Editor's note: The following letter was received responding to a recently published article. We are always willing to listen to our audience and publish their thoughts.
The recent study on the emotional burden in implant dentistry puts numbers behind something many clinicians already know from experience: The procedure itself is only part of the difficulty. A technically complex implant case can be manageable when the patient understands the process, communicates clearly, and has realistic expectations. A relatively straightforward case can become exhausting when those things are missing.
That distinction matters because dentistry is often discussed as if stress comes mainly from the clinical side. We talk about surgical difficulty, complications, time pressure, and treatment planning. All of those are real pressures. But patient behavior can change the entire character of a case.
Dr. Henry Hackney.
In my experience, the most draining situations usually involve a mismatch between what the patient expects and what dentistry can realistically deliver.
Some patients arrive expecting an immediate, perfect result from treatment that may require multiple stages, healing time, or compromise.
Others are highly anxious, repeatedly seek reassurance, change their mind, or interpret normal post-treatment symptoms as evidence that something has gone wrong. None of those reactions make someone a bad patient. But they do require additional emotional energy from the clinician.
That energy has a cost. It can also build gradually, which makes it easy to overlook. One difficult interaction may be manageable. Several similar cases in the same week can feel very different.
When a dentist is spending large amounts of time managing anxiety, conflict, repeated calls, or unrealistic expectations, part of their attention is being pulled away from the clinical problem in front of them. Even if the treatment itself is going well, the case can start to feel difficult. That can contribute to frustration, decision fatigue, and eventually avoidance.
The study found that greater emotional burden was associated with more difficulty interacting with patients, more avoidance of similar patients, and lower perceived clinical performance. That is an important finding, because avoidance is not always about the unwillingness to treat. Sometimes it is a sign that the clinician knows a case is taking more from them than they can safely continue to give.
Dentists should not wait until they are burned out to create boundaries.
One of the most useful things we can do is improve expectation-setting before treatment begins. A patient should understand what the procedure involves, how long it may take, what discomfort or temporary symptoms are normal, what complications are possible, and what the final result can realistically look like. This conversation can feel repetitive, but it prevents many problems later.
I also think dentists need to become more comfortable identifying cases where the communication risk is as important as the clinical risk. We routinely assess bone quality, medical history, bite, hygiene, and anatomy. We should also pay attention to whether the patient understands the treatment, whether expectations are realistic, and whether trust exists on both sides.
If that relationship is already breaking down before treatment starts, proceeding anyway can be a mistake.
There is sometimes a belief that referring a patient to a colleague means the dentist has failed. I disagree. Referral is part of responsible clinical judgment. If another clinician has more experience with a particular case, more appropriate resources, or simply a better fit with the patient, transferring care may be the best decision for everyone involved.
The same applies when a dentist is emotionally overloaded. If difficult cases are accumulating and the clinician notices dread before appointments, irritability after work, trouble concentrating, or a tendency to rush conversations, those signals should be taken seriously. They do not automatically mean someone is burned out, but they are signs that the current workload may not be sustainable.
Dentistry also needs better internal support for these situations. Clinicians are trained extensively in diagnosis and technique but far less in conflict management, emotional regulation, or difficult patient communication. Those skills are often learned through experience, usually after something has already gone wrong.
Practices can help by making it normal to discuss difficult cases with colleagues, review communication problems, and redistribute patients when appropriate. A second opinion can be useful clinically, but it can also provide perspective. Sometimes another dentist will confirm that the treatment plan is sound and the problem is mainly expectation management. Other times, they may notice that the case is becoming unproductive for both sides.
My main takeaway from this research is that we should stop treating the emotional side of dentistry as something separate from clinical performance. It is part of clinical performance.
A dentist who is exhausted, frustrated, or constantly anticipating conflict is not working under ideal conditions. Protecting clinicians from that point is not about avoiding difficult patients. It is about recognizing that good dentistry depends on judgment, communication, and concentration as much as it depends on technical skill.
Sometimes the best way to protect the patient is to recognize when the dentist needs support too.
Dr. Henry Hackney,
Head Clinician
DentaVacation
Dr. Henry Hackney is the head clinician at DentaVacation, where he oversees clinical care, treatment standards, and complex dental cases. He is responsible for guiding treatment decisions, ensuring consistency across procedures, and maintaining high standards of patient outcomes.
