5 Tips to Manage the Difficult Patient

challenges in the chair dealing with difficult patients dental hygienist improving patient care Mar 21, 2022
managing the difficult patient

Daily Dental Hygiene: 5 Tips to Manage the Difficult Patient

By Suzanne L. Vila, RDH, PHDHP, B.A.

If you’re a practicing clinical dental hygienist, you have probably encountered your share of challenging patients.  That’s not surprising considering that going to the dentist is not typically a favorite activity for most people. Think about it, here we are providing a service that many people would rather not face! In fact, studies show that one-third of the population suffers from dental anxiety with 12% suffering from extreme dental fear.1  

Whether it’s fear or other reasons, a difficult patient can mean a frustrating and exhausting day for us as dental hygienists. So, wouldn’t it be great to find ways to manage those patients and make our days less stressful both physically and mentally? 

If you said, ‘Yes!!’ - Keep reading!

What is a Difficult Patient?

Dental hygiene is a challenging profession.  The work we do is difficult for us AND for the patients we treat. So, defining the ‘difficult patient’ is not as easy as it may seem. Sometimes, the difficulty is more situational rather than personal.  

Sometimes ‘difficult patients’ are not difficult people outside of the dental chair.  But in the chair, their attitudes and actions may be influenced by fear, financial worries, time constraints, or even physical limitations. 

Other times, we are simply faced with patients who are not easy to treat because they are strong personalities who are just impossible to please whether in the dental chair or not.  Oftentimes, those patients are hard to please because they have unrealistic expectations before they even step into the dental office. According to experts, these are the patients who are more likely to complain if those expectations are not met.2

Managing the Challenge

Although the bad news is that we cannot avoid difficult patients, the good news is that we can find ways to manage their care so that it helps them feel better about their dental experience.  If they feel better, our own experience is more positive as well.   That is a WIN-WIN!

Here are some tips that you can begin to implement into your daily practice that can help manage difficult patient situations:


  • Define the Situation


Rather than labeling the patient immediately as difficult and starting the appointment with immediate frustration, start by assessing the situation first by asking yourself some questions: Is the patient in pain? Has it been many years since the patient has seen a dentist? Does your patient seem nervous or fearful? Does your patient have physical limitations? 

Once you have assessed, you can identify what may make the situation challenging, and can gain some insight into why your patient is exhibiting their behavior. 


  • Listen with Empathy


After you have asked yourself questions, you can ask your patient open-ended questions and take time to use your empathetic listening skills. Taking time to listen to their problems, expectations, and stories can help you gain important insight to what they want to achieve and what may be causing them concern.

Listening can set the stage for overall appointment success. Several years ago, I wrote a dental hygiene article for an online publication on how empathetic listening can foster trust and treatment acceptance.

When a patient knows you care, they do too, not just about their oral health but also how you are feeling while treating them. 


  • Understand Fear & Phobia


My 30-year dental hygiene career has shown me that most difficult or grumpy patients come from a place of fear.  Considering that over one-third of the patients we see have dental anxiety, their fear may show in defensive ways such as anger, hyper-sensitivity, or impatience. 

With that idea in mind, when a patient is mean, grumpy, or super jumpy, I often tell myself that they are coming from a place of fear and try to find ways to reduce it.  For example, I may offer to play their favorite music, offer them a pillow or even a blanket, or discuss ways to reduce sensitivity before we even open an instrument pack.  


  • Use Clear Language


As dental professionals, our dental language can be confusing and intimidating to patients, which is why we must always work on our communication skills. Through practice or continuing education, we can find ways to use simple yet clear ways to answer questions, explain procedures, and clearly communicate what we can and cannot achieve during the appointment.  

A patient who leaves understanding as much as possible is a more satisfied patient who will be happier to return in the future.2 


  • Make Modifications


We know how we want the appointment to go, right? (And if we are Perfectionist Hygienists, we want to do it all!)  However, when dealing with a difficult patient situation, what can diffuse the situation is the ability to modify how we offer treatment.  

This may sound crazy or out of your comfort zone but what if you focus on getting to know the patient’s needs rather than be so focused on removing their calculus?  While removing calculus is important, it is also difficult to do if a patient is angry, sensitive, or won’t stay open. So, rather than get frustrated, take a step back, slow down, and make whatever modifications you need to get through the appointment with positive patient perception of the visit.  

For example, sometimes I pre-polish with sensitivity agents before scaling or use ultrasonics on a super-low setting (even though it may not be my setting of choice) because I want to focus on patient comfort over fast calculus removal. There are countless ways to modify treatment to meet your patient’s needs.  Just because you modify doesn’t mean you are doing less or have to give the patient everything they demand. If you give them the perception that you are listening to them, care, and are giving them something they want, they are typically quite grateful and more pleasant. 

I guarantee you that they will be much happier the next time they see you! (And YOU will be happier too!)

Reducing negative experiences during your clinical day is so essential for career satisfaction.  Being prepared for a challenging patient means having plans in place that you can utilize at a moment’s notice.  Using these tips, you can develop your own difficult patient game plan that you can keep on hand and ready to use the next time you encounter Mr. Grumpy, Miss Fearful, or Mrs. Sensitive in your chair!

Join Us for the Hygiene Summit

*Early Bird Special Until 4/1/22 for $25 off of registration, originally $65*

All levels of dental hygienists are invited to join us for the Hygiene Summit held at The Hotel Hershey on April 9th, 2022, held from 8 am - 12:30 pm.

Guest speakers include Angie Lehman RDH, COM®, Dr. Chris Balaban DMD MSC FACD, plus a panel of 3 dental professionals.

Click Here to Sign Up




About the Author: Suzanne L. Vila, RDH, PHDHP, B.A.


Suzanne is a Registered Dental Hygienist in Central PA who works in private periodontal practice and at a local college as an adjunct dental hygiene faculty. After a thirty-year career in dental hygiene, Suzanne is now creating non-clinical projects involving professional enhancement, public health initiatives, and patient education. In addition to being a passionate dental practitioner, Suzanne enjoys teaching fitness classes such as Pilates and yoga, volunteering with the local dog rescue Pitties.Love.Peace, and spending time with her family and their two rescued pit bulls, Rudy & Freya.



1- Beaton, Laura et al. “Why are people afraid of the dentist? Observations and explanations.” Medical principles and practice : international journal of the Kuwait University, Health Science Centre vol. 23,4 (2014): 295-301. doi:10.1159/000357223


2- Meyer,Ellen. “Meeting the Needs of Difficult Dental Patients.” Inside Dental Assisting vol 10 (2012). Retrieved from: