinforce stress by talking badly about the patient, ever.  It’s normal to want to vent or release the stress of working with a fearful patient to your team.  DON’T!  The more you talk about how awkward it is to work with that patient, or how much they squirm and jump while you blow air on their teeth, or even when they don’t say two words to you the more you reinforce to you and others that it was a negative experience.  Find another way to release your stress like breathing, positive self-talk, or take a 5 minute break.  What you tell yourself you believe so be careful of what you think.

Flight patients are experiencing something very real.  As a dental professional, you want to learn how to navigate through working with this type of patient because it will make  your job and that of your team much easier.  Plus you will have less stress!


Jen Butler, M.Ed., CPC, BCC has been working in the area of stress management and resiliency coaching for over 20 years.  She is available as a coach/consultant, speaker and trainer. To learn more about her services and sign up for her monthly stressLESS newsletter to go www.jenbutlercoaching.com.  Take the Dental Stress Self-Assessment at www.jenbutlercoaching.com/quiz/ to find out your stress levels. Her partnership with The Business Backer removes any financial barrier so you get the support you deserve.  Go to www.thebusinessbacker.com/JenButler or contact Jen Butler directly at 623-776-6715 for more information.

Last modified: July 9, 2014

2 Responses to " What a Dentist Should Do When a Patient is Fearful "

  1. David says:

    I’m a dentist, retired after practicing and teaching dentistry for over 30 years. One of the most neglected, ignored, and safest ways of reducing patient stress is nitrous oxide. I’m not trying to minimize the approaches mentioned in the article. I’m just wondering why so many dentists ignore this agent which is a proven mild analgesic and stress reducer.

    • Jen Butler says:

      Thank you for your contribution. You are absolutely correct about nitrous oxide being used during procedures as a means to reduce anxiety. The point of the post is to offer means to reduce stress prior to and up until case acceptance. So often patients reject case acceptance due to their high anxiety from the time they enter the practice. Teams can’t even offer nitrous as patients are already screaming ‘NO” before the treatment plan is presented or the thought of nitrous is not enough of a coping method for patients to say ‘YES’. Keeping patient’s stress levels as low as possible prior to tx presentation allows them to listen more attentively, concentrate, focus and controls the fight/flight response.

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