Why Are Patients Being Difficult

Before you implement strategies to handle difficult behavior, it helps to understand why it happens.

Dental Anxiety and Fear

While anxiety is an emotional state in response to perceived threats that may not be clearly identifiable, fear represents a reaction to a known threat. In severe cases, this manifests as dental phobia (odontophobia).

Anxious patients often perceive dental discomfort more acutely and may exaggerate their memories of pain, which creates a negative feedback loop that intensifies with each visit. 

These patients can get angry quickly, especially if they feel like the staff is ignoring their concerns.

Past Negative Experiences

Many difficult behaviors stem from early maladaptive schemas formed during childhood and adolescence. When patients' emotional needs go unmet during formative years, they can develop problematic thinking patterns that show up as anxiety or challenging behaviors in the dental office.

Berggren's model describes a vicious cycle where avoided dental visits lead to deteriorating oral health, reinforcing feelings of shame and inferiority. This cycle grips patients who've had traumatic dental experiences particularly tightly, and creates a pattern that's tough to break without help.

Personal Stressors

Outside life stressors also affect how patients behave at the dentist. According to the Schema Therapy approach, people need five basic emotional needs satisfied: autonomy, sense of identity/competence, freedom to express valid emotions and needs, spontaneity/play, and self-control/realistic limits.

A dental appointment can trigger problematic behaviors when these needs go unmet in a patient's life. All patients want to feel understood, respected, and in control of their decisions, which extends to those in healthcare and dental care.

4 Strategies for Dealing With Difficult Patients

When a patient gets angry or upset, here’s what you can do:

1. Stay Calm and Professional

When a patient becomes upset or confrontational, your first priority is to remain composed. 

Take a moment to ground yourself—slow your breathing, relax your posture, and assess your emotional state. Your calm presence can help de-escalate the situation and set the tone for a more constructive interaction. 

Speak clearly and calmly and address the patient respectfully. 

Miscommunication often fuels frustration. Use straightforward, jargon-free language when explaining procedures, treatment plans, or office policies. Avoid interrupting patients, and ask clarifying questions. Using these protocols can help improve your practice reputation and prevent unpleasant patient experiences. 

2. Listen With Intention

Active listening goes beyond simply hearing a patient’s words. It requires your full attention and an open mindset. One helpful framework is the LOWLINE model:

• Listen without interruption
  
  

• Offer minimal encouragement
  
  

• Wait patiently for them to finish
  
  

• Look for nonverbal cues
  
  

• Incline your body slightly forward
  
  

• Nod to show you’re engaged
  
  

• Express understanding through brief, supportive responses

Use open-ended prompts like, “Can you help me understand what’s going on?” to encourage the patient to share their concerns more fully.

3. Demonstrate Empathy and Understanding

Empathy is one of the best tools for defusing tension. Begin by giving the patient your full attention—put down distractions, face them directly, and maintain eye contact. When patients feel heard, they’re more likely to de-escalate.

Acknowledge their feelings without rushing to respond or offer solutions. Pausing for a moment can give them space to express themselves more fully.

To show you understand, reflect their concerns in your own words. For example: “It sounds like the delay this morning has been frustrating.” Simple phrases like “I hear you” or “That makes sense” can help patients feel validated and respected. 

Setting boundaries is an integral part of this process. Recognize a patient’s feelings while clarifying that disrespectful behavior won’t be tolerated. Firm, respectful boundaries protect your team and maintain a professional environment.

4. Involve Patients in Decisions

Patients are far less likely to feel frustrated or combative when they feel seen, heard, and actively involved in their own care. Difficult situations often arise when people feel powerless, so giving them a role in the decision-making process can go a long way in defusing tension and building trust.

Offer two or three clear options, when possible, and explain the pros and cons of each. For example: “We can move forward with the crown today, or we can place a temporary filling and schedule the procedure for next week. I’ll walk you through what each would involve, and then we can decide together what feels right for you.”

If cost is part of the issue, involve your office manager or billing coordinator early in the conversation to help present financing options or payment plans.

The Role of Dental Staff in Dealing With Difficult Patients

Managing difficult patient interactions is a team effort. You can create a better environment for everyone involved by taking strategic approaches to communication and conflict resolution.

Team Training

Communication training for all dental staff is vital for handling challenging situations. Training should cover verbal and nonverbal skills, including active listening, empathy, and body language. Role-playing exercises help dental professionals distinguish between effective and ineffective communication when dealing with difficult patients.

Staff should also learn specialized approaches for patients with unique needs, such as hearing or vision impairments, learning disabilities, language barriers, or anxiety.

Regular professional development keeps staff current with new patient care and communication strategies. Establishing and setting collective goals can further unify the team.

Consistent Policies

Uniform policies for handling difficult situations help all team members respond appropriately and as a unit. These policies should detail steps for de-escalating conflicts, managing complaints, and addressing disruptive behaviors.

These policies help create a positive communication climate where everyone feels respected, improving patient communication. This approach encourages solving problems together rather than confrontation when challenges arise.

Debriefing Sessions

After challenging patient encounters, team debriefing sessions allow staff to discuss what happened, what worked, and what needs improvement. 

Debriefing helps dental professionals stay objective and manage emotions. By sharing experiences, team members can develop better strategies for similar situations.

These sessions also provide opportunities for informal feedback, especially when team members excel in dealing with intractable patients, such as calming anxious patients or adapting to schedule changes. Recognizing these successes reinforces positive behaviors, encourages ongoing communication skill development, and improves team morale.

The Impact of Staffing on Managing Difficult Patients

Difficult patient interactions don’t happen in a vacuum—they’re often shaped by the overall environment in your practice. When patients experience delays, rushed communication, or a lack of attention, frustration builds quickly. Your staffing model plays an important role in preventing these issues and creating a setting where patients feel supported and heard.

Maintain Adequate Staffing Levels

When your team is appropriately staffed, patients are seen on time, conversations aren’t rushed, and staff can focus on care rather than scrambling between tasks. This calmer pace helps reduce tension and prevents avoidable friction that can lead to complicated interactions. In contrast, understaffing contributes to long waits, miscommunication, and lower tolerance from patients—conditions where conflict is more likely to arise.

Use Flexible Staffing Solutions

Unexpected absences, seasonal fluctuations, or vacations can leave practices short-handed. On-demand staffing platforms such as Teero help fill those gaps quickly, ensuring consistent service without overburdening your core team. Maintaining continuity of care during staffing disruptions helps avoid appointment cancellations, delays, and the kind of disorganization that can frustrate patients.

Match Staff to Patient Needs

Some patients may require more support, clearer communication, or specialized care. Flexible staffing allows you to bring in professionals with the right background or certifications to meet those needs. Cross-training your existing team also adds versatility, allowing staff to step into different roles as needed.

Examples of Dealing with Difficult Patients

Here are some practical examples of how to deal with patients experiencing different challenges:

Supporting a Patient With Severe Dental Anxiety

One patient had avoided dental care for over a decade due to intense dental anxiety, resulting in significant oral health issues. Even discussing treatment triggered visible distress. Rather than rushing into procedures, the dental team took a patient-centered, psychological approach to gradually rebuild trust and reduce fear.

The dentist used a series of tailored interventions:

• Assessment: The Modified Dental Anxiety Scale (MDAS) was used to confirm the severity of the patient’s anxiety.
  
  

• Open communication: A calm, uninterrupted conversation helped uncover specific fears and past negative experiences.
  
  

• Tell-show-do technique: Each procedure was explained and demonstrated before being performed, helping reduce uncertainty.
  
  

• Relaxation techniques: The patient practiced progressive muscle relaxation before appointments to manage physical tension.
  
  

• Distraction tools: Noise-canceling headphones and personalized music provided comfort and reduced external stimuli.

Over several months, this consistent, supportive approach allowed the patient to complete the necessary dental treatment with only mild anxiety.

This case highlights how a thoughtful, behavioral strategy can turn an avoidant patient into an engaged one.

Managing Aggressive Behavior with De-escalation Techniques

At an emergency dental clinic, a dental assistant successfully de-escalated a tense situation involving a visibly agitated patient experiencing withdrawal symptoms and severe tooth pain.

After being informed of a 45-minute wait, the patient became increasingly distressed—raising their voice, clenching their fists, and pacing the waiting room. Recognizing the early signs of escalation, the assistant applied a series of de-escalation strategies to prevent the situation from worsening:

• Maintained a steady, calm tone to avoid adding to the patient’s heightened state.
  
  

• Used active listening, validating the patient’s pain and frustration without judgment.
  
  

• Offered a quiet space away from the crowded waiting area to reduce sensory overload.
  
  

• Provided clear, factual information about over-the-counter pain relief options that could be used safely before treatment.
  
  

• Involved the patient in decision-making by offering choices on how to manage the wait, giving them a sense of control.

These small but intentional actions helped defuse the situation without requiring outside intervention.

This case illustrates how early recognition of distress signals and an empathetic response can prevent conflict from escalating. In high-stress clinical settings, equipping staff with basic de-escalation skills is essential for maintaining a safe and supportive environment for both patients and providers.

Keep Your Practice Calm, Patient-Friendly, and Fully Staffed

Dealing with difficult patients is never easy, but the right approach can make all the difference. A calm, welcoming environment helps ease anxiety and makes patients feel more comfortable. Clear, empathetic communication is necessary for patients to feel heard and understood. Staying professional and composed in tense situations can prevent escalation.

Having enough staff on hand also plays a big role in patient experience. When a practice is short-staffed, wait times increase, stress levels rise, and patients get frustrated. Teero’s platform helps dental offices find skilled hygienists quickly, whether for temporary shifts or long-term positions.

Give us a call.