The Difficult Dental Patient

  • James Gall


The acceptance of active dental procedures is not always easy and this is particularly so with children, some of whom demonstrate extreme patterns of bad behavior. For the dentist several techniques are available to deal with this type of child. These include oral premedication, intra-venous sedation, relative anesthesia, general anesthesia and hypnotherapy. Whatever technique is selected should, in addition to meeting the crisis situation, be helpful to promote a proper attitude and a more ready acceptance of program for maintenance of oral health. An endeavor should be made to elicit the reason or reasons for the child being difficult. It is important for the practitioner to be kind, considerate, firm, to have understanding and an ability to communicate. Formerly, undergraduate dental training concentrated largely on developing skills to undertake technical procedures, to meet restorative needs and to consider the mouth in isolation. Today there is appreciation that treatment is being given to a person who has a dental problem. There is a requirement to allay fears, many of which are false, to control anxiety and to reeducate the patient to have a more positive and confident approach to acceptance of dental care. The use of hypnosis trance is an excellent way in which to conduct desensitization, modelling, contingency management, and to develop self-confidence.

Before embarking on these therapies it is important to establish rapport with the patient. This can, of course, mean that the practitioner must be prepared to surrender active dental treatment at the first visit as an initial investment, in order to receive the reward in which a dental cripple, (i.e. the difficult patient) will become a normal and trusting patient. This paper details effective techniques for managing the difficult child.


Oral Health Dental Care Dental Treatment Dental Visit Dental Anxiety 
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Copyright information

© Plenum Press, New York 1985

Authors and Affiliations

  • James Gall
    • 1
  1. 1.Scottish Home and Health DepartmentEdinburghScotland

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