Beyond the Practice: Care in Uncertain Times
For many patients, a periodontal appointment is more than just a clinical visit. This appointment can be an emotionally charged experience. A diagnosis involving bone loss and potential tooth loss can trigger anxiety, embarrassment, and even grief.
In times when patients are already navigating personal and societal uncertainty, periodontists are increasingly recognizing that effective care requires more than technical expertise. It requires empathy, careful listening, and an awareness of how fear and trauma may shape a patient’s experience in the chair.
Three AAP members, Gregory A. Toback, DMD, MS, Kristi M. Soileau, DDS, MEd, MSHCE, FACD, FICD, and Michael Sonick, DMD, shared how they recognize signs of stress in their patients and how trauma-informed, empathy-driven care can help create a safer and more supportive treatment environment.
Recognizing what isn’t being said
Patients do not always voice their thoughts and fears directly. “One of the most important skills I’ve developed over nearly three decades in periodontics is learning to read what isn’t being said,” Dr. Toback shared. “Anxiety, fear, and stress reveal themselves in subtle ways.”
Dr. Toback explains that body language often provides the earliest clues that a patient may be feeling overwhelmed. “Body language offers the first clues—crossed arms, shallow breathing, disengagement, or lack of eye contact,” he listed. “When responding to questions, anxious patients may present in very different ways: overly talkative, unusually quiet, or even slightly hostile.”
Other behaviors may also signal underlying anxiety. “Delayed decision-making, repeated questions about minor details, or an unexpected focus on cost before we’ve fully discussed treatment can also signal underlying anxiety,” Dr. Toback mentioned. “On the surface, these patients may appear unmotivated or resistant—but often they’re simply overwhelmed.”
Dr. Soileau notes that these behaviors may sometimes reflect deeper emotional responses that patients themselves may not fully recognize. “The patient could be responding without making eye contact, asking the same question more than once, or redirecting a doctor’s advisories such that it leaves the patient with an answer with which they are more comfortable in comparison to the doctor’s actual explanations and directives.”
Similarly, Dr. Sonick emphasized that communication extends far beyond spoken words. “You see it in their posture, how they hold their hands, the tension in their shoulders, or the way they avoid eye contact,” he explained. “A dental operatory is an inherently vulnerable place for people, and you have to be attuned to those non-verbal cues.”
Rather than waiting for patients to verbalize their fears, Dr. Sonick believes that clinicians must create an environment where patients feel comfortable expressing them. “You’re not a doctor and a patient anymore. You’re two human beings in a room, trying to solve a problem together.”
Emotional weight of diagnosis
For many patients, periodontal disease carries emotional implications beyond the clinical diagnosis. “The experience of loss can be profound and difficult to articulate,” Dr. Toback said. “Loss of bone. Loss of gum tissue. Loss of a tooth—or multiple teeth. And sometimes, something even deeper: a perceived loss of youth, health, identity, or control.”
Patients may also feel embarrassment or self-blame, believing they should have prevented the condition and somehow failed to maintain their oral health. “If we don’t acknowledge that undercurrent, we risk speaking past them instead of to them,” Dr. Toback emphasized.
For Dr. Sonick, restoring a sense of hope is a key part of the conversation. “The most common anxieties patients express are fear of pain, concern about cost, and the possibility of losing their teeth,” he stated. “By the time they see a specialist, many feel discouraged and overwhelmed—often believing they are at the end of their options.” His approach is to present solutions alongside diagnoses. “Patients should never feel alone in their problem; they should immediately understand that there is a pathway forward.”
Recognizing trauma
Dr. Soileau notes that past trauma or difficult life experiences may also influence how patients respond to treatment recommendations. “Something about that person’s behavior implies trauma and intimates at a feeling of a lack of trust or safety, either physically, emotionally, or both,” she said.
Trauma can influence both behavior during appointments and engagement with care over time. “Expression of trauma in patients may further be exhibited by frequent missed appointments, reluctance to discuss medical history, confusion or poor memory challenges, adhering to treatment, varying perceptions of pain experiences, cycling in and out of crisis, and delays in care,” Dr. Soileau explained.
Certain aspects of the dental environment may also trigger anxiety for some patients. “Leaning the chair back suddenly. Sounds of dental instruments on a tray. Closing the door to the room or being left alone in an operatory with only one person. These may seem like normal experiences by most patients, whereas in others such can serve as triggers to anxiety and panic,” Dr Soileau mentioned.
Recognizing these possibilities allows clinicians to adjust their approach and create a calmer, more supportive experience. “A calm atmosphere can make a big difference in assuaging patient anxiety, such as by avoiding stressful TV programs in operatories, adding plants and images of nature, directing conversations to more pleasurable topics, aimed at the patient’s interests, or playing soothing music in the office.”
Creating a supportive environment
For many clinicians, empathy-driven care extends beyond the clinical interaction itself. “It’s everything,” Dr. Sonick said. “It’s the entire philosophy of ‘People, not Patients.’” That philosophy shapes every stage of the patient experience. “It starts before they even walk in the door. It’s the music they hear when they’re on hold, the fact that we answer the phone promptly, and the pre-operative call to make sure they’re comfortable,” he explained. “From the moment they arrive, we are on stage, and it is all about the patient.”
Even small details can influence how patients feel during treatment. “In our office, we want it to feel like a spa. We offer warm blankets, music, and a selection of teas and coffees,” Dr. Sonick stated.
Dr. Toback similarly emphasized that empathy is a team effort. “When we recruit team members, we look for emotional intelligence as much as technical skill,” he voiced. “Systems can be taught. Protocols can be refined. But empathy, attentiveness, and the instinct to serve must already be part of who they are.”
Simple actions like sitting at eye level during consultations, speaking calmly, and allowing patients time to process information can also help build trust. “When I sense fear, I slow my pace,” Dr. Toback said. “I lower my voice. I ask open-ended questions like, ‘What concerns you most about what I just shared?’ That question restores a sense of control.”
Balancing compassion with clinical clarity
While empathy is essential, clinicians must also clearly explain diagnoses and treatment options. “You can’t be all compassion without clarity, and you can’t be all clarity without compassion.” Dr. Sonick said.
Providing patients with options can help restore a sense of control. “There can only be one true diagnosis, but there can be multiple treatment plans,” he voiced. “By giving them choices, you give them a sense of control, which is often what’s missing when a patient is anxious.
Advice for supporting anxious patients
When asked what advice they would offer colleagues, the members emphasized the importance of authenticity, communication, and teamwork. “You can’t fake culture in a busy periodontal practice,” Dr. Toback said. “Patients feel it the moment they walk through the door.”
Dr. Sonick encourages clinicians to connect with patients as fellow human beings. “Make yourself vulnerable. Tell your own stories. When you lead with authenticity, you create real connection—and that’s the greatest antidote to fear.”
Dr. Soileau highlights the growing importance of trauma-informed care across healthcare and how it can help clinicians respond more thoughtfully to patient behavior. “When defining trauma–informed care and seeking more information on specific answers to difficult questions, one might look to methodologies promoted by the Substance Abuse and Mental Health Services Administration (SAMHSA). Their approach emphasizes safety, trust, collaboration, empowerment, and case-by-case sensitivity from caregiver to patient. TIC is an emerging field that will require more study to create an evidence space for implementation within the healthcare system via trauma-informed principles within organizational policies and procedures.”
By recognizing signs of stress, fostering trust, and creating spaces where patients feel heard and respected clinicians can help transform anxiety into confidence, and ensure patients feel supported through their periodontal care journey.
For many patients, a periodontal appointment is more than just a clinical visit. This appointment can be an emotionally charged experience. A diagnosis involving bone loss and potential tooth loss can trigger anxiety, embarrassment, and even grief.
In times when patients are already navigating personal and societal uncertainty, periodontists are increasingly recognizing that effective care requires more than technical expertise. It requires empathy, careful listening, and an awareness of how fear and trauma may shape a patient’s experience in the chair.
Three AAP members, Gregory A. Toback, DMD, MS, Kristi M. Soileau, DDS, MEd, MSHCE, FACD, FICD, and Michael Sonick, DMD, shared how they recognize signs of stress in their patients and how trauma-informed, empathy-driven care can help create a safer and more supportive treatment environment.
Recognizing what isn’t being said
Patients do not always voice their thoughts and fears directly. “One of the most important skills I’ve developed over nearly three decades in periodontics is learning to read what isn’t being said,” Dr. Toback shared. “Anxiety, fear, and stress reveal themselves in subtle ways.”
Dr. Toback explains that body language often provides the earliest clues that a patient may be feeling overwhelmed. “Body language offers the first clues—crossed arms, shallow breathing, disengagement, or lack of eye contact,” he listed. “When responding to questions, anxious patients may present in very different ways: overly talkative, unusually quiet, or even slightly hostile.”
Other behaviors may also signal underlying anxiety. “Delayed decision-making, repeated questions about minor details, or an unexpected focus on cost before we’ve fully discussed treatment can also signal underlying anxiety,” Dr. Toback mentioned. “On the surface, these patients may appear unmotivated or resistant—but often they’re simply overwhelmed.”
Dr. Soileau notes that these behaviors may sometimes reflect deeper emotional responses that patients themselves may not fully recognize. “The patient could be responding without making eye contact, asking the same question more than once, or redirecting a doctor’s advisories such that it leaves the patient with an answer with which they are more comfortable in comparison to the doctor’s actual explanations and directives.”
Similarly, Dr. Sonick emphasized that communication extends far beyond spoken words. “You see it in their posture, how they hold their hands, the tension in their shoulders, or the way they avoid eye contact,” he explained. “A dental operatory is an inherently vulnerable place for people, and you have to be attuned to those non-verbal cues.”
Rather than waiting for patients to verbalize their fears, Dr. Sonick believes that clinicians must create an environment where patients feel comfortable expressing them. “You’re not a doctor and a patient anymore. You’re two human beings in a room, trying to solve a problem together.”
Emotional weight of diagnosis
For many patients, periodontal disease carries emotional implications beyond the clinical diagnosis. “The experience of loss can be profound and difficult to articulate,” Dr. Toback said. “Loss of bone. Loss of gum tissue. Loss of a tooth—or multiple teeth. And sometimes, something even deeper: a perceived loss of youth, health, identity, or control.”
Patients may also feel embarrassment or self-blame, believing they should have prevented the condition and somehow failed to maintain their oral health. “If we don’t acknowledge that undercurrent, we risk speaking past them instead of to them,” Dr. Toback emphasized.
For Dr. Sonick, restoring a sense of hope is a key part of the conversation. “The most common anxieties patients express are fear of pain, concern about cost, and the possibility of losing their teeth,” he stated. “By the time they see a specialist, many feel discouraged and overwhelmed—often believing they are at the end of their options.” His approach is to present solutions alongside diagnoses. “Patients should never feel alone in their problem; they should immediately understand that there is a pathway forward.”
Recognizing trauma
Dr. Soileau notes that past trauma or difficult life experiences may also influence how patients respond to treatment recommendations. “Something about that person’s behavior implies trauma and intimates at a feeling of a lack of trust or safety, either physically, emotionally, or both,” she said.
Trauma can influence both behavior during appointments and engagement with care over time. “Expression of trauma in patients may further be exhibited by frequent missed appointments, reluctance to discuss medical history, confusion or poor memory challenges, adhering to treatment, varying perceptions of pain experiences, cycling in and out of crisis, and delays in care,” Dr. Soileau explained.
Certain aspects of the dental environment may also trigger anxiety for some patients. “Leaning the chair back suddenly. Sounds of dental instruments on a tray. Closing the door to the room or being left alone in an operatory with only one person. These may seem like normal experiences by most patients, whereas in others such can serve as triggers to anxiety and panic,” Dr Soileau mentioned.
Recognizing these possibilities allows clinicians to adjust their approach and create a calmer, more supportive experience. “A calm atmosphere can make a big difference in assuaging patient anxiety, such as by avoiding stressful TV programs in operatories, adding plants and images of nature, directing conversations to more pleasurable topics, aimed at the patient’s interests, or playing soothing music in the office.”
Creating a supportive environment
For many clinicians, empathy-driven care extends beyond the clinical interaction itself. “It’s everything,” Dr. Sonick said. “It’s the entire philosophy of ‘People, not Patients.’” That philosophy shapes every stage of the patient experience. “It starts before they even walk in the door. It’s the music they hear when they’re on hold, the fact that we answer the phone promptly, and the pre-operative call to make sure they’re comfortable,” he explained. “From the moment they arrive, we are on stage, and it is all about the patient.”
Even small details can influence how patients feel during treatment. “In our office, we want it to feel like a spa. We offer warm blankets, music, and a selection of teas and coffees,” Dr. Sonick stated.
Dr. Toback similarly emphasized that empathy is a team effort. “When we recruit team members, we look for emotional intelligence as much as technical skill,” he voiced. “Systems can be taught. Protocols can be refined. But empathy, attentiveness, and the instinct to serve must already be part of who they are.”
Simple actions like sitting at eye level during consultations, speaking calmly, and allowing patients time to process information can also help build trust. “When I sense fear, I slow my pace,” Dr. Toback said. “I lower my voice. I ask open-ended questions like, ‘What concerns you most about what I just shared?’ That question restores a sense of control.”
Balancing compassion with clinical clarity
While empathy is essential, clinicians must also clearly explain diagnoses and treatment options. “You can’t be all compassion without clarity, and you can’t be all clarity without compassion.” Dr. Sonick said.
Providing patients with options can help restore a sense of control. “There can only be one true diagnosis, but there can be multiple treatment plans,” he voiced. “By giving them choices, you give them a sense of control, which is often what’s missing when a patient is anxious.
Advice for supporting anxious patients
When asked what advice they would offer colleagues, the members emphasized the importance of authenticity, communication, and teamwork. “You can’t fake culture in a busy periodontal practice,” Dr. Toback said. “Patients feel it the moment they walk through the door.”
Dr. Sonick encourages clinicians to connect with patients as fellow human beings. “Make yourself vulnerable. Tell your own stories. When you lead with authenticity, you create real connection—and that’s the greatest antidote to fear.”
Dr. Soileau highlights the growing importance of trauma-informed care across healthcare and how it can help clinicians respond more thoughtfully to patient behavior. “When defining trauma–informed care and seeking more information on specific answers to difficult questions, one might look to methodologies promoted by the Substance Abuse and Mental Health Services Administration (SAMHSA). Their approach emphasizes safety, trust, collaboration, empowerment, and case-by-case sensitivity from caregiver to patient. TIC is an emerging field that will require more study to create an evidence space for implementation within the healthcare system via trauma-informed principles within organizational policies and procedures.”
By recognizing signs of stress, fostering trust, and creating spaces where patients feel heard and respected clinicians can help transform anxiety into confidence, and ensure patients feel supported through their periodontal care journey.