Asking for a Friend: I don’t like how my dental office handled that difficult patient. What do I do?

Dear Asking for a Friend: Recently, I saw a patient whose behavior toward me felt hostile and inappropriate. I tried to diffuse the situation, but it ended with a complaint about me. To resolve the problem, my office apologized to the patient and offered her the option to return with the other hygienist, who works beside me. This makes me uncomfortable and confused. Why isn’t my office supporting me?

Dear Unsupported: Unfortunately, these encounters do occur in the dental hygiene profession, and some have hostile, disparaging, or inappropriate undertones. Now, inappropriate could mean anything from throwing a bib holder at you to spitting blood on the floor when they thought you weren't looking, so I will try to cover all grounds.

An interesting observation in human behavior plays out among dental hygienists: since they typically work in a confined, unchaperoned space, patients tend to behave more poorly toward them than they would in front of a dentist with an assistant or the administrative staff. If you are sensing an altercation, there are ways to diffuse, as you had attempted, but verbal abuse from a patient that includes discrimination, sexual harassment, or name-calling is completely inappropriate and can certainly be grounds for dismissal from the practice.

Establishing your professionalism

The truth of the matter is that the patient-provider relationship requires mutual respect to be constructive. In one study, 95% of responding dental providers reported verbal abuse from patients, and 27% reported physical abuse.¹ Research suggests that 73% of patients experience dental fear and anxiety when going to their appointments,² and these emotions can muddle respect from patient to provider.

Providers can lead the overall tone of the visit by asserting their role upon seating. Offer a friendly, professional introduction and a detailed overview of the plan for your time together, then invite them to share their current concerns or questions during their visit.

“Hi, my name is ____, I am the licensed dental hygienist for your periodontal maintenance today. Welcome to my operatory. What concerns may I address for you today in addition to your periodontal assessment and cleaning?”

This is much different than a simple “Hi! Right this way. Take a seat. Anything hurting?”

By establishing your level of expertise in a professional introduction, you can address the patient’s health-related concerns with expertise and intention. This introduction also gives you the opportunity to observe your patient and identify whether they appear anxious, aggressive, or have unrealistic expectations for the visit, allowing you to tailor your verbal and nonverbal communication for success.

Communication strategies and de-escalation

If you're sensing there may be a communication issue with your patient from the start, go back to your training to mitigate the situation.

• Be aware of your nonverbal cues, such as eye contact and open body language, to encourage trust and comfort with your patient.
• Demonstrate active listening to understand a patient’s fears and concerns and use empathy in responding to their emotions to ensure they are validated in their past experiences and current concerns.
• Use clear, concise language when explaining their current health status and treatment recommendations and reassure them of the pain- or anxiety-management strategies you have to offer them.
• If a patient develops a hostile attitude, try to meet them where they are in that moment and continue to offer understanding of their concerns. Ask them how they would like to proceed to make them feel like an active participant in their visit.

Understand that as a provider, you may not be able to deliver the level of care you want when starting out with an anxious patient. However, if the patient’s behavior is completely unmanageable or takes a personal turn, with harassing or discriminatory tones, it is best to involve a witness and/or your manager or boss while the patient is still there.

Office policies

Strike three, get ‘em outta here! Right? Well, while the ADA supports you in dismissing a patient from your practice, it does require a process. Dismissing a patient may be necessary to maintain a positive, functional dental practice.³ The office must establish clear policies and document issues with patients thoroughly when they occur. After the patient leaves (or storms out), they must be provided with formal written notice. Guidelines may be state-specific (see your Dental Practice Act) and often include an end date, after which they can seek emergency care at the office before termination. By handling the situation professionally and with care, dental professionals can ensure the process is conducted respectfully and legally. Fact-based, accurate documentation in your notes, free of emotion, can help protect the practice if a patient disputes the dismissal or legal issues arise.

Additionally, this provides support to the affected team member and reinforces a zero-tolerance policy against abuse toward providers.

Recommended verbiage: “We stand behind our patient care philosophy in providing the most comprehensive dentistry to our patients. Since our philosophies differ, we are dismissing you from the practice. This will ensure you can find a provider that best fits your needs. We understand that our philosophy and practice values do not match your expectations. There has been an apparent breakdown in our doctor-patient relationship, which is necessary for optimal care. Your dental needs would be better met elsewhere. We will transfer your records once you delegate a new dental home. In the next 30 days, if an emergency arises, please do not hesitate to reach out so we can accommodate the acute issue.³

The problem with reassigning a hygienist

In my experience, your office culture will make or break how rude or difficult patients affect you and your rate of burnout. I’ve worked in offices where offended staff have felt completely supported and a patient was rightfully dismissed, and offices where the opposite happened, and a provider had to listen to the enabled offender in the op next door after being apologized to by management and offered another hygienist. In reflection, a patient should feel surprised that they got away with an unapologetic outburst, name-calling, or other inappropriate behavior. If they are not confronted and instead rewarded with an apology from the office, a refund, and a plea to see a different provider, it not only enables abusive behavior but also enhances poor office culture.

Hygiene burnout will accelerate in offices that don’t take action to protect their providers. Encountering patient abuse is discouraging and embarrassing for the hygienist, especially when they feel unsupported by their office. For many, it can be the reason to pursue a new workplace or field altogether. I do believe it is up to us to set a standard of what we will and won’t accept, pushing for office policy reform and enforcement. In other words, they can “see the other,” in another office.

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

1. Fux-Noy A, Getter O, Shmueli A, Halperson E, Moskovitz M. Patient-initiated violence against dental staff: a survey in faculty clinic settings. Public Health. 2025;13. doi:3389/fpubh.2025.1630346
2. Versaci MB. September JADA finds dental fear still prevalent in US. ADANews. September 2, 2025. https://adanews.ada.org/ada-news/2025/september/september-jada-finds-dental-fear-still-prevalent-in-us
3. AADOM DISTIINCTIONcast: Navigating patient dismissal: insights and professional practice for dental office managers. American Association of Dental Office Management. Updated December 17, 2025. https://www.dentalmanagers.com/blog/distinctioncast-navigating-patient-dismissal-insights-and-professional-practices-for-dental-office-managers/